Abstract 13465: Digital Health and Multifaceted Interventions to Help Manage Cardiovascular Patients in a Resource-Constrained Area in Brazil Before and During COVID-19 Pandemic

Abstract

Introduction: During the COVID-19 pandemic, social isolation led to a reduction in the number of consultations of patients with hypertension and diabetes mellitus (DM) , which may cause serious complications. Objective: To assess the effect of the pandemic on the control of hypertension and DM in primary care. Additionally, to develop and assess usability of a digital solution to improve patient monitoring. Methods: Quasi-experimental study. Patients ≽30 years-old with diagnosis of hypertension or DM from 34 primary health care centers from 10 Brazilian municipalities were assessed from Jun/2017 to Dec/2020. Data on the number of consultations, systolic, diastolic blood pressure (SBP, DBP) and glycohemoglobin levels were collected. A decision support system (DSS) was developed, to be used by community health workers (CHW), to identify patients with uncontrolled diseases during household visits. Software usability was assessed by a panel of experts. Results: From 5,070 patients (mean age 56.0 [IQR 48.0-62.0], 66.4% women), 94.9% had hypertension and 27.0% DM. There was a significant reduction in the weekly number of consultations before vs. after social restriction, (107 [IQR 60, 153] vs (20 [IQR 7, 29]), p<0.001). Only 772 patients (15.2%) returned for consultation since the beginning of the pandemic. They had lower SBP (120.0, IQR 120.0-140.0 mmHg) and DBP (80.0, IQR 80.0-80.0 mmHg), comparing to individuals who did not return (SBP: 130.0, IQR 120.0-140.0 mmHg; DBP: 80.0, IQR 80.0-90.0 mmHg; p<0.001). There was no difference in glycohemoglobin levels. The expert panel agreed the DSS may identify patients at risk, and can be incorporated into the CHW routine. Up to March 2021, over 17,000 registries were performed using the app. Conclusion: COVID-19 pandemic caused a significant reduction in the number of consultations of patients with hypertension and DM in PHC. The DSS was considered useful, and it was well accepted by the CHW.