Effectiveness of an Integrated Responsive Web Application for Cardiovascular Disease Management in Primary Care: 1 Year Multicenter, Open-Label Randomized Controlled Trial

Abstract

Background: Although consumer digital health applications (apps) have the potential to improve health behaviors and outcomes most are not integrated with existing health information systems. We aimed to examine the effectiveness of a consumer web-based app linked to primary care electronic health records (EHRs). Methods: Multicenter, open-label, randomized controlled trial involving patients with or at risk of cardiovascular disease (CVD) recruited from Australian primary care. 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. Findings: Total of 934 patient were recruited (intervention, n=486 and control, n=448); mean age 67.6 (±8.1) years, 76.7% male. At 12 months, the proportion with >80% days covered with recommended medicines was low overall and there was no difference between intervention and control 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 (16.5% vs 11.6% RR 1.41 [95% CI, 0.98–2.03] p=0.06). 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). Interpretation : 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. To enhance effectiveness of such interventions, it is likely multifaceted strategies targeting health system, provider and patient are needed. Trial Registration: The trial was registered at the Australian New Zealand Clinical Trials Registry (ACTRN12613000715774). Funding Statement: Australian National Health and Medical Research Council Project Grant (APP047508). The CONNECT study was funded by the Australian National Health and Medical Research Council (NHMRC) (ID 1047508). JR is funded by a NHMRC Career Development Fellowship [APP1143538]. DP is funded by a NHMRC Career Development Fellowship [APP1143904] and a National Heart Foundation Future Leader Fellowship. GC was supported by a Health Professional Scholarship [ID: 101544] from the National Heart Foundation of Australia. CKC was funded by a Career Development Fellowship co-funded by the NHMRC and National Heart Foundation [APP1105447]. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Ethical approval was obtained from the University of Sydney Human Research Ethics Committee (2013/716) and the New South Wales Aboriginal Health and Medical Research Council (959/13).