Published in News
As part of the GACD ‘s Annual JTSC Meeting on 13 – 15 November 2013 in Cape Town, South Africa, the members of the Hypertension Programme took part in a unique site visit to the Vanguard Community Health Centre.
The centre provides healthcare services to the Bonteheuwel and Langa’s mainly black African and coloured residents including HIV testing, and the care and monitoring of hypertensive and diabetic patients.
Project leader Kirsty Bubrow showed us how a new blood pressure management intervention (called the StAR programme, SMS text Adherence Support Study) that uses mobile phone technology is impacting the lives of local hypertension sufferers.
South Africa has one of the highest rates of hypertension in the world with 6.3 million hypertension sufferers [i] and the prevalence mainly resides in the black African and coloured communities[ii].
The SMS project, which forms part of the Chronic Diseases Initiative for Africa (CDIA), Primary Care Trials Unit (PCTU), and the Institute for Biomedical Engineering (IBME), aims to fill a gap for much needed simple technologies designed for needs of some of the world’s poorest people, and it is hoped that this new intervention will improve blood pressure control for the approximately 1400 patients who use the hypertension service.
‘‘It was very interesting to view a health care delivery system similar to that in India but much more advanced and effective. It was a surprise for me to learn that the clinic caters to a population of 200,000 with 28,000 visits per month’‘ – Dr D Praveen, The George Institute for Global Health, India
Vanguard Community Health Centre – group blood pressure monitoring
During the visit members were shown how technology can be integrated and linked to clinical devices by monitoring their own blood pressure using a blood pressure cuff linked to a mobile phone device. The blood pressure (BP) readings generated from this exercise were then sent from the mobile device to a central database electronically.
The database consolidates the BP readings with patient demographic and clinical record information, which is then used to interact with patients via auto–generated SMS messages from appointment and medication pick–up reminders to medication adherence support. Education messages on hypertension risk factors are also sent to their personal mobile phone via information only or interactive SMS messages.
Some of the unique aspects heralded as beneficial to the intervention are the fact that patients feel empowered by monitoring their own blood pressure and feel more relaxed when doing so (giving more accurate blood pressure readings) rather than being probed by a doctor: a term called White Coat Hypertension[iii]. In addition, the individual BP monitoring exercises generally took place in a group setting where patients are able to talk amongst themselves which will also contributes to a positive experience overall and encourage patients to monitor their BP.
The end process
Overall the patient management system appeared extremely efficient, with the prescription being sent directly to the pharmacy electronically, where the medication is pre–packed, often with several months supply of drugs free of charge. But despite the SMS message interaction, education and support of the Vanguard hypertensive patients, GACD participants viewed boxes of discarded medicines that had failed to be collected. Why patients fail to return to the Vanguard to pick up their medication is unclear and demonstrates that hypertension control in Cape Town township communities is more complex and requires more than just modernised services.’‘The most eye–catching aspect was the pharmacy for me. Once the prescription comes to the pharmacy, the medicines are packed for a month or two and kept ready at the pharmacy for the patient to make another visit to the clinic to pick up their medications. It was difficult to understand that with such a well-placed system, only 50% of the medication packets are actually picked up by the patients. ’’– Dr D Praveen, The George Institute for Global Health, India
The site visit to the Vanguard Community Health Centre has shown that SMS based platforms can work to encourage patients in Cape Town to overcome some of the challenges to hypertension control. But having said this, it would appear that new technologies will need to be combined with additional support and innovation to ensure that medication is being collected and used by the hypertensive patients at the end of the process.
Acknowledgements
Vanguard Community Health Centre, Chronic Diseases Initiative for Africa (CDIA), Primary Care Trials Unit (PCTU), and Institute for Biomedical Engineering (IBME)
Dr Kirsty Bubrow and Professor Andrew Farmer
Blood Pressure UK ‘White coat hypertension (and white coat effect)’