Enhancing adherence and management in patients with hypertension: Impact of form and frequency of knowledge intervention

Background: The alarming rise in prevalence of hypertension warrants psychosocial methods supplementing pharmacotherapy for better management and prevention of cardiac emergencies. The objective of the study was to assess the differential impact of the form and frequency of knowledge intervention on management of primary hypertension. Materials and method: The study was conducted on 256 hypertensive patients recruited through purposive sampling at health centers in Hyderabad, India. Pretest post-test control group quasiexperimental design was adopted for the study. There were two forms of the knowledge intervention, namely ‘Direct Interaction’ and ‘Audio-Visual’. Each form was presented in two frequencies namely ‘single exposure’ and ‘double exposure’. The four groups were labelled as Direct Intervention Single (DIS), Direct Intervention Double (DID), Audio-Visual Single (AVS) and Audio-Visual Double (AVD). Adherence and management of hypertension were assessed at baseline and six weeks post experiment. Analysis of Covariance (ANCOVA) was applied using IBM SPSS Statistics version 20. Results: ANCOVA followed by Bonferroni Multiple Group Comparison Test revealed significant differences between the four intervention groups and control group on adherence (p< .001). In case of hypertension management significant differences were observed between Control group and DIS, DID (p < .001), Control and AVS (p < .01). Control group did not differ from AVD. Conclusion: There was a positive impact of Knowledge Intervention on adherence and management of hypertension. Double exposure in audio visual form was counterproductive in hypertension management.

Hypertension Management System Based on Mobile Intelligent Computation / 医学信息学杂志

In this paper,a hypertension management system based on mobile intelligent computation is built,intorduces its overall architecture and function realization.The user side can implement collection and monitoring of body signs,behavior monitoring,hypertension riskassessment and emergence help,etc.In addition,the doctor side can assist the doctor in diagnosis service.With the help of this system,the user can know his/her physical status and make self-adjustment in time,and the doctor can quickly track the progressof the patient and provide health guidance.As a result,the personalized hypertension management for both the doctor and the patient can be achieved.

What's New and What Gaps in 2013 European Guidelines for the Management of Arterial Hypertension: A Reappraisal.

Arterial hypertension is the most common cardiovascular risk factor causing over 9 million deaths worldwide. Its treatment is crucial in preventing adverse outcomes, in reducing morbidity and mortality and related socio-economic impact of cardiovascular diseases. The European Society of Cardiology and the European Society of Hypertension recently published the new guidelines for the management of hypertension in order to provide physicians diagnostic and therapeutic tools and indications for improving health outcomes. Despite the new advances proposed by the authors, gaps in evidences still persist. The aim of our paper is to give an overview about the new aspects proposed in the arterial hypertension management and the dark side of the knowledge still persisting about such a matter.

Evaluation of Knowledge Model for a Hypertension Management CDSS Using a Standard-based Knowledge Authoring Tool / 대한의료정보학회지

OBJECTIVE: For the development of interoperable and sharable knowledge-based clinical decision support systems, it is important to evaluate the appropriateness of knowledge in each phase. In this study, an evaluation of early phase's knowledge model for hypertension management was conducted to develop a more precise and useful knowledge model. METHODS: The knowledge model for hypertension management based on JNC7 was modeled using a knowledge representation tool based on SAGE. Two physicians were involved in evaluating the process of the knowledge model. They reviewed 36 scenarios and made recommendations based on the knowledge model. These recommendations were compared with those derived from the model. RESULTS: Eight algorithms and 223 evidence statements were included in the knowledge model. The concordance rate of the recommendations between the physicians and the model for the goal BP were 61% and 93% by the respective physicians. Six scenarios showed low proficiency and efficiency for drug recommendation. Two refinements of the knowledge model were made based on the results. CONCLUSION: The evaluation process of the knowledge model in the early phase provides more precise and useful knowledge model in the next.

The Knowledge, Attitude and Practice of Blood Pressure Management from the Patient's Viewpoint: A Qualitative Study / 예방의학회지

OBJECTIVES: This study adopted a qualitative method to explore the layman's beliefs and experience concerning high blood pressure and its management in order to develop a strategy to increase adherence to proper medical treatment. METHODS: Semi-structured interviews that focused on personal experiences with hypertension and its management were conducted with 26 hypertensive patients. The participants were selected according to a BP above 140/90 mmHg (hypertension stage 1), based on the seventh report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure (JNC-VII). The interviews lasted for approximately 30 minutes (range: 20-60 minutes). The resulting questions were formulated into open-ended questions. The interview questionnaire was composed 17 items to examine non-adherence to treatment and 19 items to examine adherence to treatment. RESULTS: Most participants recognized that the direct cause of high blood pressure was unhealthy behavior rather than inheritance. Thus, the hypertensive patient believed they could recover their blood pressure to a normal level through removing the direct cause of hypertension (weight reduction, diet, exercise) instead of taking drugs. The reasons for these statements were that the drugs for controlling hypertension are not natural or they are artificial, and they may have side effects, and drugs are not treatment for the root cause of hypertension. Most of the hypertensive patients chose to manage their behaviors as soon as they knew their blood pressure was high. Therefore, we should not divide the subjects into two groups according to their taking drugs or not, but they should be divided into two groups according to their willingness or not to manage their condition. CONCLUSIONS: For developing a strategy for an individual approach to hypertension management, we need to develop a client-centered attitude and strategy. That is, we need to tailor our approach to individual cases to avoid generalizations and stereotyping when developing an adherence increasing strategy.

Concept representation of decision logic for hypertension management using SNOMED CT / 대한의료정보학회지

OBJECTIVE: To obtain sharable and reusable knowledge among various hospital information systems, it is essential to represent each term with standard terminology. To support knowledge representation for interoperable clinical decision support system for hypertension management, the feasibility of SNOMED CT was evaluated. METHODS: Concept matching was conducted using the method of direct matching, post-coordinated matching and general matching. For semantic matching, the SNOMED CT hierarchy was considered, and for raising the mapping rate, preferred terms and synonyms were used. RESULTS: Excluding the recommendation concepts that were not used in clinical data, finally 182 concepts were evaluated in terms of concept matching. Seventy two percent of the concepts was directly matched to pre-coordinated concepts in SNOMED CT. For the post-coordinated matching and the general matching to broader meaning, 9.3% and 18.7% were covered respectively. CONCLUSION: The direct coverage of SNOMED CT was moderate to high level for representing guideline knowledge concepts without loss of semantics. To supplement the coverage, it is inevitable to consider defining local concepts for implementing hypertension management systems.

Approach to the Requirements of a Decision Support System for Hypertension Management in a Health Center / 대한의료정보학회지

BACKGROUND: Guidelines and protocols have gained support as vehicles for promulgating the best practices in clinical medicine, and many researchers have proposed frameworks for modeling them in a computer-interpretable format. However, for guidelines to be most useful for decision support, they need to be integrated into the patient care process and to be patient-specific. OBJECTIVE: To achieve this, as a part of the development of interoperable and sharable clinical decision support system in the context of electronic health records, we identified the system requirements on the CDS for integrating hypertension management into workflow of a health center. We also introduced our approach to the acquisition of medical knowledge. METHODS: A method combining the top-down and bottom-up approaches was used. For the top-down, the service scope and target group of patients were defined, and the knowledge sources, including JNC 7 and other guidelines from which decision logic was extracted, were identified. For the bottom-up approach, scenario-use cases were applied and an analysis of care data and a survey of the care providers were conducted. RESULTS: This bidirectional method revealed the opportunities of our approach and the means by which improvements can be suggested in practice. The content and functions expected by users were also identified. These results will be used for further encoding knowledge at the computable level and application development at the implemental level.