title: The Impact of a Clinical Decision Support System in Diabetes Primary Care Patients in a Developing Country.
abstract: 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.
  
  
  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.
authors: 1 Telehealth Network of Minas Gerais , Belo Horizonte, Minas Gerais, Brazil .
authors: Júnia Xavier
authors: JX
authors: Maia
authors: 1 Telehealth Network of Minas Gerais , Belo Horizonte, Minas Gerais, Brazil .
authors: Lidiane Aparecida Pereira
authors: LA
authors: de Sousa
authors: 1 Telehealth Network of Minas Gerais , Belo Horizonte, Minas Gerais, Brazil .|2 Medical School and Clinical Hospital, Federal University of Minas Gerais , Minas Gerais, Belo Horizonte, Brazil .
authors: Milena Soriano
authors: MS
authors: Marcolino
authors: 1 Telehealth Network of Minas Gerais , Belo Horizonte, Minas Gerais, Brazil .|3 Federal University of São João Del-Rey , Divinópolis, Minas Gerais, Brazil .
authors: Clareci Silva
authors: CS
authors: Cardoso
authors: 4 Department of Statistics, Federal University of Minas Gerais , Belo Horizonte, Minas Gerais, Brazil .
authors: José Luiz Padilha
authors: JL
authors: da Silva
authors: 1 Telehealth Network of Minas Gerais , Belo Horizonte, Minas Gerais, Brazil .|2 Medical School and Clinical Hospital, Federal University of Minas Gerais , Minas Gerais, Belo Horizonte, Brazil .
authors: Maria Beatriz Moreira
authors: MB
authors: Alkmim
authors: 1 Telehealth Network of Minas Gerais , Belo Horizonte, Minas Gerais, Brazil .|2 Medical School and Clinical Hospital, Federal University of Minas Gerais , Minas Gerais, Belo Horizonte, Brazil .
authors: Antonio Luiz Pinho
authors: AL
authors: Ribeiro
mesh_terms: D000368:Aged; D001938:Brazil; D003131:Combined Modality Therapy; D020000:Decision Support Systems, Clinical; D003906:Developing Countries; D048909:Diabetes Complications / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006284:Health Plan Implementation; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D017216:Telemedicine
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human