Monitoring heart disease patients via an app

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Published: September 9, 2019 2:02:22 AM

SMARThealth, an Indo-Australian mobile device-based clinical decision support system, allows community health workers to assess risks of cardiovascular diseases using basic equipment.

The mobile application, developed in Australia and piloted in India, will soon be rolled out in other countriesThe mobile application, developed in Australia and piloted in India, will soon be rolled out in other countries

An Indo-Australian mobile app-supported system that helps to identify and manage people with high risk of cardiovascular disease (CVD) is being used in rural Indonesian communities to improve the use of appropriate medications and lower blood pressure. The mobile application, developed in Australia and piloted in India, will soon be rolled out in other countries.

SMARThealth is a mobile device-based clinical decision support system (CDSS) developed by The George Institute for Global Health that allows community health workers to assess CVD risk using basic equipment and refer those at high risk to nurses or physicians for further consultation. Originally developed in Australia, the SMARThealth system is also being evaluated for a range of conditions in China, India, Thailand and Myanmar. The pilot study, conducted in Bhimavaram in Andhra Pradesh and replicated in Haryana, showed that the system holds great promise.

“In this study, we deliberately set out to evaluate how effective our technology platform could be when embedded within the context of a complex local health system,” D Praveen, global SMARThealth project director based at The George Institute, India, says. “The results suggest that instead of reinventing the wheel, efforts should be directed towards culturally adapting and integrating many of the innovations and interventions from other low to middle-income countries to strengthen health systems in Indonesia,” he says.According to a study, published in JAMA Cardiology, about 15% of high risk patients in Indonesian villages, where the system was used, were taking medications to manage their risk factors at follow-up compared to just 1% receiving usual care, with the greatest difference being the use of blood pressure medication which was 57% as against 16%. Blood pressure was also lower in the intervention group at followup.

Though there are a limited number of apps on non-communicable diseases, they mostly are siloed in nature – working for one particular component of the healthcare. For instance, they can be used in screening and record keeping but not for management. SMARThealth is unique as it provides an end-to-end platform for CVD care provision. “Through this platform, health workers can collect information, inform individuals of their risk status, provide lifestyle advice, and refer high-risk individuals for nurse or physician consultation,’’ explains Praveen.

Shared electronic record functionality in the platform allows synchronous or asynchronous transfer of this data to a server through which physicians and nurses receive tailored decision support regarding appropriate prescription of preventive medications, using previous data as well as new data collected during patient consultations. Treatment plans were immediately available to healthworkers, ensuring community-based follow-up. Previously evaluated mobile technology-driven solutions to this problem have focused more on the technology itself, without taking into account the complexity of the healthcare systems in which they are deployed.

A consortium of researchers including the George Institute for Global Health, The University of Brawijaya and the University of Manchester have been funded by the Australian National Health and Medical Research Council to provide technical assistance and to evaluate the scaleup. Lead author and chief scientist at The George Institute for Global Health, Anushka Patel said that it has the potential to improve the lives of people, particularly in low to middle-income countries where CVD is on the rise.

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