Development and Evaluation of a Mobile Decision Support System for Hypertension Management in the Primary Care Setting in Brazil: Mixed-Methods Field Study on Usability, Feasibility, and Utility.

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.

Abordagem da dermatite atópica na infância pelo Médico de Família e Comunidade / Approach to atopic dermatitis in children by the Family Physician / Enfoque de la dermatitis atópica em niños por el Médico de Familia y Comunidad

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.

Atopic dermatitis (AD) is a chronic and inflammatory disease that affects the skin of children in their early stages of life. Its aetiology remains little understood, but it is known that there is a dysfunction of the skin barrier, which facilitates the penetration of allergens/irritants into the epidermis, causing an inflammatory response with a predominance of Th2 response relative to Th1. The diagnosis is clinical and may be associated with previous and family medical history of atopies such as rhinitis and asthma. AD manifests itself through eczematous, pruritic injuries with the presence of erythema, papules, vesicles, and scales. The main differential diagnoses of AD are seborrheic dermatitis, contact dermatitis, psoriasis and scabies. The treatment is based on the education of patients and their families, plus the control of pruritus with antihistamines and of inflammation with corticosteroids or calcineurin inhibitors. Given the high prevalence and impact of AD on the quality of life of paediatric patients, early diagnosis and an individualized approach are paramount.

La dermatitis atópica (DA) es una enfermedad crónica e inflamatorio en la piel, que afecta a los niños en los primeros años de vida. Su etiología sigue siendo poco dilucidado, pero se sabe que existe una disfunción de la barrera de la piel que facilita la penetración de alérgeno/irritante sobre la piel, causando una reacción inflamatoria con predominante respuesta Th2 hacia Th1. El diagnóstico es clínico y puede estar asociado con la presencia de la historia familiar y la historia anterior de enfermedades atópicas, tales como la rinitis y el asma. La DA se manifiesta a través de lesiones eczematosas y pruriginosas, la presencia de eritema, pápulas, vesículas y escamas. Los principales diagnósticos diferenciales son dermatitis seborreica, dermatitis de contacto, la psoriasis y la sarna. El tratamiento se basa en la educación de los pacientes y sus familias, además del control del prurito con antihistamínicos y la inflamación con corticoides y los inhibidores de la calcineurina. Dada la alta prevalencia y el impacto de la DA en la calidad de vida de los pacientes pediátricos, corroborase la importancia del diagnóstico precoz y un enfoque individualizado.