Estratégia de rastreamento de hipertensão arterial e diabetes mellitus na Atenção Primária com suporte de um sistema de apoio à decisão clínica

Abstract

Introduction: The fact that cardiovascular diseases (CVD) are the main cause of death in the world is a cause for concern of several social factors. As their main risk factors, hypertension and diabetes mellitus (DM), are well-known, efforts are directed towards expanding diagnosis, better clinical treatment and prevention of complications. Telemedicine has contributed in this context, mainly enabling specialized assistance to populations marked by isolation and scarcity of health resources. Objectives: To develop and implement the application with a decision support system (DSS) to screen hypertension and DM system in the Primary Care setting, in the Vale do Mucuri region. Additionally, to evaluate usability and satisfaction of the users who used the application during the tracking activities. Methods: This is a sub-study of the Healthrise Brasil program, which is part of a multicenter project engaged to expand access to care for cardiovascular diseases and DM. Focused on the strategy of screening for hypertension and DM, the first stage of the project comprised the needs assessment. The application was developed in the second stage, involving a multidisciplinary team, going through the following phases: pre-prototype; software development; software validation. In the third stage, from April 2017 to October 2018, a field study with a cross-sectional design was carried out in 10 municipalities located in the Vale do Mucuri region, through events (health fairs) or home visits carried out by community health workers. In the initial approach, individuals aged between 30 and 69 years-old answered a questionnaire with personal information and health data and measurements (blood pressure, capillary blood glucose, waist circumference) were obtained and recorded. These data were used to make suggestions from the DSS regarding the sequence of the screening. The fourth stage was carried out by applying a Likert scale questionnaire with 15 questions to assess usability (System Usability Scale) and satisfaction to the professionals who participated in the study. Results: In the study, 13,775 individuals were assessed. In the hypertension flow, 6,115 (44.39%) had a previous diagnosis, 7,660 participants were included in the screening. Of these, 2,415 (31.52%) individuals were screened negative, 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 a previous diagnosis and, therefore, 12,236 participants were screened. Of these, 6,522 (53.3%) were screened negative; 5,674 (46.37%) did not underwent the evaluations with nursing and 35 (0.25%) new cases were diagnosed. At the end of the screening, 185 patients were diagnosed with hypertension, 35 with DM and five individuals with both diseases, totaling 225 new diagnoses. To assess usability and satisfaction, 258 health professionals answered the questionnaire (median age 33 [IQ 29-39] years, 74.5% women; 71.7% were community health agents (CHA), 14.7% were nurses, 4.6% were doctors and 10.4% others). Fifty-one percent considered prior knowledge about the use of technologies to be good; 85.3% of the participants agreed that the application was easy to use; 81.8% considered the interface pleasant; 53.7% reported the desire to use the application frequently; and 78.4% would recommend the platform to a colleague. Conclusion: The use of a DSS as a screening strategy for hypertension and DM proved to be feasible in a region with limited resources and low access to specialized health, in addition to evaluating with good user satisfaction. The resource may allow the early diagnosis of hypertension and DM. A low proportion of new diagnoses was observed when using the criteria recommended by the guidelines.