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Original Investigation
August 28, 2019

Association of Multifaceted Mobile Technology–Enabled Primary Care Intervention With Cardiovascular Disease Risk Management in Rural Indonesia

Author Affiliations
  • 1The George Institute for Global Health, University of New South Wales, Sydney, Australia
  • 2The George Institute for Global Health, University of New South Wales, Hyderabad, India
  • 3Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
  • 4Division of Cardiovascular Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
  • 5Department of Biomedicine, Faculty of Medicine, University of Airlangga, Surabaya, Indonesia
  • 6Independent Public Health Consultant, New Delhi, India
  • 7Department of Public Administration, University of Brawijaya, Malang, Indonesia
  • 8Global Development Institute, The University of Manchester, Manchester, United Kingdom
JAMA Cardiol. Published online August 28, 2019. doi:10.1001/jamacardio.2019.2974
Key Points

Question  Is a mobile technology–supported primary health care intervention associated with greater use of preventive drug treatments compared with usual care among individuals at high risk of cardiovascular disease?

Findings  In this quasi-experimental study involving 8 villages and 6579 high-risk individuals in rural Indonesia, 15.5% of individuals in the intervention villages reported appropriate use of preventive medications compared with 1.0% in the control villages. A total of 56.8% of individuals in the intervention villages used blood pressure medication vs 15.7% of individuals in the control villages.

Meaning  The primary health care intervention was associated with increased use of preventive drug therapies in people with high estimated risk of cardiovascular disease.

Abstract

Importance  Cardiovascular diseases (CVDs) are the leading cause of disease burden in Indonesia. Implementation of effective interventions for CVD prevention is limited.

Objective  To evaluate whether a mobile technology–supported primary health care intervention, compared with usual care, would improve the use of preventive drug treatment among people in rural Indonesia with a high risk of CVD.

Design, Setting, and Participants  A quasi-experimental study involving 6579 high-risk individuals in 4 intervention and 4 control villages in Malang district, Indonesia, was conducted between August 16, 2016, and March 31, 2018. Median duration of follow-up was 12.2 months. Residents 40 years or older were invited to participate. Those with high estimated 10-year risk of CVD risk (previously diagnosed CVD, systolic blood pressure [BP] >160 mm Hg or diastolic BP >100 mm Hg, 10-year estimated CVD risk of 30% or more, or 10-year estimated CVD risk of 20%-29% and a systolic BP >140 mm Hg) were followed up.

Interventions  A multifaceted mobile technology–supported intervention facilitating community-based CVD risk screening with referral, tailored clinical decision support for drug prescription, and patient follow-up.

Main Outcomes and Measures  The primary outcome was the proportion of individuals taking appropriate preventive CVD medications, defined as at least 1 BP-lowering drug and a statin for all high-risk individuals, and an antiplatelet drug for those with prior diagnosed CVD. Secondary outcomes included mean change in BP from baseline.

Results  Among 22 635 adults, 3494 of 11 647 in the intervention villages (30.0%; 2166 women and 1328 men; mean [SD] age, 58.3 [10.9] years) and 3085 of 10 988 in the control villages (28.1%; 1838 women and 1247 men; mean [SD] age, 59.0 [11.5] years) had high estimated risk of CVD. Of these, follow-up was completed in 2632 individuals (75.3%) from intervention villages and 2429 individuals (78.7%) from control villages. At follow-up, 409 high-risk individuals in intervention villages (15.5%) were taking appropriate preventive CVD medications, compared with 25 (1.0%) in control villages (adjusted risk difference, 14.1%; 95% CI, 12.7%-15.6%). This difference was driven by higher use of BP-lowering medication in those in the intervention villages (1495 [56.8%] vs 382 [15.7%]; adjusted risk difference, 39.4%; 95% CI, 37.0%-41.7%). The adjusted mean difference in change in systolic BP from baseline was −8.3 mm Hg (95% CI, −10.1 to −6.6 mm Hg).

Conclusions and Relevance  This study found that a multifaceted mobile technology–supported primary health care intervention was associated with greater use of preventive CVD medication and lower BP levels among high-risk individuals in a rural Indonesian population.

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