Using mHealth tools to improve access, coverage and treatment of uninsured people with high cardiovascular disease risk in Argentina: a study protocol for a pragmatic cluster randomised trial

ABRAHAMS-GESSEL, SHAFIKA; BERATARRECHEA, ANDREA; IRAZOLA, VILMA; GUTIERREZ, LAURA; MOYANO, DANIELA; FERNANDEZ, ARIEL; CIGANDA, ALVARO; CELIS, LEO ANTHONY; WINKLER, ERIC; RUBINSTEIN, ADOLFO; GAZIANO, THOMAS A

BMJ Innovations

BMJ

Año: 2018

2055-8074

AbstractIntroduction Cardiovascular disease (CVD)accounts for approximately one-third ofArgentina´s deaths. Despite governmentprovision of free primary care health servicesto the uninsured population, with a focus onnon-communicable diseases, screening andmanagement of those with high CVD risk atprimary care clinics (PCCs) remain low.Methods and analysis This pragmatic clusterrandomised trial will take place in two provincesof Argentina and will recruit 740 participants.Eight PCCs will be randomised to either theintervention or current practice arm. Communityhealth workers (CHWs) in the intervention armwill be trained to use a set of integrated mHealthtools (a validated risk screening tool mobileapplication; electronic scheduling system usingwireless access to PCCs; and educational textmessages) to screen for CVD and to scheduleappointments with primary care providers forpersons with high CVD risk (≥10%). The primaryaims of this study are to determine if the use ofmHealth tools will (1) increase attendance of firstappointments scheduled by CHWs for personsdetermined to have high risk for CVD duringscreening and, (2) lead to an increase in followupvisits at PCCs by high risk patients. Secondaryoutcomes include assessing the proportionof high-risk patients receiving appropriatemedications and a cost-effective analysis of theintervention.Ethics and dissemination This study has beenapproved by the Institutional Review Boardsat Partners/Brigham and Women?s Hospital(USA) and the Hospital Italiano de Buenos Aires(Argentina). The open-source software for themHealth tools will be made publicly available atthe end of the study.Trial registration number NCT02913339