Nearly one in three Indian adults has hypertension and many more have pre-hypertension. In rural India, roughly three-quarters of adults with hypertension never receive treatment, and 90% of individuals receiving treatment for hypertension fail to achieve adequate blood pressure control. The current Indian public healthcare system is neither oriented nor equipped to process the total caseload of hypertension. This is due in part to poor coordination across facilities at different levels of the healthcare system and lack of mechanisms to efficiently follow-up with or refer patients, resulting in a mismatch between patient needs and treatment availability as well as inefficient use of limited healthcare resources. To address these gaps in the healthcare delivery model, the All India Institute of Medical Sciences, Public Health Foundation of India, and Emory University will partner to develop an Integrated Tracking, Referral, Electronic Decision Support and Care Coordination (I-TREC) package focused on hypertension and its most frequent comorbidity, diabetes. This multi-component package will improve coordination of care across various levels of the healthcare facility hierarchy and will include electronic data capture, electronic decision support, and care coordination training for healthcare professionals; text messaging to patients for appointments and disease management advice; facility level retrieval of patient history and inventory needs; and health administration monitoring of data across levels. Our objectives are to (1) adapt I-TREC for implementation within the public healthcare system with input of local, national, and international stakeholders; (2) implement I-TREC across all 15 health facilities comprising the government healthcare system in Banga Block (sub-district level administrative unit) of Punjab state, India; and (3) evaluate I-TREC using a quasi-experimental design by comparing performance of key indicators in Banga Block with another non-neighboring but comparable block in the same district. The proposed T4 intervention promises to consolidate previously proven strategies at single-levels of the healthcare hierarchy into a coordinated system of care delivery that relies entirely on the existing healthcare workforce. Findings will have the potential to revolutionize care for deadly chronic diseases across India in the most vulnerable and hard-to-reach patients who rely heavily on the government healthcare system and generate a scalable model that can be applied to other similar settings.
In rural India, roughly three-quarters of adults with high blood pressure never receive treatment, and 90% of individuals receiving treatment for high blood pressure fail to achieve blood pressure control. We will work with a state Department of Health in India to use information technology to address this issue by creating and testing an Integrated Tracking, Referral, Electronic Decision Support and Care Coordination (I-TREC) package focused on high blood pressure and diabetes, a condition that commonly occurs among people with high blood pressure in India. Findings will have the potential to revolutionize care for deadly chronic diseases across India in the most vulnerable and hard-to-reach patients who rely mostly on the government healthcare system and generate a scalable model that can be applied to other similar settings.