Ramiro Mora knew it was serious when he was diagnosed with high blood pressure at age 29. Hypertension runs in his family, and he was aware of the risks of letting it go uncontrolled.
But Mora, a press brake operator who lives outside Charleston, S.C., sometimes forgot to take his medication. Or he’d skip it when he was feeling good.
“I’d take my pills for a while and then I’d stop,” he says. “But then I started having dizziness, and I wondered if my high blood pressure was the reason why.”
In 2013, Mora signed up to participate in a study to see if smartphone technology could be used to help patients manage their hypertension. Designed by researchers at the Medical University of South Carolina, the project is funded by a multi-year grant from The Duke Endowment.
Hypertension puts patients at risk of stroke, renal failure, coronary artery disease and heart failure, but it often lacks symptoms.
“Essential hypertension” – meaning that the cause of high blood pressure isn’t known – is the most commonly diagnosed chronic disease in the United States. Sticking to medication regimens helps patients control their hypertension, but experts say that average medication compliance rates hover at 50 percent.
The South Carolina study began in July 2012. It’s called SMASH, for Smartphone Medication Adherence Stops Hypertension.
In the first months, researchers gathered input from five focus groups, and finished software programming and beta testing. They then recruited 16 high-risk patients for a three-month proof of concept trial, with half of the patients randomly assigned to standard care. A six-month randomized clinical trial expanded the project to 48 patients in three South Carolina counties.
Study participants were given cellular-connected electronic trays with compartments for daily medication. Called the “MedMinder,” the tray was programmed to remind patients when to take their doses. The first reminder was a blinking light. The second was a loud chime. After that, the patient got an automated call.
Participants also received a portable blood pressure monitor to take reading every three days. Personalized smartphone-delivered motivational messages helped keep them on schedule. Physicians received weekly automated reports of their patients’ medication adherence and blood pressure levels.
Putting Technology to Work
The project was housed in the Technology Applications Center for Healthful Lifestyles at the Medical University of South Carolina. The center’s 10-year goal includes dissemination of successful health technology programs as part of standard patient management, which leaders believe will help reduce chronic disease health disparities in the state.
Dr. Frank Treiber, a clinical psychologist, leads the work. Formerly a vice president for research and development at the Medical College of Georgia, he came to MUSC in 2010 with a South Carolina Centers of Economic Excellence endowed research chair to launch the Technology Applications Center.
“Mobile health technologies allow a doctor and a patient to be interconnected with each other 24/7,” Treiber says. “Doctors receive automated summary reports on their patients’ vital signals, medication adherence, lifestyle behaviors, etc. They are able to make more timely changes in patients’ medical regimens, preventing deterioration of function and ultimately keeping patients out of the ERs and hospitals.”
Early results from SMASH look promising. After funding from The Duke Endowment ends in June 2014, a National Institute of Health grant will launch another pilot.
Ramiro Mora says he’s happy he had a chance to be a part of an important study. The program helped him take his medicine on time – and, as a result, reinforced good habits.
“Before this, I knew about high blood pressure, but I didn’t really care much about it when I felt OK,” he says. “I now know what I need to do to stay healthy.”
Lin B. Hollowell III
Director of Health Care