Abstract
BackgroundHypertension remains the top global cause of disease burden. Decision support systems (DSS) could provide an adequate and cost-effective means to improve the management of hypertension at a primary health care (PHC) level in a developing country, nevertheless evidence on this regard is rather limited.Methods Development of DSS software was based on an algorithmic approach for (a) evaluation of a hypertensive patient, (b) risk stratification (c) drug management and (d) lifestyle interventions, based on Indian guidelines for hypertension II (2007). The beta testing of DSS software involved a feedback from the end users of the system on the contents of the user interface. Software validation and piloting was done in field, wherein the virtual recommendations and advice given by the DSS were compared with two independent experts (government doctors from the non-participating PHC centers).ResultsThe overall percent agreement between the DSS and independent experts among 60 hypertensives on drug management was 85% (95% CI: 83.61 - 85.25). The kappa statistic for overall agreement for drug management was 0.659 (95% CI: 0.457 - 0.862) indicating a substantial degree of agreement beyond chance at an alpha fixed at 0.05 with 80% power. Receiver operator curve (ROC) showed a good accuracy for the DSS, wherein, the area under curve (AUC) was 0.848 (95% CI: 0.741 - 0.948). Sensitivity and specificity of the DSS were 83.33 and 85.71% respectively when compared with independent experts.ConclusionA point of care, pilot tested and validated DSS for management of hypertension has been developed in a resource constrained low and middle income setting and could contribute to improved management of hypertension at a primary health care level.
Highlights
Hypertension exerts a substantial public health burden on cardiovascular health status and health care systems in India [1,2]
Phase I - Development of Decision support systems (DSS) software The knowledge base for the evaluation, staging and risk stratification of a hypertensive patient; algorithmic drug based management and lifestyle interventions in the DSS were developed based on the Indian Hypertension II (2007) guidelines, which have been developed by the Association of Physicians of India (API) and endorsed by the Cardiological Society of India, Hypertension Society of India and the API [17]
The overall percent agreement between the DSS software and the independent experts on the stage of the blood pressure (BP) measurement, risk, drug management, side effects and adverse interactions, lifestyle advice and follow up advice was 90%; 91.67%; 85%; 86.67%; 90%; and 83.33% respectively
Summary
Hypertension exerts a substantial public health burden on cardiovascular health status and health care systems in India [1,2]. Decision support systems (DSS) could provide an adequate and cost-effective means to improve the management of hypertension at a primary health care (PHC) level in a developing country, evidence on this regard is rather limited. Methods: Development of DSS software was based on an algorithmic approach for (a) evaluation of a hypertensive patient, (b) risk stratification (c) drug management and (d) lifestyle interventions, based on Indian guidelines for hypertension II (2007). Conclusion: A point of care, pilot tested and validated DSS for management of hypertension has been developed in a resource constrained low and middle income setting and could contribute to improved management of hypertension at a primary health care level
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
