Improving diabetes care: multi-component cardiovascular disease risk reduction strategies for people with diabetes in South Asia--the CARRS multi-center translation trial
CARRS Trial Writing Group, Seema Shah, Kavita Singh, Mohammed K Ali, V Mohan, Muhammad Masood Kadir, A G Unnikrishnan, Rakesh Kumar Sahay, Premlata Varthakavi, Mala Dharmalingam, Vijay Viswanathan, Qamar Masood, Ganapathi Bantwal, Rajesh Khadgawat, Ankush Desai, Bipin Kumar Sethi, Roopa Shivashankar, Vamadevan S Ajay, K Srinath Reddy, K M Venkat Narayan, Dorairaj Prabhakaran, Nikhil Tandon, K M Venkat Narayan, K Srinath Reddy, Nikhil Tandon, Mohammed Masood Kadir, Mohammed K Ali, Nikhil Tandon, Dorairaj Prabhakaran, Kavita Singh, Raji Devarajan, Roopa Shivanshankar, Mark Hutcheson, Dimple Kondal, Shivam Pandey, Ramanathan K, Gnanasekaran Kuppusamy, Anushka Patel, Mohan Pandey, Sanjay Kalra, A G Unnikrishnan, V Usha Menon, Nisha Bhavani, Sangetha Sukumar, Rahmana Wahab, Nadeera Banu, Rupali Iratwar, Sahil Zari, Jeena John, Akhila Ghosh, Sulfia Jabbar, Kirtica C R, Diana Antony, Premlatha Varthakavi, Manoj Chadha, Nikhil Bhagwat, Roshan D'Britto, Vaibhavi Mungekar, Rohini Gajare, Charul Arora, Bipin Sethi, Mazher Ali, Pandurang Balaji, Mazher Ali, Vijay Vishwanathan, K Uma Mahesh, Bhanu Priya, Mansi Shah, Mala Dharmalingam, Priti Shankar, Nalinakshi Reddy, Ganapati Bantwal, Prem Pais, Vaggesh Aiyyar, Sudha Suresh, Jomia Michael, Praveena Simha, Ritish Colleru, Janice Mascarenhas, Rakesh Kumar Sahay, Ramachandra Reddy, Qamar Masood, Abdul Jabbar, Hassan Daudzai, Imraan Naeem, Sabahat Naz, Nida Zaidi, Rajesh Khadgawat, Kanika Aggarwal, Mansi Chopra, Prashant Singh, Bhanvi Arora, Manish Sachdev, Ankush Desai, P S Narvencar, Vivek Naik, Prashan Navelkar, Rupali Naik, Aparna Pai, Dorairaj Prabhakaran, Seema Shah, Santoshi M, CARRS Trial Writing Group, Seema Shah, Kavita Singh, Mohammed K Ali, V Mohan, Muhammad Masood Kadir, A G Unnikrishnan, Rakesh Kumar Sahay, Premlata Varthakavi, Mala Dharmalingam, Vijay Viswanathan, Qamar Masood, Ganapathi Bantwal, Rajesh Khadgawat, Ankush Desai, Bipin Kumar Sethi, Roopa Shivashankar, Vamadevan S Ajay, K Srinath Reddy, K M Venkat Narayan, Dorairaj Prabhakaran, Nikhil Tandon, K M Venkat Narayan, K Srinath Reddy, Nikhil Tandon, Mohammed Masood Kadir, Mohammed K Ali, Nikhil Tandon, Dorairaj Prabhakaran, Kavita Singh, Raji Devarajan, Roopa Shivanshankar, Mark Hutcheson, Dimple Kondal, Shivam Pandey, Ramanathan K, Gnanasekaran Kuppusamy, Anushka Patel, Mohan Pandey, Sanjay Kalra, A G Unnikrishnan, V Usha Menon, Nisha Bhavani, Sangetha Sukumar, Rahmana Wahab, Nadeera Banu, Rupali Iratwar, Sahil Zari, Jeena John, Akhila Ghosh, Sulfia Jabbar, Kirtica C R, Diana Antony, Premlatha Varthakavi, Manoj Chadha, Nikhil Bhagwat, Roshan D'Britto, Vaibhavi Mungekar, Rohini Gajare, Charul Arora, Bipin Sethi, Mazher Ali, Pandurang Balaji, Mazher Ali, Vijay Vishwanathan, K Uma Mahesh, Bhanu Priya, Mansi Shah, Mala Dharmalingam, Priti Shankar, Nalinakshi Reddy, Ganapati Bantwal, Prem Pais, Vaggesh Aiyyar, Sudha Suresh, Jomia Michael, Praveena Simha, Ritish Colleru, Janice Mascarenhas, Rakesh Kumar Sahay, Ramachandra Reddy, Qamar Masood, Abdul Jabbar, Hassan Daudzai, Imraan Naeem, Sabahat Naz, Nida Zaidi, Rajesh Khadgawat, Kanika Aggarwal, Mansi Chopra, Prashant Singh, Bhanvi Arora, Manish Sachdev, Ankush Desai, P S Narvencar, Vivek Naik, Prashan Navelkar, Rupali Naik, Aparna Pai, Dorairaj Prabhakaran, Seema Shah, Santoshi M
Abstract
Aims: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in people with diabetes in South Asia. The CARRS Translation Trial tests the effectiveness, cost-effectiveness, and sustainability of a clinic-based multi-component CVD risk reduction intervention among people with diabetes in India and Pakistan.
Methods: We randomly assigned 1146 adults with diabetes recruited from 10 urban clinic sites, to receive usual care by physicians or to receive an integrated multi-component CVD risk reduction intervention. The intervention involves electronic health record management, decision-support prompts to the healthcare team, and the support of a care coordinator to actively facilitate patient and provider adherence to evidence-based guidelines. The primary outcome is a composite of multiple CVD risk factor control (blood glucose and either blood pressure or cholesterol, or all three). Other outcomes include control of the individual CVD risk factors, process and patient-centered measures, cost-effectiveness, and acceptability/feasibility.
Conclusion: The CARRS Translation Trial tests a low-cost diabetes care delivery model in urban South Asia to achieve comprehensive cardio-metabolic disease case-management of high-risk patients (clinicaltrials.gov number: NCT01212328).
Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Figures
CC checks EHR to track which patients have upcoming visits. CC sends reminder (text message or phone call) to patient to visit clinic and get needed lab tests done for visit evaluation.
During clinic visit, CC first takes the patient’s intake (history, labs, measurements) and enters the information into the EHR to patient-specific DSS prompts.
CC takes patient to physician and conveys the patient’s status and the treatment DSS prompts to the physician. Physician conducts any exam, updates the plan accounting for the DSS prompts, and provides patient education and needed prescriptions/referrals. The CC updates the response to the DSS prompts (accepted or rejected) and treatment plan in the EHR, including any reminders to schedule.
CC checks EHR to track and send patient reminders for referrals, lab tests, or pharmacy.
CC checks EHR to track and send patient reminders for self-care and motivation.
Source: PubMed