1. Protocol for the mWellcare trial: a multicentre, cluster randomised, 12-month, controlled trial to compare the effectiveness of mWellcare, an mHealth system for an integrated management of patients with hypertension and diabetes, versus enhanced usual care in India
- Author
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Dorairaj Prabhakaran, Vikram Patel, Kavita Singh, Devraj Jindal, Nikhil Tandon, Jonathan Nyong, Priti Gupta, Ambuj Roy, Vidya Venugopal, Pramod Jacob, David Prieto-Merino, Shifalika Goenka, Dilip Jha, Vamadevan S. Ajay, and Pablo Perel
- Subjects
Blood Glucose ,Rural Population ,decision support system ,Cost-Benefit Analysis ,030204 cardiovascular system & hematology ,Cardiovascular Medicine ,law.invention ,0302 clinical medicine ,Randomized controlled trial ,law ,Outcome Assessment, Health Care ,Protocol ,Cluster Analysis ,030212 general & internal medicine ,Cluster randomised controlled trial ,mHealth ,Evidence-Based Medicine ,diabetes ,General Medicine ,Telemedicine ,3. Good health ,Cardiovascular Diseases ,Community health ,Guideline Adherence ,medicine.medical_specialty ,hypertension ,India ,03 medical and health sciences ,medicine ,Diabetes Mellitus ,Humans ,Glycated Hemoglobin ,integrated management of chronic conditions ,Primary Health Care ,business.industry ,Public health ,Decision Support Systems, Clinical ,Integrated care ,Clinical trial ,Family medicine ,Physical therapy ,Managed care ,business ,Cell Phone ,Program Evaluation - Abstract
IntroductionRising burden of cardiovascular disease (CVD) and diabetes is a major challenge to the health system in India. Innovative approaches such as mobile phone technology (mHealth) for electronic decision support in delivering evidence-based and integrated care for hypertension, diabetes and comorbid depression have potential to transform the primary healthcare system.Methods and analysismWellcare trial is a multicentre, cluster randomised controlled trial evaluating the clinical and cost-effectiveness of a mHealth system and nurse managed care for people with hypertension and diabetes in rural India. mWellcare system is an Android-based mobile application designed to generate algorithm-based clinical management prompts for treating hypertension and diabetes and also capable of storing health records, sending alerts and reminders for follow-up and adherence to medication. We recruited a total of 3702 participants from 40 Community Health Centres (CHCs), with ≥90 at each of the CHCs in the intervention and control (enhanced care) arms. The primary outcome is the difference in mean change (from baseline to 1 year) in systolic blood pressure and glycated haemoglobin (HbA1c) between the two treatment arms. The secondary outcomes are difference in mean change from baseline to 1 year in fasting plasma glucose, total cholesterol, predicted 10-year risk of CVD, depression, smoking behaviour, body mass index and alcohol use between the two treatment arms and cost-effectiveness.Ethics and disseminationThe study has been approved by the institutional Ethics Committees at Public Health Foundation of India and the London School of Hygiene and Tropical Medicine. Findings will be disseminated widely through peer-reviewed publications, conference presentations and other mechanisms.Trial registrationmWellcare trial is registered with Clinicaltrial.gov (Registration numberNCT02480062; Pre-results) and Clinical Trial Registry of India (Registration number CTRI/2016/02/006641). The current version of the protocol is Version 2 dated 19 October 2015 and the study sponsor is Public Health Foundation of India, Gurgaon, India (www.phfi.org).
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- 2017