The Impact of a Clinical Decision Support System in Diabetes Primary Care Patients in a Developing Country.

BACKGROUND: Telehealth strategies have the potential to improve diabetes care, but there is a lack of evidence about the impact of these strategies in developing countries. Our objective was to analyze the feasibility, usability, and clinical impact of a decision support system (DSS) in Brazilian primary care diabetes patients. MATERIALS AND METHODS: This was a quasi-experimental study that included type 2 diabetes primary care patients >40 years of age. Patients were assessed before (during 6 months) and after the implementation of the DSS application (4 months). The DSS application, used by health professionals, included clinical evaluations and blood glucose measurements and generated specific recommendations based on the data entered. RESULTS: In total, 145 patients were included (mean age, 62.0 ± 9.9 years), 62.1% were female, and 70.0% had been diagnosed with diabetes more than 5 years ago. Overall, there was no decrease in median hemoglobin A1c (HbA1c), from 7.7% (range, 6.5-9.8%) to 7.4% (range, 6.5-9.2%) (P for slope = 0.347). Subgroup analysis showed that patients with an HbA1c level of ≥9% at baseline had a significant reduction in median HbA1c level, from 10.5% (range, 9.9-11.3%) to 10.0% (range, 8.9-10.9%) (P for difference of slope between subgroups = 0.004). The reduction occurred in the first phase of the study, before the DSS use. Healthcare practitioners considered the DSS easy to use (99%) and believed that it provided useful information for patient care (100%). CONCLUSIONS: In this study the improvement of glycemic control before the application in more decompensated patients (HbA1c ≥9%) probably reflects the systematization of diabetes care. The DSS use did not improve the HbA1c level, possibly because of the short follow-up and/or infrequent use by the healthcare practitioners.

[The Portuguese version, cross-cultural adaptation and validation of specific quality-of-life questionnaire -AQUAREL - for pacemaker patients]. / Versão em português, adaptação transcultural e validação de questionário para avaliação da qualidade de vida para pacientes portadores de marcapasso: AQUAREL.

OBJECTIVE: To translate, to make the cultural adaptation and to evaluate reproducibility and validity of the Portuguese version of the AQUAREL (Assessment of QUAlity of life and RELated events) questionnaire, which is a specific tool to assess quality of life in pacemaker patients. METHODS: We evaluated 202 pacemaker patients: 63 patients during the cross-cultural adaptation stage and 139 during the reproducibility and validity evaluation stages. The questionnaire translation was reviewed repeatedly until > or = 85% of patients correctly understood the questions. Reproducibility of the final version was tested in 69 patients in whom the interview was performed twice by the same researcher. Validity was checked by the correlation between scores obtained in AQUAREL domains and those obtained in SF36 domains, in the functional class and the distance walked in the six-minute test. RESULTS: The internal consistency of AQUAREL was adequate, with Cronbachs alpha coefficient varying between 0.59 and 0.85. Reproducibility was good, with high correlation coefficients (0.68-0.89) and random distribution of data in Bland and Altman plots, without systematic bias. A significant association was observed among AQUAREL domains and those obtained in SF36 domains and the functional class (p<0.01), although significant correlations with the distance walked in the six-minute test were not found. CONCLUSION: The Portuguese version of the AQUAREL questionnaire is easy and rapid to apply, and could be used as a specific questionnaire to assess quality of life in pacemaker patients.