Ghana Health Service, La General Hospital, PMB, La, Greater Accra Region, Accra, Ghana.
Ghana Health Service, Research and Development Division, Dodowa Health Research Center, P.O. Box DD1, Dodowa, Ghana.
BMC Pregnancy Childbirth. 2021 Jan 13;21(1):56. doi: 10.1186/s12884-020-03534-2.
Referral and clinical decision-making support are important for reducing delays in reaching and receiving appropriate and quality care. This paper presents analysis of the use of a pilot referral and decision making support call center for mothers and newborns in the Greater Accra region of Ghana, and challenges encountered in implementing such an intervention.
We analyzed longitudinal time series data from routine records of the call center over the first 33 months of its operation in Excel.
During the first seventeen months of operation, the Information Communication Technology (ICT) platform was provided by the private telecommunication network MTN. The focus of the referral system was on maternal and newborn care. In this first phase, a total of 372 calls were handled by the center. 93% of the calls were requests for referral assistance (87% obstetric and 6% neonatal). The most frequent clinical reasons for maternal referral were prolonged labor (25%), hypertensive diseases in pregnancy (17%) and post-partum hemorrhage (7%). Birth asphyxia (58%) was the most common reason for neonatal referral. Inadequate bed space in referral facilities resulted in only 81% of referrals securing beds. The national ambulance service was able to handle only 61% of the requests for assistance with transportation because of its resource challenges. Resources could only be mobilized for the recurrent cost of running the center for 12 h (8.00 pm - 8.00 am) daily. During the second phase of the intervention we switched the use of the ICT platform to a free government platform operated by the National Security. In the next sixteen-month period when the focus was expanded to include all clinical cases, 390 calls were received with 51% being for medical emergency referrals and 30% for obstetrics and gynaecology emergencies. Request for bed space was honoured in 69% of cases.
The call center is a potentially useful and viable M-Health intervention to support referral and clinical decision making in the LMIC context of this study. However, health systems challenges such inadequacy of human resources, unavailability of referral beds, poor health infrastructure, lack of recurrent financing and emergency transportation need to be addressed for optimal functioning.
转诊和临床决策支持对于减少获得适当和高质量医疗服务的时间延误非常重要。本文介绍了对加纳大阿克拉地区母亲和新生儿试点转诊和决策支持呼叫中心的使用情况进行分析，并讨论了在实施此类干预措施时所遇到的挑战。
我们使用 Excel 分析了该呼叫中心运营头 33 个月的常规记录中的纵向时间序列数据。
在运营的前 17 个月，信息通信技术（ICT）平台由私营电信网络 MTN 提供。转诊系统的重点是母婴保健。在第一阶段，该中心共处理了 372 个电话。其中 93%的电话是请求转诊协助（87%是产科，6%是新生儿科）。转诊的最常见临床原因是产程延长（25%）、妊娠高血压疾病（17%）和产后出血（7%）。新生儿转诊最常见的原因是新生儿窒息（58%）。由于转诊机构床位不足，只有 81%的转诊患者能够获得床位。由于资源有限，国家救护车服务仅能够处理 61%的援助请求。由于资源有限，仅能为中心每天 12 小时（晚上 8 点至早上 8 点）的运营经常性成本筹集资源。在干预的第二阶段，我们将 ICT 平台的使用切换到由国家安全运营的免费政府平台。在接下来的 16 个月期间，当重点扩大到包括所有临床病例时，共接到 390 个电话，其中 51%是医疗紧急转诊，30%是妇产科紧急转诊。在 69%的情况下，都满足了床位需求。
呼叫中心是一种在本研究中的中低收入国家环境下支持转诊和临床决策的潜在有用且可行的移动健康干预措施。然而，需要解决人力资源不足、转诊床位不足、卫生基础设施不完善、缺乏经常性融资和紧急交通等卫生系统挑战，以实现最佳运作。
