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

 描述（由申请方提供）：心血管疾病（CVD）是阿根廷的主要死亡原因，其死亡率随着CVD风险因素的增加而沿着上升。低收入和中等收入国家（LMIC）的控制挑战包括认识不足，训练有素的卫生保健工作者短缺，过度拥挤的初级保健中心（PCC），以及卫生保健系统整体缺乏资源。确定如何增加社区环境中的筛查和有效转诊到PCCs是减少阿根廷CVD负担的重要优先事项。由美国国立卫生研究院资助的先前工作表明，有效的低成本筛查工具是可用的，社区卫生工作者可以接受培训，在社区中使用经过验证的简单的非实验室筛查工具来识别高心血管疾病风险，使用移动的电话应用程序来使用该工具可以降低社区卫生工作者的培训成本和筛查时间。尚未显示的是，是否可以适当地将CVD高危人群转介到PCCs进行适当的CVD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，其目标是增加未投保的心血管疾病高危人群的数量，使他们得到筛查、识别、转诊，并得到适当的护理和治疗，包括基本的诊断和药物。我们建议开发一种移动健康工具，它集成了手机应用程序的风险筛查工具，以无线方式直接连接到PCC的电子调度系统。这将使社区卫生服务员能够进入政府诊所的预约系统，以便在 进行筛查，以增加这些人接受转诊和随访的次数。这一综合调度系统将允许使用短信来提醒患者他们的预约和安排后续护理。最后，该系统将与公共投诉中心的电子记录系统相结合，以便对该方案进行持续监测和评价。我们提出了一个务实的集群随机试验，其中个别PCC将被随机分配到使用集成的mHealth工具，或使用现有的基于纸张的筛选常规筛选程序。其目标是确定使用移动保健工具是否会增加转诊就诊的高危人群数量，是否会增加转诊患者随后的后续护理就诊率，以及干预措施的成本效益。

 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.