mHealth to Enable Task Sharing for Hypertension Care in LMIC

虽然高血压的诊断相对简单，而且有廉价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40%的高血压患者 他们知道自己的诊断，只有不到10%的人能很好地控制血压。社区卫生 员工(CHW)和移动医疗(MHealth)技术在LMIC中的使用越来越多，以填补 高血压治疗，但目前的方法过于依赖医生的指导。长期目标是 增加LMIC中确诊和有效治疗的高血压患者数量 通过与配备了mHealth技术的CHW分担任务。本应用程序的总体目标 1)开发移动应用程序，为社区卫生工作者提供高级临床决策支持(CDS) 危地马拉，一个中等收入国家；2)确定CHW使用此应用程序诊断的准确性 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 与由医生提供的护理相比。中心假设是使用mHealth应用程序的CHW 远程监控可以诊断和管理高血压，其准确性、有效性和安全性与 一个内科医生。这一项目基本原理是展示卫生工作者使用移动医疗的效果 独立的高血压诊断和管理技术将对健康产生广泛的影响 LMIC中的服务交付以及为该提案开发的应用和护理模型可能很容易 适应其他环境。核心假设将通过追求三个具体目标来检验：1)检验 配备移动应用程序的CHWS诊断高血压的准确性；2)评估 通过移动应用程序实现CHW主导的高血压管理；以及3)确定 与医生护理相比，CHW领导的高血压管理通过移动应用程序进行帮助。在第一个下 目的，CHW使用为这项建议开发的应用程序将筛查高血压患者和他们的 诊断准确率与医生的诊断准确率进行比较。对于第二个目标，使用该应用程序的CHW将 管理一小群高血压患者以评估干预的可行性并继续迭代 应用程序开发。对于目标三，将进行随机、对照、非劣势试验，以 配备移动应用的社区卫生服务管理高血压的安全性和有效性比较 到内科医生的护理。这项拟议的研究具有创新性，因为它代表了对 让社区卫生工作者独立识别和治疗高血压的现状 使用复杂的mHealth CDS应用程序进行监督，为滴定多个 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应世界各地低资源环境的护理模式， 从而增加高血压的诊断和治疗，减少心血管疾病和死亡。

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.