Effect of a multifaceted mobile technology enabled primary care intervention on cardiovascular disease risk management in rural Indonesia: a quasi-experimental study

Importance: Cardiovascular diseases (CVD) are the leading cause of disease burden in Indonesia. Implementation of effective interventions for CVD prevention is limited. Objective: To evaluate whether a mobile technology-supported primary healthcare intervention would improve use of preventive drug treatment among people with high CVD risk, vs usual care. Design: Quasi-experimental study involving four intervention and four control villages conducted between September 2016 and March 2018. Median duration of follow-up was 12.2 months. Setting: Malang district, Indonesia Participants: Residents aged ≥40 years were invited to participate. Those with high predicted 10-year CVD risk (previous diagnosed CVD; systolic blood pressure (BP) >160 mmHg or diastolic BP >100 mmHg; 10-year predicted CVD risk ≥ 30%; or 10-year predicted CVD risk of 20-29% and a systolic BP>140 mmHg) were followed. Intervention: A multi-faceted mobile technology-supported intervention facilitating community-based CVD risk screening with referral, tailored clinical decision support for drug prescription and patient follow-up. Main outcomes and measures: The primary outcome was the proportion on appropriate preventive CVD medications, defined as at least one BP lowering drug and a statin for all high-risk individuals, and an antiplatelet drug for those with prior diagnosed CVD. Secondary outcomes included mean change in BP from baseline. Results: Among 22,635 adults, 3494 (29.9%) and 3085 (28.1%) had high predicted CVD risk in the intervention and control villages, respectively. Of these, follow-up was completed in 2632 (75.3%) from intervention villages and 2429 (78.7%) from control villages. At follow-up, 15.5% of high-risk individuals in intervention villages were taking appropriate preventive CVD medications, compared with 1.0% of in control villages (adjusted risk difference, 14.1%, [95% CI, 12.7% to 15.6%]). This difference was driven by higher BP lowering treatment use (56.8% vs. 15.7%; adjusted risk difference, 39.4% [95% CI, 37.0% to 41.7%). The adjusted mean difference in change in systolic BP from baseline was -8.3 mmHg, [95% CI, -6.6 to -10.1 mmHg]). Conclusions and relevance: A multi-faceted mobile technology supported primary healthcare intervention was associated with greater use of preventive CVD medication use and lower BP levels among high-risk individuals in a rural Indonesian population.