Feasibility and acceptability of pharmacist-led remote patient monitoring for carvedilol dose titration in clinically significant portal hypertension

INTRODUCTION: Carvedilol reduces the risk of hepatic decompensation and improves survival in patients with compensated cirrhosis and clinically significant portal hypertension (CSPH). Remote patient monitoring (RPM) has demonstrated benefits in other chronic conditions but has yet to be investigated for carvedilol titration in CSPH. AIM: We aimed to evaluate the feasibility and acceptability of a novel pharmacist-led, technology enabled model of care called Optimising One Medication for Patients with Cirrhosis (OOMPa-C). METHOD: In this prospective mixed-methods feasibility study, participants were provided with a Bluetooth-enabled blood pressure (BP) and heart rate (HR) monitor linked to a smartphone app during a home visit from a nurse. Initial education on how to take daily BP and HR readings was provided by a pharmacist via telehealth. Two pharmacists then conducted RPM of BP and HR and regular telehealth visits with patients to titrate carvedilol, following a protocol, to a maximum of 12.5 mg daily as tolerated. Semi-structured interviews with participants and stakeholders were undertaken to explore acceptability of the program. RESULTS: Twenty-two participants were recruited, 20 of whom achieved successful dose optimisation. Readings were transmitted on at least 90% of study days by 20 (91%) participants and 18 (82%) were taking the target dose of 12.5 mg daily at study completion. Despite issues with internet connectivity and the telehealth application, the program was broadly perceived as easy to use. Participants reported benefits including convenience and greater self-efficacy, while stakeholders noted advantages in efficiency and quality of care. Participants described apprehension in using new technologies, but family and carers were seen to facilitate participation. Nurses involved with the program described time constraints due to unfamiliarity with digital navigation processes. CONCLUSION: Our study established the feasibility, acceptability and implementation outcomes of a new pharmacist-led model of care for carvedilol dose optimisation. We provide practical insights to inform the implementation of similar technology enabled multidisciplinary models of care at scale for patients with cirrhosis.