Birinci basamak sağlık hizmetlerinde klinik karar destek ve hasta izleme sistemi geliştirilmesi ve örnek uygulamalar

Physicians' guidelines utilization rates for diagnosis, treatment and monitoring of diabetes mellitus (DM) and hypertension (HT) is very low. Time constraints, patient overpopulation and complex guidelines require alternative solutions. Rapidly evolving e-health technology combined with clinical decision support systems provides an effective solution to these problems. The purpose of the study is to develop a user-friendly, comprehensive, fully integrated web and mobile-based clinical decision support and monitoring system (CDSMS) for the screening, diagnosis, treatment and monitoring of DM and HT diseases for the use of physicians and patients in primary care. CDSMS is based on evidence-based guidelines for DM and HT diseases. A web and mobile-based application has been developed. The physician remotely monitors the patient data collected from mobile application. The developed CDSMS has been tested in two stages. In the first stage, the usability, understandability and adequacy of the application has been determined. Three family physicians have used the developed application for their 15 DM patients. Then, necessary improvements in the application have been made in accordance with the physician feedback. In the second phase, a parallel single blind randomized controlled trial has been implemented. Using CDSMS, DM diagnosed patients recruited for trial by their primary care physicians. Eligible participants were assigned to intervention and control groups with simple randomization. Seventy-five patients were assigned to intervention group and 226 patients were assigned to control group. In the intervention group, the system made recommendations on diagnosis, treatment and patient monitoring. These recommendations were implemented at the physician's discretion. In the control group, physicians treated DM patients without using CDSMS. Patients in both groups have been monitored for 6 months. Patient data has been compared between 0th and 6th month of the study. In conclusion, this study aims to decrease the rate of morbidity and mortality as well as number of visits to healthcare centers by providing continuous monitoring and effective treatment to patients. The developed system using evidence-based guidelines is the first example among the medical expertise fields providing health services to DM patients.