评估利用手机技术加强社区卫生工作者进行心血管疾病筛查的情况。
Evaluating the use of mobile phone technology to enhance cardiovascular disease screening by community health workers.
作者信息
Surka Sam, Edirippulige Sisira, Steyn Krisela, Gaziano Thomas, Puoane Thandi, Levitt Naomi
机构信息
Chronic Disease Initiative for Africa, University of Cape Town, South Africa.
Centre for Online Health, University of Queensland, Brisbane, Australia.
出版信息
Int J Med Inform. 2014 Sep;83(9):648-54. doi: 10.1016/j.ijmedinf.2014.06.008. Epub 2014 Jun 21.
BACKGROUND
Primary prevention of cardiovascular disease (CVD),by identifying individuals at risk is a well-established, but costly strategy when based on measurements that depend on laboratory analyses. A non-laboratory, paper-based CVD risk assessment chart tool has previously been developed to make screening more affordable in developing countries. Task shifting to community health workers (CHWs) is being investigated to further scale CVD risk screening. This study aimed to develop a mobile phone CVD risk assessment application and to evaluate its impact on CHW training and the duration of screening for CVD in the community by CHWs.
METHODS
A feature phone application was developed using the open source online platform, CommCare(©). CHWs (n=24) were trained to use both paper-based and mobile phone CVD risk assessment tools. They were randomly allocated to using one of the risk tools to screen 10-20 community members and then crossed over to screen the same number, using the alternate risk tool. The impact on CHW training time, screening time and margin of error in calculating risk scores was recorded. A focus group discussion evaluated experiences of CHWs using the two tools.
RESULTS
The training time was 12.3h for the paper-based chart tool and 3h for the mobile phone application. 537 people were screened. The mean screening time was 36 min (SD=12.6) using the paper-base chart tool and 21 min (SD=8.71) using the mobile phone application, p=<0.0001. Incorrect calculations (4.3% of average systolic BP measurements, 10.4% of BMI and 3.8% of CVD risk score) were found when using the paper-based chart tool while all the mobile phone calculations were correct. Qualitative findings from the focus group discussion corresponded with the findings of the pilot study.
CONCLUSION
The reduction in CHW training time, CVD risk screening time, lack of errors in calculation of a CVD risk score and end user satisfaction when using a mobile phone application, has implications in terms of adoption and sustainability of this primary prevention strategy to identify people with high CVD risk who can be referred for appropriate diagnoses and treatment.
背景
通过识别高危个体对心血管疾病（CVD）进行一级预防是一种成熟的策略，但基于依赖实验室分析的测量方法时成本较高。此前已开发出一种基于纸质的非实验室CVD风险评估图表工具，以使发展中国家的筛查更具成本效益。目前正在研究将任务转移给社区卫生工作者（CHW），以进一步扩大CVD风险筛查的规模。本研究旨在开发一款手机CVD风险评估应用程序，并评估其对CHW培训以及CHW在社区中进行CVD筛查所需时间的影响。
方法
使用开源在线平台CommCare(©)开发了一款功能手机应用程序。对24名CHW进行培训，使其能够使用纸质和手机CVD风险评估工具。将他们随机分配使用其中一种风险工具对10 - 20名社区成员进行筛查，然后交叉使用另一种风险工具对相同数量的成员进行筛查。记录对CHW培训时间、筛查时间以及计算风险评分时的误差幅度的影响。通过焦点小组讨论评估CHW使用这两种工具的体验。
结果
纸质图表工具的培训时间为12.3小时，手机应用程序的培训时间为3小时。共筛查了537人。使用纸质图表工具时，平均筛查时间为36分钟（标准差 = 12.6），使用手机应用程序时为21分钟（标准差 = 8.71），p < 0.0001。使用纸质图表工具时发现存在计算错误（平均收缩压测量值的4.3%、BMI的10.4%和CVD风险评分的3.8%），而所有手机计算均正确。焦点小组讨论的定性结果与初步研究结果一致。
结论
使用手机应用程序时，CHW培训时间、CVD风险筛查时间减少，CVD风险评分计算无误差且终端用户满意度高，这对采用和维持这种一级预防策略具有重要意义，该策略可识别出具有高CVD风险的人群，以便将其转诊进行适当的诊断和治疗。
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