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Pandemic-related impairment in the monitoring of patients with hypertension and diabetes and the development of a digital solution for the community health worker: quasi-experimental and implementation study

Pandemic-related impairment in the monitoring of patients with hypertension and diabetes and the development of a digital solution for the community health worker: quasi-experimental and implementation study
Pandemic-related impairment in the monitoring of patients with hypertension and diabetes and the development of a digital solution for the community health worker: quasi-experimental and implementation study
Background: The restrictions imposed by the COVID-19 pandemic reduced health service access by patients with chronic diseases. The discontinuity of care is a cause of great concern, mainly in vulnerable regions.

Objective: This study aimed to assess the impact of the COVID-19 pandemic on people with hypertension and diabetes mellitus (DM) regarding the frequency of consultations and whether their disease was kept under control. The study also aimed to develop and implement a digital solution to improve monitoring at home.

Methods: This is a multimethodological study. A quasiexperimental evaluation assessed the impact of the pandemic on the frequency of consultations and control of patients with hypertension and DM in 34 primary health care centers in 10 municipalities. Then, an implementation study developed an app with a decision support system (DSS) for community health workers (CHWs) to identify and address at-risk patients with uncontrolled hypertension or DM. An expert panel assessment evaluated feasibility, usability, and utility of the software.

Results: Of 5070 patients, 4810 (94.87%) had hypertension, 1371 (27.04%) had DM, and 1111 (21.91%) had both diseases. There was a significant reduction in the weekly number of consultations (107, IQR 60.0-153.0 before vs 20.0, IQR 7.0-29.0 after social restriction; P<.001). Only 15.23% (772/5070) of all patients returned for a consultation during the pandemic. Individuals with hypertension had lower systolic (120.0, IQR 120.0-140.0 mm Hg) and diastolic (80.0, IQR 80.0-80.0 mm Hg) blood pressure than those who did not return (130.0, IQR 120.0-140.0 mm Hg and 80.0, IQR 80.0-90.0 mm Hg, respectively; P<.001). Also, those who returned had a higher proportion of controlled hypertension (64.3% vs 52.8%). For DM, there were no differences in glycohemoglobin levels. Concerning the DSS, the experts agreed that the CHWs can easily incorporate it into their routines and the app can identify patients at risk and improve treatment.

Conclusions: The COVID-19 pandemic caused a significant drop in the number of consultations for patients with hypertension and DM in primary care. A DSS for CHW has proved to be feasible, useful, and easily incorporated into their routines.
COVID-19, clinical decision support systems, diabetes mellitus, hypertension, pandemic, patient care management, primary health care, telemedicine
2291-9694
Cimini, Christiane Correa Rodrigues
35079fef-91dc-4156-948d-334e0671df53
Maia, Junia Xavier
7e0ab617-d53f-4a6f-892a-dde05d9d6f5d
Pires, Magda Carvalho
a8437086-d44d-4761-b9a1-fec7315d8079
Ribeiro, Leonardo Bonisson
11a4dfb9-5b78-4b49-be82-93aee1cde939
Pinto, Vânia Soares de Oliveira e Almeida
cd2ba5d5-71be-417a-9932-637726c136c9
Batchelor, James
e53c36c7-aa7f-4fae-8113-30bfbb9b36ee
Ribeiro, Antonio Luiz Pinho
de3f94ff-488b-418b-bcc9-0dd2fc5fa547
Marcolino, Milena Soriano
52fd857b-578a-4946-a0da-868449080227
Cimini, Christiane Correa Rodrigues
35079fef-91dc-4156-948d-334e0671df53
Maia, Junia Xavier
7e0ab617-d53f-4a6f-892a-dde05d9d6f5d
Pires, Magda Carvalho
a8437086-d44d-4761-b9a1-fec7315d8079
Ribeiro, Leonardo Bonisson
11a4dfb9-5b78-4b49-be82-93aee1cde939
Pinto, Vânia Soares de Oliveira e Almeida
cd2ba5d5-71be-417a-9932-637726c136c9
Batchelor, James
e53c36c7-aa7f-4fae-8113-30bfbb9b36ee
Ribeiro, Antonio Luiz Pinho
de3f94ff-488b-418b-bcc9-0dd2fc5fa547
Marcolino, Milena Soriano
52fd857b-578a-4946-a0da-868449080227

Cimini, Christiane Correa Rodrigues, Maia, Junia Xavier, Pires, Magda Carvalho, Ribeiro, Leonardo Bonisson, Pinto, Vânia Soares de Oliveira e Almeida, Batchelor, James, Ribeiro, Antonio Luiz Pinho and Marcolino, Milena Soriano (2022) Pandemic-related impairment in the monitoring of patients with hypertension and diabetes and the development of a digital solution for the community health worker: quasi-experimental and implementation study. JMIR Medical Informatics, 10 (3), [e35216]. (doi:10.2196/preprints.35216).

Record type: Article

Abstract

Background: The restrictions imposed by the COVID-19 pandemic reduced health service access by patients with chronic diseases. The discontinuity of care is a cause of great concern, mainly in vulnerable regions.

Objective: This study aimed to assess the impact of the COVID-19 pandemic on people with hypertension and diabetes mellitus (DM) regarding the frequency of consultations and whether their disease was kept under control. The study also aimed to develop and implement a digital solution to improve monitoring at home.

Methods: This is a multimethodological study. A quasiexperimental evaluation assessed the impact of the pandemic on the frequency of consultations and control of patients with hypertension and DM in 34 primary health care centers in 10 municipalities. Then, an implementation study developed an app with a decision support system (DSS) for community health workers (CHWs) to identify and address at-risk patients with uncontrolled hypertension or DM. An expert panel assessment evaluated feasibility, usability, and utility of the software.

Results: Of 5070 patients, 4810 (94.87%) had hypertension, 1371 (27.04%) had DM, and 1111 (21.91%) had both diseases. There was a significant reduction in the weekly number of consultations (107, IQR 60.0-153.0 before vs 20.0, IQR 7.0-29.0 after social restriction; P<.001). Only 15.23% (772/5070) of all patients returned for a consultation during the pandemic. Individuals with hypertension had lower systolic (120.0, IQR 120.0-140.0 mm Hg) and diastolic (80.0, IQR 80.0-80.0 mm Hg) blood pressure than those who did not return (130.0, IQR 120.0-140.0 mm Hg and 80.0, IQR 80.0-90.0 mm Hg, respectively; P<.001). Also, those who returned had a higher proportion of controlled hypertension (64.3% vs 52.8%). For DM, there were no differences in glycohemoglobin levels. Concerning the DSS, the experts agreed that the CHWs can easily incorporate it into their routines and the app can identify patients at risk and improve treatment.

Conclusions: The COVID-19 pandemic caused a significant drop in the number of consultations for patients with hypertension and DM in primary care. A DSS for CHW has proved to be feasible, useful, and easily incorporated into their routines.

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More information

Accepted/In Press date: 13 February 2022
e-pub ahead of print date: 29 March 2022
Published date: 29 March 2022
Additional Information: Originally published in JMIR Medical Informatics (https://medinform.jmir.org), 29.03.2022.
Keywords: COVID-19, clinical decision support systems, diabetes mellitus, hypertension, pandemic, patient care management, primary health care, telemedicine

Identifiers

Local EPrints ID: 470118
URI: http://eprints.soton.ac.uk/id/eprint/470118
ISSN: 2291-9694
PURE UUID: 18894cce-24fa-4002-98c9-cb79ec037d7e
ORCID for James Batchelor: ORCID iD orcid.org/0000-0002-5307-552X

Catalogue record

Date deposited: 03 Oct 2022 16:56
Last modified: 17 Mar 2024 02:45

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Contributors

Author: Christiane Correa Rodrigues Cimini
Author: Junia Xavier Maia
Author: Magda Carvalho Pires
Author: Leonardo Bonisson Ribeiro
Author: Vânia Soares de Oliveira e Almeida Pinto
Author: James Batchelor ORCID iD
Author: Antonio Luiz Pinho Ribeiro
Author: Milena Soriano Marcolino

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