Pharmacy-based hypertension care employing mHealth in Lagos, Nigeria – a mixed methods feasibility study
Abstract Background Access to quality hypertension care is often poor in sub-Saharan Africa. Some community pharmacies offer hypertension monitoring services, with and without involvement of medical doctors. To directly connect pharmacy staff and cardiologists a care model including a mobile applica...
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doaj-0e03d2be50bc449c9b63cdd8a737a4fe2020-11-25T01:58:18ZengBMCBMC Health Services Research1472-69632018-12-0118111410.1186/s12913-018-3740-3Pharmacy-based hypertension care employing mHealth in Lagos, Nigeria – a mixed methods feasibility studyHeleen E. Nelissen0Anne L. Cremers1Tochi J. Okwor2Sam Kool3Frank van Leth4Lizzy Brewster5Olalekan Makinde6René Gerrets7Marleen E. Hendriks8Constance Schultsz9Akin Osibogun10Anja H. van’t Hoog11Department of Global Health, Amsterdam UMC, University of AmsterdamAmsterdam Institute for Global Health and DevelopmentCentre for Epidemiology and Health Development, IbejuAmsterdam Institute for Global Health and DevelopmentDepartment of Global Health, Amsterdam UMC, University of AmsterdamDepartment of Global Health, Amsterdam UMC, University of AmsterdamDepartment of Community Health, Lagos University Teaching HospitalAmsterdam Institute for Global Health and DevelopmentJoep Lange InstituteDepartment of Global Health, Amsterdam UMC, University of AmsterdamCentre for Epidemiology and Health Development, IbejuDepartment of Global Health, Amsterdam UMC, University of AmsterdamAbstract Background Access to quality hypertension care is often poor in sub-Saharan Africa. Some community pharmacies offer hypertension monitoring services, with and without involvement of medical doctors. To directly connect pharmacy staff and cardiologists a care model including a mobile application (mHealth) for remote patient monitoring was implemented and pilot tested in Lagos, Nigeria. Pharmacists provided blood pressure measurements and counselling. Cardiologists enrolled patients in the pilot program and remotely monitored them, for which patients paid a monthly fee. We evaluated the feasibility of this care model at five private community pharmacies. Outcome measures were retention in care, blood pressure change, quality of care, and patients’ and healthcare providers’ satisfaction with the care model. Methods Patients participated in the care model’s pilot at one of the five pharmacies for approximately 6–8 months from February 2016. We conducted structured patient interviews and blood pressure measurements at pilot entry and exit, and used exports of the mHealth-application, in-depth interviews and focus group discussions with patients, pharmacists and cardiologists. Results Of 336 enrolled patients, 236 (72%) were interviewed at pilot entry and exit. According to the mHealth data 71% returned to the pharmacy after enrollment, with 3.3 months (IQR: 2.2–5.4) median duration of activity in the mHealth-application. Patients self-reported more visits than recorded in the mHealth data. Pharmacists mentioned use of paper records, understaffing, the application not being user-friendly, and patients’ unwillingness to pay as reasons for underreporting. Mean systolic blood pressure decreased 9.9 mmHg (SD: 18). Blood pressure on target increased from 24 to 56% and an additional 10% had an improved blood pressure at endline, however this was not associated with duration of mHealth activity. Patients were satisfied because of accessibility, attention, adherence and information provision. Conclusion Patients, pharmacists and cardiologists adopted the care model, albeit with gaps in mHealth data. Most patients were satisfied, and their mean blood pressure significantly reduced. Usage of the mHealth application, pharmacy incentives, and a modified financing model are opportunities for improvement. In addition, costs of implementation and availability of involved healthcare providers need to be investigated before such a care model can be further implemented.http://link.springer.com/article/10.1186/s12913-018-3740-3HypertensionPharmacy careDecentralizationTask-shiftingmHealthPrivate sector |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Heleen E. Nelissen Anne L. Cremers Tochi J. Okwor Sam Kool Frank van Leth Lizzy Brewster Olalekan Makinde René Gerrets Marleen E. Hendriks Constance Schultsz Akin Osibogun Anja H. van’t Hoog |
spellingShingle |
Heleen E. Nelissen Anne L. Cremers Tochi J. Okwor Sam Kool Frank van Leth Lizzy Brewster Olalekan Makinde René Gerrets Marleen E. Hendriks Constance Schultsz Akin Osibogun Anja H. van’t Hoog Pharmacy-based hypertension care employing mHealth in Lagos, Nigeria – a mixed methods feasibility study BMC Health Services Research Hypertension Pharmacy care Decentralization Task-shifting mHealth Private sector |
author_facet |
Heleen E. Nelissen Anne L. Cremers Tochi J. Okwor Sam Kool Frank van Leth Lizzy Brewster Olalekan Makinde René Gerrets Marleen E. Hendriks Constance Schultsz Akin Osibogun Anja H. van’t Hoog |
author_sort |
Heleen E. Nelissen |
title |
Pharmacy-based hypertension care employing mHealth in Lagos, Nigeria – a mixed methods feasibility study |
title_short |
Pharmacy-based hypertension care employing mHealth in Lagos, Nigeria – a mixed methods feasibility study |
title_full |
Pharmacy-based hypertension care employing mHealth in Lagos, Nigeria – a mixed methods feasibility study |
title_fullStr |
Pharmacy-based hypertension care employing mHealth in Lagos, Nigeria – a mixed methods feasibility study |
title_full_unstemmed |
Pharmacy-based hypertension care employing mHealth in Lagos, Nigeria – a mixed methods feasibility study |
title_sort |
pharmacy-based hypertension care employing mhealth in lagos, nigeria – a mixed methods feasibility study |
publisher |
BMC |
series |
BMC Health Services Research |
issn |
1472-6963 |
publishDate |
2018-12-01 |
description |
Abstract Background Access to quality hypertension care is often poor in sub-Saharan Africa. Some community pharmacies offer hypertension monitoring services, with and without involvement of medical doctors. To directly connect pharmacy staff and cardiologists a care model including a mobile application (mHealth) for remote patient monitoring was implemented and pilot tested in Lagos, Nigeria. Pharmacists provided blood pressure measurements and counselling. Cardiologists enrolled patients in the pilot program and remotely monitored them, for which patients paid a monthly fee. We evaluated the feasibility of this care model at five private community pharmacies. Outcome measures were retention in care, blood pressure change, quality of care, and patients’ and healthcare providers’ satisfaction with the care model. Methods Patients participated in the care model’s pilot at one of the five pharmacies for approximately 6–8 months from February 2016. We conducted structured patient interviews and blood pressure measurements at pilot entry and exit, and used exports of the mHealth-application, in-depth interviews and focus group discussions with patients, pharmacists and cardiologists. Results Of 336 enrolled patients, 236 (72%) were interviewed at pilot entry and exit. According to the mHealth data 71% returned to the pharmacy after enrollment, with 3.3 months (IQR: 2.2–5.4) median duration of activity in the mHealth-application. Patients self-reported more visits than recorded in the mHealth data. Pharmacists mentioned use of paper records, understaffing, the application not being user-friendly, and patients’ unwillingness to pay as reasons for underreporting. Mean systolic blood pressure decreased 9.9 mmHg (SD: 18). Blood pressure on target increased from 24 to 56% and an additional 10% had an improved blood pressure at endline, however this was not associated with duration of mHealth activity. Patients were satisfied because of accessibility, attention, adherence and information provision. Conclusion Patients, pharmacists and cardiologists adopted the care model, albeit with gaps in mHealth data. Most patients were satisfied, and their mean blood pressure significantly reduced. Usage of the mHealth application, pharmacy incentives, and a modified financing model are opportunities for improvement. In addition, costs of implementation and availability of involved healthcare providers need to be investigated before such a care model can be further implemented. |
topic |
Hypertension Pharmacy care Decentralization Task-shifting mHealth Private sector |
url |
http://link.springer.com/article/10.1186/s12913-018-3740-3 |
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