Mobile Clinical Decision Support System for the Management of Diabetic Patients With Kidney Complications in UK Primary Care Settings: Mixed Methods Feasibility Study

Hala Ibrahim Alhodaib; Christina Antza; Joht Singh Chandan; Wasim Hanif; Sailesh Sankaranarayanan; Sunjay Paul; Paul Sutcliffe; Krishnarajah Nirantharakumar

doi:10.2196/19650

Mobile Clinical Decision Support System for the Management of Diabetic Patients With Kidney Complications in UK Primary Care Settings: Mixed Methods Feasibility Study

JMIR Diabetes. 2020 Nov 18;5(4):e19650. doi: 10.2196/19650.

Authors

Hala Ibrahim Alhodaib^{1

2}, Christina Antza³, Joht Singh Chandan⁴, Wasim Hanif⁵, Sailesh Sankaranarayanan⁶, Sunjay Paul⁷, Paul Sutcliffe², Krishnarajah Nirantharakumar^{4

8}

Affiliations

¹ Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
² Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
³ Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.
⁴ Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.
⁵ Diabetes Centre, University Hospitals Birmingham, Birmingham, United Kingdom.
⁶ Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism Centre, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom.
⁷ The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom.
⁸ Health Data Research UK, Birmingham, United Kingdom.

PMID: 33206055
PMCID: PMC7710444
DOI: 10.2196/19650

Abstract

Background: Attempts to utilize eHealth in diabetes mellitus (DM) management have shown promising outcomes, mostly targeted at patients; however, few solutions have been designed for health care providers.

Objective: The purpose of this study was to conduct a feasibility project developing and evaluating a mobile clinical decision support system (CDSS) tool exclusively for health care providers to manage chronic kidney disease (CKD) in patients with DM.

Methods: The design process was based on the 3 key stages of the user-centered design framework. First, an exploratory qualitative study collected the experiences and views of DM specialist nurses regarding the use of mobile apps in clinical practice. Second, a CDSS tool was developed for the management of patients with DM and CKD. Finally, a randomized controlled trial examined the acceptability and impact of the tool.

Results: We interviewed 15 DM specialist nurses. DM specialist nurses were not currently using eHealth solutions in their clinical practice, while most nurses were not even aware of existing medical apps. However, they appreciated the potential benefits that apps may bring to their clinical practice. Taking into consideration the needs and preferences of end users, a new mobile CDSS app, "Diabetes & CKD," was developed based on guidelines. We recruited 39 junior foundation year 1 doctors (44% male) to evaluate the app. Of them, 44% (17/39) were allocated to the intervention group, and 56% (22/39) were allocated to the control group. There was no significant difference in scores (maximum score=13) assessing the management decisions between the app and paper-based version of the app's algorithm (intervention group: mean 7.24 points, SD 2.46 points; control group: mean 7.39, SD 2.56; t₃₇=-0.19, P=.85). However, 82% (14/17) of the participants were satisfied with using the app.

Conclusions: The findings will guide the design of future CDSS apps for the management of DM, aiming to help health care providers with a personalized approach depending on patients' comorbidities, specifically CKD, in accordance with guidelines.

Keywords: chronic kidney disease; clinical decision support application; diabetes mellitus; eHealth; feasibility study.

©Hala Ibrahim Alhodaib, Christina Antza, Joht Singh Chandan, Wasim Hanif, Sailesh Sankaranarayanan, Sunjay Paul, Paul Sutcliffe, Krishnarajah Nirantharakumar. Originally published in JMIR Diabetes (http://diabetes.jmir.org), 18.11.2020.