Evaluation of a pharmacist-led digital hypertension management program in a tertiary hospital in Singapore

To determine if a pharmacist-led digital enablement for medication optimization (DEMO) program was non-inferior to standard physician consultation in achieving a blood pressure (BP) target of <140/90mmHg within six months. Secondary outcomes included assessing BP changes and time to exit in DEMO group, system usability scale (SUS), and willingness to pay (WTP) for the DEMO program.

A prospective cohort study was conducted in a hospital outpatient setting (Mar 2023 -Oct 2024). The intervention group used a mobile application to transmit home BP readings to a clinical dashboard, with pharmacist-led teleconsultations every 2 - 4 weeks, during which antihypertensives were adjusted. Control group received standard physician consultations.

Using 1:4 nearest neighbour propensity score matching, 145 control patients were matched to 56 DEMO participants. The probability of achieving BP <140/90mmHg within six months was 53% (95% CI 44-62) in DEMO vs 39% (95% CI 31-47) in controls. DEMO participants had a 36% higher relative probability of achieving the BP target (RD 0.14, 95% CI 0.01-0.27; P=0.041). Mean change in systolic and diastolic BP in DEMO group was -16.4mmHg (95% CI -21.9 to -10.9; P<0.001) and of -7.7mmHg (95% CI -10.5 to -4.9; P<0.001) respectively. Median time to exit DEMO was 46 days (IQR 20.5-74). Mean SUS was 82.2±13.7, indicating excellent usability. Mean WTP was SGD$13.2 per month (95% CI 0-32.0).

The pharmacist-led DEMO program was non-inferior to standard physician consultation in achieving a BP target of 140/90mmHg within six months, with high usability and modest WTP.