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
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Key result
A technology-enabled task-sharing intervention involving non-physician health workers improved blood pressure control rates by 12% among known hypertensive individuals over 24 months.
Why the study?
The feasibility and effectiveness of an mHealth and task-sharing strategy using non-physician health workers for population-level detection, treatment, and control of hypertension and diabetes in India remained to be determined.
Does a technology-enabled task-sharing strategy using non-physician health workers improve blood pressure and blood sugar control in rural Indian adults?
Population
Adult individuals from two randomly selected villages in Medchal district, Telangana, India
Comparison
mHealth and task-sharing intervention with non-physician health workers and telemedicine vs baseline (pre-post)
Design
Pre-post demonstration project
Follow-up
24 months
Authors
Discussion
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Member takes
Implication
May support task-sharing models in hypertension care; leaves open confirmation via randomized trials.
Study Design
Type
Observational (n=1,835)
Structured PICO
Does a technology-enabled task-sharing strategy using non-physician health workers improve blood pressure and blood sugar control in rural Indian adults?
P
Population
1,835 adults aged 20 years and older from two rural villages in India, screened and managed for hypertension and diabetes over a 24-month follow-up period.
I
Intervention
mHealth and task-sharing strategy involving non-physician health workers (NPHWs) equipped with tablet computers and point-of-care devices for blood pressure and blood sugar measurements. NPHWs conducted household visits, facilitated Skype consultations with a study physician, provided e-prescriptions, and conducted monthly follow-ups for 24 months.
O
Outcome
Control of blood pressure (systolic BP <140 mm Hg and diastolic BP <90 mmHg) and blood sugar (HbA1c <7% or fasting blood sugar <126 mg/dl) after 24 months of intervention.surrogate
Main Result
Effect estimate: 12% improvement (95% CI 7.9-16.0)
Absolute Event Rate: 59% vs 47%
p-value: p=<0.0001
A technology-enabled, task-sharing intervention utilizing non-physician health workers is feasible and effectively improves blood pressure and blood sugar control in resource-limited rural communities.
Limitations
- Small scale demonstration project without a comparison group, limiting generalizability.
- The study non-physician health workers were above average in capabilities and motivation, which may be challenging to replicate in scale-up operations.
- Intensive in-office and long duration of on-field supervised training are quite demanding for an average ASHA, making it a challenge to maintain quality in scale-up operations
- Use of venous blood for HbA1c instead of point-of-care testing due to cost constraints
Cite This Study
Dandge et al. (2019) conducted an observational in Hypertension and diabetes (n=1,835). mHealth and task-sharing strategy involving non-physician health workers vs. Pre-intervention baseline was evaluated on Blood pressure control in known hypertensive individuals (12% improvement, 95% CI 7.9-16.0, p=<0.0001). A technology-enabled task-sharing intervention involving non-physician health workers improved blood pressure control rates by 12% among known hypertensive individuals over 24 months.
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