Abstract
Digital health applications (apps) have the potential to improve health behaviors and outcomes. We aimed to examine the effectiveness of a consumer web-based app linked to primary care electronic health records (EHRs). CONNECT was a multicenter randomized controlled trial involving patients with or at risk of cardiovascular disease (CVD) recruited from primary care (Clinical Trial registration ACTRN12613000715774). Intervention participants received an interactive app which was pre-populated and refreshed with EHR risk factor data, diagnoses and, medications. Interactive risk calculators, motivational messages and lifestyle goal tracking were also included. Control group received usual health care. Primary outcome was adherence to guideline-recommended medications (≥80% of days covered for blood pressure (BP) and statin medications). Secondary outcomes included attainment of risk factor targets and eHealth literacy. In total, 934 patients were recruited; mean age 67.6 (±8.1) years. At 12 months, the proportion with >80% days covered with recommended medicines was low overall and there was no difference between the groups (32.8% vs. 29.9%; relative risk [RR] 1.07 [95% CI, 0.88–1.20] p = 0.49). There was borderline improvement in the proportion meeting BP and LDL targets in intervention vs. control (17.1% vs. 12.1% RR 1.40 [95% CI, 0.97–2.03] p = 0.07). The intervention was associated with increased attainment of physical activity targets (87.0% intervention vs. 79.7% control, p = 0.02) and e-health literacy scores (72.6% intervention vs. 64.0% control, p = 0.02). In conclusion, a consumer app integrated with primary health care EHRs was not effective in increasing medication adherence. Borderline improvements in risk factors and modest behavior changes were observed.
Highlights
Cardiovascular disease (CVD) is responsible for most of the global burden of non-communicable diseases (NCD) accounting for over 17 million deaths globally in 20161
Our randomized controlled trial (RCT) found a physician-focused decision support tool to be effective in increasing CVD risk assessment when embedded within the primary care clinical record system[9]
Hypothesized as a useful springboard to more engagement by patients with CVD risk factor control, the concept was adapted to a consumer-facing resource in the current trial
Summary
Cardiovascular disease (CVD) is responsible for most of the global burden of non-communicable diseases (NCD) accounting for over 17 million deaths globally in 20161. The aim of this study was to evaluate the effect of a consumer-focused digital health intervention, integrated with each participant’s primary care EHR, on guideline-recommended medication adherence, cardiovascular risk factor control and, lifestyle behaviors at one year in people at moderate to high risk of CVD. In this study there was some misalignment in results in terms of medication prescription and risk factor measurements and qualitative consumer/patient usefulness and perceived value This is a common potential problem for RCTs that have a focus on behavior change based on complex interventions where there are multiple moving parts[22]. A consumer app integrated with primary health care EHRs was not effective in increasing medication usage in a population at high risk of CVD events with low pre-existing use of recommended medications. Innovative approaches to intensify the effects of such interventions are needed and it is likely such approaches need to target multiple levels of the health system
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