No abstract

Introduction Mobile applications (apps) may improve adherence and disease state‐related outcomes in patients with uncontrolled chronic diseases, including hypertension. Objective The purpose of this study was to determine the effectiveness of using a pharmacist‐designed app to improve blood pressure (BP) and promote adherence to antihypertensive medications. Methods This study was a prospective, multicenter, randomized controlled trial. Patients were randomized to an intervention or control group for 3 months. The intervention was a pharmacist‐designed mobile app. Antihypertensive medication refill history was assessed 3 months before, during study, and 3 months after study completion. Continuous outcome measures investigated were systolic/diastolic BP and medication refill history using the cumulative medication gap (CMG). Statistical analysis comparing median difference in BPs and CMGs between groups was conducted using Theil‐Sen Siegel regression. Results The propensity score adjusted population consisted of 78 patients (n = 39 for both groups). No significant difference was observed in the conditional median difference in CMG between groups at the 3‐month follow‐up visit (−0.06 [P = .70]). No significant difference was observed in the conditional median difference in systolic and diastolic BP between groups at the 3‐month follow‐up visit (−2.00 [P = .07] and −1.00 mmHg [P = .39] systolic and diastolic, respectively). Upon subgroup analysis, those nonadherent at baseline in the intention to treat population experienced a significant improvement in outcomes (−0.06 P = .03] and −12.00 mmHg [P = .002] CMG and systolic BP, respectively). Conclusion A pharmacist‐designed mobile app did not result in improved medication adherence or BP control, but may be beneficial in patients with hypertension who struggle with medication adherence.

Objectives. Clinical reasoning (CR) is integral to the provision of patient-centered care as outlined in the Pharmacists' Patient Care Process (PPCP). However, the PPCP was not created to foster CR in student pharmacists and cannot be the sole tool used to characterize or cultivate these skills. This article seeks to describe elements of CR, the relationship between CR and PPCP, and concepts from the CR literature that should inform the teaching of CR skills. Findings. Key elements of the PPCP were identified in CR definitions, but differences emerged. The literature supports CR as a bidirectional, fluid process that is highly collaborative. Effective CR requires multiple types of "thinking", interaction with others and the environment, self-assessment, and a tolerance for nuance or ambiguity. Teaching strategies can be used in the didactic and experiential setting to target the cognitive and contextual factors associated with CR. Summary. Educators should consult the CR literature to enhance our understanding of CR in seeking to teach, model, and foster these skills in our students. Future scholarship should include the development of models to support CR within the profession of pharmacy, adoption and experimentation with CR teaching techniques, and valuation of the utility of various assessment tools and processes.

No abstract