Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
J Med Internet Res. 2021 Jan 11;23(1):e18872. doi: 10.2196/18872.
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.
The 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.
This 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.
A 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.
The 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.
高血压和糖尿病的控制水平较低是一个挑战，需要创新策略来克服资源匮乏、距离远和医疗质量低等障碍。
本研究旨在开发一种用于初级保健的糖尿病和高血压管理的临床决策支持系统（CDSS），并在资源有限的地区实施，同时评估其可用性和医疗保健从业者的满意度。
这是一项混合方法研究，是 HealthRise Brazil 项目的子研究，该项目是一项多国研究，旨在实施试点计划，以改善服务不足社区的高血压和糖尿病的筛查、诊断、管理和控制。在确定常规护理中的差距后，一组临床医生确定了软件的功能要求。审查了基于证据的指南建议，并将其组织成决策算法，为 CDSS 的提醒和建议提供依据。经过预测试和专家小组评估后，在巴西一个资源有限地区的 10 个城市的 34 个初级保健单位进行了试点测试。在 6 个月后，应用了一份评估应用程序的感知可行性、可用性和实用性以及专业人员满意度的李克特量表问卷。在最终评估中，对初级保健医生和护士进行了 2 次焦点小组讨论。
共创建并实施了 159 个提醒和建议，用于 CDSS。在 6 个月的评估中，应用程序数据库中注册了 1939 名患者，初级保健团队进行了 2160 次咨询。在受邀评估可用性的 96 名医疗保健专业人员中，26%（25/96）是医生，46%（44/96）是护士，28%（27/96）是其他卫生专业人员。该问卷包含 24 个关于可行性、可用性、实用性和满意度的印象的项目，总体 Cronbach α 为.93。关于可行性，所有专业人员都一致认为（中位数为 4 或 5）该应用程序可用于初级保健环境，并且易于融入工作流程，但医生认为该应用程序可能导致日常工作出现显著延迟。关于可用性，总体评价良好，并且声称该应用程序易于理解和使用。所有专业人员都认为该应用程序具有实用性（得分为 4 或 5），可用于促进预防、辅助治疗，并可能改善患者护理，并且他们对该应用程序总体感到满意（中位数得分在 4 到 5 之间）。在最终评估中，应用程序数据库中注册了 4211 名患者（94.82%[3993/4211]患有高血压，24.41%[1028/4211]患有糖尿病），初级卫生保健团队进行了 7960 次咨询。17 名焦点小组参与者一致表示，他们对 CDSS 非常满意。
CDSS 适用于低收入地区的初级保健环境，用户满意度高，有潜力提高对基于证据的实践的依从性。
