Effectiveness of an mHealth-Based Electronic Decision Support System for Integrated Management of Chronic Conditions in Primary Care
| Autor: | Dorairaj Prabhakaran, Dilip Jha, David Prieto-Merino, Ambuj Roy, Kavita Singh, Vamadevan S. Ajay, Devraj Jindal, Priti Gupta, Dimple Kondal, Shifalika Goenka, Pramod Jacob, Rekha Singh, B. G. Prakash Kumar, Pablo Perel, Nikhil Tandon, Vikram Patel, C. Venkat, S. Ram, Sudhir Saxena, K. Venugopal, Lars Gredsted, Vikram Sheel Kumar, Shirshendu Mukherjee, K. Srinath Reddy, Nitish Naik, S.N. Dwivedi, A.G. Unnikrishnan, Meenakshi Sharma |
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| Rok vydání: | 2019 |
| Předmět: |
Decision support system
Telemedicine business.industry Primary health care Primary care 030204 cardiovascular system & hematology Disease cluster medicine.disease law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Physiology (medical) Medicine 030212 general & internal medicine Medical emergency Cardiology and Cardiovascular Medicine business mHealth Integrated management |
| Zdroj: | Circulation. 139:380-391 |
| ISSN: | 1524-4539 0009-7322 |
| DOI: | 10.1161/circulationaha.118.038192 |
| Popis: | Background: The burden of noncommunicable diseases and their risk factors has rapidly increased worldwide, including in India. Innovative management strategies with electronic decision support and task sharing have been assessed for hypertension, diabetes mellitus, and depression individually, but an integrated package for multiple chronic condition management in primary care has not been evaluated. Methods: In a prospective, multicenter, open-label, cluster-randomized controlled trial involving 40 community health centers, using hypertension and diabetes mellitus as entry points, we evaluated the effectiveness of mWellcare, an mHealth system consisting of electronic health record storage and an electronic decision support for the integrated management of 5 chronic conditions (hypertension, diabetes mellitus, current tobacco and alcohol use, and depression) versus enhanced usual care among patients with hypertension and diabetes mellitus in India. At trial end (12-month follow-up), using intention-to-treat analysis, we examined the mean difference between arms in change in systolic blood pressure and glycated hemoglobin as primary outcomes and fasting blood glucose, total cholesterol, predicted 10-year risk of cardiovascular disease, depression score, and proportions reporting tobacco and alcohol use as secondary outcomes. Mixed-effects regression models were used to account for clustering and other confounding variables. Results: Among 3698 enrolled participants across 40 clusters (mean age, 55.1 years; SD, 11 years; 55.2% men), 3324 completed the trial. There was no evidence of difference between the 2 arms for systolic blood pressure (Δ=−0.98; 95% CI, −4.64 to 2.67) and glycated hemoglobin (Δ=0.11; 95% CI, −0.24 to 0.45) even after adjustment of several key variables (adjusted differences for systolic blood pressure: – 0.31 [95% CI, −3.91 to 3.29]; for glycated hemoglobin: 0.08 [95% CI, −0.27 to 0.44]). The mean within-group changes in systolic blood pressure in mWellcare and enhanced usual care were −13.65 mm Hg versus −12.66 mm Hg, respectively, and for glycated hemoglobin were −0.48% and −0.58%, respectively. Similarly, there were no differences in the changes between the 2 groups for tobacco and alcohol use or other secondary outcomes. Conclusions: We did not find an incremental benefit of mWellcare over enhanced usual care in the management of the chronic conditions studied. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02480062. |
| Databáze: | OpenAIRE |
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