mHealth to Enable Task Sharing for Hypertension Care in LMIC

移动医疗将在中低收入国家实现高血压护理任务共享

• 批准号: 10269175
• 负责人: Sean Michael Duffy
• 金额: $ 16.41万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-10 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10269175
• 关键词: Address; Adult; Adverse event; Awareness; Blood Pressure; Cardiovascular Diseases; Caring; Cause of Death; Cessation of life; Chronic; Chronic Disease; Clinic; Clinical; Collaborations; Communities; Community Health Aides; Counseling; Country; Development; Diabetes Mellitus; Diagnosis; Disease Outcome; Enrollment; Event; Experimental Designs; Goals; Gold; Government; Guatemala; Health Promotion; Health Technology; Health system; Healthcare; Hypertension; Income; Infrastructure; Intervention; Intervention Trial; Life Style; Longevity; Medical; Mission; Mobile Health Application; Modeling; Morbidity - disease rate; Nurses; Patient Education; Patients; Pharmaceutical Preparations; Physicians; Play; Preclinical Testing; Primary Health Care; Problem Solving; Process; Protocols documentation; Provider; Public Health; Randomized; Recommendation; Research; Resources; Role; Rural; Safety; Supervision; Testing; Titrations; Training; Vision; Work; acute care; base; blood pressure regulation; burden of illness; clinical decision support; cost effective; diabetes management; diagnostic accuracy; disability; effectiveness evaluation; empowered; health care delivery; hypertension control; hypertension treatment; improved; innovation; international center; low and middle-income countries; mHealth; mobile application; mortality; neighborhood safety; patient screening; primary outcome; programs; rural area; safety outcomes; screening; standard care

Although hypertension diagnosis is relatively simple and there are cheap and effective medications for lowering blood pressure, less than 40% of patients with hypertension in low- and middle-income countries (LMIC) are aware of their diagnosis and less than 10% have good control of their blood pressure. Community health workers (CHWs) and mobile health (mHealth) technology are increasingly being used in LMIC to fill gaps in hypertension care, but current approaches are too dependent on physician direction. The long-term goal is to increase the number of patients living with hypertension in LMIC who are diagnosed and effectively treated through task sharing with CHWs equipped with mHealth technology. The overall objectives in this application are to 1) develop a mobile application to provide advanced clinical decision support (CDS) for CHWs in Guatemala, a middle-income country; 2) determine the accuracy of CHWs using this application in diagnosing hypertension; and 3) determine the effectiveness of these CHWs thus-equipped in managing hypertension compared to care provided by a physician. The central hypothesis is that CHWs using an mHealth application and remotely supervised can diagnose and manage hypertension with similar accuracy, efficacy, and safety to a physician. The rationale for this project is that demonstration of the efficacy of CHWs using mobile health technology for independent hypertension diagnosis and management would have broad implications for health service delivery in LMIC and the application and care model developed for this proposal could be easily adapted to other settings. The central hypothesis will be tested by pursuing three specific aims: 1) Test the accuracy of CHWs equipped with a mobile application to diagnose hypertension; 2) Assess the feasibility of CHW-led hypertension management enabled by a mobile application; and 3) Determine the efficacy of CHW-led hypertension management aided by a mobile application compared to physician care. Under the first aim, CHWs using the application developed for this proposal will screen patients for hypertension and their diagnostic accuracy compared with that of a physician. For the second aim, CHWs using the application will manage a small group of patients with hypertension to assess intervention feasibility and continue iterative application development. For aim three, a randomized, controlled, non-inferiority trial will be conducted to compare the safety and efficacy of hypertension management by CHWs equipped with the mobile application to physician care. The proposed research is innovative because it represents a substantive departure from the status quo by enabling CHWs to independently identify and treat hypertension with asynchronous physician supervision using a sophisticated mHealth CDS application providing guidance on titration of multiple medications and validated through a rigorous experimental design. This project is significant because it is expected to result in a model of care that would be widely adaptable to low-resource settings around the world, leading to increased diagnosis and treatment of hypertension and reduced cardiovascular disease and death.

尽管高血压的诊断相对简单，并且有廉价有效的降压药物 低收入和中等收入国家 (LMIC) 中不到 40% 的高血压患者患有高血压 了解自己的诊断，并且只有不到 10% 的人能够很好地控制血压。社区健康 中低收入国家越来越多地使用工人（CHW）和移动医疗（mHealth）技术来填补医疗保健方面的空白 高血压护理，但目前的方法过于依赖医生的指导。长期目标是 增加中低收入国家高血压患者得到诊断和有效治疗的数量 通过与配备移动医疗技术的社区卫生工作者分担任务。本申请的总体目标 1) 开发一款移动应用程序，为以下地区的社区卫生工作者提供先进的临床决策支持 (CDS) 危地马拉，中等收入国家； 2) 使用此应用程序确定 CHW 诊断的准确性 高血压; 3) 确定这些配备如此装备的社区卫生工作者在控制高血压方面的有效性 与医生提供的护理相比。中心假设是使用移动医疗应用程序的社区卫生工作者 远程监督可以诊断和管理高血压，其准确性、有效性和安全性与 一位医生。该项目的基本原理是展示社区卫生工作者使用移动医疗的功效 独立高血压诊断和管理技术将对健康产生广泛影响 中低收入国家的服务提供以及为此提案开发的应用和护理模型可以很容易地 适应其他设置。将通过追求三个具体目标来检验中心假设：1）检验 配备移动应用程序的社区卫生工作者诊断高血压的准确性； 2）评估可行性 通过移动应用程序实现社区卫生工作者主导的高血压管理； 3) 确定功效 与医生护理相比，社区卫生工作者主导的高血压管理由移动应用程序辅助。在第一个下 目标是，使用为此提案开发的应用程序的社区卫生工作者将筛查患者的高血压及其症状 与医生的诊断准确性相比。对于第二个目标，使用该应用程序的社区卫生工作者将 管理一小群高血压患者以评估干预可行性并继续迭代 应用程序开发。对于目标三，将进行一项随机、对照、非劣效性试验 比较配备移动应用程序的社区卫生工作者进行高血压管理的安全性和有效性 接受医生护理。拟议的研究具有创新性，因为它代表了与现有研究的实质性背离。 使社区卫生工作者能够与异步医生一起独立识别和治疗高血压，从而改变现状 使用复杂的 mHealth CDS 应用程序进行监督，为多种药物的滴定提供指导 药物并通过严格的实验设计进行验证。这个项目意义重大，因为它 预计将产生一种广泛适用于世界各地资源匮乏环境的护理模式， 导致高血压的诊断和治疗增加，并减少心血管疾病和死亡。