Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Metro Manila, Philippines.
Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Metro Manila, Philippines
BMJ Open Qual. 2024 Feb 29;13(1):e002526. doi: 10.1136/bmjoq-2023-002526.
Strengthening primary care helps address health inequities that continue to persist in the Philippines. The Philippine Primary Care Studies pilot-tested interventions to improve the primary care system. One intervention was the provision of a free subscription to an electronic decision support application called UpToDate (UTD) for primary care providers (PCPs), including doctors, nurses, midwives and community health workers (CHWs). This study aimed to (1) assess the feasibility of using UTD as information source for PCPs in urban, rural and remote settings, (2) determine the acceptability of UTD as an information source for PCPs and (3) examine the impact of UTD access on PCP clinical decision-making.
Four focus group discussions (FGDs) and two key informant interviews (KII) were conducted to gather insights from 30 PCPs. Thematic analysis through coding in NVivo V.12 was done using the technology acceptance model (TAM) as a guiding framework.
All PCPs had positive feedback regarding UTD use because of its comprehensiveness, accessibility, mobility and general design. The participants relayed UTD's benefit for point-of-contact use, capacity-building and continuing professional development. PCPs across the three sites, including CHWs with no formal medical education, were able to provide evidence-based medical advice to patients through UTD. However, external factors in these settings impeded the full integration of UTD in the PCPs' workflow, including poor internet access, unstable sources of electricity, lack of compatible mobile devices and the need for translation to the local language.
UTD was a feasible and acceptable clinical decision support tool for the PCPs. Factors affecting the feasibility of using UTD include technological and environmental factors (ie, internet access and the lack of translation to the local language), as well as the organisational structure of the primary care facility which determines the roles of the PCPs. Despite the difference in roles and responsibilities of the PCPs, UTD positively impacted decision-making and patient education for all PCPs through its use as a point-of-contact tool and a tool for capacity-building.
加强基层医疗有助于解决菲律宾持续存在的健康不平等问题。菲律宾基层医疗研究试点测试了改善基层医疗系统的干预措施。其中一项干预措施是为基层医疗提供者（包括医生、护士、助产士和社区卫生工作者）提供免费订阅电子决策支持应用程序 UpToDate（UTD）的服务。本研究旨在：(1) 评估在城市、农村和偏远地区使用 UTD 作为基层医疗提供者信息来源的可行性；(2) 确定 UTD 作为基层医疗提供者信息来源的可接受性；(3) 考察 UTD 获取对基层医疗提供者临床决策的影响。
进行了 4 次焦点小组讨论（FGD）和 2 次关键知情人访谈（KII），以从 30 名基层医疗提供者那里收集见解。使用 NVivo V.12 通过编码进行主题分析，并使用技术接受模型（TAM）作为指导框架。
所有基层医疗提供者对 UTD 的使用都给予了积极的反馈，因为它具有全面性、可及性、移动性和总体设计。参与者传达了 UTD 对接触点使用、能力建设和持续专业发展的益处。来自三个地点的基层医疗提供者，包括没有正规医学教育背景的社区卫生工作者，都能够通过 UTD 为患者提供基于证据的医疗建议。然而，这些环境中的外部因素阻碍了 UTD 在基层医疗提供者工作流程中的全面整合，包括互联网接入差、电力不稳定、缺乏兼容的移动设备以及需要翻译成当地语言。
UTD 是基层医疗提供者可行且可接受的临床决策支持工具。影响使用 UTD 的可行性的因素包括技术和环境因素（即互联网接入和缺乏翻译成当地语言），以及基层医疗设施的组织结构，这决定了基层医疗提供者的角色。尽管基层医疗提供者的角色和职责不同，但 UTD 通过作为接触点工具和能力建设工具的使用，对所有基层医疗提供者的决策制定和患者教育产生了积极影响。
