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: 10880472
• 负责人: Sean Michael Duffy
• 金额: $ 25.01万
• 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 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10880472
• 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; Community Healthcare; Counseling; Country; Development; Diabetes Mellitus; Diagnosis; Disease; Disease Outcome; Enrollment; Event; Experimental Designs; Fogarty International Center; Goals; 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; Patient Participation; Patients; Persons; Pharmaceutical Preparations; Physicians; Play; Preclinical Testing; Primary Care; Process; Protocols documentation; Provider; Public Health; Randomized; Recommendation; Research; Resource-limited setting; Role; Rural; Safety; Supervision; Technology; Testing; Titrations; Training; Vision; Work; acute care; blood pressure control; burden of illness; clinical decision support; cost effective; diabetes management; diagnostic accuracy; disability; effectiveness evaluation; efficacy evaluation; empowerment; health care delivery; hypertension control; hypertension treatment; hypertensive; improved; innovation; 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.

尽管高血压诊断相对简单，并且有廉价有效的药物来降低 血压，低收入和中等收入国家（LMIC）的高血压患者中不到40％ 意识到他们的诊断，少于10％可以很好地控制其血压。社区健康 LMIC越来越多地使用工人（CHW）和移动健康（MHealth）技术来填补空白 高血压护理，但是当前的方法过于取决于医师的方向。长期目标是 增加LMIC患有高血压的患者数量，这些患者被诊断并有效治疗 通过与配备MHealth技术的CHW共享任务。此应用程序中的总体目标 到1）开发移动应用程序，以提供CHW的高级临床决策支持（CD） 危地马拉，中等收入国家； 2）在诊断中使用此应用程序确定CHW的准确性 高血压; 3）确定这些CHW在管理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MHealth应用程序的CHW 远程监督可以以相似的准确性，功效和安全性来诊断和管理高血压 医生。该项目的理由是使用移动健康的CHW的功效证明 独立高血压诊断和管理的技术对健康有广泛的影响 LMIC的服务交付以及为此建议开发的应用和护理模型很容易 适应其他设置。中心假设将通过追求三个具体目标来检验：1）测试 配备了移动应用程序以诊断高血压的CHW的准确性； 2）评估可行性 由移动应用程序启用了CHW领导的高血压管理； 3）确定 与医师护理相比，CHW领导的高血压管理得到了移动应用程序的帮助。在第一个 目的，使用为该建议开发的应用程序的CHW将筛查患者的高血压及其 与医生相比，诊断准确性。对于第二个目标，使用该应用程序的CHW将 管理一小组高血压患者，以评估可行性并继续迭代 应用程序开发。对于AIM三，将进行随机，受控的非效率试验 比较配备了移动应用程序的CHW的高血压管理的安全性和功效 致力医师护理。拟议的研究具有创新性，因为它代表了与 通过使CHW能够独立识别和治疗高血压来使用异步医生来实现现状 使用复杂的MHealth CD申请进行监督，提供有关滴定的指导 药物并通过严格的实验设计进行了验证。这个项目很重要，因为它是 预计将导致一种护理模式，该模型将广泛适应世界各地的低资源环境， 导致高血压的诊断和治疗增加，心血管疾病和死亡减少。