Accepted for/Published in: JMIR Medical Informatics
Date Submitted: Nov 25, 2021
Date Accepted: Feb 13, 2022
Date Submitted to PubMed: Feb 22, 2022
Pandemic-related impairment in the monitoring of patients with hypertension and diabetes and the development of a digital solution for the community health worker: quasi-experimental and implementation study
ABSTRACT
Background:
The restrictions imposed by the COVID-19 pandemic reduced the access of patients with chronic diseases to health services. The discontinuity of care is a cause of great concern, mainly in vulnerable regions.
Objective:
To assess the impact of the COVID-19 pandemic on the frequency of consultations and control of people with hypertension and diabetes (DM) and to develop and implement a digital solution to improve monitoring at home.
Methods:
This is a multi-methodological study. A quasi-experimental evaluation assessed the impact of the pandemic on the frequency of consultations and control of patients with hypertension and DM in 34 primary healthcare centers in 10 municipalities. Then, an implementation study developed an app with a decision support system (DSS) for community health workers (CHW) to identify and address patients with uncontrolled hypertension or DM at risk. An expert panel assessment evaluated feasibility, usability and utility of the software.
Results:
From 5070 patients, 4810 had hypertension (94.87%), 1371 had DM (27.4%) and 1111 (23.1%) had both diseases. There was a significant reduction in the weekly number of consultations (107 [IQR 60.0, 153.0] before vs 20.0 [IQR 7.0, 29.0] after social restriction, P<.001). Only 15.2% of all patients returned for consultation during the pandemic. Individuals with hypertension had lower systolic (120.0 [IQR 120.0-140.0] and diastolic blood pressure (80.0 [IQR 80.0-80]) than the ones that did not return (130.0 [IQR 120.0-140.0] and (80.0 [IQR 80.0-90.0]), P<.001. Also, those who returned had a higher proportion of controlled hypertension (64.3% vs 52.8%). For DM, there were no differences in glycohemoglobin levels. Concerning the DSS, the experts agreed that the CHWs can easily incorporate it into their routines and the app can identify patients at risk and improve the treatment.
Conclusions:
The COVID-19 pandemic caused a significant drop in the number of consultations for patients with hypertension and DM in primary care. A DSS for CHW has proved to be feasible, useful and easily incorporated into their routines.
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