Mobile Health or mHealth, is a major practice in the field of medical sciences and public health which is assisted by mobile devices such as mobile phones, tablets, laptops or any modern day technological devices. These devices are used in order to administer and observe health services such as diagnosing illness, information and data collection.
Though it is more prominent and of higher utility in the developed nations such as the United States, United Kingdom, Japan, etc., it is also being recognised in a developing nation such as India.
Recently, a large-scale study on the effectiveness of M-Health-Based Electronic Decision Support System for Integrated Management of Chronic Conditions in Primary Care in India assessed the potency of M-Wellcare (Mobile Wellcare) – a mHealth system which consists of electronic health record storage and electronic decision support for the integrated management of five chronic conditions of hypertension, diabetes mellitus, current tobacco and alcohol use, and depression.
“The multi-centred research study involving 40 community health centres in the states of Haryana and Karnataka maneuvered the data related to hypertension and diabetes mellitus as against the enhanced usual care among patients with hypertension and diabetes mellitus in India.”
The trial ended after a continuous evaluation of 12 months and the researchers examined the mean difference between the two arms in change in systolic blood pressure and glycated haemoglobin (HBA1c) as primary outcomes and fasting blood glucose, total cholesterol, predicted 10-year risk of cardiovascular disease and depression score.
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The major findings from this study were reduction of blood pressure (both Systolic BP and HBA1c). This declined significantly in both the arms at the end of the trial. The mHealth system which consists of clinical decision support and storage of electronic health records was not significantly different from the enhanced usual care which also subsequently deteriorated.
It is pertinent to note that from the last few decades, India has been facing the challenges of non-communicable diseases (NCDs) such as diabetes mellitus, hypertension, tobacco and alcohol use and depression.
“The results of the study were published in the American Heart Association Journal Circulation and released simultaneously in Chicago.”
The study provides several key lessons. In order to manage diabetes mellitus and hypertension, it is important to provide clinical nurse to support the physician. There is also a need to ensure continuous availability of essential drugs. Further, it states that it is important to train healthcare professionals on guidelines-directed care periodically. Nonetheless, generating useful information from the registry for planning (e.g., forecasting requirement of drugs, diagnostics, manpower) is essential.
The present study also bestows upon several clinical implications. The feasibility of an ambitious multi-factorial electronic health record and electronic decision support–based mHealth intervention across multiple sites at the primary level using available trained staff is demonstrated in this trial.
“As per the study, national health policymakers in low- and middle-income countries, including India, can use this information to inform decisions surrounding the rollout of widespread public health interventions.”
Professor Dorairaj Prabhakaran, Vice President – Research and Policy, PHFI and the principal investigator of the study said the key lessons from the mWellcare study “can contribute to the Government of India’s ambitious Ayushman Bharat program of enhancing the capacity of 1,50,000 health and wellness centers to provide comprehensive primary health care”.
The study design highlights the views of notable Professor Pablo Perel, Professor of Clinical Epidemiology and the Director Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine (LSHTM) and co- investigator of the study.
“The M-Wellcare study showed that it is possible to conduct large and high-quality trials to robustly evaluate ways of improving the care of people with chronic NCDs in low and middle-income countries. Although the study did not find strong evidence that the intervention improved the primary outcome, the substantial improvement in the enhanced (control) arm suggests that there are potential approaches used in that arm (e.g. capacity building, task shifting, etc) that could have an important role in improving the care of these patients,” he said.
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He further added that the M-Wellcare trial was also an example of “the importance of conducting mixed methods studies” for implementation research questions, as the process evaluation component of the study will shed light on some of the potential mechanisms (and therefore implications) behind the findings of this study.
The entire practice of mHealth is a perfect example of how technology is a boon to the society. Though the entire practice of mHealth would take some more years to develop to its fullest and become completely functional in a developing nation like India, it is a positive start in order to make some necessary changes in the health care system of this nation.
