Department of Ambulatory Care and Community Medicine, Lausanne, Switzerland.
University of Lausanne Medical School, Lausanne, Switzerland.
BMC Public Health. 2019 Apr 29;19(1):449. doi: 10.1186/s12889-019-6692-6.
Electronic clinical decision algorithms (eCDAs) that guide clinicians during patient management are being deployed in resource-limited settings to improve the quality of care and rational use of medicines (especially antimicrobials). Little is known on how local clinicians perceive the use and impact of these tools in their daily practice. This study investigates clinician insights on an eIMCI tool. Specifically, we report their views on its medical content, assess their knowledge on microbes, antimicrobials and the development of resistance.
This qualitative study was conducted in the frame of a large-scale implementation in Burkina Faso of an eIMCI tool developed by the Swiss NGO Terre des hommes. Twelve in-depth interviews and 2 focus-group discussions were conducted including 21 health workers from 10 primary care facilities. Emerging themes were identified using qualitative data analysis software.
eIMCI users expressed a high level of satisfaction, slowness of the tablet was perceived as the major inconvenience limiting uptake. Several frequent illnesses were identified as missing in the algorithm along with guidance for fever without focus. When asked about existing types of microbes, 9 and 4 out of 21 participants could mention bacteria and virus respectively; only 5 correctly answered that antibiotics had no action on viral disease and 6 mentioned the risk of antibiotic resistance. Level of knowledge was higher in nurses than in less trained health workers. The tool was perceived as improving patient management and the rational use of antibiotics. Positive changes in health facility organisation were reported, such as task shifting and improved triage. eIMCI was also perceived as a learning tool, and users expressed a strong desire to expand the geographic and temporal scope of the intervention.
The use of eICMI was widely accepted and perceived as a powerful tool guiding daily practice. Findings suggest that it has positive effects on the health care system beyond the quality of consultation. To support large uptake and sustainability, better training of health workers in infectiology is essential and the medical content of eIMCI should be optimized to include frequent diseases and, for each of them, the appropriate management plan.
电子临床决策算法（eCDAs）在资源有限的环境中被用来指导临床医生管理患者，以提高医疗质量和合理使用药物（尤其是抗菌药物）。目前尚不清楚当地临床医生如何看待这些工具在日常实践中的使用和影响。本研究调查了临床医生对电子儿童基本健康检查（eIMCI）工具的看法。具体来说，我们报告了他们对该工具医疗内容的看法，评估了他们对微生物、抗菌药物和耐药性发展的了解。
这项定性研究是在瑞士非政府组织 Terre des hommes 在布基纳法索开展的一项大规模 eIMCI 工具实施框架内进行的。在 10 个初级保健机构中，对 21 名卫生工作者进行了 12 次深入访谈和 2 次焦点小组讨论。使用定性数据分析软件识别出了新出现的主题。
eIMCI 用户表示非常满意，他们认为平板电脑的速度较慢是阻碍其使用的主要不便。算法中还确定了一些常见疾病缺失，以及针对无焦点发热的指导。当被问及现有的微生物类型时，21 名参与者中有 9 名和 4 名能分别提到细菌和病毒；只有 5 名正确回答抗生素对病毒病无效，6 名提到抗生素耐药的风险。护士的知识水平高于培训较少的卫生工作者。该工具被认为改善了患者管理和抗生素的合理使用。报告称医疗机构组织发生了积极变化，如任务转移和分诊改善。eIMCI 也被认为是一种学习工具，用户强烈希望扩大干预的地理和时间范围。
eICMI 的使用得到了广泛的接受，并被认为是指导日常实践的有力工具。研究结果表明，它对医疗保健系统的影响超出了咨询质量。为了支持广泛采用和可持续性，必须对卫生工作者进行传染病学方面的更好培训，并且应该优化 eIMCI 的医疗内容，以纳入常见疾病，并且针对每种疾病，纳入适当的管理计划。
