Pharmacy-based hypertension care employing mHealth in Lagos, Nigeria - a mixed methods feasibility study.

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