Telehas: desenvolvimento e avaliação de um sistema de suporte à decisão clínica para o cuidado da Hipertensão Arterial Sistêmica

Abstract

Introduction: Despite being an important cardiovascular risk factor, hypertension has low levels of control in Brazil. Computerized clinical decision support systems (CDSS) may be effective in reducing blood pressure, with a potential impact in reducing cardiovascular risk. Objectives: To evaluate the feasibility and usability of a CDSS in the care of patients with hypertension in the context of primary care setting in Brazil, as well as satisfaction of physicians with its use. Methods: The TeleHAS application was developed by the Telehealth Network of Minas Gerais and consists of a platform integrating clinical and laboratory data of a particular patient, from which it performs the cardiovascular risk calculation and provides evidence-based recommendations. Ten physicians were randomly selected among all primary care physicians in the city of Montes Claros, Brazil, to use the application in the hypertensive patients’ care for a period of six months. After three and six months of use, the feasibility and usability of the CDSS in the routine care of the primary care teams and the physicians’ satisfaction with it were assessed through printed questionnaires and semistructured interviews. Results: During the study period, 535 hypertensive patients were registered (average of 1.24 consultation/patient). Women accounted for 80% of participant doctors, median age of 31.5 years (interquartile range 27 – 59 years). As for feasibility, 100% of medical users claimed it is possible to use the application and for 80% it is easy to incorporate its use in the daily routine and home visits. However, 70% claimed that the time taken to fill out the blanks of the CDSS causes significant delays in service. The TeleHAS was evaluated as good (80% of users), with easy filling blanks and friendly interface (100%) and with the potential to improve hypertensive patients’ treatment (100%). Ninety percent of physicians had access to new knowledge about cardiovascular risk and high blood pressure through the applications recommendations and found it useful to promote prevention and optimize treatment. Conclusion: In this study, a CDSS developed to assist the care of primary care patients with hypertension was applicable in the context of primary care setting, with good user’s satisfaction and potential to improve adherence to evidence-based practices. The next step is to perform studies to assess the impact of the application in clinical outcomes.