CHArMING - Control of Hypertension and diAbetes in MINas Gerais

Background

In Brazil, the prevalence of hypertension is near 35%, while diabetes is self-reported in 6.2% of adults. Treatment of hypertension and diabetes can avoid complications and death, but, in Brazil and most low- and middle-income countries, blood pressure and glycohemoglobin control rates are still low. The Telehealth Network of Minas Gerais is established in 2005 to provide innovative solutions for health care, using telehealth and mHealth tools. Some of these innovative interventions have been tested in the HealthRise project, in the Northeast of Minas Gerais, a resource-limited and remote region, with good results.

The intervention consists of a multidimensional strategy with multidisciplinary approach, including: (a) telehealth tools, as teleconsultations and telediagnosis, as well as short message service (SMS); (b) a web system for health professionals including an organised patient flow and a decision support system; (c ) continued education, including web courses and in-person activities; (d) group activities for health professionals, as Balint groups; and (e) educational and groups for hypertensive and diabetic patients, to promote physical activity, patient autonomy and empowerment. The overall goal is to build a sustainable model for diabetes and hypertension management, embedded in the Brazilian public health system to reduce the present and future burden in the country.

Aims

The aim of the study is to develop and implement an integrated multidimensional strategy using digital health to be widely used in the PHC setting for the management of patients with hypertension and diabetes, leading to better adherence to glycohemoglobin and blood pressure measurement and decreased glycohemoglobin and blood pressure levels.

Project plan

This study is a partnership among the University of Southampton, Universidade Federal de Minas Gerais (Belo Horizonte, Brazil), Universidade Federal dos Vales do Jequitinhonha e Mucuri (Teófilo Otoni) and Einstein Hospital (São Paulo). Participation of stakeholders, frontline health professionals and patients are guaranteed in all steps, including a participation in the Advisory Committee.

The study will be conducted in the Mucury Valley, in the northeast region of the Minas Gerais state. The 1st phase will consist in a before-and after study, combined with a qualitative studies. The research team will visit each primary care center to assess barriers for the successful implementation of the intervention. The 2nd phase is a cluster randomized controlled open label trial in which 34 PHC units will be randomized to receive or not the intervention. We will recruit hypertensive and diabetic patients from 30 to 80 years-old, 150 per centre, with an expected total sample of 5264 persons.

Funding organisations

•