MHealth interventions to improve access and coverage of uninsured people with high cardiovascular risk in Argentina

 描述(由申请人提供)：心血管疾病(CVD)是阿根廷的主要死亡原因，其死亡率随着CVD的风险因素而持续上升。在低收入和中等收入国家(LMIC)面临的控制挑战包括低认识、训练有素的卫生保健人员短缺、初级保健中心(PCCs)过度拥挤以及卫生保健系统总体上缺乏资源。确定在社区环境中增加筛查和有效转诊到初级保健中心的方法是减轻阿根廷心血管疾病负担的一个重要优先事项。由NIH资助的以前的工作表明，有效的低成本筛查工具是可用的，CHW可以在社区中接受培训，使用一种经过验证的、简单的非实验室筛查工具来识别那些心血管疾病风险较高的人，并且使用该工具的移动电话应用程序降低了CHW的培训成本和筛查时间。尚未显示的是，是否可以将心血管疾病高危人群适当地转介到PCC进行适当的心血管疾病评估、治疗和有效管理。阿根廷卫生部通过Redes方案建立了一个奖励制度，目的是增加未参保的心血管疾病高危人群的人数，对他们进行筛查、识别、转介，并向他们提供适当的护理和治疗，提供必要的诊断和药物。我们建议开发一个mHealth工具，将手机应用程序整合在一起，使风险筛查工具与PCCS的电子调度系统无线直接连接。这将允许卫生福利院使用政府诊所的预约时间安排系统，允许他们在以下情况下为被识别的高危人士预约 筛查以增加这些个人参加的转介和后续访问的数量。这一集成的日程安排系统将允许使用短信来提醒患者他们的预约并安排后续护理。最后，该系统将与委员会的电子记录系统相结合，以便能够对该方案进行持续监测和评价。我们提出了一项实用的整群随机试验，将单个PCC随机分为使用集成的mHealth工具或使用现有纸质筛查的常规筛查程序。目标将是确定使用mHealth工具是否增加了转诊的高危人群的数量，是否增加了转介人员随后的后续护理就诊率，以及干预的成本效益。

 DESCRIPTION (provided by applicant): Cardiovascular disease (CVD) is a leading cause of death in Argentina where death rates have continued to rise along with risk factors for CVD. Challenges to control in low- and middle income countries (LMIC) include low awareness, shortages of trained health care workers, overcrowded primary care centers (PCCs), and overall lack of resources in health care systems. Determining ways to increase screening in community settings and efficient referral to PCCs is a significant priority in reducing the CVD burden in Argentina. Previous work funded by the NIH shows that effective low-cost screening tools are available, CHWs can be trained to use a validated, simple non-lab based screening tool in communities to identify those at high CVD risk, and use of a mobile phone application for this tool reduced both the cost of training and screening time for CHWs. What has not been shown is whether persons at high risk for CVD can be appropriately referred for proper evaluation, treatment, and effective management of CVD at the PCCs. The Ministry of Health in Argentina has instituted an incentive system through the REDES Program that has the goal of increasing the number of uninsured who are at high risk for CVD are screened, identified, referred, and provided with appropriate care and treatment with essential diagnostics and medicines. We propose to develop a mHealth tool that integrates the cell phone application for the risk screening tool to be wirelessly and directly connected with the electronic scheduling systems at PCCs. This will allow CHWs to access the appointment scheduling system at the government clinics, allowing them to make appointments for the identified high-risk individuals at the time of screening to increase the number of referral and follow-up visits that these individuals attend. This integrated scheduling system will allow for SMS messaging to be used to remind patients of their appointments and to schedule follow- up care. Finally, the system will be integrated with the electronic record system at the PCC so that ongoing monitoring and evaluation of the program can be implemented. We proposed a pragmatic cluster randomized trial in which individual PCCs will be randomized to either to use of the integrated mHealth tool, or usual screening procedures using existing paper based screening. The objectives will be to determine if use of the mHealth tool increases the number of high-risk persons who show up for the referral visits, if it increases the rate of subsequent follow-up care visits for the referred persns, and the cost-effectiveness of the intervention.