Abstract
ObjectivesWe aimed to determine the feasibility and effectiveness of an intervention anchored on mHealth and task sharing strategy of involving non-physician health workers (NPHW) on population level detection, treatment and control of hypertension and diabetes in India.MethodsNon-physician health workers (NPHWs) equipped with tablet computers that were linked with point-of-care devices for blood pressure (BP) and blood sugar measurements visited households, screened adult individuals for hypertension and diabetes from two randomly selected villages in the Medchal district, Telangana, India. Further, they digitally connected those individuals with hypertension and diabetes to a study physician via Skype, and handed over a printed e-prescription. Medication adherence checks, BP and fasting blood sugar measurements were done once a month and doctor consultations once in three months during follow-up.ResultsAmong 2456 eligible individuals, 1751 and 1686 individuals were screened for hypertension and diabetes, respectively. Prevalence of hypertension was 23·6% (95% CI 21·6%-25·6%) and among them 38.9% were newly detected. Prevalence of diabetes was 11·2% (9·7%-12·7%) and 28.6% of them were newly detected. After 24 months of intervention, control of BP and blood sugar was achieved in 54.0% and 34·1% of individuals with hypertension and diabetes, respectively. Blood pressure control rate improved by 12% (7.9%-16.0%) in known hypertensive individuals over the intervention period.InterpretationThis research demonstrates the feasibility and local acceptability of a mHealth intervention strategy anchored on NPHWs guided by physicians for detection, treatment and regular follow-up of individuals with hypertension and diabetes in a community setting in India.
Highlights
28% of all deaths in India are attributable to cardiovascular diseases (CVD)[1]
Achieving better treatment and control rates of both hypertension and diabetes are crucial to contain the epidemic of CVD in India
We conducted a recent national summit of sixty leading cardiovascular researchers in India and recommended technology enabled non-physician health care workers (NPHW) in management of both hypertension and diabetes [8].Based on the recommendations of the national summit, we developed a tablet computer based digital health tool to enable NPHWs with a decision support system for management of hypertension and diabetes in community settings
Summary
28% of all deaths in India are attributable to cardiovascular diseases (CVD)[1]. Hypertension attributes 48% and 18% of all stroke and Coronary Heart Disease (CHD) deaths in India, respectively[2,3]. Achieving better treatment and control rates of both hypertension and diabetes are crucial to contain the epidemic of CVD in India. Task-sharing strategy of involving non-physician health care workers (NPHW) has been recognised as a useful strategy for achieving better treatment and control rates of both blood pressure(BP) and blood sugar. The mHealth technology has the potential to facilitate the task-sharing strategies by enabling the NPHW with new skills in cardiovascular risk reduction. We describe the feasibility, and impact of a novel strategy anchored on technology enabled NPHW in management of hypertension and diabetes
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