New smartphone app to fight toll from high blood pressure

.Researchers in India and Australia have come together to undertake a new smartphone research project aimed at fighting the heavy toll of high blood pressure in rural communities.

 High blood pressure, or hypertension, has been strongly linked to increased risk of death and disability from heart attacks and strokes. More than 30% urban and 25% rural Indians are hypertensive. 

The George Institute for Global Health research project, known as SMART Health India, begins next month  (first week in December). It provides health care workers in 54 villages in rural Andhra Pradesh with electronic tablets loaded with tools developed at the George Institute and the University of Sydney to screen patients, identify them for high risk of cardiovascular diseases and refer them to medical services if necessary. The system also allows these workers to provide on-the-spot, personalised health recommendations along with provision of management recommendations to the doctors.

The decision support system (DSS) was initially developed by researchers at the George Institute Australia and the University of Sydney, to manage common cardiovascular diseases in urban, rural and remote Australian settings. It was  later modified using Indian guidelines. Along with the DSS, a suite of other support mechanisms like priority listing to  prioritise patients, voice messages and a computer based training platform were developed to increase the uptake of the intervention and make it more suitable for the community. 

It is partly funded by a $1million Australian National Health and Medical Research Council grant, as part of an international initiative coordinated by the Global Alliance for Chronic Disease (GACD).

Study leader Dr D Praveen, of the George Institute India and the University of Sydney, said: “Since wireless networks  now reach over 80 per cent of India’s population, SMART Health India has the potential to revolutionise the delivery of  essential healthcare to those who previously had little or no access.

"If the app flashes a high risk sign, ASHA workers refer patients to the nearest primary health center for the doctor  there to act. The tablet with the doctor is automatically updated with the data entered by the ASHA. Females married  into the village are selected as ASHA workers by the Government so that they do not leave the village and are easily  connected with the community," said Dr Praveen.

"Our ultimate goal is to determine whether this approach will deliver meaningful reductions in death, disability  and ‘catastrophic’ healthcare expenditure (i.e. healthcare costs that endanger the financial security of patients and  their families) across a range of geographies and cultures. We believe that such evidence will provide a strong case for  scale-up to all disadvantaged communities in the region and many other parts of the world, with implications for the  health and wellbeing of billions of people," says Dr Praveen.

The app will now be used to provide an intervention that aims to demonstrate task-sharing between doctors and non-physician health care workers aimed at widening health care access to people in these villages. It is designed to save doctors’ time, by using health workers to conduct basic screening. 

Originally, SMART Health was developed for the management of cardiovascular disease, but now the George Institute is  planning to branch out to include other chronic diseases such as diabetes and other illnesses such as kidney disease,  respiratory disease, tuberculosis and malaria. Common mental health disorders will now also be targeted, following new funding from the Welcome Trust and Grand Challenges, Canada.

“This is an important program on non-communicable diseases and we welcome this development as this research output will  be useful in the scaling up of NCD programs throughout the State and the country,’’ says a spokesperson of the  Directorate of Public Health and Family Welfare of the Andhra Pradesh Government, which has issued a letter of support to the Institute in this regard.     

The project which has been approved by the ethics committee and the Health Ministry screening committee will use the 'SMART Health-India', an android-based decision support system app developed by the George Institute for Global Health India with support from the Institute of Bio-Medical Engineering at Oxford University.