英国基层医疗环境中用于管理患有肾脏并发症的糖尿病患者的移动临床决策支持系统：混合方法可行性研究

Mobile Clinical Decision Support System for the Management of Diabetic Patients With Kidney Complications in UK Primary Care Settings: Mixed Methods Feasibility Study.

作者信息

Alhodaib Hala Ibrahim, Antza Christina, Chandan Joht Singh, Hanif Wasim, Sankaranarayanan Sailesh, Paul Sunjay, Sutcliffe Paul, Nirantharakumar Krishnarajah

机构信息

Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.

Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.

出版信息

JMIR Diabetes. 2020 Nov 18;5(4):e19650. doi: 10.2196/19650.

DOI:10.2196/19650

PMID:33206055

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7710444/

Abstract

BACKGROUND

Attempts to utilize eHealth in diabetes mellitus (DM) management have shown promising outcomes, mostly targeted at patients; however, few solutions have been designed for health care providers.

OBJECTIVE

The purpose of this study was to conduct a feasibility project developing and evaluating a mobile clinical decision support system (CDSS) tool exclusively for health care providers to manage chronic kidney disease (CKD) in patients with DM.

METHODS

The design process was based on the 3 key stages of the user-centered design framework. First, an exploratory qualitative study collected the experiences and views of DM specialist nurses regarding the use of mobile apps in clinical practice. Second, a CDSS tool was developed for the management of patients with DM and CKD. Finally, a randomized controlled trial examined the acceptability and impact of the tool.

RESULTS

We interviewed 15 DM specialist nurses. DM specialist nurses were not currently using eHealth solutions in their clinical practice, while most nurses were not even aware of existing medical apps. However, they appreciated the potential benefits that apps may bring to their clinical practice. Taking into consideration the needs and preferences of end users, a new mobile CDSS app, "Diabetes & CKD," was developed based on guidelines. We recruited 39 junior foundation year 1 doctors (44% male) to evaluate the app. Of them, 44% (17/39) were allocated to the intervention group, and 56% (22/39) were allocated to the control group. There was no significant difference in scores (maximum score=13) assessing the management decisions between the app and paper-based version of the app's algorithm (intervention group: mean 7.24 points, SD 2.46 points; control group: mean 7.39, SD 2.56; t=-0.19, P=.85). However, 82% (14/17) of the participants were satisfied with using the app.

CONCLUSIONS

The findings will guide the design of future CDSS apps for the management of DM, aiming to help health care providers with a personalized approach depending on patients' comorbidities, specifically CKD, in accordance with guidelines.

摘要

背景

在糖尿病（DM）管理中尝试使用电子健康已显示出有前景的结果，大多针对患者；然而，为医疗保健提供者设计的解决方案却很少。

目的

本研究的目的是开展一个可行性项目，开发并评估一款专门为医疗保健提供者管理糖尿病患者慢性肾脏病（CKD）的移动临床决策支持系统（CDSS）工具。

方法

设计过程基于以用户为中心的设计框架的3个关键阶段。首先，一项探索性定性研究收集了糖尿病专科护士在临床实践中使用移动应用程序的经验和观点。其次，开发了一个用于管理糖尿病和慢性肾脏病患者的CDSS工具。最后，一项随机对照试验检验了该工具的可接受性和影响。

结果

我们采访了15名糖尿病专科护士。糖尿病专科护士目前在临床实践中未使用电子健康解决方案，而大多数护士甚至不知道现有的医疗应用程序。然而，他们认识到应用程序可能给他们的临床实践带来的潜在益处。考虑到最终用户的需求和偏好，基于指南开发了一款新的移动CDSS应用程序“糖尿病与慢性肾脏病”。我们招募了39名一年级初级医生（44%为男性）来评估该应用程序。其中，44%（17/39）被分配到干预组，56%（22/39）被分配到对照组。在评估应用程序和基于纸质版应用程序算法的管理决策得分（最高分 = 13）上，两组之间没有显著差异（干预组：平均7.24分，标准差2.46分；对照组：平均7.39分，标准差2.56分；t = -0.19，P = 0.85）。然而，82%（14/17）的参与者对使用该应用程序感到满意。