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.
Dermatite atópica (DA) é uma inflamação crônica e pruriginosa da pele, que acomete crianças nos primeiros anos de vida. Sua etiologia permanece pouco elucidada, mas sabe-se que ocorre uma disfunção da barreira cutânea que facilita a penetração de alérgenos/irritantes na epiderme, provocando reação inflamatória com predomínio de resposta Th2 em relação a Th1. O diagnóstico é clínico, podendo associar-se com a presença de história familiar e pregressa de atopias, como rinite e asma. A DA manifesta-se por meio de lesões eczematosas, pruriginosas, com presença de eritema, pápulas, vesículas e escamas. Os principais diagnósticos diferenciais são dermatite seborreica, dermatite de contato, psoríase e escabiose. O tratamento baseia-se na educação do paciente e de seus familiares, somado ao controle do prurido com anti-histamínicos e da inflamação com corticoides e inibidores da calcineurina. Devido à alta prevalência e impacto da DA na qualidade de vida de crianças, corrobora-se a importância do diagnóstico precoce e de uma abordagem individualizada.
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 semistructured 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.
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