Study Finds Cost-effective Ways in Improving Primary Care in Resources-poor Areas

September 1, Circulation published a research paper based on a dual-country study led by Prof. Lijing L. Yan, Head of Non-Communicable Diseases Research at the Global Health Research Center of Duke Kunshan University (DKU). The study, the simplified cardiovascular management program (known as SimCard), discovered cost-effective ways to improve the quality of primary care and clinical outcomes in resource-poor settings in China and India that could have major benefits for the general population.

SimCard was a one-year cluster-randomized controlled trial carried out in 47 villages (27 in Tibet, China and 20 in Haryana, India) where access to basic cardiovascular disease (CVD) management and appropriate medications were extremely limited. A total of 2,086 individuals with high cardiovascular risk participated in this study. Researchers developed a simplified ‘2+2’ intervention model, consisting of two medications (blood pressure lowering agents and aspirin) and two lifestyle modifications (smoking cessation and salt reduction). During the trial period, community health workers managed all the participants through a smartphone-based electronic decision support system.

The combined results found in the study strongly demonstrated the effectiveness of this program in increasing the use of the anti-hypertensive medications, with the primary outcome being a net-difference of 25.5%. In China, a significant decrease in systolic blood pressure (-4.1mmHg) and increase in the proportion of taking aspirin (24.5%) were also observed. No actual lifestyle changes were found in either country.

‘Both population-based and high-risk strategies are needed for prevention and control of chronic diseases like CVD,’ said Professor Yan, Principal Investigator of the study. ‘In resource-limited settings, it would be highly cost-effective if we could adapt the high-risk approach first and then implement core strategies recommended by guidelines.’

Circulation is the official journal of the American Heart Association with a five-year impact factor of 15.2. It is the second highest ranked journal in the ‘Cardiology and Cardiovascular Medicine’ category.

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