An e-Health Decision Support System for Improving Compliance of Health Workers to the Maternity Care Protocols in South Africa
An e-Health Decision Support System for Improving Compliance of Health Workers to the Maternity Care Protocols in South Africa
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DOI：
10.4338/aci-2012-10-ra-0044
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发表时间：
2013-01-01
影响因子：
2.9
通讯作者：
Kwinda, H.
中科院分区：
文献类型：
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作者：
Horner, V.;Rautenbach, P.;Kwinda, H.
背景：南非初级卫生保健层面的产妇服务存在质量问题。其中许多问题可以追溯到不遵守孕产妇护理指南以及缺乏支持诊所工作人员和管理人员履行职责的工具。目的：本研究的目的是调查电子医疗（计算机化）决策支持系统在解决南非初级卫生保健中卫生工作者遵守孕产妇护理指南的问题方面的效用。尽管南非初级卫生保健临床决策支持系统被列为国家卫生部电子卫生战略的一部分，但目前南非还没有关于初级卫生保健电子卫生临床决策支持系统的研究记录。方法：开发了名为Bacis（基本产前保健信息系统）计划的电子健康决策支持系统，然后在初级卫生保健诊所实施和评估。研究持续两年：包括开发、实施和评估。结果和结论：依从性总体提高，从 85.1% 提高到 89.3%。这一结果没有统计学意义。然而，当结果被分层到特定类别时，Bacis 计划在九个重要类别中的三个类别中显示出与检查表系统相比的合规性显着改善。这些是预约时的合规性、18 岁以下的患者以及 20 周后预约的患者。此外，我们还获得了在南非初级卫生保健等资源紧张环境中开发和实施临床信息系统的见解和经验。这些结果、见解和经验对于在南非实施拟议的电子卫生战略非常宝贵。
Background: There are problems of quality in maternity services at primary health care level in South Africa. Many of these problems can be traced to non-adherence to the maternity care guidelines and lack of tools to support clinic staff and managers in their roles. Objective: The aim of this research was to investigate the utility of e-health (computerized) decision support systems at addressing the problem of compliance of health workers to the maternity care guidelines at primary health care in South Africa. At present there are no documented studies on e-health clinical decision support systems for primary health care in South Africa, though clinical decision support systems for primary health care are listed as part of the e-health strategy of the National Department of Health. Methods: An e-health decision support system named the Bacis (Basic Antenatal Care Information System) Program was developed, then implemented and evaluated at a primary health care clinic. The duration of the study was two years: this includes development, implementation and evaluation.Results and Conclusion: There was an overall improvement in compliance from 85.1 % to 89.3%. This result was not statistically significant. However when results were stratified into specific categories, the Bacis Program showed statistically significant improvement in compliance over the checklist system in three out of nine important categories. These are compliance at booking, patients younger than 18 years and patients booking after week 20. Further, insights and experience were also gained on development and implementation of clinical information systems at resource strained environments such as primary health care in South Africa. These results, insights and experience are invaluable for the implementation of the proposed e-health strategy in South Africa.