Sukums Felix, Mensah Nathan, Mpembeni Rose, Massawe Siriel, Duysburgh Els, Williams Afua, Kaltschmidt Jens, Loukanova Svetla, Haefeli Walter E, Blank Antje
Heidelberg University Hospital, Department of Clinical Pharmacology & Pharmacoepidemiology, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Muhimbili University of Health and Allied Sciences (MUHAS), Directorate of Information and Communication Technology, P.O. Box 65001, Dar es Salaam, Tanzania.
Heidelberg University Hospital, Department of Clinical Pharmacology & Pharmacoepidemiology, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana.
Int J Med Inform. 2015 Sep;84(9):647-57. doi: 10.1016/j.ijmedinf.2015.05.002. Epub 2015 Jun 3.
The QUALMAT project has successfully implemented an electronic clinical decision support system (eCDSS) for antenatal and intrapartum care in two sub-Saharan African countries. The system was introduced to facilitate adherence to clinical practice guidelines and to support decision making during client encounter to bridge the know-do gap of health workers.
This study aimed to describe health workers' acceptance and use of the eCDSS for maternal care in rural primary health care (PHC) facilities of Ghana and Tanzania and to identify factors affecting successful adoption of such a system.
This longitudinal study was conducted in Lindi rural district in Tanzania and Kassena-Nankana district in Ghana between October 2011 and December 2013 employing mixed methods. The study population included healthcare workers who were involved in the provision of maternal care in six rural PHC facilities from one district in each country where the eCDSS was implemented.
All eCDSS users participated in the study with 61 and 56 participants at the midterm and final assessment, respectively. After several rounds of user training and support the eCDSS has been successfully adopted and constantly used during patient care in antenatal clinics and maternity wards. The eCDSS was used in 71% (2703/3798) and 59% (14,189/24,204) of all ANC clients in Tanzania and Ghana respectively, while it was also used in 83% (1185/1427) and 67% (1435/2144) of all deliveries in Tanzania and in Ghana, respectively. Several barriers reported to hinder eCDSS use were related to individual users, tasks, technology, and organization attributes.
Implementation of an eCDSS in resource-constrained PHC facilities in sub-Saharan Africa was successful and the health workers accepted and continuously used the system for maternal care. Facilitators for eCDSS use included sufficient training and regular support whereas the challenges to sustained use were unreliable power supply and perceived high workload. However our study also shows that most of the perceived challenges did not substantially hinder adoption and utilization of the eCDSS during patient care.
QUALMAT项目已在撒哈拉以南非洲的两个国家成功实施了用于产前和产时护理的电子临床决策支持系统（eCDSS）。引入该系统是为了促进对临床实践指南的遵守，并在与患者接触期间支持决策制定，以弥合卫生工作者的知行差距。
本研究旨在描述加纳和坦桑尼亚农村初级卫生保健（PHC）机构中卫生工作者对用于孕产妇护理的eCDSS的接受情况和使用情况，并确定影响此类系统成功采用的因素。
这项纵向研究于2011年10月至2013年12月在坦桑尼亚的林迪农村地区和加纳的卡塞纳-南卡纳地区采用混合方法进行。研究人群包括在实施了eCDSS的每个国家一个地区的六个农村初级卫生保健机构中参与提供孕产妇护理的医护人员。
所有eCDSS用户都参与了研究，中期评估时有61名参与者，最终评估时有56名参与者。经过几轮用户培训和支持，eCDSS已在产前诊所和产科病房的患者护理中成功采用并持续使用。eCDSS分别在坦桑尼亚和加纳所有ANC客户的71%（2703/3798）和59%（14189/24204）中使用，同时也分别在坦桑尼亚和加纳所有分娩的83%（1185/1427）和67%（1435/2144）中使用。据报告，阻碍eCDSS使用的几个障碍与个人用户、任务、技术和组织属性有关。
在撒哈拉以南非洲资源有限的初级卫生保健机构中实施eCDSS是成功的，卫生工作者接受并持续使用该系统进行孕产妇护理。eCDSS使用的促进因素包括充分的培训和定期支持，而持续使用的挑战是电力供应不可靠和工作量大。然而，我们的研究还表明，大多数察觉到的挑战并未在很大程度上阻碍在患者护理期间采用和使用eCDSS。
