Guideline Adherence in Slums Project - Template-based documentation and decision support for primary healthcare clinics in the private sector

贫民窟项目中的指南遵守 - 为私营部门的初级保健诊所提供基于模板的文档和决策支持

• 批准号: MR/N005015/1
• 负责人: Pratap Kumar
• 金额: $ 12.61万
• 依托单位: Strathmore University
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2015
• 资助国家: 英国
• 起止时间: 2015 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FN005015%2F1
• 关键词: Guideline; Adherence; Slums; Project; Template

With large numbers of people in slums seeking care through the private sector, it is important to develop tools to help providers in these clinics improve the quality of their services. For example, documenting the need for an antibiotic helps reduce the number of cases of unnecessary antibiotic prescriptions.Clinical practice guidelines (CPGs) are tools developed to help doctors and nurses give evidence-based care. These are however not easy to use in a patient-facing scenario (e.g. a doctor looking through a manual when the patient is seated in front of him/her). They also need to be tweaked to be relevant to the local context (e.g. is the first line drug available or affordable?). For CPGs to be relevant in low-resource settings it is important to address multiple, if not all, barriers to using guidelines, but in a manner that does not strain limited resources.Our intervention involves working with clinical care providers and developing templates (think checklist) that can be used while they are seeing the patient. The templates take the form of rubber stamps that can be printed into the paper case sheet (e.g. if a woman presents with increased frequency of urination, the clinician stamps the Urinary Tract Infection template into her case sheet). This template is both a guide to what questions to ask the patient and how to manage UTIs. Other illnesses get other templates, but a set of 6-8 templates covers the majority of patients walking into primary care clinics.Importantly these templates are easy to digitise and analyse. They are in the form of a multiple choice exam paper where bubbles need to be shaded. A cell phone image of a filled-in template can quickly give us data on how the case was managed without revealing patient identity. Being rubber stamps we avoid the need to keep track of multiple printed sheets of paper. We also avoid wastage when guidelines change because changing the rubber engraving on the stamp is simple and cheap.We now have a tool to easily monitor the clinician's work, check for quality, and work with them if there are reasons to deviate from the guidelines by during regular feedback sessions. The intervention is being used in two slum clinics in Nairobi with great initial responses. We now want to study this intervention in a set of 10 different private sector clinics in Nairobi's slums. We would like to test if this intervention is:a) Usable - different clinics have different priorities and attitudes and we need to be sure that the intervention poses no big challengesb) Effective - does the intervention actually improve clinical practice (e.g. by reducing unnecessary antibiotic prescription)?c) Sustainable - how much does it cost for us to support these clinics with tools and feedback? Can the clinics afford to pay us for this service?d) Scalable - is there a realistic chance for us to roll this intervention out at national (or even provincial) level?If successful the intervention has the potential to change how healthcare is delivered in low-resource settings. More and more people are seeking care in the private sector, but very few regulations, services and tools exist to ensure that care in the private sector is of high quality. We hope to make a significant impact in the quality of care that is delivered to the poor.

由于大量贫民窟的人通过私营部门寻求护理，重要的是开发工具来帮助这些诊所的提供者提高他们的服务质量。例如，记录对抗生素的需求有助于减少不必要的抗生素处方的数量。临床实践指南(CPGs)是为帮助医生和护士提供循证护理而开发的工具。然而，在面向病人的情况下(例如，当病人坐在他/她前面时，医生正在翻阅手册)，这些都不容易使用。它们还需要根据当地情况进行调整(例如，一线药物是可获得的还是负担得起的？)。要让CPG在低资源环境中发挥作用，重要的是要解决使用指南的多个障碍(如果不是全部)，但要以不给有限资源带来压力的方式解决。我们的干预涉及与临床护理提供者合作，并开发可在他们看患者时使用的模板(如核对表)。模板采取橡皮图章的形式，可以打印到纸质病历中(例如，如果妇女出现尿频增加，临床医生将尿路感染模板印在她的病历中)。该模板既是向患者提出什么问题的指南，也是如何管理尿路感染的指南。其他疾病有其他模板，但一组6-8个模板覆盖了大多数走进初级保健诊所的患者。重要的是，这些模板很容易数字化和分析。它们的形式是多项选择试卷，需要遮盖气泡。一张填写好的模板的手机图像可以在不透露患者身份的情况下，迅速为我们提供有关如何管理病例的数据。由于是橡皮图章，我们避免了跟踪多张打印纸张的需要。我们还避免了指南更改时的浪费，因为更换印章上的橡胶雕刻既简单又便宜。我们现在有一个工具，可以轻松监控临床医生的工作，检查质量，并在定期反馈会议期间，如果有理由偏离指南，就与他们合作。该干预措施正在内罗毕的两个贫民窟诊所使用，初步反应良好。我们现在想在内罗毕贫民窟的10个不同的私营部门诊所中研究这种干预。我们想测试这种干预措施是否有用：a)可用--不同的诊所有不同的优先事项和态度，我们需要确保干预措施不会构成重大挑战b)有效-干预措施是否真的改善了临床实践(例如，通过减少不必要的抗生素处方)？c)可持续-我们为这些诊所提供工具和反馈支持需要多少成本？诊所支付得起这项服务的费用吗？d)可伸缩性--我们有现实的机会在国家(甚至省级)层面推出这项干预措施吗？如果成功，干预措施有可能改变在低资源环境下提供医疗保健的方式。越来越多的人在私营部门寻求护理，但很少有法规、服务和工具来确保私营部门的护理质量高。我们希望对向穷人提供的护理质量产生重大影响。

项目成果

Implementation barriers for mHealth for non-communicable diseases management in low and middle income countries: a scoping review and field-based views from implementers.

低收入和中等收入国家非传染性疾病管理移动医疗的实施障碍：范围审查和实施者的实地观点。

• DOI: 10.12688/wellcomeopenres.15581.2
• 发表时间: 2020
• 期刊: Wellcome open research
• 作者: Van Olmen J

I've got 99 problems but a phone ain't one: Electronic and mobile health in low and middle income countries.

• DOI: 10.1136/archdischild-2015-308556
• 发表时间: 2016-10
• 期刊: Archives of disease in childhood
• 影响因子: 5.2
• 作者: Kumar P;Paton C;Kirigia D
• 通讯作者: Kirigia D

Rubber stamp templates for improving clinical documentation: A paper-based, m-Health approach for quality improvement in low-resource settings.

• DOI: 10.1016/j.ijmedinf.2017.10.014
• 发表时间: 2018-06
• 期刊: International journal of medical informatics
• 影响因子: 4.9
• 作者: Kleczka B;Musiega A;Rabut G;Wekesa P;Mwaniki P;Marx M;Kumar P
• 通讯作者: Kumar P