title: Medication adherence and activity patterns underlying uncontrolled hypertension: Assessment and recommendations by practicing pharmacists using digital health care.
abstract: This report summarizes the first use of a digital health feedback system (DHFS) by practicing pharmacists to establish evidence-based blood pressure (BP) management recommendations.
  
  
  
  Fifteen commercial pharmacies and 39 patients in the Isle of Wight participated.
  
  
  
  The pharmacists were experienced in providing New Medicine Services to patients in their communities.
  
  
  
  The pharmacists utilized a commercially available DHFS. The DHFS utilized FDA-cleared and CE-marked class 2 medical devices passively captured and shared information about medication-taking using an ingestible sensor, and daily patterns of rest, activity, and exercise using a wearable patch that incorporates an accelerometer.
  
  
  
  Pharmacists provided targeted counselling for BP management as guided by the digital information.
  
  
  
  Blood pressure was measured serially, and patient and provider experiences with DHFS use were assessed using satisfaction surveys.
  
  
  
  The mean change in SBP over the 2-week evaluation period was -7.9 ± 22.1; mean change in DBP was -2.8 ± 12.9. A root cause for persistent hypertension was determined for all of these 34 patients: 68% had pharmaceutical resistance, and 32% had inadequate medication use. Specifically, 29% were found to be capable to achieving blood pressure control on their currently prescribed medications, 68% were found to have a need for additional pharmacological treatment, and 3% needed additional adherence support. Pharmacists found that the DHFD helped in targeting specific recommendations, and to create a collaborative experience with their patients. Patients found the experience to be positive and helpful.
  
  
  
  DHFS that provides confirmation of medication taking and objective measures of lifestyle patterns can help pharmacists to identify specific factors contributing to uncontrolled hypertension, to make evidence-based prescribing and lifestyle recommendations for achieving treatment goals, and to create a collaborative experience for patients in the management of their self-care.
authors.forename: Kevin
authors.initials: K
authors.lastname: Noble
authors.forename: Karl
authors.initials: K
authors.lastname: Brown
authors.forename: Maria
authors.initials: M
authors.lastname: Medina
authors.forename: Francis
authors.initials: F
authors.lastname: Alvarez
authors.forename: Julian
authors.initials: J
authors.lastname: Young
authors.forename: Sarah
authors.initials: S
authors.lastname: Leadley
authors.forename: Yoona
authors.initials: Y
authors.lastname: Kim
authors.forename: Lorenzo
authors.initials: L
authors.lastname: DiCarlo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010595:Pharmacists / Q000458:organization & administration*; D058998:Remote Sensing Technology / Q000295:instrumentation*; D012648:Self Care; D013222:State Medicine; D006113:United Kingdom
chemical_list: D000959:Antihypertensive Agents