Design and Testing of a Mobile Cardiovascular Risk Service With Patient Partners

Cardiovascular disease (CVD) is the leading cause of death in the United States, with a healthcare cost of nearly $300 billion per year. Optimal CVD management requires patient self-management and adherence to potentially complex medication regimens. Patients need information and support to achieve this. Mobile health (mHealth) is a promising strategy for providing individualized patient support between provider visits. Greater involvement of pharmacists has been shown to improve provision of evidence-based care and to improve medication adherence. Additionally, research from integrated health care systems suggests that risks can be better controlled and treatment strategies for CVD can be improved by using a centralized cardiovascular risk service (CVRS) managed by pharmacists.

This project evaluated the impact of two applications (apps), one mobile and one web-based, on patient engagement in a CVRS for improving CVD management. Users of both apps had the capability to add and edit personal health data including blood pressure, blood sugar, and cholesterol, in addition to maintaining a current medication list. Users also had the ability to communicate with study pharmacists, who provided consultations and recommendations. While both the mobile and web apps offered the same core functions, the mobile app offered the ability to use some features when offline, sent reminders to users who started but did not complete enrollment forms, and reminded participants to submit their health assessments.

The specific aims of the project were as follows:

• To implement user-centered design methods to partner with mHealth technology users in the design of a mobile app for disseminating a pharmacist-managed evidence-based CVRS into practice. 
• To examine the feasibility of mHealth technology to disseminate evidence-based risk reduction guidelines in a randomized controlled trial (RCT) among diverse primary care offices. 

Researchers recruited adults over the age of 55 with cardiovascular risks for a focus group session to obtain design guidelines and test prototypes. App features were prioritized for development to best support patient interaction with a study pharmacist. Participants were then assigned to an RCT to test the final version of the mobile and web apps, compared with the web app alone, in a 4-month trial.

Researchers found that the in-app health assessment was used by 89 percent of patients, health data was entered by 74 percent of patients, and pharmacist messaging was used by 81 percent of patients. The mean number of unique days of system interaction was 9.7 in the intervention group and 8.8 in the control group. Participants in the intervention group contacted the study pharmacists on a mean of 4.8 days with a mean number of 6.2 messages, compared with 3.1 days and 5.1 messages in the control group. There were no significant differences between the intervention and control groups, with a potential explanation being that both groups had access to the study pharmacists and the same core app functionality.