Batchelor - MRC UKRI - CHArMING: Control of Hypertension and diAbetes in MINas Gerais (September 2018)

In Brazil, the frequency of adults with high blood pressure is around 35%, while diabetes is self-reported in 6.2%. Getting treatment for hypertension and diabetes can avoid people having difficulty managing their illness and their problems getting worse. Limited access to health services and few health workers to support have led to deficiencies in treatment, outcomes and quality of life of hypertensive and diabetic patients. In Minas Gerais state, the university and hospital established a Telehealth Network, in 2005, to use digital health solutions to improve access and quality to health care. A specific intervention in hypertension and diabetes was developed with positive results in the HealthRise project (2016-2018), in the Northeast of Minas Gerais, a remote region with limited number of health resources. The present project will develop a framework to implement this intervention in a larger number of primary health care (PHC) units, using these locations to improve the management of patients with high blood pressure and diabetes. Training and clinical support developed by UFMG allow health workers in different roles to use the software and clinical workflows during a patient's visit to the PHC. The staff receives guidance and support from the software and additional specialist medical input to help managing hypertension and diabetes using the best practice. Additionally the software contacts the patient via SMS to check in on the patient regularly, to help remind them about medication, activities and lifestyle changes such as diet that would help them manage and control their disease, empowering them in self-care when away from the care teams. The health care workers also participate in further online and face to face training to help continually develop understanding of the management of these patients. In the fist part of the project, over the first two years, the teams from the different organisations will work with clinical staff, researchers, software designers, and trainers, to look and improve the intervention and software tools as they are currently being used. In the second part of the project, in years three to five, the teams will undertake a study in the Mucury Valley to compare the use of the intervention and training across the 34 primary health centres: one half of the sites will be given the software and training to treat and manage their patients, and the other half the sites will continue to treat and manage patients in the standard way. This will be a significant step to evaluate this innovation that has been developed within Brazil and look at how best to support this approach at scale to the wider state or country, reaching many communities living in poor urban and rural settings and reducing the burden of these diseases in this continental country.