开发一款支持智能手机的高血压和糖尿病管理软件包，以促进印度初级医疗保健机构提供循证护理：mPower心脏项目。

Development of a Smartphone-Enabled Hypertension and Diabetes Mellitus Management Package to Facilitate Evidence-Based Care Delivery in Primary Healthcare Facilities in India: The mPower Heart Project.

作者信息

Ajay Vamadevan S, Jindal Devraj, Roy Ambuj, Venugopal Vidya, Sharma Rakshit, Pawar Abha, Kinra Sanjay, Tandon Nikhil, Prabhakaran Dorairaj

机构信息

Centre for Chronic Disease Control (CCDC), New Delhi, India.

Centre for Control of Chronic Conditions (CCCC), Public Health Foundation of India (PHFI), Gurgaon, India.

出版信息

J Am Heart Assoc. 2016 Dec 21;5(12):e004343. doi: 10.1161/JAHA.116.004343.

BACKGROUND

The high burden of undetected and undertreated hypertension and diabetes mellitus is a major health challenge worldwide. The mPower Heart Project aimed to develop and test a feasible and scalable intervention for hypertension and diabetes mellitus by task-sharing with the use of a mobile phone-based clinical decision support system at Community Health Centers in Himachal Pradesh, India.

METHODS AND RESULTS

The development of the intervention and mobile phone-based clinical decision support system was carried out using mixed methods in five Community Health Centers. The intervention was subsequently evaluated using pre-post evaluation design. During intervention, a nurse care coordinator screened, examined, and entered patient parameters into mobile phone-based clinical decision support system to generate a prescription, which was vetted by a physician. The change in systolic blood pressure, diastolic blood pressure, and fasting plasma glucose (FPG) over 18 months of intervention was quantified using generalized estimating equations models. During intervention, 6797 participants were enrolled. Six thousand sixteen participants had hypertension (mean systolic blood pressure: 146.1 mm Hg, 95% CI: 145.7, 146.5; diastolic blood pressure: 89.52 mm Hg, 95% CI: 89.33, 89.72), of which 3152 (52%) subjects were newly detected. Similarly, 1516 participants had diabetes mellitus (mean FPG: 177.9 mg/dL, 95% CI: 175.8, 180.0), of which 450 (30%) subjects were newly detected. The changes in systolic blood pressure, diastolic blood pressure, and FPG observed at 18 months of follow-up were -14.6 mm Hg (95% CI: -15.3, -13.8), -7.6 mm Hg (CI: -8.0, -7.2), and -50.0 mg/dL (95% CI: -54.6, -45.5), respectively, and were statistically significant even after adjusting for age, sex, and Community Health Center.

CONCLUSIONS

A nurse-facilitated, mobile phone-based clinical decision support system-enabled intervention in primary care was associated with improvements in blood pressure and blood glucose control and has the potential to scale-up in resource poor settings.

CLINICAL TRIAL REGISTRATION

URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01794052. Clinical Trial Registry-India: CTRI/2013/02/003412.

背景

未被发现和治疗不足的高血压和糖尿病负担沉重，是全球面临的一项重大健康挑战。“增强心脏项目”旨在通过在印度喜马偕尔邦的社区卫生中心采用基于手机的临床决策支持系统进行任务分担，开发并测试一种针对高血压和糖尿病可行且可扩展的干预措施。

方法与结果

在五个社区卫生中心采用混合方法开展干预措施及基于手机的临床决策支持系统的开发。随后采用前后评估设计对干预措施进行评估。在干预期间，一名护士护理协调员对患者进行筛查、检查，并将患者参数输入基于手机的临床决策支持系统以生成处方，该处方由一名医生审核。使用广义估计方程模型对干预18个月期间收缩压、舒张压和空腹血糖（FPG）的变化进行量化。干预期间，共纳入6797名参与者。6016名参与者患有高血压（平均收缩压：146.1毫米汞柱，95%置信区间：145.7，146.5；舒张压：89.52毫米汞柱，95%置信区间：89.33，89.72），其中3152名（52%）受试者为新发现病例。同样，1516名参与者患有糖尿病（平均空腹血糖：177.9毫克/分升，95%置信区间：175.8，180.0），其中450名（30%）受试者为新发现病例。随访18个月时观察到的收缩压、舒张压和空腹血糖变化分别为-14.6毫米汞柱（95%置信区间：-15.3，-13.8）、-7.6毫米汞柱（置信区间：-8.0，-7.2）和-50.0毫克/分升（95%置信区间：-54.6，-45.5），即使在对年龄、性别和社区卫生中心进行调整后，这些变化仍具有统计学意义。