Using mH ealth Tools to Improve Access and Coverage of People With Public Health Insurance and High Cardiovascular Disease Risk in Argentina: A Pragmatic Cluster Randomized Trial

Andrea Beratarrechea, Shafika Abrahams-Gessel, Vilma Irazola, Laura Gutierrez, Daniela Moyano, Thomas A Gaziano, Andrea Beratarrechea, Shafika Abrahams-Gessel, Vilma Irazola, Laura Gutierrez, Daniela Moyano, Thomas A Gaziano

Abstract

Background Control of cardiovascular disease ( CVD ) risk factors is suboptimal in Argentina, despite the government's provision of free blood pressure and cholesterol-lowering medications for people without private insurance. We assessed whether community health workers' use of an integrated mH ealth tool encourages patients to attend visits at primary care clinics to improve CVD risk management in 2 provinces of Argentina. Methods and Results We conducted a pragmatic cluster randomized trial, with primary care clinics randomly assigned to intervention or control. Eligible people were aged 40 to 79 years, lived in the catchment area of primary care clinics, possessed a mobile phone for personal use, had public health coverage, and a 10-year CVD risk ≥10%. In the control arm, community health workers screened for CVD risk using a paper-based tool and encouraged high-risk people to present to the primary care clinics for care. In the intervention arm, community health workers used the mH ealth tool to calculate CVD risk and confirm a scheduled physician appointment. Primary outcomes were the proportion of participants who attended a baseline visit and completed at least 1 follow-up, respectively. We enrolled 755 people (376 interventions; 379 controls). Intervention participants were significantly more likely to complete baseline visits (49.4% versus 13.5%, P value 0.0008) and follow-up visits (31.9% versus 7.7%; P value 0.0041). The use of chronic medication and current smoking were significant predictors of primary outcomes. Conclusions Use of mH ealth tools identifies patients at high CVD risk in their home, increases the likelihood of participating in chronic CVD risk factor management, and strengthens referrals. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 02913339.

Trial registration: ClinicalTrials.gov NCT02913339.

Keywords: Argentina; cardiovascular; mHealth; prevention; screening.

Figures

Figure 1
Figure 1
Process flow in the intervention arm. CHW indicates community health worker; CVD, cardiovascular disease; PCC, primary care center; WHO, World Health Organization.
Figure 2
Figure 2
Flow diagram of trial participants.

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