Results from one-year use of an electronic Clinical Decision Support System in a post-conflict context: An implementation research
Results from one-year use of an electronic Clinical Decision Support System in a post-conflict context: An implementation research
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DOI：
10.1371/journal.pone.0225634
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发表时间：
2019-12-02
期刊：
影响因子：
3.7
通讯作者：
Rossi, Rodolfo
中科院分区：
文献类型：
--
作者：
Bernasconi, Andrea;Crabbe, Francois;Rossi, Rodolfo
背景2017年，阿达马瓦州初级卫生保健发展局推出了ALMANACH，这是一种基于IMCI修改版的电子临床决策支持系统。目标地区是联邦阿达马瓦州（尼日利亚），这是一个在博科圣地叛乱之后正在恢复的地区。这一实施研究的目的是评估一年的利用tool.MethodsWe进行了两个横断面研究，在6个初级卫生保健中心，以评估与实施前进行的基线相比，改善提供的优质护理方面的改进。其中一项调查是在咨询室内进行的，其依据是对2至59个月大的儿童的235次咨询的直接观察。第二次调查询问了189保健设施外，他们的意见进行咨询，通过使用平板电脑，处方和药物gived.ResultsIn与基线相比，更多的儿童被检查的危险迹象（60.0%与37.1%在基线），此外，儿童实际上是在咨询过程中称重（61.1%与27.7%）。在35.1%的儿童中进行了营养不良筛查（对12.1%）。通过ALMANACH，预防措施的执行情况也得到了显著改善（p< 0.01）：39.8%的病例检查了疫苗接种情况（基线时为10.6%），驱虫和维生素A处方分别增加到46.5%（0.7%）和48.3%（2.8%）。此外，儿童接受了全面的体格检查（58.3% vs. 45.5%，p< 0.01）和正确的治疗（48.4% vs. 29.5%，p< 0.01）。关于抗生素处方，69.3%的患者接受至少一种抗生素（基线77.7%，p< 0.05）。ConclusionsOur研究结果突出了护理质量方面的重大改善，尽管许多问题仍有待回答，在阿达马瓦卫生系统的工具的全面整合。
BackgroundIn 2017, the Adamawa State Primary Healthcare Development Agency introduced ALMANACH, an electronic clinical decision support system based on a modified version of IMCI. The target area was the Federal State of Adamawa (Nigeria), a region recovering after the Boko Haram insurgency. The aim of this implementation research was to assess the improvement in terms of quality care offered after one year of utilization of the tool.MethodsWe carried out two cross-sectional studies in six Primary Health Care Centres to assess the improvements in comparison with the baseline carried out before the implementation. One survey was carried out inside the consultation room and was based on the direct observation of 235 consultations of children aged from 2 to 59 months old. The second survey questioned 189 caregivers outside the health facility for their opinion about the consultation carried out through using the tablet, the prescriptions and medications given.ResultsIn comparison with the baseline, more children were checked for danger signs (60.0% vs. 37.1% at baseline) and in addition, children were actually weighed (61.1% vs. 27.7%) during consultation. Malnutrition screening was performed in 35.1% of children (vs. 12.1%). Through ALMANACH, also performance of preventive measures was significantly improved (p< 0.01): vaccination status was checked in 39.8% of cases (vs. 10.6% at baseline), and deworming and vitamin A prescription was increased to 46.5% (vs. 0.7%) and 48.3% (vs. 2.8%) respectively. Furthermore, children received a complete physical examination (58.3% vs. 45.5%, p< 0.01) and correct treatment (48.4% vs. 29.5%, p< 0.01). Regarding antibiotic prescription, 69.3% patients received at least one antibiotic (baseline 77.7%, p< 0.05).ConclusionsOur findings highlight major improvements in terms of quality of care despite many questions still pending to be answered in relation to a full integration of the tool in the Adamawa health system.