Shopping Cart

INTRODUCTION

Simple testing devices are available from pharmacies to help patients monitor a number of medical conditions at home. These tests are convenient, easy to use, increasingly more reliable, and they allow patients to check their vital signs or laboratory indicators routinely.¹ The number and type of these devices have increased significantly as engineers apply smart technology to create accurate monitoring devices that are increasingly user friendly. Home health monitoring devices are optimally lightweight, portable, fast, and handheld. Some devices may be covered by third party payers. Ideally, they are also inexpensive, small in size, and sturdy enough to withstand being dropped.¹

Home health monitoring devices benefit patients in numerous ways. These devices make it easy for patients to take accurate readings (ie, blood pressure, blood glucose) without having to visit a health care provider. They may also increase the likelihood that patients will contact a health care provider if their results fall outside the normal range.² In turn, health care professionals can identify developing health care problems, disease exacerbations, or medication failures early, allowing them to take action to restore patients’ health.²

Home health monitoring devices are not perfect. Many of the limitations are of the “user” variety. Patients who do fail to understand how to use home health monitoring devices may misinterpret results and believe their health is fine—when in actuality it may not be. There is always the possibility that patients will use devices in ways that the manufacturer failed to anticipate.¹ Or patients may store devices inappropriately, causing mechanical problems. Some devices may become less reliable as their batteries age, or they may need to be recalibrated periodically. Manufacturers follow detailed guidance from the United States (US) Food and Drug Administration (FDA) when they create home health monitoring devices to try to address these potential complications.¹ Most devices are remarkably safe and reliable, but it is impossible for manufacturers to anticipate every potential problem. For this reason, devices may fail.¹

This continuing education module describes the following 5 medical conditions and the types of home health monitoring equipment that patients look for and use most often:

• Blood pressure deviations and blood pressure monitoring devices
• Diabetes and devices used to monitor blood glucose
• Physical exertion and heart rate monitors
• Common breathing disorders and peak flow meters
• Febrile illness and thermometers

Pharmacy technicians are well placed to assist patients in the selection of the best device for their needs. To provide excellent guidance, pharmacy technicians need to understand:

• The basics of the disease or condition the device is meant to monitor
• The variety of available devices
• How each home health monitoring device works

BLOOD PRESSURE

Nearly 1 in 3 American adults (32%) has high blood pressure (hypertension), and only about half (54%) of people with high blood pressure control their condition adequately.² Nearly one-third of elderly Americans have the opposite problem—hypotension or low blood pressure. Although this problem is not as widely publicized as high blood pressure, it can create serious health challenges.³ High blood pressure costs the nation $48.6 billion each year. This total includes the cost of health care services, medications to treat high blood pressure, and missed days of work. ²

Hypertension

High blood pressure is often symptomless until it rises to extremely high levels.^2,4,5 As a result, medical professionals often refer to high blood pressure as “the silent killer.” Long-term, uncontrolled high blood pressure can lead to heart attack, stroke, heart failure, blindness, and/or kidney damage.⁴ Table 1 lists common causes of high blood pressure, although for most people, no cause can be identified.

A blood pressure reading shows 2 different measurements: (1) systolic pressure (written as the top number) is the pressure in your arteries when the heart is beating, and (2) diastolic pressure (the bottom number) is the pressure in your arteries between heart beats. Blood pressure varies during the day: it is highest shortly after waking and in the afternoon and lowest at night.⁷ Therefore, when comparing results, it is important to compare readings that were taken at the same time of day.

Medical experts continually perform research to determine ideal blood pressure ranges. This data helps form medical management guidelines so prescribers know when patients need to be treated and which medications suit specific patients. In the US, The Joint National Committee (JNC) and the American Cardiology College/American Heart Association (ACC/AHA) have convened periodically to review studies of how blood pressure affects long-term health. Over the years, they have changed their recommendations based on study findings and best evidence. For instance, in the most recent update, the 2018 ACC/AHA tightened treatment thresholds again.¹⁰ Currently treatment is started in patient above 130/80mmHg and is changed to achieve a blood pressure goal of below 130/80mmHg.¹⁰

Patients who have high blood pressure should monitor it regularly,^2,8 and pharmacy technicians are well-placed to reassure them. For instance, when patients pick up medication for high blood pressure, pharmacy technicians can encourage home health monitoring by asking, “Are you taking your blood pressure regularly?”

Hypotension

Occasionally, patients will present with the opposite problem—low blood pressure or hypotension. Approximately one-third of elderly Americans are hypotensive.³ People diagnosed with Parkinson’s disease, stroke, transient ischemic attacks, myocardial infarction, electrocardiogram (EKG) abnormalities, and Alzheimer’s disease are at increased risk.³ Hypotension can be caused by numerous medications. A common type of drug-induced low blood pressure is orthostatic hypotension (OH), a low blood pressure that makes patients dizzy when rising from a lying or sitting position to a standing one.³ Patients develop OH if blood that should be routed to the heart pools in their extremities instead. Drugs that often cause OH include diuretics, antihypertensives, monoamine oxidase inhibitors, tricyclic antidepressants, levodopa, dopamine, selegiline, barbiturates, and alcohol.³ Hypotension can cause dizziness, weakness, fainting and a risk of injury from falls.

Blood Pressure Monitors

Home blood pressure monitors (also referred to as sphygmomanometers, blood pressure meters, or blood pressure gauges) allow patients to track their blood pressure without visiting a health care professional. Taking blood pressure readings at home allows patients to monitor blood pressure in a familiar setting, determine if medication is working, and catch changes in blood pressure early.⁹

Taking blood pressure in a familiar setting is important. Some patients have elevated blood pressure readings when they visit the doctor for myriad reasons. This is commonly referred to as white coat hypertension (WCH). WCH used to be considered harmless, but recent studies show that many patients often have unidentified elevated blood pressure at times other than medical office visits, making them susceptible to cardiovascular disease as they age.¹⁰ Consequently, monitoring in the home may help patients identify extreme blood pressure early, thereby reducing health problems that might occur later in life.

Home health monitoring can prompt patients to contact a health care provider for an overall assessment or a medication adjustment if blood pressure rises and stays high.² (Or it may prompt patients to visit an emergency room if the results are very high.) On the other hand, it can also alert to falling blood pressure. Patients who are actively losing weight or in the process of quitting smoking may identify falling blood pressure early; they may require less medication.^2,5

Pharmacy technicians should ensure that patients know the precise way to apply their monitor; this includes how to open the kit, where to place the cuff, and how to sit during the test.^11-13 Many blood pressure cuffs have a velcro fastener and they should be snug—but not tight—when closed around the arm. Patients need cuffs that fit their arms appropriately to ensure an accurate measurement, as an overly-tight cuff may give a false high reading and a loose cuff may not register a reading at all.¹² Patients should not use monitors that are designed to measure blood pressure at one body part (eg, the wrist) on another body part (eg, the ankle).¹³

Monitors may give inaccurate readings if the batteries are too low.^12,13 When reviewing a device, pharmacy technicians should remind patients to replace their monitor’s batteries when necessary. Most devices have a warning signal that indicates when batteries are low. It is good practice for the pharmacist or pharmacy technician to demonstrate how to replace batteries.

Understanding a monitor’s directions for use is critical.¹³ Depending on the monitor, patients may need to rest their arm on a table or ensure the monitor is level with the heart. If a patient places the monitor lower than specified, the blood pressure reading tends to be higher. For all monitors, patients should place their feet flat on the floor and remain still during measurement.¹² Tobacco, caffeine, and exercise increase blood pressure for about 30 minutes, so it is a good idea to remind patients to avoid these measures before taking readings.^12,13 When patients visit the pharmacy and mention blood pressure readings that are higher than normal, pharmacists and pharmacy technicians can ask the patient to bring in their home monitor to ensure improper technique is not the cause.

Hypertension, hypotension, and vision loss are diseases of aging. Some patients may experience difficulty seeing their monitor’s display. Glare and small print (less than 0.18 inches high, smaller than size 18 font) can make it hard to see the display clearly. High glare can decrease the contrast (darkness of the print relative to the background) by 90%.¹³ If a patient who has difficulty seeing is choosing a monitor, a monitor with a matte finish and large print display may be the best option. A number of monitors now work through Bluetooth technology and provide downloaded readings to mobile devices. This can be a convenient way to show healthcare providers blood pressure history.^11,12

Recommending a Pharmacist Consult

Extremely high blood pressure is a medical emergency. If the patient has chest pain, severe indigestion, diaphoresis (sweating and clamminess), and/or confusion, call 911. The pharmacist needs to be involved promptly if a patient reports a blood pressure at or above 180/110 mmHg.¹⁴ While waiting for the pharmacist, talk to the patient and note all medication information (including over-the-counter medicines and herbals). Extreme blood pressure is especially serious for children and pregnant women.¹⁴ Also, patients who have had long-term high blood pressure may report low blood pressure. Pharmacy technicians should alert the pharmacist about these patients because the inappropriate use of medication may be responsible for their lower results.

DIABETES

Diabetes is a metabolic disorder in which patients have high blood glucose because¹⁵:

• Their body’s insulin production is inadequate; or
• Their cells do not respond properly to insulin; or
• They suffer from inadequate insulin production and their cells respond poorly to insulin.

Approximately 5% of patients with diabetes are unable to produce insulin from pancreatic cells.¹⁵ This type of patient has type 1 diabetes mellitus (T1DM). Most patients who have diabetes have type 2 diabetes mellitus (T2DM). In T2DM, the body can produce some insulin (though this ability decreases over time), but more importantly, the body cannot respond to insulin as it should.¹⁵ In these circumstances, blood glucose levels become too high. Long-term elevated blood glucose can cause heart attacks, stroke, kidney failure, blindness, and nerve damage.¹⁶

The only way to be certain about a patient’s blood glucose levels is to measure them. High or low blood glucose levels are associated with particular symptoms. Patients with high blood glucose may seem especially irritated or tired. Additionally, patients may drink and urinate more than normal and may present with sweet-smelling or “fruity” breath.^15,16 Patients with low blood glucose levels may be sweaty and shaky or appear confused. Normal blood glucose values are typically between 70 milligrams per deciliter (mg/dL) and 180 mg/dL, depending on when food is ingested (eg, fasting and pre- or post-meal). Pharmacy technicians should be familiar with the most recent version of Standards of Medical Care in Diabetes, a reference document released annually by the American Diabetes Association, as its many tables and figures provide clear information about managing diabetes.¹⁷ Those patients who reach target blood glucose levels and maintain them for extended periods of time are considered tightly controlled, which is typically associated with a better long-term outlook.^17,18 However, sometimes patients with diabetes experience low blood glucose levels (commonly referred to as hypoglycemia). Skipping meals, taking too much insulin, or taking certain medications without food can lead to low blood glucose levels. In these circumstances, patients may have an increased heart rate, and they may appear confused or even unconscious in severe cases.¹⁹

The frequency at which patients choose to test their blood glucose levels can vary considerably. Some patients may check multiple times per day, while other may only check a few times per week—some patients may not check at all. Importantly, patients are routinely instructed to check their blood glucose levels at the following times^17,19: before each meal, 1 or 2 hours after a meal, at bedtime, before and after physical activity, and when they are sick or under stress. Checking blood glucose levels ultimately serves 2 purposes: avoiding blood glucose levels that are too high or too low and assessing the effectiveness of treatment. Listed below are methods in which blood glucose testing can influence treatment^17,19:

• Comparing bedtime and morning blood glucose indicates how consistent blood glucose levels have been while the patient was asleep.
• Patients use premeal or fasting glucose levels to see if their medications are working and to determine how much to eat to maintain a healthy blood glucose level.
• Postmeal levels help determine if patients need additional insulin or other medications to control their blood glucose after meals. The change between the pre and postmeal readings indicate how successfully the meal and the patient’s drug regimen are matched.

Blood Glucose Monitors

When patients first use blood glucose monitors or a new box of test strips, they made need to code the monitor to ensure accurate readings. Device coding methods vary and are described in detail in each product’s instructions for use. Notably, some devices may not need to be coded.^21,22 Moreover, if the monitor displays a message that the batteries need to be changed, the patient should do so promptly because tests results may be less accurate as the monitor loses power. Pharmacy technicians can review key steps with patients when they purchase blood glucose monitors in order to ensure testing is performed correctly. These steps are highlighted below in (Figure 1).

Certain testing conditions can skew results.¹⁹ If the patient does not place enough blood on the test strip, the reading may be inaccurate or may not register. If the strip is exposed to air for more than a certain amount of time, the patient may need to use a new strip.²³ Pharmacy technicians should be aware of warnings in the product’s instructions and bring them to the patient’s attention.

The fingertip is considered the most accurate blood glucose monitoring site.¹⁹ However, some patients, especially those with T1DM, develop calloused fingertips from repeated testing. Some blood glucose meters allow for alternate site testing, such as the upper arm or palms.²¹ If patients wish to use sites other than their fingers, it is important that they read the instructions for the meter, considering some meters require the testing site to be identified for accuracy. Patients who test at alternate sites should return to fingertip testing when blood glucose levels are rapidly changing or when low blood glucose readings are possible.²⁰ Also, those who are generally asymptomatic until blood glucose levels are very low should avoid testing at alternate testing sites, if possible; these types of patients often report previous episodes of low blood glucose that occurred without warning signs.²⁴

More than 30.3 million people have diabetes, and nearly 14% have impaired vision because of diabetic retinopathy.^15,25 Glucose monitoring machines are similar to blood pressure monitoring devices, and the same considerations about device readability apply. Glare and small print can make it hard to see display screens. High glare can decrease the contrast by 90%. Pharmacy personnel should recommend monitors with a matte finish, high contrast, and large print display screens for patients who have impaired vision.²⁵ Bluetooth technology is also widely available in blood glucose meters to connect data to smart phone apps which can allow patients to share their monitoring results with healthcare providers.²¹

Recently, continuous glucose monitoring systems (e.g. Freestyle Libre) have come onto the market. Instead of pricking the finger multiple times in the day, the patient will attach a half dollar sized senor to the back of the arm which than can be worn up to 14 days.²⁶ One hour after placement and activation the patient can hold the glucose meter over the sensor to get a glucose reading. As a final note, traditional glucometers can be purchased over the counter, but the new continuous monitoring systems are only available with a prescription.

Recommending a Pharmacist Consult

• Ask the pharmacist to speak with any diabetic patient who has especially high or low blood sugar readings.
• If the patient has a caregiver, encourage the patient to bring the caregiver along for a pharmacist consultation.
• If you notice medication nonadherence concerns when reviewing a patient’s profile, notify the pharmacist

HEART RATE

Physical inactivity is a public health crisis in the US.²⁷ In conjunction with diet, physical activity can help patients who are overweight or obese lose weight, which decreases the risk of heart attack, stroke, diabetes, and cancer.^27,28 Among patients who have health problems, exercise provides many benefits, including the following²⁸:

• For frail or out of shape patients, strengthening the heart helps patients function and do the things they need or want to do (including household tasks and walking).
• Exercise lessens symptoms of heart failure (such as ankle swelling).
• Muscle mass declines with age, increasing the risk of falling. Maintaining lean muscle decreases fall risk by improving balance.

Staying active is a good way to maintain and improve health. An effective method to monitor exercise and its intensity is to use a heart rate monitor.³⁰ Before exercising, it is good practice for all patients to identify their maximum recommended heart rate (MHR) because a patient’s heart rate goal during exercise is a percentage of MHR (determined in beats per minute).³⁰ To calculate MHR, one subtracts their age from 220. For example, a patient who is 20 years old would have an MHR of 200 (ie, 220 – 20 = 200). Age-specific estimated heart rate goals are listed below in Table 2. According to the American Heart Association, healthy patients should aim for a target heart rate (during exercise) that is between 50% and 85% of MHR.²⁹Exercising at MHR for extended periods of time is not recommended.

Importantly, patients who have chronic health conditions should discuss appropriate physical activity regimens with their primary care providers.²⁹ For instance, patients who develop heart failure— a condition in which the heart is unable to pump sufficiently to maintain blood flow to meet the body’s demands—often have elevated heart rates even when they are sedentary; an elevated resting heart rate is associated with an increased risk of developing further health-related complications.³¹ Patients with heart failure can benefit from exercise; however, they should contact their health care provider before starting an exercise regimen because they usually need to start slowly.³⁰

Heart Rate Monitors

Primary care physicians or cardiologists may recommend heart rate monitors for patients. Heart rate monitors measure general activity levels throughout the day. Unlike a pedometer, heart rate monitors record exertion even when the patient is not moving.²⁹ The body placement of heart rate monitors varies. For instance, one type is worn on the wrist, another as an armband, and a third around the chest at heart level. Patients with small wrists may be tempted to wear small-sized wrist monitors higher on their arms; however, health care professionals should remind patients that the reliability of a monitor’s results may be compromised if it is worn at a site other than intended.³² Additionally, patients should be instructed to avoid applying makeup or sunscreen under monitors; these types of products may affect the readings. Heartrate monitoring is a common function in widely available fitness tracker products which use Bluetooth technology to connect fitness tracking to the smart phone app.³³

Recommending a Pharmacist Consult

Patients may wear heart rate monitors based on their health care provider’s advice or on their own initiative. If patients use a heart rate monitor without physician supervision, encourage them to talk to a doctor and pharmacist about their plans and goals, especially if they have an underlying heart condition. Importantly, if a patient reports pain in the chest, back, neck, or jaw during or after exercise, they should consult their health care provider before continuing with their exercise regimen.

COMMON BREATHING DISORDERS

Breathing disorders create discomfort for patients and require continuous monitoring. Two common breathing disorders are listed below:

• Asthma is a chronic inflammatory disorder that causes tightening of the airways, resulting in difficulty breathing. Allergens, infections, and tobacco smoke are common triggers of an asthma attack; symptoms include wheezing, coughing, and shortness of breath. Asthma is a leading cause of missed work and school days.³⁴
• Chronic obstructive pulmonary disorder (COPD) is a long-term, gradually worsening disease that decreases the ability to expire air (breathe out).
• Patients may have both COPD and asthma.

One way to monitor airway health in patients who have breathing disorders is to measure peak expiratory flow using a hand-held peak flow meter. It measures airflow through the bronchi, and it reports the degree of airway obstruction by assigning each exhalation a number. Patients who are relatively healthy (ie, mild asthma) will have higher peak flow readings than those who have narrowed airways (airway constriction or obstruction). Peak flow readings are recommended, and used most often, in patients who have asthma.^34,35

Peak Flow Meters

Medical providers prefer that patients’ measure and report their peak flow readings rather than severity of symptoms, which can be subjective. Patients may have difficulty describing their symptoms; in addition, they may under or overestimate symptom severity. Peak flow meters provide a number that can be compared to previous peak flow results. Importantly, each patient will have a unique peak flow baseline.^36,37 However, peak flow meters have some limitations. For instance, patients find it easier to describe their symptoms rather than using a peak flow meter. Also, patients may have difficulty intuitively understanding what a peak flow result means.³⁶ Accordingly, pharmacy technicians should be familiar with proper peak flow meter technique, which is further explained below^35,36:

• Patients should establish a personal best peak flow result, which is obtained from several efforts when they are symptom-free. Patients will use this value to compare future readings.
• When measuring peak flow, patients should stand with an empty mouth and slowly fill the lungs with air.
• The patient then places the peak flow meter in the mouth, with the tongue under the mouthpiece, and places his or her lips tightly around the mouthpiece.
• At this point, the patient should blow as much air as possible, and as quickly as possible, into the meter. The force of the air coming out of their lungs causes the marker on the peak flow meter to move along the numbered scale. They patient should be instructed to write down this number.
• Patients should repeat this process 2 more times, noting the peak flow readings each time. Importantly, do not instruct patients to take the average of the peak flow readings; the individual numbers are used for the assessment.
• Patients should use the same peak flow meter for consistency and test result comparability.
• If peak expiratory flow falls below 80% of baseline, patients should follow their asthma action plan and check peak expiratory flow more frequently.
• Encourage patients to demonstrate proper technique to the pharmacist so they can educate and reassure the patient.

In general, patients who are experiencing symptoms and have peak flow readings less than 80% of their baseline should use their rescue inhaler.³⁴ Rescue inhalers are those that contain fast-acting medication that relax smooth muscle in the lungs in a relatively short amount of time, allowing patients to breathe better. Albuterol is a drug commonly used in rescue inhalers. Figure 2 is an example action plan for interpreting peak expiratory numbers.^34-38

In addition to peak flow meters, new inhaler technology that has Bluetooth technology linked to smart phone apps will allow patients to monitor how well they are using their inhalers and how often which may be able to supplement asthma monitoring and allow data sharing with healthcare providers.³⁹

Recommending a pharmacist consult

Pharmacy technicians should inform the pharmacist when patients have troubling symptoms or when changes in peak flow occur because their medication may not be working and may need to be changed.If peak flow is between 50% and 80% of baseline, pharmacy technicians should alert the pharmacist promptly. If a patient has a peak flow reading that is less than 50% of baseline, the patient is severely affected; these patients should be referred to their health care provider or the nearest emergency department (ED).³⁴ Also, any patient who presents with difficulty speaking, poor response to rescue inhalers, and symptoms that occur without triggers is in respiratory distress and should be referred to the nearest ED.

FEVER

Body temperature varies throughout the day. It is usually lower in the morning and higher in the evening.⁴⁰ In humans, a normal oral (taken in the mouth) temperature is 36.5˚C to 37.5°C (97.7˚F to 99.5°F). When body temperature exceeds the normal range, patients are said to have a fever, which is often beneficial because elevated body temperature helps fight infections; however, fever causes patients to feel chilly, tired, and uncomfortable.⁴⁰ Fever is a measurement for overall patient sickness. Children, especially infants, have difficulty telling their caregivers that they do not feel well. Taking a temperature not only indicates if patients are sick, but it serves as an indicator of the extent of their sickness.⁴⁰ Several types of thermometers can be used to measure body temperature or fever, which are discussed below.

Thermometers

Thermometers come in numerous types. The most common are digital stick-type thermometers. These thermometers can be used for rectal, oral, and axillary (armpit) temperature measurements.⁴⁰ However, patients should be encouraged to use separate, well-marked thermometers for each site. Importantly, none of these 3 methods directly correspond to a person’s actual core body temperature. Instead, they represent a measurement that can be compared to the average core temperature.⁴⁰

• Rectal temperatures are considered to be the most accurate and precise; they are both close to core body temperature and consistent. Rectal temperatures are the most reliable method for infants and are preferred in children under 4 years of age.⁴⁰Each unique thermometer requires a specific disposable cover and must be lubricated with an appropriate lubricant before use. Caregivers should be reminded to insert the thermometer gently into the patient’s rectum to a depth (depending on age) recommended by the manufacturer.⁴⁰
• Oral temperatures can be affected by eating and drinking so patients should avoid these up to 30 minutes before taking an oral temperature.⁴⁰Patients must keep their mouths tightly closed around the thermometer to obtain accurate readings. They should place the tip of the thermometer into the space between the molars and the tongue. If a child older than 4 years of age can follow proper technique, an oral thermometer can be used.⁴⁰ 
• Axillary temperatures are typically lower and less precise compared with oral and rectal measurements, but when patients are uncooperative, have mouth sores, or are otherwise unreceptive to rectal or oral thermometers, this method may be the only option.³⁹Patients should squeeze the thermometer tightly in the armpit fold for at least 30 seconds. A temperature of 99°F (37.2°C) or higher should be confirmed with another method.⁴¹

Other thermometers include tympanic (in the ear) and forehead thermometers as well as infrared (heat) scanners. 

• Tympanic thermometersare easier to place than oral/rectal thermometers because the probe is pointed (closing off the ear canal). Ear thermometers are not recommended for infants younger than 3 months because their ear canals are usually too small.³⁹ The results from this method are slightly less accurate than oral or rectal thermometers, but patients are generally more compliant because it is less invasive. This measurement can be artificially low if the ear has excess earwax and artificially high if the patient has an ear infection.⁴¹ Patients should be reminded to remove their hearing aid at least 20 minutes before a measurement is taken.⁴²
• Temporal artery thermometersare noninvasive and relatively easy to use.⁴³ These thermometers measure temperature by simply sweeping the device across the patient’s forehead; however, this method is prone to error.^41,43
• Infrared thermometersmeasure the body’s temperature without contacting the patient, and the forehead is the ideal part of the body for the temperature measurement.⁴¹ This method is mostly used if quick surveillance of many people is necessary or if the patient is highly contagious. However, these measurements are also prone to error.^41,43

Recommending a Pharmacist Consult

Any patient with a fever greater than 104^oF (40^oC) should be referred to the pharmacist. Also, the pharmacist should be notified if an infant (less than 3 months old) has a fever of 100.4^oF (38^oC) or higher. Fevers with earache, nausea, vomiting, or diarrhea are also possible medical emergencies that require the pharmacist’s attention.⁴¹

CONCLUSION

Pharmacy technicians can use a few general guidelines to help them gather patient information about select disease states. Technicians should always ask patients specifically what disease or condition they wish to monitor and if they have any preferences about machine types, manufacturers, or costs. Once the patient selects a product, the pharmacy technician should make sure they have all of the necessary supplies—and the correct supplies—to test accurately. Further, it is always a good idea for patients to record their measurements from their home monitoring devices and present these readings to their health care providers. Pharmacy technicians should refer patients with troublesome symptoms or symptoms that may indicate a medication problem to the pharmacist. Importantly, pharmacy personnel should never encourage or advise a patient to change or stop medicines without speaking to a health care provider.

REFERENCES

1. Kaye R, Crowley J. Guidance for Industry and FDA Premarket and Design Control Reviewers. Medical Device Use-Safety: Incorporating Human Factors Engineering into Risk Management.Bethesda, MD: US Food and Drug Administration, US Department of Health and Human Services, Center for Devices and Radiological Health, Division of Device User Programs and Systems Analysis, Office of Health and Industry Programs; 2000. https://www.federalregister.gov/documents/2000/07/18/00-18061/guidance-for-industry-and-fda-reviewers-on-medical-device-use-safety-incorporating-human-factors. Accessed January 5, 2020.
2. High blood pressure fact sheet. Division for Heart Disease and Stroke Prevention. June 16, 2016. Centers for Disease Control and Prevention website. https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_bloodpressure.htm. Accessed January 5, 2020
3. Feldstein C, Weder AB. Orthostatic hypotension: a common, serious and underrecognized problem in hospitalized patients. J Am Soc Hypertens. 2012;6:27-39.
4. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520.
5. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. JAMA. 2003;290(2):199-206.
6. High blood pressure risk factors. Centers for Disease Control and Prevention website. https://www.cdc.gov/bloodpressure/risk_factors.htm . Accessed January 5, 2020.
7. Schillaci G, Battista F, Settimi L, et al. Antihypertensive drug treatment and circadian blood pressure rhythm: a review of the role of chronotherapy in hypertension. Curr Pharm Des. 2015;21(6):756-772.
8. Niiranen TJ, Asayama K, Thijs L, Johansson JK, et al; IDHOCO Investigators. Optimal Number of Days for Home Blood Pressure Measurement. Am J Hypertens. 2015;28(5):595-603.
9. Ross KL, Bhasin S, Wilson MP, et al. Accuracy of drug store blood pressure monitors: an observational study. Blood Press Monit. 2013;18:339-341.
10. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol.2018;71:e127-e248.
11. Braun Blood Pressure Monitors. Braun website. . https://www.braunbloodpressuremonitors.co.uk/ Accessed on January 5, 2020.
12. Blood pressure. Omron Healthcare, Inc. website. http://omronhealthcare.com/service-and-support/faq/blood-pressure-monitors/. Accessed January 5, 2020.
13. Wallace LS, Keenum AJ. Using a home blood pressure monitor: do accompanying instructional materials meet low literacy guidelines? Blood Press Monit. 2008;13(4):219-223.
14. Marik PE, Varon J. Hypertensive crises: challenges and management. Chest. 2007;131(6):1949-1962.
15. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017: Estimates of Diabetes and Its Burden in the United States.Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2017. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf Accessed on January 5, 2020.
16. Diabetes, heart disease and stroke. National Institute of Diabetes and Digestive and Kidney Diseases website. February 2017. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/heart-disease-stroke Accessed on January 5, 2020.
17. American Diabetes Association. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020 Jan;43(Suppl 1):S98-S110.
18. Ang L, Jaiswal M, Martin C, Pop-Busui R. Glucose control and diabetic neuropathy: lessons from recent large clinical trials. Curr Diab Rep. 2014;14(9):528.
19. Dubois W. Blood glucose self-monitoring. Part 3: smart monitoring. Diabetes Self Manag.2014;31(5):14, 17-19.
20. Diabetes management: self-monitoring blood glucose. Roche Diagnostics website. https://www.accu-chek.com/management-tips/introduction-self-monitoring-blood-glucose Accessed January 5, 2020.
21. Blood Glucose Meters. American Diabetes Association website. 2016. http://main.diabetes.org/dforg/pdfs/2016/2016-cg-meters-chart.pdf Accessed January 5, 2020.
22. Blood Glucose Monitoring Devices. Medical Devices. Food and Drug Administration website. September 27, 2018. https://www.fda.gov/medicaldevices/productsandmedicalprocedures/invitrodiagnostics/glucosetestingdevices/default.htm Accessed January 5, 2020.
23. Dubois W. Blood glucose self-monitoring. Part 2: monitoring technique. Diabetes Self Manag.2014;31(4):66-69.
24. Gilles G. Alternative blood sugar testing sites: are they safe and accurate? VeryWell Health website. October 31, 2018. https://www.verywellhealth.com/alternate-blood-sugar-testing-sites-3289624. Accessed January 5, 2020.
25. Blubaugh MV, Uslan MM. Accessibility attributes of blood glucose meter and home blood pressure monitor displays for visually impaired persons. J Diabetes Sci Technol. 2012;6(2):246-251.
26. Freestyle Libre [Internet]. Abbott; 2018. Frequently asked questions about the FreeStyle Libre 14 day System. Available from: https://www.freestylelibre.us/support/faq.html Accessed January 5, 2020.
27. The 2018 report card on physical activity for children and youth. The National Physical Activity Plan website. http://www.physicalactivityplan.org/projects/reportcard.html. Accessed January 5, 2020.
28. Physical activity in older Americans. American Heart Association website. August 17, 2015. https://atgprod.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/FitnessBasics/Phys%20ical-Activity-in-Older-Americans_UCM_308039_Article.jsp. Accessed January 5, 2020.
29. Sylvia LG, Bernstein EE, Hubbard JL et al. Practical guide to measuring physical activity. J Acad Nutr Diet.2014;114(2):199-208.
30. Target heart rates. American Heart Association website. http://www.heart.org/en/healthy-living/fitness/fitness-basics/target-heart-rates. Accessed January 5, 2020.
31. Reil JC, Böhm M. Is heart rate a treatment target in heart failure? Curr Cardiol Rep. 2012;14:308-313.
32. Schaefer SE, Van Loan M, German JB. A feasibility study of wearable activity monitors for pre-adolescent school-age children. Prev Chronic Dis.2014;11:E85.
33. Peckham J. Best fitness tracker 2018: the top 10 activity bands on the planet. December 17, 2018. Techrader.com website. https://www.techradar.com/news/wearables/10-best-fitness-trackers-1277905. Accessed January 5, 2020.
34. Global Initiative for Asthma. Asthma management and prevention for adults and children older than 5 years. A pocket guide for health professionals. 2019. https://ginasthma.org/wp-content/uploads/2019/04/GINA-2019-main-Pocket-Guide-wms.pdf Accessed January 5, 2020.
35. Bailey W, Gerald LB. Peak flow meter overview. In: UpToDate, Barnes PJ, Hollingsworth H (Eds), UpToDate, Waltham, MA. http://www.uptodate.com/contents/how-to-use-a-peak-flow-meter-beyond-the-basics. Accessed January 5, 2020.
36. Measuring your peak flow rate. American Lung Association website. Mary 24, 2018. http://www.lung.org/lung-disease/asthma/living-with-asthma/take-control-of-your-asthma/measuring-your-peak-flow-rate.html  Accessed January 5, 2020.
37. Harver A, Humphries CT, Kotses H. Do asthma patients prefer to monitor symptoms or peak flow? J Asthma.2009;46(9):940-943.
38. General tools—peak flow zone chart. National Jewish Health website. April 1, 2012. http://www.nationaljewish.org/healthinfo/conditions/asthma/lifestyle-management/tools/peak-flow-zone-chart/ Accessed January 5, 2020.
39. Teva Announces FDA Approval of First and Only Digital Inhaler with Built-In Sensors – ProAir® Digihaler™ (albuterol sulfate 117 mcg) Inhalation Powder. [press release] Jerusalem, Israel. https://ir.tevapharm.com/news-and-events/press-releases/press-release-details/2018/Teva-Announces-FDA-Approval-of-First-and-Only-Digital-Inhaler-with-Built-In-Sensors--ProAir-Digihaler-albuterol-sulfate-117-mcg-Inhalation-Powder/default.aspx Accessed January 5, 2020.
40. Fever and taking your child’s temperature. KidsHealth website. http://kidshealth.org/parent/general/body/fever.html# Accessed January 5, 2020.
41. Thermometer comparison. Pharmacist’s Letter/Prescriber’s Letter. 2010;26(11):261115.
42. Braun 6021 owner’s manual. Manuals Online website. http://personalcare.manualsonline.com/manuals/mfg/braun/6021.html?p=1 Accessed January 5, 2020.
43. Allegaert K, Casteels K, van Gorp I, Bogaert G. Tympanic, infrared skin, and temporal artery scan thermometers compared with rectal measurement in children: a real-life assessment. Curr Ther Res Clin Exp. 2014;76:34-38.

Back to Top