@article{20514,
  author = {Heritier Stephane and Maulik P. and Joshi Rohina and Clifton P. and D Prabhakaran and Praveen Devarsetty and Peiris David and Patel Anushka and Jan Stephen and Macmahon S},
  title = {A multifaceted strategy using mobile technology to assist rural primary healthcare doctors and frontline health workers in cardiovascular disease risk management: protocol for the SMARTHealth India cluster randomised controlled trial},
  abstract = {<p>
BACKGROUND: Blood Pressure related disease affected 118 million people in India in the year 2000; this figure will double by 2025. Around one in four adults in rural India have hypertension, and of those, only a minority are accessing appropriate care. Health systems in India face substantial challenges to meet these gaps in care, and innovative solutions are needed. METHODS: We hypothesise that a multifaceted intervention involving capacity strengthening of primary healthcare doctors and non-physician healthcare workers through use of a mobile device-based clinical decision support system will result in improved blood pressure control for individuals at high risk of a cardiovascular disease event when compared with usual healthcare. This intervention will be implemented as a stepped wedge, cluster randomised controlled trial in 18 primary health centres and 54 villages in rural Andhra Pradesh involving adults aged &gt;/=40 years at high cardiovascular disease event risk (approximately 15,000 people). Cardiovascular disease event risk will be calculated based on World Health Organisation/International Society of Hypertension's region-specific risk charts. Cluster randomisation will occur at the level of the primary health centres. Outcome analyses will be conducted blinded to intervention allocation. EXPECTED OUTCOMES: The primary study outcome is the difference in the proportion of people meeting guideline-recommended blood pressure targets in the intervention period vs. the control period. Secondary outcomes include mean reduction in blood pressure levels; change in other cardiovascular disease risk factors, including body mass index, current smoking, reported healthy eating habits, and reported physical activity levels; self-reported use of blood pressure and other cardiovascular medicines; quality of life (using the EQ-5D); and cardiovascular disease events (using hospitalisation data). Trial outcomes will be accompanied by detailed process and economic evaluations. SIGNIFICANCE: The findings are likely to inform policy on a scalable strategy to overcome entrenched inequities in access to effective healthcare for under-served populations in low and middle income country settings. TRIAL REGISTRATION: Clinical Trial Registry India CTRI/2013/06/003753.
</p>
},
  year = {2013},
  journal = {Implementation Science},
  volume = {8},
  edition = {25 November 2013},
  number = {1},
  pages = {137},
  isbn = {1748-5908 (Electronic) - 1748-5908 (Linking)},
  note = {Praveen, Devarsetty<br/>Patel, Anushka<br/>McMahon, Stephen<br/>Prabhakaran, Dorairaj<br/>Clifford, Gari D<br/>Maulik, Pallab K<br/>Joshi, Rohina<br/>Jan, Stephen<br/>Heritier, Stephane<br/>Peiris, David<br/>Implement Sci. 2013 Nov 25;8(1):137.},
  language = {Eng},
}