New Delhi, April 08 (India Science Wire): A group of Indian and Australian scientists has developed and tested a mobile application-based system that promises to help doctors and health workers in villages to identify, monitor and manage patients with high blood pressure and heart-related ailments in remote areas.

The app is in the form of a clinical
decision support system (CDSS), which can be loaded on an android phone. The
system also had a module that can send alerts to health workers about high-risk
individuals who need follow-up visits. In addition, it reminds patients on when
to take their medication and when to visit the doctor for follow-up via an
interactive voice response system.

In the study, people aged 40 and drawn from 54 villages in West Godavari district of Andhra Pradesh were screened to identify those at high risk of heart disease. Health workers, ASHAs, were trained to evaluate the risk of heart disease using tablet phones loaded with the app and refer those with high risk to Primary Health Centres (PHCs).

The intervention
was rolled out in 18 PHCs in a step-wise manner and was evaluated by comparing
improvements during the periods when PHCs were receiving the intervention and
when they were not. The study
found that ASHA workers screened about 86% of the population in the
selected area and doctors followed up 70 % of high risk referrals. Overall, there
was a marked increase in both using of blood pressure medications and blood
pressure control during both the control and intervention periods.

An important
take-away is that ASHA workers can expand their role beyond maternal and child
health to non-communicable disease management and prevention. The platform can
also link village-based assessments to doctor-level care and follow-up. A
similar trial has been completed recently in Haryana, testing the strategy in a
different set of population with PHCs of different levels of capacity.

Despite availability of low-cost
medicines to control blood pressure in PHCs, the use of such treatments in villages
is limited. Only a minority of individuals who are at risk of heart disease or
who have heart disease have adequately controlled blood pressure levels. This
is alarming as India has about 140 million people diagnosed with high blood
pressure.

“India’s health system faces great challenges to improve coverage and quality of care for its citizens. Reduced numbers of health care facilities and care providers, reliance on informal and private care providers and high out-of-pocket costs are major barriers that need addressing to effectively identify people at high risk for heart disease and refer them appropriately for medical care,” noted Prof David Peiris, a member of the research team.

The research results have been published in journal PLoS
One. The team included David Peiris, Devarsetty Praveen, Kishor Mogulluru, Mohammed Abdul
Ameer, Qiang Li, Pallab K. Maulik, Stephen MacMahon, Rohina Joshi, Stephen Jan,
Anushka Patel (The George Institute of Global Health); Arvind Raghu, Lionel
Tarassenko (University of Oxford); Stephane Heritier (Monash University); Dorairaj
Prabhakara (Public Health Foundation of India);  and Gari D. Clifford (Emory University).

By Monika Kundu Srivastava