Background The low levels of control of hypertension and diabetes mellitus are a challenge that requires innovative strategies to surpass barriers of low sources, distance, and quality of health care. Objective The aim of this study is to develop a clinical decision support system (CDSS) for diabetes and hypertension management in primary care, to implement it in a resource-constrained region, and to evaluate its usability and health care practitioner satisfaction. Methods This mixed methods study is a substudy of HealthRise Brazil Project, a multinational study designed to implement pilot programs to improve screening, diagnosis, management, and control of hypertension and diabetes among underserved communities. Following the identification of gaps in usual care, a team of clinicians established the software functional requirements. Recommendations from evidence-based guidelines were reviewed and organized into a decision algorithm, which bases the CDSS reminders and suggestions. Following pretesting and expert panel assessment, pilot testing was conducted in a quasi-experimental study, which included 34 primary care units of 10 municipalities in a resource-constrained area in Brazil. A Likert-scale questionnaire evaluating perceived feasibility, usability, and utility of the application and professionals’ satisfaction was applied after 6 months. In the end-line assessment, 2 focus groups with primary care physicians and nurses were performed. Results A total of 159 reminders and suggestions were created and implemented for the CDSS. At the 6-month assessment, there were 1939 patients registered in the application database and 2160 consultations were performed by primary care teams. Of the 96 health care professionals who were invited for the usability assessment, 26% (25/96) were physicians, 46% (44/96) were nurses, and 28% (27/96) were other health professionals. The questionnaire included 24 items on impressions of feasibility, usability, utility, and satisfaction, and presented global Cronbach α of .93. As for feasibility, all professionals agreed (median scores of 4 or 5) that the application could be used in primary care settings and it could be easily incorporated in work routines, but physicians claimed that the application might have caused significant delays in daily routines. As for usability, overall evaluation was good and it was claimed that the application was easy to understand and use. All professionals agreed that the application was useful (score 4 or 5) to promote prevention, assist treatment, and might improve patient care, and they were overall satisfied with the application (median scores between 4 and 5). In the end-line assessment, there were 4211 patients (94.82% [3993/4211] with hypertension and 24.41% [1028/4211] with diabetes) registered in the application’s database and 7960 consultations were performed by primary health care teams. The 17 participants of the focus groups were co...
Background Around the world, people receive care at various institutions; therefore, clinical information is recorded either on paper or distributed on different information systems with reduced capabilities for sharing data. One approach to handling the complex nature of the health information systems and making it interoperable is the two-level modeling, and the ISO 13606 standard is an option to support this model. A regionally governed EHR program in Brazil proposed to use the ISO 13606 standard and archetypes. This program includes an EHR repository for consolidating the longitudinal electronic record of patients' health. Objective This article aims to present the results and lessons learned from a proof-of-concept (POC) for integrating the Maternal and Neonatal Healthcare Information System (SISMater) developed by the Federal University of Minas Gerais (UFMG) with the EHR system developed by the Department of Healthcare for the State of Minas Gerais (SES/MG). Methods The design of the architecture and software development were driven by the content to be exchanged between the SISMater system and the EHR system and the usage of XML transformation to translate an ISO 13606 EHR extract and vice versa. This POC did not include tests related to revision objects according to ISO 13606 reference model. Results The software architecture and software components required for this POC were proposed and tested. The EHR system validated the syntax and semantic and persisted the extract in the EHR repository. Complete results can be accessed at https://github.com/pocppsus/repository. Conclusion The approach for using XML transformations could make easier the process for ISO 13606 noncompliant EMR systems to exchange EHR data with the SES/MG EHR system.
Introdução: Em pacientes recebendo Cuidados Paliativos (CP), a necessidade de cuidados e a intensidade dos sintomas aumentam gradativamente, associadas à progressão da doença principal. Objetivo: Descrever o desenvolvimento do aplicativo móvel "Cuidados Paliativos", multiplataforma, de apoio ao profissional de saúde que atua em CP. Método: Uma equipe multidisciplinar procedeu com revisão teórica, levantamento dos requisitos de software, análise do cotidiano dos profissionais em CP e desenvolvimento do aplicativo. Resultado: Aplicativo móvel, que permite ao profissional se apropriar de conceitos básicos de CP e de estratégias para comunicação de más notícias e monitorar os principais sintomas e a funcionalidade do paciente. Em junho de 2017, o aplicativo tinha nota 4,8/5,0 no Google Play e mais de 2.400 downloads. Conclusão: O aplicativo obteve expressivo número de downloads logo após sua publicação, êxito que pode evidenciar o alcance atual do tema e impulsiona a expansão do "Cuidados Paliativos" visando incorporar novas funcionalidades.
Aim: To assess spatial distribution patterns of residence addresses of postpartum women, according to risk pregnancy and obstetric outcome. Method: Descriptive geographic-spatial research. This study analysed a cohort of 1792 women living in Belo Horizonte (Brazil) and having received care during childbirth in the universitary maternity-school. The prototype SISMater-GIS was used to select the specific features for the analysis in this study. The ArcGIS Online software was used to generate thematic maps. Results: We observed a concentration of women living in the northwest of the city to officially refer to their childbirth mothers in the maternity-school. About a quarter of the analyzed population had some type of perinatal complications. In cases of high risk pregnancy and perinatal complications referencing also occurs from practically all other regions of the city. Conclusion: the integration of hospital clinical and administrative data with cartographic databases City through prototype SISMater-GIS was able to make clear the patterns of referencing for childbirth in maternity-school in high risk pregnancy. Despite the limitations of a descriptive study the analysis makes clear that the choice of place of childbirth exceeds the matters set out in government planning of emergency obstetric referencing by sanitary districts.
Background: Information systems allow for the availability of clinical records in computer databases. Obstetric caring demands a continuous process of information sharing between health professionals. However, the lack of communication between points of assistance has allowed for an accumulation of local data without the benefits of data interoperability. Objective: The study's objective is to develop an information model with essential obstetric data to reuse information from primary sources through to tertiary level of care, and to foster the continuity of information. Methods: An exploratory research involved focus group discussions with obstetricians as domain specialists and computer scientists. Fictitious cases of obstetric emergencies were discussed to select meaningful information from prenatal care for the specialists' decision making. Ninety electronic medical records (EMR) from a university obstetric emergency unit were used to validate the information model. A second-round evaluation with the obstetrician met
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.
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