- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05511701
Preventing Ischemic Heart Disease With mHealth (Mobile Health), Electronic Decision Support and Community Health Workers (PRIMECare)
April 2, 2024 updated by: Thomas Gaziano, Harvard School of Public Health (HSPH)
Preventing Ischemic Heart Disease With mHealth, Electronic Decision Support, and Community Health Workers (PRIMECare Trial)
This is a cluster-randomized clinical trial (cRCT) designed to assess the effectiveness of a multicomponent strategy linking key aspects of the cardiovascular disease (CVD) care continuum across three provinces in Argentina using using five primary components: a data management system linking a digital mHealth (mobile health) screening tool used by community health workers (CHWs), an electronic appointment scheduler which is integrated with the clinic electronic appointment system, point of care (POCT) testing for lipids, a clinical decision support system for medication initiation, and a text message (SMS) reminder system to improve treatment adherence and life-style changes.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed Description
954 eligible women and men aged 40-74 with high CVD risk living in the catchment area of 18 primary care clinics (PCCs) in 3 different provinces (Quilmes, La Rioja, and San Juan) in Argentina will be recruited for the study.
Eighteen PCCs will be randomized to either the usual care (control) arm or the intervention arm (3 usual care and 3 intervention PCCs in each province).
Participants who reside in the catchment area of intervention PCCs will receive the multicomponent intervention with central data management system linking digital mHealth (mobile health) screening tool for CHWs, electronic appointment scheduling which is integrated with the clinic electronic appointment system, point of care testing (POCT) for lipids, clinical decision support for medication initiation, and a SMS reminder system for adherence to medications and life-style changes, while participants who reside in the catchment area of usual care PCCs will receive usual care with paper-based guidelines used by community health workers and providers.
The recruitment goals are 477 persons in the intervention arm and 477 in the usual care arm.
Participants will be enrolled for a 12 month study period from baseline visit, and the primary outcome is mean difference in absolute 10-year CVD risk.
Study Type
Interventional
Enrollment (Estimated)
954
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Shafika Abrahams-Gessel, AB, MS< DRPH
- Phone Number: 6174324385
- Email: sabraham@hsph.harvard.edu
Study Locations
-
-
-
Buenos Aires, Argentina
- Recruiting
- Iecs Instituto de Efectividad Clinica Y Sanitaria
-
Contact:
- Andrea Beratarrechea
- Email: aberatarrechea@iecs.org.ar
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
40 years to 74 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- aged 40-74
- depend exclusively on public health insurance
- have access to a cell phone for personal use
- can open and read SMS messages on cell phone
- receive primary care at the local PCC
- have a 10-year CVD risk >= 10% and mean SBP >= 140 mmHg OR
- have a 10-year CVD risk >= 10% and LDL-C >= 70 mg/dL for persons with diabetes OR
- have a 10-year CVD risk >= 10% and LDL-C >= 100 mg/dL for persons without diabetes
Exclusion Criteria:
- Persons who plan to move from the neighborhood within the next 2 years
- pregnant at the time of screening
- Bed bound
- Weight > 180 kg - this exceeds the upper limit that can be measured on portable scales.
- Total cholesterol < 100 mg/dL or > 500 mg/dL.
- LDL-C > 300 mg/dL
- Triglycerides < 45 mg/dL or > 400 mg/dL.
- HDL < 15 mg/dL.
- Systolic blood pressure (SBP) >=180 mmHg or Diastolic blood pressure (DBP) >= 120 mmHg, and experiencing chest pain, palpitations, or shortness of breath.
- currently on dialysis or has a history of chronic kidney disease.
- self-reported history of CVD (stroke, AMI).
- self-reported history of a liver abnormality.
- have a mid-upper arm circumference > 42 cm - this is the maximum cuff size available for use with blood pressure monitors in Argentina
- do not consent to participate.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Usual Care
with paper-based guidelines used by community health workers (CHW) and providers
|
All study participants will be visited in their home by a CHW and a nurse for eligibility assessment, screening, and enrollment.
The CHW will then measure the participant's blood pressure and the readings along with other demographic variables already collected, to calculate the participant's absolute CVD risk score.
In the usual care arm the CHW will use the WHO paper-based non-lab CVD risk calculator and, if the participant's risk is > 10%, they are asked to sign the informed consent and s/he will have their cholesterol tested by nurses using POCT during a home enrollment visit.
The CHW will further verbally encourage her/him to schedule an appointment with a primary care physician at the PCC for evaluation.
This is the usual care practice.
|
Experimental: Intervention
with central data management system linking digital mHealth screening tool for CHWs, electronic appointment scheduling, point of care testing (POCT) for lipids, clinical decision support for medication initiation, and a SMS reminder system for adherence to medications and life-style changes
|
The CHW will measure the participant's blood pressure (BP) and along with other demographic variables, calculate the participant's absolute CVD risk score, using the mHealth (mobile health) app.
If the participant's risk is > 10%, they are asked to sign the informed consent.
The CHW will electronically schedule an appointment at the PCC.
The participant will receive a SMS appointment confirmation.
S/he will have their cholesterol tested by nurses using a home POCT.
Nurses will repeat POCT lipids and BP measurements at all PCC visits and other clinical information will be entered into the electronic decision support tool that will generate a guideline based treatment recommendation for the physician.
CHWs will make up to four home visits or telephone calls to intervention participants over the 12 month study period to check on medication adherence, as well as to determine if the patient is in possession of the medication
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Difference in mean change in absolute CVD risk, calculated using the Framingham cardiovascular disease lab-based risk equation, between study arms at 12 months
Time Frame: At enrollment (baseline) and 12 months after enrollment
|
The difference in mean change in 10-year CVD risk between study arms
|
At enrollment (baseline) and 12 months after enrollment
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Difference in mean change in LDL-C between study arms at 12 months
Time Frame: At enrollment (baseline) and 12 months after enrollment
|
The difference in mean change in LDL-C between study arms.
|
At enrollment (baseline) and 12 months after enrollment
|
Difference in mean change in systolic blood pressure between study arms at 12 months
Time Frame: At enrollment (baseline) and 12 months after enrollment
|
The difference in mean change in systolic blood pressure between study arms.
|
At enrollment (baseline) and 12 months after enrollment
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Changes in smoking rates over 12-month study period
Time Frame: At enrollment (baseline) and 12 months after enrollment
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The difference in mean smoking rates between study arms
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At enrollment (baseline) and 12 months after enrollment
|
Medical costs incurred over 12-month study period
Time Frame: From enrollment to end of the study period at 12 months
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The difference in medical costs between study arms
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From enrollment to end of the study period at 12 months
|
Medication possession ratios at 12 months between study arms
Time Frame: At 12 months after enrollment
|
Ratio of prescribed statins and anti-hypertension medications in participants' possession
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At 12 months after enrollment
|
Medication intensity changes
Time Frame: From enrollment to end of the study period at 12 months
|
Number of treatment intensity changes for statins and anti-hypertension medications in the intervention arm
|
From enrollment to end of the study period at 12 months
|
Major adverse reactions for statins and anti-hypertension medications
Time Frame: From enrollment to end of the study period at 12 months
|
Number of reported adverse reactions for statins and anti-hypertension medications in intervention arm
|
From enrollment to end of the study period at 12 months
|
Quality adjusted life years (QALYs)
Time Frame: From enrollment to end of the study period at 12 months
|
Summary of the impact the intervention on CVD risk
|
From enrollment to end of the study period at 12 months
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Proportion of patients with a 10-year CVD risk ≥ 10% that complete a first visit at the local clinic within 6 weeks after enrollment in the study.
Time Frame: 6 weeks from enrollment.
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Proportion of patients with a 10-year CVD risk ≥ 10% that complete a visit at the local clinic within 6 weeks after enrollment in the study.
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6 weeks from enrollment.
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Proportion of patients with a 10-year CVD risk ≥ 10% that complete a first visit at the local clinic within 4 months after enrollment in the study.
Time Frame: 4 months from enrollment
|
Proportion of patients with a 10-year CVD risk ≥ 10% that complete a first visit at the local clinic within 4 months after enrollment in the study.
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4 months from enrollment
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Number of clinical visits between study arms at 12 months
Time Frame: From enrollment to end of the study period at 12 months
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Number of clinical visits by participants to primary care clinics
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From enrollment to end of the study period at 12 months
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Health utilization outcomes
Time Frame: From enrollment to end of the study period at 12 months
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Number of hospitalizations, emergency room visits, outpatient visits and procedures, and primary care clinic visits
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From enrollment to end of the study period at 12 months
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Mortality
Time Frame: From the start of enrollment to 12, then 60 months after enrollment
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Number of deaths from all causes
|
From the start of enrollment to 12, then 60 months after enrollment
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Thomas A Gaziano, MD, MSc, Harvard School of Public Health (HSPH)
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
October 14, 2022
Primary Completion (Estimated)
December 1, 2024
Study Completion (Estimated)
June 1, 2025
Study Registration Dates
First Submitted
August 5, 2022
First Submitted That Met QC Criteria
August 19, 2022
First Posted (Actual)
August 23, 2022
Study Record Updates
Last Update Posted (Actual)
April 4, 2024
Last Update Submitted That Met QC Criteria
April 2, 2024
Last Verified
April 1, 2024
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- IRB20-1166
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
YES
IPD Plan Description
Because of the sensitive nature of the data collected for this study, requests to access the data set from qualified researchers trained in human subject confidentiality protocols may be sent to the primary investigator.
IPD Sharing Time Frame
After the date of study closure up to 5 years.
IPD Sharing Access Criteria
Investigators who wish to use the data will be required to send a detailed proposal, including an analytic plan, to the primary investigator for review.
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- ICF
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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