Browsing by Author "Nelissen, Heleen E"
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- ItemPatients' and healthcare providers' perceptions and practices regarding hypertension, pharmacy-based care, and mHealth in Lagos, Nigeria: a mixed methods study.(0000-00-00) Cremers, Anne L; Alege, Abiola; Nelissen, Heleen E; Okwor, Tochi J; Osibogun, Akin; Gerrets, René; Van't Hoog, Anja HBACKGROUND In sub Saharan Africa cardiovascular disease is becoming a leading cause of death with high blood pressure as number one risk factor In Nigeria access and adherence to hypertension care are poor A pharmacy based hypertension care model with remote monitoring by cardiologists through mHealth was piloted in Lagos to increase accessibility to quality care for hypertensive patients OBJECTIVES To describe patients and healthcare providers perceptions and practices regarding hypertension pharmacy based care and mHealth and explore how this information may improve innovative hypertension service delivery METHODS This study consisted of observations of patient pharmacy staff interactions and hypertension care provided four focus group discussions and in depth interviews with 30 hypertensive patients nine community pharmacists and six cardiologists and structured interviews with 328 patients RESULTS Most patients were knowledgeable about biomedical causes and treatment of hypertension but often ignorant about the silent character of hypertension Reasons mentioned for not adhering to treatment were side effects financial constraints lack of health insurance and cultural or religious reasons Pharmacists additionally mentioned competition with informal cheaper healthcare providers Patients highly favored pharmacy based care because of the pharmacist patient relationship accessibility small scale and a pharmacy s registration at an association The majority of respondents were positive towards mHealth CONCLUSION Facilitating factors for innovative pharmacy based hypertension care were patients biomedical perceptions pharmacies strong position in the community and respondents positive attitude towards mHealth We recommend health education and strengthening pharmacists role to address barriers such as misperceptions that hypertension always is symptomatic treatment nonadherence and unfamiliarity with mHealth Future collaboration with insurance providers or other financing mechanisms may help diminish patients financial barriers to appropriate hypertension treatment
- ItemPharmacy-based hypertension care employing mHealth in Lagos, Nigeria - a mixed methods feasibility study.(0000-00-00) Nelissen, Heleen E; Cremers, Anne L; Okwor, Tochi J; Kool, Sam; van Leth, Frank; Brewster, Lizzy; Makinde, Olalekan; Gerrets, René; Hendriks, Marleen E; Schultsz, Constance; Osibogun, Akin; Van't Hoog, Anja HBACKGROUND 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
- ItemPharmacy-based hypertension care employing mHealth in Lagos, Nigeria - a mixed methods feasibility study.(0000-00-00) Nelissen, Heleen E; Cremers, Anne L; Okwor, Tochi J; Kool, Sam; van Leth, Frank; Brewster, Lizzy; Makinde, Olalekan; Gerrets, René; Hendriks, Marleen E; Schultsz, Constance; Osibogun, Akin; Van't Hoog, Anja HBACKGROUND 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