Unboxed Health’s mission is to help individuals and healthcare providers combat chronic diseases at a large scale. We believe that patients can provide the motivating force that leads to improved health if they have the information they need. That is why BProactive is designed to give each patient personalized guidance. Hypertension is one of the conditions that we are focused on. Effective treatments for high blood pressure have been available for many years, yet a large proportion of those who are diagnosed still live with it uncontrolled: 34% in Canada and 47% in the United States. Millions of people are living with this deadly condition that don’t need to be.
To achieve our mission, we have developed a digital solution based on the latest clinical research into hypertension care. Recently, several research reports have been published demonstrating how digital tools can aid the treatment of hypertension. Unfortunately, there have been very few attempts to extend this research into practical solutions that can be used by thousands or millions of people suffering from high blood pressure. BProactive was developed to combine research discoveries with a practical solution that can reach the population at large. It monitors the normal clinical workflow required to discover a patient’s optimal treatment, intervening when needed to ensure that an effective and standardized approach is followed.
In this post we examine how BProactive aligns with a clinical hypertension management framework presented in a paper entitled “Measure accurately, Act rapidly, and Partner with patients: An intuitive and practical three-part framework to guide efforts to improve hypertension control” by Boonyasai, Rakotz, Lubomski, Daniel, Marstellar, Taylor, Cooper, Hasan and Wynia (2017), and that is discussed in the AMA Wire here. The M.A.P. framework introduces a practical guide to improve hypertension control that can be used by a multidisciplinary team of healthcare workers.
BProactive is a mobile app that provides personalized treatment guidance to individuals with hypertension. It automates the process of discovering the correct treatment for patients by triggering blood pressure assessments at the right time and providing next step recommendations until healthy blood pressure is reached.
Both M.A.P. and BProactive target three key deterrents to hypertension control: sub-optimal blood pressure data; therapeutic or clinical inertia, which is the failure to modify or intensify treatment when outcomes are not being achieved; and lack of patient adherence to prescribed treatment. This article explores the ways in which BProactive can be used by patients to implement M.A.P. effectively.
The first requirement of M.A.P. is accurate blood pressure measurement. The developers of M.A.P. explain that poor quality measurements can impair a clinician’s ability to make accurate treatment decisions. A patient with an in-office measurement that only appears to be high can lead to treatment that is too intense. Conversely, inaccurate measurements that appear low can deter a clinician from starting or intensifying treatment. The M.A.P. authors recommend allowing the patient to self-measure several times while in the office to get a more accurate reading.
The benefits of patient self-monitoring are now being proven (e.g., The Lancet). BProactive ensures that accurate blood pressure is known by each patient by guiding the patient through a multi-day measurement collection period at key points during treatment: during initial diagnosis and after the effects of each treatment adjustment can be observed. BProactive actively prompts users to take measurements at the appropriate times, and provides a clear indication of how many measurements are needed and how many are complete. The app gently nudges users who are not completing the requested measurements.
With reliable blood pressure measurements available, the healthcare team is in a position to “Act rapidly” to determine a patient’s treatment. Typically, the prescribed therapy will need to be adjusted until BP control is reached. The M.A.P. guideline states that “most hypertensive patients require treatment with two or more medication classes”. However, therapeutic inertia often prevents achieving the correct combination of medications. There are a number of contributing causes to this inertia, but the two most significant appear to be lack of clarity of the patient’s real BP and de-prioritizing of BP control during office visits by primary care practitioners. The M.A.P. guideline suggests two steps to reduce inertia: adopt a standardized algorithm for zeroing in on the right treatment, and follow-up early after each treatment change.
BProactive ensures measurements are available and gives clinicians the data they need to determine each patient’s real blood pressure, eliminating doubt over whether accurate blood pressure is known. As well, the app actively motivates early follow-ups by automatically prompting patients to perform a blood pressure assessment after a follow-up. It waits for any treatment changes to take effect and then based on the assessment notifies the patient to schedule another follow-up. Again, BProactive nudges the patient to do the assessment and to schedule and complete the follow-up if necessary.
The M.A.P framework recommends that clinicians “partner with patients, families, and communities” in order to strengthen patient adherence to prescribed treatments. Patients adhering to treatment and managing their own health is desired, and engaged patients “experience better outcomes”. Patient engagement is enhanced when they are involved in decision-making.
Patient engagement is the core of BProactive. Patients are empowered to take charge of their own health with guidance from BProactive. Patients are encouraged to take their own measurements and know their blood pressure numbers, they are encouraged to adhere to their treatment and they are provided with the critical personalized information they need to promptly and confidently initiate follow-ups and reviews of their treatment with their healthcare providers.
By addressing some of the biggest problems limiting treatment effectiveness, the M.A.P. framework provides a compelling guide for improving hypertension control. BProactive facilitates implementation of these guidelines that is practical and accessible to anyone with hypertension who wants to take control of their own health.
To find out more about BProactive, visit https://www.unboxedhealth.com.