Background• Hypertension is a serious, chronic illness that impacts millions of Americans. According

to the CDC, 67 million American adults have hypertension, that is 1 in 3 adults. The CDC also reports that only approximately 47% of individuals with hypertension have it controlled.

• Medication non-adherence is a major contributing factor in uncontrolled hypertension. It

is estimated that improved adherence to anti-hypertensive medications could prevent 89,000 deaths in the US annually.

• Medication non-adherence can be defined as non-compliance to an agreed upon treatment plan between patient and physician to take specific medications at specific frequencies.

• Traditional medication reminders include; pill boxes, calendars, and human reminders. Advances in technology have led to the development of several electronic medication reminders including: emails, text messages, automatic dispensing machines, and electronic paging devices. This project planned to examine the effectiveness of electronic medication reminders

AbstractThe purpose of this project was to examine the effectiveness of electronic medication reminders for increasing medication adherence, and ultimately improved blood pressure control. The results provided evidence that electronic medication reminders can increase medication adherence to anti-hypertensive medications and significantly decrease blood pressure. This information can be used by medical case manager RNs to increase education on medication adherence and encourage the use of electronic medications reminders to clients who are identified as non-compliant with their hypertensive medications.

Goals1. To determine if the existing research proves that electronic medication reminders improved medication adherence

2. To determine if medical case managers should educate clients who are currently taking daily anti-hypertensive medications on electronic medications reminders

Problem-In adults with diagnosed hypertension who are taking daily doses of antihypertensive medications, who have been identified as non-compliant to medication through a nursing assessment,

Intervention – does an electronic medication reminder such as a daily email, sent by a nurse case manager or care coach

Comparison- when compared to traditional medication reminders such as pill boxes, calendars, and human reminders,

Outcome – provide evidence that there is an increase in medication adherence to the prescribed medications, as measured by self-reported compliance.

Nursing TheoryDorothea Orem’s Self-care Deficit Theory was used to guide this research. Orem’s five key concepts to this theory; self –care, self-care deficit, self-care requisites, self-care demand, and agency focus around the ideal that nurses help clients when they are unable to manage their own self-care activities. This research is aimed to provide best practices of self care education to clients.

AcknowledgmentsThis research was completed with the supervision of Cary Robertson, RN, CCM and Health Integrated care management department.

Methods / Literature Review

• An integrative research review was conducted using CINAHL, Medline, and Proquest databases. • A total of 15 studies were found, three were excluded for being in the proposal phase and two were excluded for not containing

primary research• The ten remaining studies were analyzed, data was extracted and place into a table

Results

Interventions to increase medication adherence• Interactive phone calls• Visual messages (Short Message Services) sent to cell phones• Text messages & text message programs (My Medication Reminder Text Messaging Program)• Emails• Patient education on medication adherence • Smart phone enabled medication reminder system (mHealth device)• Electronic medication reminder pager (Telsvar device)• Electronic pillboxes

Analysis of FindingsEvidence regarding electronic pillboxes provided “no relationship between timed adherence and achieved blood pressure readings”. There appears to be a lacking of significant evidence based research in regards to traditional medication reminders. There is adequate, recent evidence based research regarding different forms of electronic medication reminders. The following table reflects the advantages versus disadvantages of electronic medication reminders through an analysis of the findings.

ConclusionsThere are multiple interventions that offer individuals with hypertension the opportunity to improve their blood pressure control. The purpose of this project was to determine if electronic medication reminders improved medication adherence in individuals with hypertension. The research provided evidence that electronic reminders such as text messages can significantly increase not only medication adherence but ultimately blood pressure control. The research also provided evidence that demonstrated no significant benefit of electronic pillboxes. Barriers to implementing this within the practice setting of medical case management include; the willingness of clients to consent to electronic reminders, and the time constraints of setting up such reminders.

Nursing ImplicationsThis research has several implications to medical case manager nurses. Once clients have been identified as non-compliant with their anti-hypertensive medications, medical case managers have the opportunity to encourage and educate clients not only on the importance of medication adherence, but on the benefits of using an electronic medication reminding system. Perhaps during an assessment of a client’s medication compliance, further assessment of their willingness and ability to use electronic medication reminders should be completed.

Elizabeth Hotaling, RN

State University of New York Institute of Technology Utica/Rome

References

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Please contact Elizabeth Hotaling at BethA429@msn.com for any further information.

Electronic Medication Reminders for Individuals with Hypertension

Advantages Disadvantages• Electronic medication reminders have been able to demonstrate an increase in medication adherence rates

• The analyzed research provided evidence that the use of electronic medications reminders can improve medication compliance, as demonstrated through decreased blood pressure readings.

• The research demonstrated that most populations, including the elderly are able to use these reminders

• Not all clients have access to electronic medication reminders. • One study provided evidence that intensive patient education on medication adherence and health lifestyles can produce a comparable improvement in blood pressure readings as electronic medication

• Could be costly if clients do not previously own a smart phone, computer, or traditional cell phone that accepts text messages.