SMS System for Patients With Uncontrolled Hypertension

Not Applicable

Completed

Interventions: Other: SMS System
Behavioral: blood pressure control education

Brief Summary: This is a pilot study to determine the potential of utilizing Short Message Service (SMS) messaging to improve health outcomes for patients with uncontrolled hypertension receiving care from the Outpatient Internal Medicine Clinic at Wake Forest Baptist Hospital.

Detailed Description: The pilot will evaluate the feasibility of implementing a Short Message Service (SMS) system and Home Blood Pressure Measurements (HBPM) in the Outpatient Internal Medicine (OPD) clinic at Wake Forest Baptist Hospital. Implementing a new short text messaging service will improve the health delivery system in three ways. 1) Increasing patient engagement: SMS and HBPM require an active commitment by the patients themselves in their medical care and results in a marked improvement in the adherence to medication. High adherence to home blood pressure (BP) measurements has also been reported to improve BP control. 2) Supporting patients outside of the office visits by identifying and resolving barriers to medication adherence earlier on (i.e. if patients are unable to get their prescriptions or are having significant side effects). 3) Adopting clinical guidelines to improve BP control in a vulnerable population.

Recruitment & Eligibility

Inclusion Criteria

Patients who have been diagnosed with hypertension
18 and older
stage 2 hypertension or greater systolic blood pressure [(SBP)>140 and diastolic blood pressure (DBP) >90] who are receiving antihypertensive treatment.

Exclusion Criteria

Pregnancy
end-stage renal disease (on hemodialysis or peritoneal dialysis)
hospice or nursing home care
dementia
Patients who do not have a phone with Short Message Service (SMS) capabilities will also be excluded.

Arm && Interventions

Group	Intervention	Description
High Blood Pressure Monitoring by Short Message Service (SMS)	blood pressure control education	Will receive the text message intervention and will be provided with a blood pressure cuff in addition to standard blood pressure control education received at clinic visits
Usual Care Plus Standard Blood Pressure Monitoring	blood pressure control education	Will receive standard blood pressure care and education, as well as a blood pressure cuff at their clinic visits
High Blood Pressure Monitoring by Short Message Service (SMS)	SMS System	Will receive the text message intervention and will be provided with a blood pressure cuff in addition to standard blood pressure control education received at clinic visits

Primary Outcome Measures

Name	Time	Method
Number of Participants Screened	during screening period, about 6 months
Number of Subjects Excluded Without SMS Capability	baseline	Number of vulnerable subjects screened but excluded because they did not own a phone with SMS capability.
Proportion of Participants Continuing myHealth	up to 12 weeks	the proportion of participants who continue to use the myHealth tool per month through three months will be tracked for the intervention
SMS Participation	up to 12 weeks	The number of patients who participate in SMS will be recorded
System Usability Scale (SUS)	Week 12	Participants will complete the SUS in person on an I-Pad or over the phone. The SUS yields a single score on a scale of 0-100. A SUS score above a 68 would be considered above average (better) usability.
Number of Subjects Enrolled	during baseline period, about 4 months
Number of Subjects Who Refuse Participation	baseline	number of participants who refuse to participate at the time of recruitment and the reason why
Number of Participants Who Responded to SMS With At Least One Home BP Measurement	up to 12 weeks

Secondary Outcome Measures

Name	Time	Method
Medication Adherence	up to 12 weeks	The number of patients who demonstrate medication compliance via SMS will be recorded.
Medication Adherence Questionnaire	baseline, week 12	Score ranges from 0 to 10 with higher score denoting better medication adherence.
Number of Participants Considered No-Shows at Clinic Visits	week 12	No-show rate at 3 months' follow-up (f/u) clinic visits. If participants fail to come to their f/u visits within 7 days of their scheduled follow-up appointment, they will be considered as "no- shows".
Monitoring of DBP	baseline and 12 weeks	Changes in values of Diastolic blood pressure (DBP) received via SMS will be recorded
Initial and Follow up BP in Office	baseline/day 0 and 12 weeks	Number of participants to attended both initial and follow up blood pressure (systolic and diastolic) visits will be recorded.
Coordinator Time	up to 12 weeks	The time spent by the coordinator on study related patient activities will be recorded
Monitoring of SBP	baseline and 12 weeks	Changes in values of Systolic blood pressure (SBP) received via SMS will be recorded

Locations (1): Wake Forest Baptist Medical Center
🇺🇸
Winston-Salem, North Carolina, United States