Przydatność, bezpieczeństwo i wstępna skuteczność aplikacji mobilnej do leczenia epilepsji w wiejskiej opiece podstawowej: badanie obserwacyjne z dwoma grupami z Indii
Feasibility, safety and preliminary effectiveness of an epilepsy treatment smartphone application in rural primary care: A two-arm prospective observational study from India
W skrócie
Badacze testowali nową aplikację na smartfonie (Epilepsy Treatment Aid - ETA) mającą pomóc lekarzom wiejskich ośrodków zdrowia w diagnozowaniu i leczeniu epilepsji. Aplikacja została wdrożona u pacjentów z podejrzeniem epilepsji w Indiach i wykazała podobne wyniki do leczenia prowadzonego przez tradycyjnie szkolonych lekarzy, a w kilku aspektach nawet lepsze (lepsze uzgodnienie diagnozy i leczenia). Wyniki sugerują, że taka aplikacja może być pomocnym narzędziem do zwiększenia dostępu do leczenia epilepsji w biedniejszych regionach.
Oryginalny abstract (angielski)
BACKGROUND: The epilepsy treatment gap remains a major public health challenge in low- and middle-income countries, including India, where up to 90% of people with epilepsy in rural settings receive no treatment. Smartphone applications capable of guiding non-specialist doctors through diagnosis and individualized treatment have been proposed as a scalable solution. We evaluated the feasibility, safety, and preliminary effectiveness of a novel decision-support application -the Epilepsy Treatment Aid (ETA) in rural primary care settings in Chhattisgarh, India. METHODS: We conducted a two-arm prospective observational study across two rural blocks in Chhattisgarh, India. Primary care doctors at both sites received structured epilepsy training; doctors at the intervention site (Nagri) additionally used the ETA to manage consecutively-presenting people with suspected epilepsy (PWSE). Specialist neurologist assessment at six months served as the reference standard for safety (treatment agreement) and preliminary effectiveness (seizure frequency change) outcomes. RESULTS: Seventy-two PWSE were recruited at the intervention site and 41 at the control site, yielding evaluable samples of 33 and 29 respectively after exclusions and loss to follow-up at completion of study. The ETA was successfully deployed in all presenting PWSE. Diagnostic agreement with the specialist was 91% in the app group versus 86% in controls. Full treatment agreement was achieved in 71% of the app group versus 48% of controls. Seizure frequency improved in 68% of the app group versus 48% of controls. None of these differences reached statistical significance. CONCLUSION: The ETA was feasible to deploy in routine rural primary care and was not associated with inferior diagnostic or treatment outcomes compared with epilepsy-trained care alone. These preliminary findings support further evaluation of the ETA as a tool to reduce the epilepsy treatment gap in resource-limited settings.