JMIR Publications

ABSTRACT

Background:

Despite being an important cardiovascular risk factor, hypertension (HT) has low control levels worldwide. Computerized clinical decision support systems (CDSS) might be effective in reducing blood pressure, with a potential impact in reducing cardiovascular risk.

Objective:

To evaluate the feasibility and usability of a CDSS, named TeleHAS, in the care of patients with HT in the context of primary care setting in a middle income country, as well as the physician’s satisfaction with its use.

Methods:

The TeleHAS application consists of a platform integrating clinical and laboratory data of 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 HT and cardiovascular risk. Ten family physicians of different primary care units in Montes Claros city, Brazil, were randomly selected to use the application for the care of hypertensive patients for 6 months. After 3 months, the feasibility and usability of the CDSS in the routine care of the health teams was evaluated through standardized questionnaire and semi-structured interviews. After 6 months, another questionnaire and semi-structured interviews were applied to test the satisfaction of the physicians with the application.

Results:

Throughout the study, clinicians registered 535 patients with HT, at an average of 1.24 consultations per patient. Women accounted for 80% of participant doctors, median age 31.5 years (interquartile range 27-59 years). As for feasibility, 100% of medical users claimed it is possible to use the application in the primary care setting and for 80% of them it is easy to incorporate its use in the daily routine and home visits. Nevertheless, 70% of physicians claimed that the time taken to fill out the CDSS causes significant delays in service. Clinicians evaluated the TeleHAS as good (80% of users), with easy filling blanks and friendly interface (100%) and with the potential to improve patients’ treatment (100%). Ninety percent of physicians had access to new knowledge about cardiovascular risk and HT through the application 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 HT was applicable in the context of primary health care setting in a middle income country, with good user’s satisfaction and potential to improve adherence to evidence-based practices.