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ORIGINAL RESEARCH article
Front. Drug Saf. Regul.
Sec. Cardiovascular Drug Safety
Volume 5 - 2025 | doi: 10.3389/fdsfr.2025.1476998
Developing Decision Support Algorithm of Hypertension Medications for Use in a Digital Therapeutic System
Provisionally accepted- University of Arizona, Tucson, United States
Adherence to hypertension medications is low among older people and there is limited guidance on the safety of taking a missed medication. Knowing the window of time when an older individual can safely take a missed medication could improve adherence and reduce the fear of overdosing. We developed and implemented a decision support algorithm for missed hypertension medications in a digital therapeutic system designed to facilitate self-management of hypertension medications and blood pressure among older adults. Methods: The medication formulary was generated including hypertension medications and doses available in the United States safe for use by older people. The decision support algorithm was developed through a literature review of clinical and pharmacokinetic studies and the use of pharmacology of aging (pharmacokinetics and pharmacodynamics). The algorithm was peer-reviewed and checked against available provider and patient instructions about missed hypertension medications. Case scenarios were used to code the algorithm into the app. Results: A total of 117 hypertension medications and combination products were included in the formulary of the Medication Education, Decision Support, Reminding, and Monitoring (MEDSReM©) system, a mobile digital therapeutic. The formulary contains medication names and dose options available for selection at onboarding or when medication changes occur. The safe window for taking missed/overdue medication was programmed into the MEDSReM© app for each medication and dosing frequency. The users are presented with "take, snooze, and skip" options when they receive a reminder and open the app to take the medication. If they open the app past the safe window hours, a recommendation to skip that dose and take the next dose at the regular time is presented. If the user decides to take the missed dose, a decision to take or skip the next dose is shown. Discussion: The MEDSReM© decision support algorithm provides a safe window of time for each hypertension medication for older adults when they need to take their medication after the intended target time has passed. The interdisciplinary collaboration of clinical, technology, and research teams resulted in a novel, older adult-centered, time-specific digital therapeutic intervention to support decision-making about taking missed hypertension medications.
Keywords: Decision Support 1, Medication Adherence 2, hypertension 3, Digital Therapeutic 4, older adults 5, Missed Dose 6
Received: 07 Aug 2024; Accepted: 17 Feb 2025.
Copyright: © 2025 Lee, Nicholas, Albadawi and Insel. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jeannie K Lee, University of Arizona, Tucson, United States
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.