Mobile Health Technology: Catalyst for Healthcare Transformation
1 / 29

Mobile Health Technology: Catalyst for Healthcare Transformation Essential Hypertension as an Example - PowerPoint PPT Presentation

  • Uploaded on

Mobile Health Technology: Catalyst for Healthcare Transformation Essential Hypertension as an Example. Subtitle Presenters Date. Frank Treiber , PhD South Carolina Smart State Endowed Research Chair Director of Technology Applications Center for Healthful Lifestyles(TACHL)

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about ' Mobile Health Technology: Catalyst for Healthcare Transformation Essential Hypertension as an Example' - arwen

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

Mobile Health Technology: Catalyst for Healthcare TransformationEssential Hypertension as an Example

  • Subtitle

  • Presenters

  • Date

Frank Treiber, PhD

South Carolina Smart State Endowed Research Chair

Director of Technology Applications Center for Healthful Lifestyles(TACHL)

Professor of Nursing & Psychiatry

Presented to : Verizon Foundation Conference , 4/2/2012.



  • Rationale Transformationfor three interrelated community based projects

  • Essential hypertension (EH) impacts 33% of US adults

  • EH is a significant  risk factor for CVD, heart attack, stroke, renal failure 

  • Antihypertensive meds. control EH and decrease CVD events

  • Medication nonadherence  is leading contributor to uncontrolled EH

  • Among EH patients, nonadherence highest among Hispanics and African Americans in underserved areas

  • Practical, sustainable adherence and BP management programs needed


  • Reviews of clinical trials indicate the following improve medication adherence and BP control:

    • Self monitoring of BP

    • Medication reminder tactics

    • Pharmacist /nurse educational & motivational programs

    • Effects usually deteriorate following cessation of program

    • Comprehensive, acceptable and sustainable patient centered program has not been developed


Proof of Concept Study Design and Methods Transformation

  • Subjects: 3 adult prehypertensives (SBP > 120 mmHg)

  • Procedures:

  • Received Tension Tamer, asked to practice 10 minute sessions 2x a day for 3-months

  • Measures collected at preintervention 1, 2, and 3 months:

    • -Resting Hemodynamics and 24-Hour Ambulatory BP

    • -Overnight Urine Sample

    • -Awakening response saliva sampling


Tension Tamer Heart Rate Acquisition Transformation


Tension Tamer Results Transformation


Proof of Concept Results Transformation

  • Reductions in Salivary Alpha-Amylase awaking curve (Marker of SNS activity) from pre to post 3 month intervention.

  • Dose-Response Reductions in 24 hour Ambulatory Blood Pressure. Reductions corresponded with Tension Tamer Adherence rates.


Proposed Feasibility TransformationStudy Design and Methods

  • Subjects: 60 stage 2 preEH adults (SBP 130-139 mmHg)

  • Procedures:

  • Random assignment to Tension Tamer or standard of care 6 months

  • Measures collected at preintervention 1, 3, 6, and 12 months:

    • -Resting Hemodynamics and 24-Hour Ambulatory BP

    • -Overnight Urine Sample

    • -Repeated saliva sampling


  • mHealthtechnology enables opportunity to integrate these tactics and help:

    • Patients establish self management skills

    • Patients avoid frequent office visits/check ups, etc.  

    • Providers deliver care in more timely manner 

    • Facilitate communication between providers & patients

    • Establish and sustain BP control


Preparatory TransformationFindings

  • Key Informant Interviews

    • FQHC patients (21 minorities, mean age: 34.5 yrs.)

    • 29% had uncontrolled EH

    • None had taken meds. in 1 yr. (reasons: poor planning; forgetfulness)

    • 95% owned cell phones (20% had smart phones)

    • All highly receptive to using mHealth technology for med. adherence, BP monitoring, linkage to doctor & fewer trips to clinic


Preparatory TransformationFindings Contd.

  • Mini Proof of Concept Study

    • Purpose: Determine acceptability of the mobile tech. system to patients and providers

    • 4 uncontrolled EH FQHC patients (2 Standard of Care [SOC] , 2 SMASH) for 3 months.


mHealth Technology Transformation


Preparatory TransformationFindings Contd.

  • SMASH Results:

    • High levels of patient & provider acceptability;

    • 95-100% med. & BP adherence rates;

    • High desire to continue SMASH;

    • Large, sustained BP reductions;

    • EH became controlled


  • Months 1-3: Focus Groups & Key Informant Interviews: Refine SMASH (e.g., motivational /reinforcement messages, educational messages /video clips; feedback reports)

  • Months 4-6: Complete software programming based upon above findings

  • Months 7-12: 3 month SMASH vs. SOC pilot clinical trial (16 EHs from 2 FQHCs)

  • Months 13-15: Statistical analyses, follow-up focus groups for SMASH refinement

  • Months 16-24: 6 month feasibility clinical trial (48 EHs from 6 FQHCs)


  • Months Transformation7-12: SMASH

  • Pilot Trial: Design & Methods

  • Subjects:16 uncontrolled EH, AAs and Hispanics 

  • Procedures:

    • Random assignment by FQHC to MedMinder/BP system vs. SOC for 3 months

    • Smart phones used for signal transfer and patient –provider linkage

    • Provider summary reports bi-monthly; immediate alerts when beyond thresholds

    • Measurements at pre-treatment, 1, 2 and 3 months (resting hemodynamics, 24hr Ambulatory BP)


  • Months Transformation16-24: SMASH

  • Feasibility Trial: Design & Methods

  • Subjects:48 uncontrolled EH, AAs and Hispanics 

  • Procedures:

    • 6 FQHCs (8 uncontrolled EHs per clinic)

    • Random assignment by FQHC to SMASH vs. SOC for 6 months

    • Measurements at pre-treatment, 3 and 6 months


Rationale Transformation

  • ESRD afflicts more than 500,000 people in the USA

  • HTN and DM are the #1 and #2 causes of ESRD

  • Kidney transplantation is the treatment of choice for ESRD

  • Kidneys are an incredibly scarce resource which mandates that their use be optimized

  • Despite significant advances, average graft survival is suboptimal at approximately 9 years

  • Graft survival is worse among African-Americans and those of lower socioeconomic status


Rationale Transformation

  • Medication nonadherence is key contributor to premature graft loss

  • Approximately 35% of renal transplant patients are nonadherent and issues often develop within weeks of transplantation

  • Medication nonadherence contributes to graft loss by allowing for immune mediated rejection and the deleterious effects of poorly controlled HTN and DM

  • Mobile health technology has the potential to improve medication adherence, blood pressure and blood sugar control, and graft survival


Aim Transformation

  • Utilize wireless technology to identify nonadherent patients early after transplant and to interact with them in real time to improve adherent behaviors as a means to improve:

    • Medication adherence

    • Control of HTN

    • Control of DM

    • Graft survival


Study Design and Methods Transformation

  • Type: Randomized control trial

  • Subjects: 20 nonadherent kidney transplant patients

  • Methods: randomly assigned to:

    • Group A: standard post operative care

    • Group B: “bundled” wireless real time medication reminder system, blood pressure/blood glucose monitoring, cognitive behavior adherence skills enhancement program


Study Design and Methods Transformation

  • Technology

    • Maya MedMinder to monitor and aid in medication adherence

    • Bluetooth enabled Fora D15b to measure and record BP and blood glucose

    • “Smart” phones for signal transmission

    • “Smart” phones for patient interaction

      • Cognitive behavioral enhancement techniques via video conferencing with adherence coach


Study Design and Methods Transformation

  • Outcomes (measured pre-, 1, 2, and 3 months):

    • Medication adherence (Maya MedMinder)

    • Blood pressure control (Fora D15b, 24h ambulatory BP)

    • Blood glucose control (Fora D15b, HgbA1c)

    • Immunosuppression (FK506 variability)


Rationale Transformation

  • Essential hypertension (EH) impacts 33% of US adults, higher prevalence among African Americans (AAs).

  • EH is a significant risk factor for CVD, heart attack, stroke, renal failure.

  • Leading predictor of EH is preEH (SBP/DBP 121-139/81-89 mmHg)

  • Sustainable/easily disseminated prevention programs needed

  • Breathing meditation shown to reduce BP among EH and preEH AA patients

  • Smartphones enable large-scale/easy dissemination