Developing a Digital Health-enabled Intervention to tackle Multimorbidity in Primary care in India
Medical Research Council
Centre for Chronic Disease Control
More than a quarter of adult patients attending primary care facilities in India have multimorbidity. However, national health programmes are disease-centric, including the ongoing National Programme for Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), which caters to large population groups in primary care for a range of chronic conditions. The specific objectives of the proposed research work in the Indian state of Tripura are: a) To discover major multimorbidity patterns relevant for NPCDCS in primary care; and b) To develop a digital health-enabled intervention, targeting major multimorbidity patterns, relevant for NPCDCS, to improve targeting and delivery of clinical services in primary care. A digital tool- comprising clinical decision support and electronic health record- is deployed in 40 primary care facilities in Tripura to aid the healthcare team in managing six chronic conditions - hypertension, diabetes, dyslipidaemia, chronic obstructive pulmonary diseases, alcoholism and tobacco use- for the past 29 months. In such patient's record, information on the presence of eight additional chronic conditions is also routinely recorded. This dataset will be used for discovering multimorbidity patterns. Using these inputs, and expert consultations, we will develop a digital health-enabled intervention for the management of multimorbidity following the MRC framework for developing complex interventions. To guide intervention development, a theory of change will be constructed, covering the building blocks of the health system and other contextual factors. Using mixed methods, we will develop a prototype intervention and pilot it in two health facilities for assessing feasibility, developing mitigation strategies for barriers, identifying potential indicators for the process of care and patient-level outcomes, sample size and recruitment feasibility for planning an application for controlled evaluation of the intervention developed in a future trial.
8.2 Health and welfare economics / P&Cs