Transition to an in-facility electronic Tuberculosis register: Lessons from a South African pilot project
Transition to an in-facility electronic Tuberculosis register: Lessons from a South African pilot project
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DOI：
10.4102/sajhivmed.v21i1.1025
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发表时间：
2020-01-01
影响因子：
1.7
通讯作者：
Hoddinott, Graeme
中科院分区：
文献类型：
--
作者：
Myburgh, Hanlie;Peters, Remco P.H.;Hoddinott, Graeme
背景：南非是全球结核病发病率最高的国家之一。艾滋病毒合并症的高流行率使结核病管理和治疗结果复杂化。越来越多的证据表明，结核病和艾滋病规划的整合将改善总体结果。目标：描述南非卫生系统各级结核病规划工作人员如何应对结核病数据从纸质登记册向与艾滋病规划数据整合的电子登记册的过渡。方法：南非西开普省Cape Winelands区的三个初级保健服务设施作为实施试点。半结构化访谈进行了有目的地选择在设施，分区，区和省一级的卫生系统，根据他们参与实施电子结核病数据的21结核病规划工作人员。一个目标驱动的主题框架被用来分析data.Results：担心的过渡包括减少数据质量，改变现状和缺乏计算机素养。参与者承认减少工作量、访问患者级数据的速度和点击按钮报告的好处。有三个因素影响了采用新系统的难易程度：第一，实施工作对结核病规划的纵向地位、结核病数据和工作人员的传统作用和责任提出了挑战;第二，认为纸质登记册功能可靠，因此似乎没有必要向电子登记册过渡;第三，缺乏变革管理进程，这对工作人员将拟议变革内化的能力提出了挑战。变革管理进程对于提高设施内结核病电子登记册的实施效率和效力至关重要。
Background: South Africa has one of the highest incidences of Tuberculosis (TB) globally. High co-morbid HIV prevalence complicates TB management and treatment outcomes. Growing evidence suggests that integrating the TB and HIV programmes will improve the overall results.Objectives: To describe how TB programme staff at various levels of the South African health system responded to the transition from a paper-based to an electronic register of TB data integrated with HIV programme data.Method: Three primary health service facilities in the Cape Winelands district, Western Cape province, South Africa served as pilot sites for implementation. Semi-structured interviews were conducted with 21 TB programme staff purposively selected at facility, sub-district, district and provincial levels of the health system, based on their involvement in implementing electronic TB data. An objective-driven thematic frame was used to analyse the data.Results: Fears about the transition included reductions in data quality, changes to the status quo and a lack of computer literacy. Participants acknowledged benefits of reduced workloads, speed of accessing patient-level data and click-of-a-button reporting. Three factors influenced the ease of adopting the new system: firstly, implementation challenged the vertical position of the TB programme, TB data and staff's conventional roles and responsibilities; secondly, perceptions of the paper-based register as functional and reliable made the transition to electronic seem unnecessary; and thirdly, lack of a process of change management challenged staff's ability to internalise the proposed change.Conclusion: A process of change management is critical to facilitate the efficiency and effectiveness with which the electronic in-facility TB register is implemented.