IBM Research Africa, Nairobi, Kenya.
CarePay Limited, Nairobi, Kenya.
J Med Internet Res. 2021 Feb 17;23(2):e18899. doi: 10.2196/18899.
Hypertension is a major risk factor of cardiovascular disease and a leading cause of morbidity and mortality globally. In Kenya, the rise of hypertension strains an already stretched health care system that has traditionally focused on the management of infectious diseases. Health care provision in this country remains fragmented, and little is known about the role of health information technology in care coordination. Furthermore, there is a dearth of literature on the experiences, challenges, and solutions for improving the management of hypertension and other noncommunicable diseases in the Kenyan private health care sector.
The aim of this study is to assess stakeholders' perspectives on the challenges associated with the management of hypertension in the Kenyan private health care sector and to derive recommendations for the design and functionality of a digital health solution for addressing the care continuity and quality challenges in the management of hypertension.
We conducted a qualitative case study. We collected data using in-depth interviews with 18 care providers and 8 business leads, and direct observations at 18 private health care institutions in Nairobi, Kenya. We analyzed the data thematically to identify the key challenges and recommendations for technology-enabled solutions to support the management of hypertension in the Kenyan private health sector. We subsequently used the generated insights to derive and describe the design and range of functions of a digital health wallet platform for enabling care quality and continuity.
The management of hypertension in the Kenyan private health care sector is characterized by challenges such as high cost of care, limited health care literacy, lack of self-management support, ineffective referral systems, inadequate care provider training, and inadequate regulation. Care providers lack the tools needed to understand their patients' care histories and effectively coordinate efforts to deliver high-quality hypertension care. The proposed digital health platform was designed to support hypertension care coordination and continuity through clinical workflow orchestration, decision support, and patient-mediated data sharing with privacy preservation, auditability, and trust enabled by blockchain technology.
The Kenyan private health care sector faces key challenges that require significant policy, organizational, and infrastructural changes to ensure care quality and continuity in the management of hypertension. Digital health data interoperability solutions are needed to improve hypertension care coordination in the sector. Additional studies should investigate how patients can control the sharing of their data while ensuring that care providers have a holistic view of the patient during any encounter.
高血压是心血管疾病的主要危险因素，也是全球发病率和死亡率上升的主要原因。在肯尼亚，高血压患者人数的增加给本已紧张的医疗体系带来了压力，而该体系传统上一直专注于传染病的管理。该国的医疗服务仍然分散，人们对医疗信息技术在医疗协调中的作用知之甚少。此外，关于改善肯尼亚私营医疗保健部门高血压和其他非传染性疾病管理的经验、挑战和解决方案的文献也很少。
本研究旨在评估利益相关者对肯尼亚私营医疗保健部门高血压管理相关挑战的看法，并为设计和开发数字健康解决方案提供建议，以解决高血压管理中连续性和质量方面的挑战。
我们进行了一项定性案例研究。我们通过深入访谈 18 名医护人员和 8 名业务负责人，并在肯尼亚内罗毕的 18 家私营医疗机构进行直接观察收集数据。我们对数据进行了主题分析，以确定关键挑战和技术支持解决方案的建议，以支持肯尼亚私营医疗保健部门的高血压管理。随后，我们利用所产生的见解来得出和描述一个数字健康钱包平台的设计和功能范围，以实现护理质量和连续性。
肯尼亚私营医疗保健部门的高血压管理面临着一些挑战，如医疗费用高、医疗保健知识有限、缺乏自我管理支持、转诊系统效率低下、医护人员培训不足、监管不足等。医护人员缺乏了解患者护理历史并有效协调努力以提供高质量高血压护理所需的工具。所提出的数字健康平台旨在通过临床工作流程编排、决策支持以及通过区块链技术实现隐私保护、可审计性和信任的数据共享，支持高血压护理协调和连续性。
肯尼亚私营医疗保健部门面临着重大挑战，需要进行重大的政策、组织和基础设施变革，以确保高血压管理中的护理质量和连续性。需要数字医疗健康数据互操作性解决方案来改善该部门的高血压护理协调。还应进一步研究如何在确保医护人员在每次就诊时都能全面了解患者的情况下，让患者控制自己数据的共享。
