Research Article: Technology enabled non-physician health workers extending telemedicine to rural homes to control hypertension and diabetes (TETRA): A pre-post demonstration project in Telangana, India

Date Published: February 19, 2019

Publisher: Public Library of Science

Author(s): Shailendra Dandge, Panniyammakal Jeemon, P. S. Reddy, Thomas Martin Deserno.


We aimed to determine the feasibility and effectiveness of an intervention anchored on mHealth and task sharing strategy of involving non-physician health workers (NPHW) on population level detection, treatment and control of hypertension and diabetes in India.

Non-physician health workers (NPHWs) equipped with tablet computers that were linked with point-of-care devices for blood pressure (BP) and blood sugar measurements visited households, screened adult individuals for hypertension and diabetes from two randomly selected villages in the Medchal district, Telangana, India. Further, they digitally connected those individuals with hypertension and diabetes to a study physician via Skype, and handed over a printed e-prescription. Medication adherence checks, BP and fasting blood sugar measurements were done once a month and doctor consultations once in three months during follow-up.

Among 2456 eligible individuals, 1751 and 1686 individuals were screened for hypertension and diabetes, respectively. Prevalence of hypertension was 23·6% (95% CI 21·6%-25·6%) and among them 38.9% were newly detected. Prevalence of diabetes was 11·2% (9·7%-12·7%) and 28.6% of them were newly detected. After 24 months of intervention, control of BP and blood sugar was achieved in 54.0% and 34·1% of individuals with hypertension and diabetes, respectively. Blood pressure control rate improved by 12% (7.9%-16.0%) in known hypertensive individuals over the intervention period.

This research demonstrates the feasibility and local acceptability of a mHealth intervention strategy anchored on NPHWs guided by physicians for detection, treatment and regular follow-up of individuals with hypertension and diabetes in a community setting in India.

Partial Text

Currently, 28% of all deaths in India are attributable to cardiovascular diseases (CVD)[1]. Hypertension and diabetes are two major risk factors of CVD. For example, hypertension attributes 48% and 18% of all stroke and Coronary Heart Disease (CHD) deaths in India, respectively[2,3]. Furthermore, individuals with diabetes are reported to be at two to four fold-increased risk of CHD compared to those without diabetes[4]

Our study demonstrates the feasibility of implementing a novel model in detection and management of hypertension and diabetes in resource poor settings. The intervention model is unique due to the following reasons; a) employs a combination of task-sharing and mHealth strategies, b) incorporates technological capabilities of integrating both screening and evaluation tools in one single mHealth application, c) facilitates direct entry of all objective measurements into the EHR, d) enables electronic consultation between the patient and the study physician that permits real time prescription of appropriate medicines for the control of BP and blood sugar. The technology enabled and trained NPHW shared the responsibility of screening, risk management, and maintenance of the electronic health records of hypertension and diabetes patients. The implementation study highlights the acceptability of the intervention model in community settings, and shows improvement in clinical outcomes in terms of BP and blood sugar control at the community level.

Our study demonstrates the feasibility, and local acceptability of implementing a mHealth and task-sharing intervention model for hypertension and diabetes detection and control in community settings in India. Our strategy holds promise to facilitate delivery of care on a continuum for hypertension and diabetes in resource poor settings.




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