Blank Evan, Tuikong Nelly, Misoi Lawrence, Kamano Jemima, Hutchinson Claire, Kimaiyo Sylvester, Fustera Valentin, Were Martin, Vedanthan Rajesh
Mount Sinai School of Medicine, New York, USA.
Stud Health Technol Inform. 2013;192:1002.
In sub-Saharan Africa (SSA), cardiovascular disease (CVD) is the leading cause of death among individuals over the age of 30. Hypertension, a major risk factor for CVD, contributes significantly to the CVD burden in SSA. In order to address the human resource challenge of managing hypertension in low- and middle-income countries (LMICs), task-shifting hypertension care from physicians to nurses has been proposed. To support this task-shifting strategy, the Academic Partnership Providing Access to Healthcare (AMPATH) has developed an Android tablet-based electronic Decision Support and Integrated Record-Keeping (DESIRE) tool to record patient data and assist with clinical decision-making. We investigated the usability of the DESIRE tool in the setting of nurse management of hypertension in rural western Kenya through the use of "mock patient" encounters and "think aloud" exercises. Fiftyseven critical incidents were identified and twenty-three design changes were suggested. Optimization of the tool has the potential to broadly impact treatment of non-communicable diseases in LMICs by providing a model of electronic decision-support in task shifting.
在撒哈拉以南非洲地区（SSA），心血管疾病（CVD）是30岁以上人群的主要死因。高血压作为CVD的主要危险因素，对SSA地区的CVD负担有显著影响。为应对低收入和中等收入国家（LMICs）管理高血压方面的人力资源挑战，有人提出将高血压护理任务从医生转移给护士。为支持这一任务转移策略，提供医疗服务的学术伙伴关系（AMPATH）开发了一种基于安卓平板电脑的电子决策支持与综合记录保存（DESIRE）工具，用于记录患者数据并协助临床决策。我们通过“模拟患者”问诊和“大声思考”练习，调查了DESIRE工具在肯尼亚西部农村地区护士管理高血压环境中的可用性。识别出57起关键事件，并提出了23项设计变更建议。通过提供任务转移中的电子决策支持模型，该工具的优化有可能对LMICs的非传染性疾病治疗产生广泛影响。
