Abstract
BackgroundThe low levels of control of hypertension and diabetes mellitus are a challenge that requires innovative strategies to surpass barriers of low sources, distance, and quality of health care.ObjectiveThe aim of this study is to develop a clinical decision support system (CDSS) for diabetes and hypertension management in primary care, to implement it in a resource-constrained region, and to evaluate its usability and health care practitioner satisfaction.MethodsThis mixed methods study is a substudy of HealthRise Brazil Project, a multinational study designed to implement pilot programs to improve screening, diagnosis, management, and control of hypertension and diabetes among underserved communities. Following the identification of gaps in usual care, a team of clinicians established the software functional requirements. Recommendations from evidence-based guidelines were reviewed and organized into a decision algorithm, which bases the CDSS reminders and suggestions. Following pretesting and expert panel assessment, pilot testing was conducted in a quasi-experimental study, which included 34 primary care units of 10 municipalities in a resource-constrained area in Brazil. A Likert-scale questionnaire evaluating perceived feasibility, usability, and utility of the application and professionals’ satisfaction was applied after 6 months. In the end-line assessment, 2 focus groups with primary care physicians and nurses were performed.ResultsA total of 159 reminders and suggestions were created and implemented for the CDSS. At the 6-month assessment, there were 1939 patients registered in the application database and 2160 consultations were performed by primary care teams. Of the 96 health care professionals who were invited for the usability assessment, 26% (25/96) were physicians, 46% (44/96) were nurses, and 28% (27/96) were other health professionals. The questionnaire included 24 items on impressions of feasibility, usability, utility, and satisfaction, and presented global Cronbach α of .93. As for feasibility, all professionals agreed (median scores of 4 or 5) that the application could be used in primary care settings and it could be easily incorporated in work routines, but physicians claimed that the application might have caused significant delays in daily routines. As for usability, overall evaluation was good and it was claimed that the application was easy to understand and use. All professionals agreed that the application was useful (score 4 or 5) to promote prevention, assist treatment, and might improve patient care, and they were overall satisfied with the application (median scores between 4 and 5). In the end-line assessment, there were 4211 patients (94.82% [3993/4211] with hypertension and 24.41% [1028/4211] with diabetes) registered in the application’s database and 7960 consultations were performed by primary health care teams. The 17 participants of the focus groups were consistent to affirm they were very satisfied with the CDSS.ConclusionsThe CDSS was applicable in the context of primary health care settings in low-income regions, with good user satisfaction and potential to improve adherence to evidence-based practices.
Highlights
Hypertension and diabetes are leading modifiable risk factors for cardiovascular disease worldwide, major contributors to premature disability, and associated with substantial premature death and morbidity [1]
Clinical decision support systems (CDSSs), which are capable of generating suggestions or information that is specific to individual patients, based on the unique individualized patient information, can make a significant contribution to the effective dissemination of evidence-based practice
Our aim was to develop a CDSS for diabetes and hypertension management in primary care, to implement it in a low-income and mostly rural region, and to evaluate its usability and health care practitioner satisfaction. This is a substudy of the HealthRise Brazil Project, a quasi-experimental study, which is part of a multinational study designed to implement and evaluate pilot programs aimed at improving screening, diagnosis, management, and control of hypertension and diabetes among underserved communities [12]
Summary
Hypertension and diabetes are leading modifiable risk factors for cardiovascular disease worldwide, major contributors to premature disability, and associated with substantial premature death and morbidity [1]. The situation is worse in low- and middle-income countries and even worse in rural communities, where awareness, treatment, and control of hypertension are lower than in urban areas [2,4,5] To face this challenge, innovative strategies are required. Clinical decision support systems (CDSSs), which are capable of generating suggestions or information that is specific to individual patients, based on the unique individualized patient information, can make a significant contribution to the effective dissemination of evidence-based practice. They may increase practitioners’ adherence to guidelines, involving clinicians in the translation of research into practice [6]. The low levels of control of hypertension and diabetes mellitus are a challenge that requires innovative strategies to surpass barriers of low sources, distance, and quality of health care
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.