Developing Accessible Telehealth Programs for Diabetes and Hypertension Management in Bolivia
Condition: Hypertension; Diabetes
MeSH terms: Hypertension; Diabetes Mellitus
Study type: Interventional

Summary: 
      The purpose of the study is to evaluate the feasibility and impact of an automated phone
      system in monitoring and improving self-care and health outcomes among patients with diabetes
      and/or hypertension in Bolivia, in addition to assessing the additional benefit of support
      from a family member or friend.
    

Detailed description: 
      All patients will receive weekly automated calls with feedback to the clinical team. Blood
      pressures will be taken for all patients by researchers and finger-stick blood glucose
      readings will be taken at baseline for diabetic patients only and if possible, at follow-up.
      Fingersticks will use the patient's own glucometer or standard home glucometers donated by
      the project to the clinic. Patients will be informed about their blood pressure results; and,
      the clinic will be alerted if the systolic BP exceeds 150.

      If participants enroll with a CarePartner, they will be randomized to have their CarePartner
      receive weekly automated updates focused on symptom monitoring and patient self-care
      (HITCM+CP) versus usual care (no updates to CarePartner), HITCM-only. All participants will
      receive a weekly 10-15 minute automated phone call to their cell phone for disease assessment
      and self-care support for up to 16 weeks. Some patients with hypertension may be provided
      with in-home cuffs for measurement of blood pressure throughout the study. During enrollment,
      the research team will explain how the cuffs are used, as well as how to work the automated
      phone system. During patients' automated calls, they will be asked questions about their
      self-care relevant to their diagnosis, blood pressure regimen and readings (hypertension
      only), diet, glucose monitoring and symptoms of high/low blood sugar (diabetes only) and
      medication adherence. Based on the patient's self-report, they will receive targeted
      suggestions for how to improve their self-management. No identifying information is included
      in the automated call sent to the patient's phone other than the patient's first name. At the
      end of each automated call, patients will hear the phone number of their clinic, which they
      can call for a health problem or to disenroll from the program. At the time of recruitment,
      an initial automated call will be sent to the patient's phone so that they can learn what to
      expect and have the chance to ask questions of the research associate.

      In the event that the patient reports a health or self-care problem during their call (i.e.,
      the patient reports rarely or never taking their medication), a report will automatically be
      generated and sent by email to the research team plus the patient's designated clinician so
      that follow-up can take place. The secure email address will be verified with each clinician,
      and be password protected.

      The intervention will last up to 16 weeks, after which the patient will have a follow-up
      meeting with the research team and will complete a survey about the program. All follow-ups
      will take place either in person or over the phone. Patients will receive an incentive at
      follow-up at no more than $10 USD.
    

Intervention name(s): HITCM-only; HITCM+CP
Intervention type(s): Other; Other
Intervention description(s): HITCM-only group: patients receive weekly automated calls with feedback to the clinical team.; HITCM + CP group: patients receive weekly automated calls with feedback to the clinical team and their CarePartner receives updates via phone or email.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Hypertension; Diabetes; mHealth; Interactive Voice Response; Bolivia; Chronic disease