Published online Jun 6, 2020. doi: 10.12998/wjcc.v8.i11.2266
Peer-review started: January 15, 2020
First decision: February 26, 2020
Revised: April 1, 2020
Accepted: May 27, 2020
Article in press: May 27, 2020
Published online: June 6, 2020
Processing time: 145 Days and 0.8 Hours
The global burden of hypertension has an upward trend and taken a huge part of healthcare expenditure. Recently, over a billion people are living with hypertensive condition, but only 20% of them can maintain their optimal blood pressure. The research evidence revealed positive outcomes of medication management models on improving the medication-related quality of care (MRQOC) such as medication appropriateness and health care accessibility. Digital health interventions (DHIs) have been utilised to improve quality of care for hypertension and to reduce the inequalities and accessibility in healthcare system.
Recently, DHIs have been implemented widely into the healthcare system in various settings to improve the chronic disease management, including hypertension. Nonetheless, the reports of those DHI varied from study to study based on the heterogeneity of methodologies, the different approaches and variety of technologies. Therefore, it is necessary to consider “lesson and learn” from existing DHIs implemented in hypertension care to improve patient outcomes and design future studies.
This review aims to summarise the outcomes from a range of research which investigated the use of DHI to improve the MRQOC for hypertensive patients.
A comprehensive search was undertaken in MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases during October 2019 for relevant published articles written in English with no date restriction. Quantitative or mixed methods studies within level I to level IV of the National Health and Medical Research Council evidence hierarchy, that measured any outcome for medication management for hypertensive patients, conducted in different settings were included in our review.
In total, 19 DHIs implemented in different countries were included. The variety of DHI were provided as community-based, clinical-based and home-based program through mobile phone, mobile health system, short message service, and telehealth, digital medicine, and online healthcare (web-based). This review revealed that utilising DHI for hypertensive care in different settings positively impacted on MRQOC leading to an improvement of patient outcomes such as blood pressure control, improvement in medication adherence and medication management, maintaining follow-ups, access to healthcare particularly in rural area and their quality of life. Nevertheless, inconclusive findings were found in some interventions, and inconsistent outcomes between DHI were noted.
DHI for hypertensive care in different settings positively impacted on MRQOC. However, the inconsistent outcomes between studies are likely due to the heterogeneity of DHI. The findings of this review can be fundamental data for digital initiatives and lead to the evidence -based practice. A future DHI for hypertension or chronic diseases should be developed in accordance with WHO recommendations and the evidence-to-decision framework to warrant the sustainability and long-term effectiveness of on healthcare practices and patient outcomes.
A future research in this area is warranted and DHI for hypertension should be developed through the evidence-to-decision framework and guidelines. A systematic review and meta-analysis looking at the effectiveness and cost-effectiveness of digital health innovation in hypertension and chronic disease is warranted to establish a more comprehensive and concrete evidence-based practice.