Browsing by Author "Patel, Vikram"
Now showing 1 - 4 of 4
Results Per Page
Sort Options
- ItemDevelopment of mWellcare: an mHealth intervention for integrated management of hypertension and diabetes in low-resource settings.(0000-00-00) Jindal, Devraj; Gupta, Priti; Jha, Dilip; Ajay, Vamadevan S; Goenka, Shifalika; Jacob, Pramod; Mehrotra, Kriti; Perel, Pablo; Nyong, Jonathan; Roy, Ambuj; Tandon, Nikhil; Prabhakaran, Dorairaj; Patel, VikramBACKGROUND Cardiovascular diseases and diabetes are among the leading causes of premature adult deaths in India Innovative approaches such as clinical decision support CDS software could play a major role in improving the quality of hypertension diabetes care in primary care settings OBJECTIVE To describe the steps and processes in the development of mWellcare a complex intervention based on mobile health mHealth technology METHODS The Medical Research Council framework was used to develop mWellcare in four steps 1 identify gaps in usual care through literature review and health facility assessments 2 identify the components of the intervention through discussions and consultations with experts 3 develop intervention clinical algorithms and mHealth system and 4 evaluate acceptability and feasibility through pilot testing in five community health centers RESULTS Lack of evidence based integrated and systematic management of chronic conditions were major gaps identified Experts in information technology clinical fields and public health professionals identified intervention components to address these gaps Thereafter clinical algorithm contextualized to primary care settings were prepared and the mWellcare intervention was developed During the 2 month pilot 631 patients diagnosed with hypertension and or diabetes were registered with a follow up rate of 36 2 The major barrier was resistance to follow mWellcare recommended patient workflow and to overcome it we emphasized onsite training and orientation program to cover all health care team member in each CHC CONCLUSION A pilot tested mWellcare intervention is an mHealth system with important components i e integrated management of chronic conditions evidence based CDS longitudinal health data and automated short messaging service to reinforce compliance to drug intake and follow up visit which will be used by nurses at primary health care settings in India The effectiveness and cost effectiveness of the intervention will be tested through a cluster randomized trial trial registration number NCT02480062
- ItemEffectiveness of an mHealth-Based Electronic Decision Support System for Integrated Management of Chronic Conditions in Primary Care: The mWellcare Cluster-Randomized Controlled Trial.(0000-00-00) Prabhakaran, Dorairaj; Jha, Dilip; Prieto-Merino, David; Roy, Ambuj; Singh, Kavita; Ajay, Vamadevan S; Jindal, Devraj; Gupta, Priti; Kondal, Dimple; Goenka, Shifalika; Jacob, Pramod David; Singh, Rekha; Prakash Kumar, B G; Perel, Pablo; Tandon, Nikhil; Patel, VikramBACKGROUND The burden of noncommunicable diseases and their risk factors has rapidly increased worldwide including in India Innovative management strategies with electronic decision support and task sharing have been assessed for hypertension diabetes mellitus and depression individually but an integrated package for multiple chronic condition management in primary care has not been evaluated METHODS In a prospective multicenter open label cluster randomized controlled trial involving 40 community health centers using hypertension and diabetes mellitus as entry points we evaluated the effectiveness of mWellcare an mHealth system consisting of electronic health record storage and an electronic decision support for the integrated management of 5 chronic conditions hypertension diabetes mellitus current tobacco and alcohol use and depression versus enhanced usual care among patients with hypertension and diabetes mellitus in India At trial end 12 month follow up using intention to treat analysis we examined the mean difference between arms in change in systolic blood pressure and glycated hemoglobin as primary outcomes and fasting blood glucose total cholesterol predicted 10 year risk of cardiovascular disease depression score and proportions reporting tobacco and alcohol use as secondary outcomes Mixed effects regression models were used to account for clustering and other confounding variables RESULTS Among 3698 enrolled participants across 40 clusters mean age 55 1 years SD 11 years 55 2 men 3324 completed the trial There was no evidence of difference between the 2 arms for systolic blood pressure 0 98 95 CI 4 64 to 2 67 and glycated hemoglobin 0 11 95 CI 0 24 to 0 45 even after adjustment of several key variables adjusted differences for systolic blood pressure 0 31 95 CI 3 91 to 3 29 for glycated hemoglobin 0 08 95 CI 0 27 to 0 44 The mean withingroup changes in systolic blood pressure in mWellcare and enhanced usual care were 13 65 mmHg versus 12 66 mmHg respectively and for glycated hemoglobin were 0 48 and 0 58 respectively Similarly there were no differences in the changes between the 2 groups for tobacco and alcohol use or other secondary outcomes CONCLUSIONS We did not find an incremental benefit of mWellcare over enhanced usual care in the management of the chronic conditions studied CLINICAL TRIAL REGISTRATION URL http www clinicaltrials gov Unique identifier NCT02480062
- ItemThe effectiveness of M-health technologies for improving health and health services: a systematic review protocol.(2010-11-10) Free, Caroline; Phillips, Gemma; Felix, Lambert; Galli, Leandro; Patel, Vikram; Edwards, PhilipBACKGROUND The application of mobile computing and communication technology is rapidly expanding in the fields of health care and public health This systematic review will summarise the evidence for the effectiveness of mobile technology interventions for improving health and health service outcomes M health around the world FINDINGS To be included in the review interventions must aim to improve or promote health or health service use and quality employing any mobile computing and communication technology This includes 1 interventions designed to improve diagnosis investigation treatment monitoring and management of disease 2 interventions to deliver treatment or disease management programmes to patients health promotion interventions and interventions designed to improve treatment compliance and 3 interventions to improve health care processes e g appointment attendance result notification vaccination reminders A comprehensive electronic search strategy will be used to identify controlled studies published since 1990 and indexed in MEDLINE EMBASE PsycINFO Global Health Web of Science the Cochrane Library or the UK NHS Health Technology Assessment database The search strategy will include terms and synonyms for the following mobile electronic devices MEDs and a range of compatible media mobile phone personal digital assistant PDA handheld computer e g tablet PC PDA phone e g BlackBerry Palm Pilot Smartphone enterprise digital assistant portable media player i e MP3 or MP4 player handheld video game console No terms for health or health service outcomes will be included to ensure that all applications of mobile technology in public health and health services are identified Bibliographies of primary studies and review articles meeting the inclusion criteria will be searched manually to identify further eligible studies Data on objective and self reported outcomes and study quality will be independently extracted by two review authors Where there are sufficient numbers of similar interventions we will calculate and report pooled risk ratios or standardised mean differences using meta analysis DISCUSSION This systematic review will provide recommendations on the use of mobile computing and communication technology in health care and public health and will guide future work on intervention development and primary research in this field
- ItemImproving access to care for children with mental disorders: a global perspective.(2013-04-15) Patel, Vikram; Kieling, Christian; Maulik, Pallab K; Divan, GauriDevelopmental disabilities emotional disorders and disruptive behaviour disorders are the leading mental health related causes of the global burden of disease in children aged below 10 years This article aims to address the treatment gap for child mental disorders through synthesising three bodies of evidence the global evidence base on the treatment of these priority disorders the barriers to implementation of this knowledge and the innovative approaches taken to address these barriers and improve access to care Our focus is on low resource settings which are mostly found in low and middle income countries LMIC Despite the evidence base on the burden of child mental disorders and their long term consequences and the recent mental health Gap Action Programme guidelines which testify to the effectiveness of a range of pharmacological and psychosocial interventions for these disorders the vast majority of children in LMIC do not have access to these interventions We identify three major barriers for the implementation of efficacious treatments the lack of evidence on delivery of the treatments the low levels of detection of child mental disorders and the shortage of skilled child mental health professionals The evidence based on implementation although weak supports the use of screening measures for detection of probable disorders coupled with a second stage diagnostic assessment and the use of non specialist workers in community and school settings for the delivery of psychosocial interventions The most viable strategy to address the treatment gap is through the empowerment of existing human resources who are most intimately concerned with child care including parents through innovative technologies such as mobile health with the necessary skills for the detection and treatment of child mental disorders