mHealth to Enable Task Sharing for Hypertension Care in LMIC

虽然高血压的诊断相对简单，而且有便宜而有效的药物来降低血压。 在低收入和中等收入国家（LMIC）， 只有不到10%的人知道他们的诊断，只有不到10%的人能够很好地控制血压。社区卫生 工作人员（CHW）和移动的健康（mHealth）技术越来越多地用于LMIC，以填补 高血压治疗，但目前的方法太依赖于医生的指导。长期目标是 增加LMIC中高血压患者的确诊和有效治疗人数 通过与配备移动健康技术的社区卫生工作者分担任务。本申请的总体目标是 1）开发一个移动的应用程序，为CHW提供高级临床决策支持（CDS）， 危地马拉，中等收入国家; 2）使用此应用程序确定CHW在诊断中的准确性 高血压;以及3）确定这些配备的CHW在管理高血压方面的有效性 与医生提供的护理相比。核心假设是，使用移动健康应用程序的CHW 和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 健康专家该项目的基本原理是，使用移动的健康示范CHW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 LMIC的服务交付以及为此建议开发的应用和护理模型可以很容易地 适应其他设置。中心假设将通过追求三个具体目标进行测试：1）测试 配备移动的应用程序的CHW诊断高血压的准确性; 2）评估 通过移动的应用程序实现CHW主导的高血压管理;以及3）确定 与医生护理相比，CHW领导的高血压管理由移动的应用程序辅助。根据第一项 目的是，CHW使用为该提案开发的应用程序将筛查高血压患者及其 与医生的诊断准确性相比。至于第二个目标，使用该应用程序的社区卫生工作者将 管理一小组高血压患者，评估干预可行性，并继续迭代 应用开发对于目标三，将进行随机、对照、非劣效性试验， 比较配备移动的应用程序的CHW管理高血压的安全性和有效性 医生的照顾。拟议的研究是创新的，因为它代表了一个实质性的偏离， 通过使社区卫生工作者能够独立地识别和治疗高血压， 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 并通过严格的实验设计进行验证。这个项目意义重大，因为它是 预计将产生一种护理模式，广泛适用于世界各地的低资源环境， 从而增加了对高血压的诊断和治疗，减少了心血管疾病和死亡。

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.