Development and implementation of a computerized decision support system for screening hypertension and diabetes in a resource constrained region: Original Paper (Preprint)
Authors: Melo Laura Defensor Ribeiro , Pinho Antonio Luiz , Oliveira João Antonio Queiroz , Maia Júnia Xavier , Sá Thabata Queiroz Vivas , Pinto Vânia Soares De Oliveira E Almeida , Lima Márcia Maria Oliveira , Endlich Patrick Wander , Ribeiro Leonardo Bonisson , Cimini Christiane Corrêa Rodrigues , Marcolino Milena Soriano 
Published: October 2020

BACKGROUND

Cardiovascular diseases (CVD) are the leading cause of death worldwide, and hypertension and diabetes mellitus (DM) are main modifiable risk factors for these conditions. Strategies aimed at improving the diagnosis and treatment of these diseases are of utmost importance. Computerized decision support systems (CDSS) are guided by updated guidelines and may be capable of benefiting screening and early diagnosis initiatives in remote regions.

OBJECTIVE

To develop a CDSS for screening hypertension and DM, as well as to assess its feasibility and usability in the context of a primary care setting in a resource constrained region.

METHODS

We conducted a substudy of Healthrise Brazil program, which is part of a multicenter project engaged to expand access to care for cardiovascular disease and DM. Focused on the strategy for screening hypertension and DM, a software based on CDSS was developed by a multidisciplinary team going through the following stages: 1. Pre-prototype; 2. Software Development; 3. Software validation. The software implementation was carried out in ten municipalities in the Teófilo Otoni Microregion (in the northeast of the state of Minas Gerais). Individuals 30 to 69 years-old were invited to participate. Activities were developed through health fairs or via health units, from April/2017 to October/2018. A Likert-scale questionnaire with 15 questions to assess usability (System Usability Scale) and satisfaction was applied to the professionals at the end of study.

RESULTS

The screening software was successfully developed. In the field study, 13,775 individuals were assessed. In hypertension flow, 6.115 (44.39%) had previous diagnosis, 7,660 participants were included in screening. Of those, 2,415 (31.52%) individuals were discharged, 5,055 (65.99%) did not complete the screening and 185 (1.34%) new cases were diagnosed. In the DM flow, 1,539 (11.2%) individuals had previous diagnosis and thus 12,236 participants were screened. Of those, a group of 6,522 (53.3%) were discharged; 5,674 (46.37%) did not underwent in nurse consultations and 35 (0.25%) new cases were diagnosed. At the end, 185 patients were diagnosed with hypertension, 35 with DM and five individuals were diagnosed for both diseases, totaling 225 new diagnosis. For the usability and satisfaction assessment, 258 health care professionals answered the questionnaire (median age 33 [IQ 29-39] years-old, 74.5% women; 71.7% were community health workers (CHWs), 14.7% were nurses, 4.6% were physicians and 10.4% other categories. Fifty one percent considered their prior knowledge for the use of technologies to be good; 85.3% agreed that the application was easy to use; 81.8% considered the interface pleasant, 53.7% reported a desire to use the application frequently; 78.4% would recommend the platform to a colleague.

CONCLUSIONS

A CDSS developed to assist screening of hypertension and DM was feasible in the context of primary care setting in a resource constrained region, with good user satisfaction.