Background: Hypertension is a major risk factor of cardiovascular disease and a leading cause of morbidity and mortality globally. In Kenya, the rise of hypertension strains an already stretched health care system that has traditionally focused on the management of infectious diseases. Health care provision in this country remains fragmented, and little is known about the role of health information technology in care coordination. Furthermore, there is a dearth of literature on the experiences, challenges, and solutions for improving the management of hypertension and other noncommunicable diseases in the Kenyan private health care sector. Objective: The aim of this study is to assess stakeholders’ perspectives on the challenges associated with the management of hypertension in the Kenyan private health care sector and to derive recommendations for the design and functionality of a digital health solution for addressing the care continuity and quality challenges in the management of hypertension. Methods: We conducted a qualitative case study. We collected data using in-depth interviews with 18 care providers and 8 business leads, and direct observations at 18 private health care institutions in Nairobi, Kenya. We analyzed the data thematically to identify the key challenges and recommendations for technology-enabled solutions to support the management of hypertension in the Kenyan private health sector. We subsequently used the generated insights to derive and describe the design and range of functions of a digital health wallet platform for enabling care quality and continuity. Results: The management of hypertension in the Kenyan private health care sector is characterized by challenges such as high cost of care, limited health care literacy, lack of self-management support, ineffective referral systems, inadequate care provider training, and inadequate regulation. Care providers lack the tools needed to understand their patients’ care histories and effectively coordinate efforts to deliver high-quality hypertension care. The proposed digital health platform was designed to support hypertension care coordination and continuity through clinical workflow orchestration, decision support, and patient-mediated data sharing with privacy preservation, auditability, and trust enabled by blockchain technology. Conclusions: The Kenyan private health care sector faces key challenges that require significant policy, organizational, and infrastructural changes to ensure care quality and continuity in the management of hypertension. Digital health data interoperability solutions are needed to improve hypertension care coordination in the sector. Additional studies should investigate how patients can control the sharing of their data while ensuring that care providers have a holistic view of the patient during any encounter.

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中文翻译：

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应对高血压管理中的护理连续性和质量挑战：肯尼亚私人卫生保健部门的案例研究

背景：高血压是心血管疾病的主要危险因素，也是全球发病率和死亡率的主要原因。在肯尼亚，高血压的增加给原本已经集中于传染病管理的，已经捉襟见肘的卫生保健系统造成压力。这个国家的医疗保健服务仍然是零散的，对卫生信息技术在医疗保健协调中的作用知之甚少。此外，在肯尼亚私人卫生保健部门，缺乏改善高血压和其他非传染性疾病管理的经验，挑战和解决方案的文献匮乏。客观的：这项研究的目的是评估利益相关者对肯尼亚私人医疗保健部门中与高血压管理相关的挑战的观点，并针对数字医疗解决方案的设计和功能性提出建议，以解决医疗保健连续性和质量方面的挑战。高血压的管理。方法：我们进行了定性的案例研究。我们通过与18位护理提供者和8位业务负责人进行了深入访谈，并在肯尼亚内罗毕的18家私人健康护理机构进行了直接观察，收集了数据。我们对数据进行了主题分析，以确定支持肯尼亚私营卫生部门高血压管理的技术解决方案的主要挑战和建议。随后，我们使用生成的见解来推导和描述数字医疗钱包平台的设计和功能范围，以实现护理质量和连续性。结果：肯尼亚私营卫生保健部门的高血压管理面临以下挑战：高昂的医疗保健费用，有限的医疗保健素养，缺乏自我管理支持，无效的转诊系统，不足的护理提供者培训以及监管不足。护理提供者缺乏了解患者护理历史并有效协调提供高质量高血压护理工作所需的工具。拟议中的数字医疗平台旨在通过临床工作流程编排，决策支持以及患者介导的数据共享和隐私保护来支持高血压护理的协调和连续性，可审计性，并通过区块链技术实现信任。结论：肯尼亚的私人卫生保健部门面临着重大挑战，需要进行重大的政策，组织和基础设施改革，以确保高血压治疗的护理质量和连续性。需要数字健康数据互操作性解决方案来改善该部门的高血压护理协调。其他研究应调查患者如何控制他们的数据共享，同时确保医护人员在遇到任何情况时都能全面了解患者。需要数字健康数据互操作性解决方案来改善该部门的高血压护理协调。其他研究应调查患者如何控制他们的数据共享，同时确保医护人员在遇到任何情况时都能全面了解患者。需要数字健康数据互操作性解决方案来改善该部门的高血压护理协调。其他研究应调查患者如何控制他们的数据共享，同时确保医护人员在遇到任何情况时都能全面了解患者。

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