SMARThealth Extend

Background:

• The SMARThealth program involves developing a mobile device-based clinical decision support system (CDSS) to help primary healthcare workers improve optimal preventive treatment in primary health care.
• SMARThealth was originally developed for primary care in Australia, after which it was substantially re-developed for primary care systems in more resource-constrained countries.

Aims:

• SMARThealth Extend – Indonesia was a demonstration project that aimed to determine whether SMARThealth can be appropriately and rapidly customised, and then successfully implemented in a rural community in the Indonesian province of East Java.
   

Methods:

• The program was implemented in Kabupaten Malang in East Java, Indonesia, with trained primary care doctors and non-physician healthcare workers (Kaders) serving a population of approximately 48,000. It focused on increasing the use of effective preventive medicines in people at high risk of cardiovascular disease (CVD).
• The impact of the program was determined by comparing outcomes in four intervention villages compared with four control villages.

Impact:

• SMARThealth resulted in a significant increase in the use of optimal combinations of preventive medications (a blood pressure lowering drug together with a statin and aspirin in those with previous CVD) among high-risk people - 15.5% in SMARThealth villages compared with 1.0% in control villages.
• In particular, SMARThealth resulted in large increases in the use of blood pressure lowering drugs in the intervention villages compared to the control villages - 57% compared to 16% - resulting in large reductions in blood pressure.
• The Malang district government will now embark on a three-year program to scale-up SMARThealth to all ~400 villages in the district. Technical assistance for, and evaluation of this scale-up, will be provided by the research consortium, with funding from the National Health & Medical Research Council (NHMRC)/Global Alliance for Chronic Diseases.