Development of a Smartphone-Enabled Hypertension and Diabetes Mellitus Management Package to Facilitate Evidence-Based Care Delivery in Primary Healthcare Facilities in India: The mPower Heart Project
Development of a Smartphone-Enabled Hypertension and Diabetes Mellitus Management Package to Facilitate Evidence-Based Care Delivery in Primary Healthcare Facilities in India: The mPower Heart Project
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DOI：
10.1161/jaha.116.004343
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发表时间：
2016-12-01
影响因子：
5.4
通讯作者：
Prabhakaran, Dorairaj
中科院分区：
文献类型：
--
作者：
Ajay, Vamadevan S.;Jindal, Devraj;Prabhakaran, Dorairaj
背景：未被发现和治疗不足的高血压和糖尿病的高负担是世界范围内的一个主要健康挑战。mPower心脏项目旨在通过在印度喜马恰尔邦的社区卫生中心使用基于移动电话的临床决策支持系统，开发和测试一种可行的、可扩展的高血压和糖尿病干预措施。方法与结果：采用混合方法，在5个社区卫生中心开展干预和基于手机的临床决策支持系统的开发。随后采用前后评估设计对干预措施进行评估。在干预期间，护士护理协调员筛选、检查并将患者参数输入基于手机的临床决策支持系统，以生成处方，由医生审查。使用广义估计方程模型量化干预18个月后收缩压、舒张压和空腹血糖（FPG）的变化。在干预期间，6797名参与者入组。61616例高血压患者（平均收缩压：146.1 mm Hg, 95% CI: 145.7, 146.5；舒张压：89.52 mm Hg, 95% CI: 89.33, 89.72），其中3152例（52%）为新发现患者。同样，1516名参与者患有糖尿病（平均FPG: 177.9 mg/dL, 95% CI: 175.8, 180.0），其中450名（30%）受试者是新发现的。在18个月的随访中观察到的收缩压、舒张压和FPG的变化分别为-14.6 mm Hg （95% CI: -15.3, -13.8）、-7.6 mm Hg （95% CI: -8.0, -7.2）和-50.0 mg/dL (95% CI: -54.6, -45.5)，即使在调整了年龄、性别和社区卫生中心后也具有统计学意义。结论：在初级保健中，护士促进的、基于移动电话的临床决策支持系统干预与血压和血糖控制的改善有关，并有可能在资源贫乏的环境中扩大规模。
Background-The high burden of undetected and undertreated hypertension and diabetes mellitus is a major health challenge worldwide. The mPower Heart Project aimed to develop and test a feasible and scalable intervention for hypertension and diabetes mellitus by task-sharing with the use of a mobile phone-based clinical decision support system at Community Health Centers in Himachal Pradesh, India.Methods and Results-The development of the intervention and mobile phone-based clinical decision support system was carried out using mixed methods in five Community Health Centers. The intervention was subsequently evaluated using pre-post evaluation design. During intervention, a nurse care coordinator screened, examined, and entered patient parameters into mobile phone-based clinical decision support system to generate a prescription, which was vetted by a physician. The change in systolic blood pressure, diastolic blood pressure, and fasting plasma glucose (FPG) over 18 months of intervention was quantified using generalized estimating equations models. During intervention, 6797 participants were enrolled. Six thousand sixteen participants had hypertension (mean systolic blood pressure: 146.1 mm Hg, 95% CI: 145.7, 146.5; diastolic blood pressure: 89.52 mm Hg, 95% CI: 89.33, 89.72), of which 3152 (52%) subjects were newly detected. Similarly, 1516 participants had diabetes mellitus (mean FPG: 177.9 mg/dL, 95% CI: 175.8, 180.0), of which 450 (30%) subjects were newly detected. The changes in systolic blood pressure, diastolic blood pressure, and FPG observed at 18 months of follow-up were -14.6 mm Hg (95% CI: -15.3, -13.8), -7.6 mm Hg (CI: -8.0, -7.2), and -50.0 mg/dL (95% CI: -54.6, -45.5), respectively, and were statistically significant even after adjusting for age, sex, and Community Health Center.Conclusions-A nurse-facilitated, mobile phone-based clinical decision support system-enabled intervention in primary care was associated with improvements in blood pressure and blood glucose control and has the potential to scale-up in resource poor settings.