Letting Patients Change Their Own Meds Using Apps and Connected Devices

This article published with permission from iMedicalApps.com.

A recent trial published in the Journal of the American Medical Association has demonstrated the efficacy of self-titration of blood pressure medications by patients with hypertension.

Personally, I’m a proponent of giving patients self-titration schedules, particularly in my patients with systolic heart failure in whom I’m trying to maximize medical therapy. It’s a strategy I use somewhat sparingly though in part because of the difficulty to follow the home monitoring these patients are doing between clinic visits.

In the TASMIN-SR study by McManus et al, randomized approximately five hundred patients considered to be at “high risk,” meaning presence of comorbidities like diabetes mellitus, cardiovascular disease, or renal disease. Half were managed with usual care with their primary care physician.

The other half were randomized to a self-management program that began with two to three 1-hour training sessions to learn how to perform home blood pressure monitoring. They then met with their primary care physician to come with up a self-titration schedule, transcribed onto paper, based on those readings of up to three steps at a time; those steps could be serial increases in a single agent or addition of additional agents.

At twelve months, the intervention arm achieved a blood pressure reduction of 9 mm Hg / 3 mm Hg in comparison to the usual care group. This effect was attributed to a significantly greater medication use, both dose and number, in the intervention group.

In this study, the self-titration plan was agreed upon in a clinic visit and then transcribed onto a paper given to the patient. The patient then used an unconnected blood pressure cuff at home with pre-set parameters for the patient to notify their primary care physician if their readings were too high or too low. Notifications of self-titration were accomplished by having the patient send in paper notifications to their primary care physician.

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