TETRA -A Technology Enabled Community Health Worker Led Intervention to Reduce Cardiovascular Disease Burden in India

TETRA Questionnaires


Cardiovascular disease is the leading cause of death in India. Morbidity due to cardiovascular disease also contributes to significant impoverishment of individuals, families and the nation. Undetected and uncontrolled hypertension and diabetes   contribute to the bulk of cardiovascular disease morbidity and mortality. Therefore, The NCD (Non Communicable Disease) project aims at detection of hypertension and diabetes proactively and initiation of regular treatment and follow -up .The project envisages reducing the burden of cardiovascular disease in the community by improving control of hypertension and diabetes in a community setting. The concept of a community health worker being used as a focal operator to liaise between the community and the health care providers is an innovative option to improve availability, accessibility and affordability of services intended to address the growing burden cardiovascular disease.

After a   pre-pilot project to identify the logistic and operational challenges was carried out in Girmapur and Athivelly  villagesof Medchal  mandal from December 2014 to May 2015,the project was piloted in  Railapur village of Medchal mandal. Using a team based approach(a typical team comprising one supervisor,4 trained SHARE INDIA field workers, one ANM and 2 community health workers-6 members in all; the two community health workers accompany, observe and  receive hands- on  supervised training during the first round of screening in the village to build their competency to independently administer questionnaire, perform blood pressure and blood sugar measurements, use the tablet device and facilitate Skype calls between  the patient and the physician)).The team of Six health workers(accompanied by two trainee community health workers ) equipped with point-of-care devices for blood sugar and blood pressure estimation and a tablet device with an interface for data entry and facility to share it via a secure data cloud with a physician at MediCiti hospital Medchal.

The software developed by our in-house data management team features secure data capture on a tab , its subsequent storage in the cloud as patient electronic health record and allows seamless  secure access and easy retrieval by a treating doctor so as to facilitate delivery of community level care for hypertension and diabetes via videoconference using Skype®. Further monitoring and evaluation of whole project can be done by a live data analytics interface which provides dynamic updates on an array of analytics of interest with regard to assess progress of the project and assess patients’ response to treatment

The health workers enabled by a Tablet computer, Electronic blood pressure measurement apparatus and a Glucometer to measure blood sugar visited each house hold in the selected   village of Medchal Mandal and screened men and women aged ≥20 years for hypertension and diabetes. Diabetes was confirmed by HB A1C. (HbA1c≥6.5). Hypertension is diagnosed when blood pressure is  ≥140/90 on at least two different occasions, with 3 readings being taken on each occasion .Whenever hypertension or Diabetes is diagnosed, the patient has virtual face to face interview with a doctor in Mediciti, facilitated by telemedicine equipment. Prescription of the doctor is printed at patient’s home using a portable wireless thermal printer carried by the health worker. Medicines are provided free of cost to all those in need by ANMS of our health care teams of SHARE INDIA. SHARE INDIA is evolving a model for cost effective technology enabled health care delivery including telemedicine. Hypertension control is defined as blood pressure <140/90 mmHg and Blood sugar control is defined as fasting Blood Sugar<130mg%.

 

Investigators:

SHARE INDIA , MediCiti Institute of Medical Sciences.

  • Dr P. S. Reddy, MD – Chairman, SHARE; Professor of Medicine, UPMC
  • Dr D. Shailendra, MD – Associate Professor, Dept of Pharmacology, MIMS
  • Dr K. Govind N. MD – Head of Department, Dept of Community Medicine, MIMS

OBJECTIVES

  1. To evaluate the effectiveness of a technology enabled community health worker led intervention to improve the extent of hypertension and diabetes control in the community

EXPECTED OUTCOME

Will help to evaluate the effectiveness of a low cost strategy for enhancing utilization of health care services for hypertension and diabetes control Offers scope to identify the operational challenges with implications for up-scaling at multiple locations across India May be used as a template into which appropriate context specific health care delivery services can be added sequentially with little additional resource burden