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Low cost mobile technology shifts the dial on cardiovascular risk in rural Indonesia

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Posted August 30, 2019

An Australian-developed mobile app supported system that helps health systems identify and better manage people at high risk of cardiovascular disease has been shown to improve the use of appropriate medications and lower blood pressure in rural Indonesian communities.

The study, published in JAMA Cardiology, showed that 15% of high risk patients in 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 (57% vs 16%). Blood pressure was also lower in the intervention group at follow up.

A senior woman. Image credit: Pxhere, CC Public Domain

A senior woman. Image credit: Pxhere, CC Public Domain

Lead author and Chief Scientist at The George Institute for Global Health, Professor Anushka Patel, said that the system has the potential to improve the lives of tens of millions of people, particularly in low to middle income countries where cardiovascular disease (CVD) is on the rise.

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 by The George Institute in Australia and India, the SMARThealth system is also being evaluated for a range of conditions in China, Thailand and Myanmar.

This study included 6579 individuals living in eight rural Indonesian villages in Malang, Indonesia who were identified as being at high risk of cardiovascular disease, defined by:

  • A history of CVD (confirmed by a physician)
  • Extremely high blood pressure (systolic >160mm Hg or diastolic >100mmHg)
  • A 10-year predicted CVD risk ≥ 30%; (based on World Health Organization and International Society of Hypertension data)
  • A 10-year estimated CVD risk of 20-29% and systolic blood pressure >140mm Hg.

Four of the villages were chosen for the intervention using the app and each was matched with one of four ‘control’ villages that received usual care. Baseline data was collected in September 2016 and follow up completed in March 2018.

After 12 months’ use of the system:

  • 15% of those in intervention villages reported appropriate use of preventive medications compared to 1% in control villages
  • 56.8% of those in intervention villages used BP medication compared to just 15.7% in control villages.

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. The Indonesian health care system is highly decentralised and relies on local district health agencies to deliver care via nurses and community health care workers at neighbourhood and village health centres.

The Malang district government is now aiming to scale-up SMARThealth to around 400 villages over the next three years.

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 for, and to evaluate, this scale-up.

Source: George Institute

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