Characteristics of the study population.

Characteristics of the study population.</p

Summary of hypertension screening.

Summary of hypertension screening.</p

Comparison of change in blood pressure.

Comparison of change in blood pressure.</p

Summary of diabetes screening.

Summary of diabetes screening.</p

Technology enabled non-physician health workers extending telemedicine to rural homes to control hypertension and diabetes (TETRA): A pre-post demonstration project in Telangana, India

ObjectivesWe aimed to determine the feasibility and effectiveness of an intervention anchored on mHealth and task sharing strategy of involving non-physician health workers (NPHW) on population level detection, treatment and control of hypertension and diabetes in India.MethodsNon-physician health workers (NPHWs) equipped with tablet computers that were linked with point-of-care devices for blood pressure (BP) and blood sugar measurements visited households, screened adult individuals for hypertension and diabetes from two randomly selected villages in the Medchal district, Telangana, India. Further, they digitally connected those individuals with hypertension and diabetes to a study physician via Skype, and handed over a printed e-prescription. Medication adherence checks, BP and fasting blood sugar measurements were done once a month and doctor consultations once in three months during follow-up.ResultsAmong 2456 eligible individuals, 1751 and 1686 individuals were screened for hypertension and diabetes, respectively. Prevalence of hypertension was 23·6% (95% CI 21·6%-25·6%) and among them 38.9% were newly detected. Prevalence of diabetes was 11·2% (9·7%-12·7%) and 28.6% of them were newly detected. After 24 months of intervention, control of BP and blood sugar was achieved in 54.0% and 34·1% of individuals with hypertension and diabetes, respectively. Blood pressure control rate improved by 12% (7.9%-16.0%) in known hypertensive individuals over the intervention period.InterpretationThis research demonstrates the feasibility and local acceptability of a mHealth intervention strategy anchored on NPHWs guided by physicians for detection, treatment and regular follow-up of individuals with hypertension and diabetes in a community setting in India.</div

Comparison of change in blood sugar and HbA1c levels.

Comparison of change in blood sugar and HbA1c levels.</p

Intervention strategy.

Intervention strategy.</p

S1 Table: Functions of home-based records (HBR), S1 Box: Different types of HBRs included in the review, S2 Table: Characteristics of included studies, S3 Table: Results of mixed methods appraisal tool, S4: Systematic review protocol registered in PROSPERO (CRD42019139365), S5: Example search strategy in EMBASE, S6: PRISMA checklist, S2 Box: Search strategy in Ovid MEDLINE.

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Impact of HBR on health service outcomes.

Impact of HBR on health service outcomes.</p

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.

LMIC = Low and middle-income countries, CVD = Cardiovascular disease, PHR = Patient-held health record, NCD = Non-communicable disease, MCH = maternal, and child health.</p