American Journal of Hypertension Advance Access published July 5, 2014
COMMENTARY
Community Hypertension Programs in the Age of Mobile Technology and Social Media Alexander G. Logan1
more fragmented and disrupted sleep. New public health approaches need to be rigorously evaluated to ensure that they are both cost-effective and applicable to large segments of the population. In the past, several well-thought-out, community-wide strategies for cardiovascular disease prevention, when properly evaluated, proved to have modest or no effect, leading the investigators to conclude that there was a need for new designs and new interventions.15–17 We are now living in an age where telecommunication systems allow individuals easy access to reliable health information anytime, anywhere. Networks using 3G and 4G technology enable high-speed data transfer and support a wide variety of information technology platforms. This new technology provides patients with direct access to personal health records, web portals, and healthcare providers. Presently, it is unclear what system works best and whether there are differences between countries. There are trials demonstrating the benefits of telecommunication in both developed13,18 and developing countries.19 Wireless connectivity is growing rapidly, and mobile devices are replacing landlines, desktop computers, and work stations as the preferred method of communication. The sale of smartphones with built-in messaging systems now outstrips that of cellphones.20 The recent flood of mobile healthcare devices and software applications has greatly expanded self-care capabilities across the spectrum of healthcare activities. Apart from ubiquitous educational materials, there is a cornucopia of self-help wellness and fitness programs for individuals interested in maintaining or improving their health. There is also a wide range of mobile services and solutions to prevent, diagnose, and treat diseases. Mobile health applications running on wireless devices facilitate disease monitoring.21,22 They enable remote monitoring of vital parameters to ensure health maintenance and provide early signals of potentially dangerous trends away from good health. Sleek wearable medical technology, now highly fashionable, allows individuals to monitor a wide array of vital signs and symptoms effortlessly and unobtrusively. Many such devices have built-in Bluetooth capabilities to transmit the data to a secure online database using
Correspondence: Alexander G. Logan ([email protected]).
1Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Initially submitted March 28, 2014; date of first revision April 26, 2014; accepted for publication May 23, 2014.
doi:10.1093/ajh/hpu125 © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: [email protected]
American Journal of Hypertension 1
Downloaded from http://ajh.oxfordjournals.org/ at University of California, San Francisco on December 2, 2014
See ARTICLE page XXX Community programs for the prevention of cardiovascular disease have generally succeeded in lowering blood pressure (BP) and improving cardiovascular health in the general population.1,2 They have also met the challenge of raising awareness, increasing knowledge, and promoting changes in health behavior.3 Moreover, they have likely contributed to the improved rates of BP control among hypertensive patients in North America over the past 2 decades.4–7 Successful population-based interventions combined the power of mass media and other communication tools with screening and counselling activities.1–3,8 These targeted BP programs were firmly rooted in sound scientific evidence that interventions to lower BP improve health outcomes.9 The study by Salazar et al. adds another dimension to population-based programs by highlighting the importance of sustained public health activity to maintain good BP control. These investigators demonstrated that individuals whose BP rose during the community intervention were at higher risk of developing a cardiovascular event.10 The new challenge for hypertension programs is maintaining community interest while reiterating the same health messages. A recent measles outbreak among unvaccinated adults in Canada has shown that in the absence of constant reminders, memories about serious preventable illnesses fade.11 To communicate effectively, community hypertension programs will need to borrow heavily from the world of technology about packaging messages to meet the changing ways that the general population consumes information.12 Public health interventions will need to take into account the new communication tools and fashion messages that fit the constraints of these instruments.13 It has amply been demonstrated that multiple approaches are required and communication strategies differ markedly among the target population to be reached.14 Interventions must also tap into risk factors that are products of the changing lifestyle of the community. It is apparent that lifestyle messages need to adapt to the reality of more prolonged periods of sitting at work, decreased time for meal preparation, financial constraints requiring dual-earner partnerships, and
Logan
2 American Journal of Hypertension
need to avoid design features such as small buttons and dim screens that impede usability. Apart from age and design issues, other impediments to the use of mobile health technology include affordability and availability that may reduce access.13,18 Such barriers are not insurmountable and are amenable to thoughtful solutions such as the use of publically available devices. In summary, there is a growing body of evidence that community programs reduce BP and improve cardiovascular health in the general population.1–3,8 Assessments of cardiovascular risk factors by the World Health Organization MONICA project from the mid-1980s to mid-1990s and by the National Health and Nutrition Examination Survey from 1971 to 2010 provide additional support for population-based interventions.6,7 Both surveys showed a leftward shift in the frequency distribution of BP. Importantly, the decrease in BP occurred equally at all levels of readings, indicating that the change was not specifically related to better clinical management of hypertension and the increasing application of antihypertensive medications. This evidence, along with the new findings of Salazar et al., justifies supporting community efforts to improve the management of cardiovascular risk factors.10 For continued success, however, community programs will need to take into account the changing way healthcare is being delivered18,23 and incorporate the advances in mobile communication technology and social media in program planning.13,24,25
References 1. Pennant M, Davenport C, Bayliss S, Greenheld W, Marshall T, Hyde C. Community programs for the prevention of cardiovascular disease: a systematic review. Am J Epidemiol 2010; 172:501–516. 2. Kaczorowski J, Chambers LW, Dolovich L, Paterson JM, Karwalajtys T, Gierman T, Farrell B, McDonough B, Thabane L, Tu K, Zagorski B, Goeree R, Levitt CA, Hogg W, Laryea S, Carter MA, Cross D, Sabaldt RJ. Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP). BMJ 2011; 342:d442. 3. Fulwood R, Guyton-Krishnan J, Wallace M, Sommer E. Role of community programs in controlling blood pressure. Curr Hypertens Rep 2006; 8:512–520. 4. Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. JAMA 2010; 303:2043–2050. 5. Wilkins K, Campbell NRC, Joffres MR, McAlister FA, Nichol M, Quach S, et al. Blood pressure in Canadian adults. Health Rep 2010; 20:1–10. 6. Tunstall-Pedoe H, Connaghan J, Woodward M, Tolonen H, Kuulasmaa K. Pattern of declining blood pressure across replicate population surveys of the WHO MONICA project, mid-1980s to mid-1990s, and the role of medication. BMJ 2006; 332:629–635. 7. Lackland DT, Roccella EJ, Deutsch AF, Fornage M, George MG, Howard G, Kissela BM, Kittner SJ, Lichtman JH, Lisabeth LD, Schwamm LH, Smith EE, Towfighi A; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; Council on Functional Genomics and Translational Biology. Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association. Stroke 2014; 45:315–353. 8. Farquhaar JW, Maccoby N, Wood PD, Alexander JK, Breitrose H, Brown BW Jr, Haskell WL, McAllister AL, Meyer AJ, Nash JD, Stern MP. Community education for cardiovascular health. Lancet 1977; 1:1192–1195.
Downloaded from http://ajh.oxfordjournals.org/ at University of California, San Francisco on December 2, 2014
a protected Internet connection, which in turn provides immediate feedback to users. In the past decade there has been a shift away from the traditional medical model of healthcare delivery to a more personalized system in which individuals are encouraged to participate in health maintenance activities and, for those with health problems, to work collaboratively with their healthcare providers.18,23 In the new paradigm, community resources and policies are integrated more closely into the health system to ensure that programs have a broad reach yet provide needed support for targeted activities. The effectiveness of this combined approach was recently demonstrated in a randomized controlled trial of a multipronged, community-based health promotion and prevention program for cardiovascular disease.2 The intervention, which targeted older adults, engaged public health units, community physicians, and local health organizations, significantly improved cardiovascular risk factor management, and reduced morbidity at the population level. An essential element of the study’s intervention was self-management support. There are many domains of health under personal control.13 Individuals can easily learn self-care skills, become more knowledgeable about health matters, modify poor lifestyle choices, use monitoring tools that track vital health parameters, and identify ways of preventing or mitigating the effects of disease. Interactive technologies and online resources such as social networks, video chat, and instant messaging platforms facilitate these self-help behaviors and are successfully filling gaps in the current health systems.24 Through social media, individuals can find or create networks with peers to share common experiences, increase problem-solving skills and gain confidence in making lifeimproving changes. Such interactions build a strong sense of belonging and encourage participation in communal efforts to combat health problems in targeted groups. These developments are encouraged by the US Institute of Medicine25 and strongly endorsed by academic leaders in the United States.12,25,26 If information technology is an important key to the future of community-based programs for chronic conditions such as hypertension, it faces many challenges. Foremost, it needs to appeal to all stakeholders, including organizations representing professionals, academic and research institutions, industry, and representatives from the general public. Age is a potential barrier in building successful interventions that use health information technology.27 The targeted population for hypertension is mostly aged >50 years and, in general, newly acquiring the skills to use the Internet and mobile devices. Nonetheless, the number of users in this age bracket is growing rapidly. A 2010 survey by the American Association of Retired Persons found that most were comfortable using a mobile phone and 7% even had a smartphone.28 Furthermore, older adults are interested in acquiring the skill to use a mobile health system to track vital signs such as BP and weight.29 For educators, it is important to recognize that many features of mobile devices are not intuitive for users aged >50 years and developing that intuition takes time.29 To increase acceptability of mobile health systems for older adults who are more likely to have hearing, vision, cognition, and mobility problems, developers
Commentary treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet 2010; 376:1838–1845. 20. Smith A. Smartphone ownership—2013 update. http://pewinternet. org/Reports/2013/Smartphone-Ownership-2013.aspx. Accessed 27 March 2014. 21. Logan AG, McIsaac WJ, Tisler A, Irvine MJ, Saunders A, Dunai A, Rizo CA, Feig DS, Hamill M, Trudel M, Cafazzo JA. Mobile phone-based remote patient monitoring system for management of hypertension in diabetic patients. Am J Hypertens 2007; 20:942–948. 22. Logan AG, Irvine MJ, McIsaac WJ, Tisler A, Rossos PG, Easty A, Feig DS, Cafazzo JA. Effect of home blood pressure telemonitoring with self-care support on uncontrolled systolic hypertension in diabetics. Hypertension 2012; 60:51–57. 23. Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self management of chronic disease in primary care. JAMA 2002; 288:2469–2475. 24. Jadad AR, Cabrera A, Martos F, Smith R, Lyons RF. When people live with multiple chronic diseases: a collaborative approach to an emerging global challenge. Granada: Andalusian School of Public Health: Granada, Spain, 2010. http://www.opimec.org/equipos/ when-people-live-with-multiple-chronic-diseases/. 25. Institute of Medicine Committee on Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. National Academy Press, Institute of Medicine: Washington, DC, 2001. 26. Steinhubl SR, Muse ED, Topol EJ. Can mobile health technologies transform health care. JAMA 2013; 310:2395–2396. 27. Zickuhr K, Madden M. Older adults and Internet use: for the first time, half of adults ages 65 and older are online. http://pewinternet.org/ Reports/2012/Older-adults-and-internet-use.aspx. Accessed 20 May 2014. 28. Barrett L. Health and caregiving among the 50+: ownership, use and interest in mobile technology. American Association of Retired Persons: Washington, DC, 2011. http://www.webcitation.org/6KbAjrNZi. Accessed 27 March 2014. 29. Grindrod KA, Li M, Gates A. Evaluating user perceptions of mobile medication management applications with older adults. A usability study. JMIR Mhealth Uhealth. 2014; 2:e11.
American Journal of Hypertension 3
Downloaded from http://ajh.oxfordjournals.org/ at University of California, San Francisco on December 2, 2014
9. Bakris G, Sarafidis P, Agarwal R, Ruilope L. Review of blood pressure control rates and outcomes. J Am Soc Hypertens 2014; 8:127–141. 10. Salazar MR, Espeche WG, Aizpurua M, Sisnieguez BCL, Balbin E, Dulbecco CA, Carbajal HA. Blood pressure response to a communitybased program and long-term cardiovascular outcome. Am J Hypertens 2014; XX:XXX. 11. MacFadden DR, Gold WL. Measles. CMAJ 2014; 186:450. 12. Califf RM, Sanderson I, Miranda ML. The future of cardiovascular clinical research: informatics, clinical investigators, and community engagement. JAMA 2012; 308:1747–1748. 13. Logan AG. Transforming hypertension management using mobile health technology for telemonitoring and self-care support. Can J Cardiol 2013; 29:579–585. 14. Fahey T, Schroeder K, Ebrahim S. Educational and organisational interventions used to improve the management of hypertension in primary care: a systematic review. Br J Gen Pract 2005; 55:875–882. 15. Luepker RV, Murray DM, Jacobs DR Jr, Mittelmark MB, Bracht N, Carlaw R, Crow R, Elmer P, Finnegan J, Folsom AR, Grimm R, Hannan PJ, Jeffrey R, Lando H, McGovern P, Mullis R, Perry CL, Pechacek T, Pirie P, Sprafka JM, Weisbrod R, Blackburn H. Community education for cardiovascular disease prevention: risk factor changes in the Minnesota Heart Health Program. Am J Public Health 1994; 84:1383–1393. 16. Carleton RA, Lasater TM, Assaf AR, Feldman HA, McKinlay S. The Pawtucket Heart Health Program: community changes in cardiovascular risk factors and projected disease risk. Am J Public Health 1995; 85:777–785. 17. Winkleby MA, Taylor CB, Jatulis D, Fortmann SP. The long-term effects of a cardiovascular disease prevention trial: the Stanford Five-City Project. Am J Public Health 1996; 86:1773–1779. 18. Carter BL, Bosworth HB, Green BB. The hypertension team: the role of the pharmacist, nurse, and teamwork in hypertension therapy. J Clin Hypertens (Greenwich) 2012; 14:51–65. 19. Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, Jack W, Habyarimana J, Sadatsafavi M, Najafzadeh M, Marra CA, Estambale B, Nquqi E, Ball TB, Thabane L, Gelmon LJ, Kimani J, Ackers M, Plummer FA. Effects of a mobile phone short message service on antiretroviral
COMMENTARY
Community Hypertension Programs in the Age of Mobile Technology and Social Media Alexander G. Logan1
more fragmented and disrupted sleep. New public health approaches need to be rigorously evaluated to ensure that they are both cost-effective and applicable to large segments of the population. In the past, several well-thought-out, community-wide strategies for cardiovascular disease prevention, when properly evaluated, proved to have modest or no effect, leading the investigators to conclude that there was a need for new designs and new interventions.15–17 We are now living in an age where telecommunication systems allow individuals easy access to reliable health information anytime, anywhere. Networks using 3G and 4G technology enable high-speed data transfer and support a wide variety of information technology platforms. This new technology provides patients with direct access to personal health records, web portals, and healthcare providers. Presently, it is unclear what system works best and whether there are differences between countries. There are trials demonstrating the benefits of telecommunication in both developed13,18 and developing countries.19 Wireless connectivity is growing rapidly, and mobile devices are replacing landlines, desktop computers, and work stations as the preferred method of communication. The sale of smartphones with built-in messaging systems now outstrips that of cellphones.20 The recent flood of mobile healthcare devices and software applications has greatly expanded self-care capabilities across the spectrum of healthcare activities. Apart from ubiquitous educational materials, there is a cornucopia of self-help wellness and fitness programs for individuals interested in maintaining or improving their health. There is also a wide range of mobile services and solutions to prevent, diagnose, and treat diseases. Mobile health applications running on wireless devices facilitate disease monitoring.21,22 They enable remote monitoring of vital parameters to ensure health maintenance and provide early signals of potentially dangerous trends away from good health. Sleek wearable medical technology, now highly fashionable, allows individuals to monitor a wide array of vital signs and symptoms effortlessly and unobtrusively. Many such devices have built-in Bluetooth capabilities to transmit the data to a secure online database using
Correspondence: Alexander G. Logan ([email protected]).
1Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Initially submitted March 28, 2014; date of first revision April 26, 2014; accepted for publication May 23, 2014.
doi:10.1093/ajh/hpu125 © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: [email protected]
American Journal of Hypertension 1
Downloaded from http://ajh.oxfordjournals.org/ at University of California, San Francisco on December 2, 2014
See ARTICLE page XXX Community programs for the prevention of cardiovascular disease have generally succeeded in lowering blood pressure (BP) and improving cardiovascular health in the general population.1,2 They have also met the challenge of raising awareness, increasing knowledge, and promoting changes in health behavior.3 Moreover, they have likely contributed to the improved rates of BP control among hypertensive patients in North America over the past 2 decades.4–7 Successful population-based interventions combined the power of mass media and other communication tools with screening and counselling activities.1–3,8 These targeted BP programs were firmly rooted in sound scientific evidence that interventions to lower BP improve health outcomes.9 The study by Salazar et al. adds another dimension to population-based programs by highlighting the importance of sustained public health activity to maintain good BP control. These investigators demonstrated that individuals whose BP rose during the community intervention were at higher risk of developing a cardiovascular event.10 The new challenge for hypertension programs is maintaining community interest while reiterating the same health messages. A recent measles outbreak among unvaccinated adults in Canada has shown that in the absence of constant reminders, memories about serious preventable illnesses fade.11 To communicate effectively, community hypertension programs will need to borrow heavily from the world of technology about packaging messages to meet the changing ways that the general population consumes information.12 Public health interventions will need to take into account the new communication tools and fashion messages that fit the constraints of these instruments.13 It has amply been demonstrated that multiple approaches are required and communication strategies differ markedly among the target population to be reached.14 Interventions must also tap into risk factors that are products of the changing lifestyle of the community. It is apparent that lifestyle messages need to adapt to the reality of more prolonged periods of sitting at work, decreased time for meal preparation, financial constraints requiring dual-earner partnerships, and
Logan
2 American Journal of Hypertension
need to avoid design features such as small buttons and dim screens that impede usability. Apart from age and design issues, other impediments to the use of mobile health technology include affordability and availability that may reduce access.13,18 Such barriers are not insurmountable and are amenable to thoughtful solutions such as the use of publically available devices. In summary, there is a growing body of evidence that community programs reduce BP and improve cardiovascular health in the general population.1–3,8 Assessments of cardiovascular risk factors by the World Health Organization MONICA project from the mid-1980s to mid-1990s and by the National Health and Nutrition Examination Survey from 1971 to 2010 provide additional support for population-based interventions.6,7 Both surveys showed a leftward shift in the frequency distribution of BP. Importantly, the decrease in BP occurred equally at all levels of readings, indicating that the change was not specifically related to better clinical management of hypertension and the increasing application of antihypertensive medications. This evidence, along with the new findings of Salazar et al., justifies supporting community efforts to improve the management of cardiovascular risk factors.10 For continued success, however, community programs will need to take into account the changing way healthcare is being delivered18,23 and incorporate the advances in mobile communication technology and social media in program planning.13,24,25
References 1. Pennant M, Davenport C, Bayliss S, Greenheld W, Marshall T, Hyde C. Community programs for the prevention of cardiovascular disease: a systematic review. Am J Epidemiol 2010; 172:501–516. 2. Kaczorowski J, Chambers LW, Dolovich L, Paterson JM, Karwalajtys T, Gierman T, Farrell B, McDonough B, Thabane L, Tu K, Zagorski B, Goeree R, Levitt CA, Hogg W, Laryea S, Carter MA, Cross D, Sabaldt RJ. Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP). BMJ 2011; 342:d442. 3. Fulwood R, Guyton-Krishnan J, Wallace M, Sommer E. Role of community programs in controlling blood pressure. Curr Hypertens Rep 2006; 8:512–520. 4. Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. JAMA 2010; 303:2043–2050. 5. Wilkins K, Campbell NRC, Joffres MR, McAlister FA, Nichol M, Quach S, et al. Blood pressure in Canadian adults. Health Rep 2010; 20:1–10. 6. Tunstall-Pedoe H, Connaghan J, Woodward M, Tolonen H, Kuulasmaa K. Pattern of declining blood pressure across replicate population surveys of the WHO MONICA project, mid-1980s to mid-1990s, and the role of medication. BMJ 2006; 332:629–635. 7. Lackland DT, Roccella EJ, Deutsch AF, Fornage M, George MG, Howard G, Kissela BM, Kittner SJ, Lichtman JH, Lisabeth LD, Schwamm LH, Smith EE, Towfighi A; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; Council on Functional Genomics and Translational Biology. Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association. Stroke 2014; 45:315–353. 8. Farquhaar JW, Maccoby N, Wood PD, Alexander JK, Breitrose H, Brown BW Jr, Haskell WL, McAllister AL, Meyer AJ, Nash JD, Stern MP. Community education for cardiovascular health. Lancet 1977; 1:1192–1195.
Downloaded from http://ajh.oxfordjournals.org/ at University of California, San Francisco on December 2, 2014
a protected Internet connection, which in turn provides immediate feedback to users. In the past decade there has been a shift away from the traditional medical model of healthcare delivery to a more personalized system in which individuals are encouraged to participate in health maintenance activities and, for those with health problems, to work collaboratively with their healthcare providers.18,23 In the new paradigm, community resources and policies are integrated more closely into the health system to ensure that programs have a broad reach yet provide needed support for targeted activities. The effectiveness of this combined approach was recently demonstrated in a randomized controlled trial of a multipronged, community-based health promotion and prevention program for cardiovascular disease.2 The intervention, which targeted older adults, engaged public health units, community physicians, and local health organizations, significantly improved cardiovascular risk factor management, and reduced morbidity at the population level. An essential element of the study’s intervention was self-management support. There are many domains of health under personal control.13 Individuals can easily learn self-care skills, become more knowledgeable about health matters, modify poor lifestyle choices, use monitoring tools that track vital health parameters, and identify ways of preventing or mitigating the effects of disease. Interactive technologies and online resources such as social networks, video chat, and instant messaging platforms facilitate these self-help behaviors and are successfully filling gaps in the current health systems.24 Through social media, individuals can find or create networks with peers to share common experiences, increase problem-solving skills and gain confidence in making lifeimproving changes. Such interactions build a strong sense of belonging and encourage participation in communal efforts to combat health problems in targeted groups. These developments are encouraged by the US Institute of Medicine25 and strongly endorsed by academic leaders in the United States.12,25,26 If information technology is an important key to the future of community-based programs for chronic conditions such as hypertension, it faces many challenges. Foremost, it needs to appeal to all stakeholders, including organizations representing professionals, academic and research institutions, industry, and representatives from the general public. Age is a potential barrier in building successful interventions that use health information technology.27 The targeted population for hypertension is mostly aged >50 years and, in general, newly acquiring the skills to use the Internet and mobile devices. Nonetheless, the number of users in this age bracket is growing rapidly. A 2010 survey by the American Association of Retired Persons found that most were comfortable using a mobile phone and 7% even had a smartphone.28 Furthermore, older adults are interested in acquiring the skill to use a mobile health system to track vital signs such as BP and weight.29 For educators, it is important to recognize that many features of mobile devices are not intuitive for users aged >50 years and developing that intuition takes time.29 To increase acceptability of mobile health systems for older adults who are more likely to have hearing, vision, cognition, and mobility problems, developers
Commentary treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet 2010; 376:1838–1845. 20. Smith A. Smartphone ownership—2013 update. http://pewinternet. org/Reports/2013/Smartphone-Ownership-2013.aspx. Accessed 27 March 2014. 21. Logan AG, McIsaac WJ, Tisler A, Irvine MJ, Saunders A, Dunai A, Rizo CA, Feig DS, Hamill M, Trudel M, Cafazzo JA. Mobile phone-based remote patient monitoring system for management of hypertension in diabetic patients. Am J Hypertens 2007; 20:942–948. 22. Logan AG, Irvine MJ, McIsaac WJ, Tisler A, Rossos PG, Easty A, Feig DS, Cafazzo JA. Effect of home blood pressure telemonitoring with self-care support on uncontrolled systolic hypertension in diabetics. Hypertension 2012; 60:51–57. 23. Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self management of chronic disease in primary care. JAMA 2002; 288:2469–2475. 24. Jadad AR, Cabrera A, Martos F, Smith R, Lyons RF. When people live with multiple chronic diseases: a collaborative approach to an emerging global challenge. Granada: Andalusian School of Public Health: Granada, Spain, 2010. http://www.opimec.org/equipos/ when-people-live-with-multiple-chronic-diseases/. 25. Institute of Medicine Committee on Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. National Academy Press, Institute of Medicine: Washington, DC, 2001. 26. Steinhubl SR, Muse ED, Topol EJ. Can mobile health technologies transform health care. JAMA 2013; 310:2395–2396. 27. Zickuhr K, Madden M. Older adults and Internet use: for the first time, half of adults ages 65 and older are online. http://pewinternet.org/ Reports/2012/Older-adults-and-internet-use.aspx. Accessed 20 May 2014. 28. Barrett L. Health and caregiving among the 50+: ownership, use and interest in mobile technology. American Association of Retired Persons: Washington, DC, 2011. http://www.webcitation.org/6KbAjrNZi. Accessed 27 March 2014. 29. Grindrod KA, Li M, Gates A. Evaluating user perceptions of mobile medication management applications with older adults. A usability study. JMIR Mhealth Uhealth. 2014; 2:e11.
American Journal of Hypertension 3
Downloaded from http://ajh.oxfordjournals.org/ at University of California, San Francisco on December 2, 2014
9. Bakris G, Sarafidis P, Agarwal R, Ruilope L. Review of blood pressure control rates and outcomes. J Am Soc Hypertens 2014; 8:127–141. 10. Salazar MR, Espeche WG, Aizpurua M, Sisnieguez BCL, Balbin E, Dulbecco CA, Carbajal HA. Blood pressure response to a communitybased program and long-term cardiovascular outcome. Am J Hypertens 2014; XX:XXX. 11. MacFadden DR, Gold WL. Measles. CMAJ 2014; 186:450. 12. Califf RM, Sanderson I, Miranda ML. The future of cardiovascular clinical research: informatics, clinical investigators, and community engagement. JAMA 2012; 308:1747–1748. 13. Logan AG. Transforming hypertension management using mobile health technology for telemonitoring and self-care support. Can J Cardiol 2013; 29:579–585. 14. Fahey T, Schroeder K, Ebrahim S. Educational and organisational interventions used to improve the management of hypertension in primary care: a systematic review. Br J Gen Pract 2005; 55:875–882. 15. Luepker RV, Murray DM, Jacobs DR Jr, Mittelmark MB, Bracht N, Carlaw R, Crow R, Elmer P, Finnegan J, Folsom AR, Grimm R, Hannan PJ, Jeffrey R, Lando H, McGovern P, Mullis R, Perry CL, Pechacek T, Pirie P, Sprafka JM, Weisbrod R, Blackburn H. Community education for cardiovascular disease prevention: risk factor changes in the Minnesota Heart Health Program. Am J Public Health 1994; 84:1383–1393. 16. Carleton RA, Lasater TM, Assaf AR, Feldman HA, McKinlay S. The Pawtucket Heart Health Program: community changes in cardiovascular risk factors and projected disease risk. Am J Public Health 1995; 85:777–785. 17. Winkleby MA, Taylor CB, Jatulis D, Fortmann SP. The long-term effects of a cardiovascular disease prevention trial: the Stanford Five-City Project. Am J Public Health 1996; 86:1773–1779. 18. Carter BL, Bosworth HB, Green BB. The hypertension team: the role of the pharmacist, nurse, and teamwork in hypertension therapy. J Clin Hypertens (Greenwich) 2012; 14:51–65. 19. Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, Jack W, Habyarimana J, Sadatsafavi M, Najafzadeh M, Marra CA, Estambale B, Nquqi E, Ball TB, Thabane L, Gelmon LJ, Kimani J, Ackers M, Plummer FA. Effects of a mobile phone short message service on antiretroviral
