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Development and Evaluation of a Mobile Decision Support System for Hypertension Management in the Primary Care
Daniel Vitório Silveira1,2,3, Milena Soriano Marcolino1,2,3, Elaine Leandro Machado2
1Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Insights
A new clinical decision support system (CDSS) called TeleHAS was found feasible for managing hypertension in primary care. The system demonstrated good usability and potential for improving evidence-based hypertension care.
Area of Science:
- Digital health interventions
- Cardiovascular disease management
- Primary healthcare technology
Background:
- Hypertension is a major cardiovascular risk factor with low global control rates.
- Computerized clinical decision support systems (CDSSs) show promise in reducing blood pressure and cardiovascular risk.
Purpose of the Study:
- To evaluate the feasibility, usability, and utility of the TeleHAS CDSS.
- To assess TeleHAS in managing hypertension within a primary care setting in a middle-income country.
Main Methods:
- Ten family physicians used the TeleHAS app for 6 months to manage hypertensive patients.
- Feasibility, usability, and utility were assessed via questionnaires and interviews.
- TeleHAS integrates patient data, calculates cardiovascular risk, and provides guideline-based recommendations.
Main Results:
- 100% found TeleHAS feasible for primary care; 80% found it easy to integrate into routines.
- 70% reported time delays due to CDSS use.
- Physicians rated TeleHAS as good (80%), with a user-friendly interface (100%) and potential to improve patient treatment (100%).
- 90% gained new knowledge and found the app useful for prevention and treatment optimization.
Conclusions:
- The TeleHAS CDSS is feasible for hypertension management in primary care in a middle-income country.
- The system achieved good user satisfaction.
- TeleHAS has the potential to enhance adherence to evidence-based hypertension care practices.
Background:
Despite being an important cardiovascular risk factor, hypertension has low control levels worldwide. Computerized clinical decision support systems (CDSSs) might be effective in reducing blood pressure with a potential impact in reducing cardiovascular risk.
Objective:
The goal of the research was to evaluate the feasibility, usability, and utility of a CDSS, TeleHAS (tele-hipertensão arterial sistêmica, or arterial hypertension system), in the care of patients with hypertension in the context of a primary care setting in a middle-income country.
Methods:
The TeleHAS app consists of a platform integrating clinical and laboratory data on a particular patient, from which it performs cardiovascular risk calculation and provides evidence-based recommendations derived from Brazilian and international guidelines for the management of hypertension and cardiovascular risk. Ten family physicians from different primary care units in the city of Montes Claros, Brazil, were randomly selected to use the CDSS for the care of hypertensive patients for 6 months. After 3 and 6 months, the feasibility, usability, and utility of the CDSS in the routine care of the health team was evaluated through a standardized questionnaire and semistructured interviews.
Results:
Throughout the study, clinicians registered 535 patients with hypertension, at an average of 1.24 consultations per patient. Women accounted for 80% (8/10) of participant doctors, median age was 31.5 years (interquartile range 27 to 59 years). As for feasibility, 100% of medical users claimed it was possible to use the app in the primary care setting, and for 80% (8/10) of them it was easy to incorporate its use into the daily routine and home visits. Nevertheless, 70% (7/10) of physicians claimed that the time taken to fill out the CDSS causes significant delays in service. Clinicians evaluated TeleHAS as good (8/10, 80% of users), with easy completion and friendly interface (10/10, 100%) and the potential to improve patients' treatment (10/10, 100%). A total of 90% (9/10) of physicians had access to new knowledge about cardiovascular risk and hypertension through the app recommendations and found it useful to promote prevention and optimize treatment.
Conclusions:
In this study, a CDSS developed to assist the management of patients with hypertension was feasible in the context of a primary health care setting in a middle-income country, with good user satisfaction and the potential to improve adherence to evidence-based practices.
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