The use of computerised clinical decision support system in maternal and neonatal care in rural Africa : enthusiasm and concerns
Author: Zakane, Sidagna Alphonse
Date: 2018-01-19
Location: Sjöqvist Library, Clin Pharmacol C1:68, Karolinska University Hospital, Huddinge
Time: 9:30
Department: Inst för laboratoriemedicin / Dept of Laboratory Medicine
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Thesis (781.7Kb)
Abstract
Background: Maternal and neonatal mortality rates remain high in sub-Saharan Africa. The shortage of skilled Healthcare Workers (HCWs) and poor access to guidelines are plausible reasons for the reported low quality in maternal and neonatal services in rural Africa. One strategy to support HCWs at point of care is to provide easy access to guidelines using computerised Clinical Decision Support Systems (CDSS). Still, data are lacking on how such systems are optimally designed and implemented to be useful for HCWs.
Aims: The aims were to develop a CDSS to be used in rural Africa (I), to understand perceived needs and attitudes among HCWs to the use of a CDSS based on the WHO guidelines in maternal and neonatal care in Burkina Faso (II), and to explore the reasons why the HCWs failed to use the CDSS as expected (III).
Methods: The CDSS was programmed in java software language to be able to run on any hardware (I). The CDSS was part of an intervention to improve quality of care in six rural healthcare facilities in Burkina Faso for 24 months. A total of 45 HCWs were interviewed to capture perceived needs and attitudes to the CDSS. Data were analysed with content analysis (II). To understand any reduced use of the CDSS a workshop was organised (group discussions and a plenary session) with 13 HCWs with data analysed thematically (III). Socio-demographic data were analysed descriptively (II-III).
Results: The CDSS was designed with a user interface and an XML database for storing patient data (signs and symptoms) as well as an algorithm to provide advice on recommended care and actions based on WHO guideline information. The CDSS was developed with limited input from HCWs (I). The HCWs expressed willingness to use new technologies such as a CDSS and computers but reported a fear of extra workload as well as a fear that the CDSS should be complicated to use (II). After 12 months, the decreased use of the CDSS was partly explained by unreliable power supply and poor fit between the CDSS and the daily workflow. Still, the HCWs were enthusiastic to learn more by using the CDSS (III).
Conclusions: The CDSS was successfully developed and tested in rural Burkina Faso. Despite this, its use was unexpectedly low. It was found that: 1. the design and the implementation of a CDSS have to be contextualised; 2. the usage of the CDSS and the software performance need to be continuously monitored and 3. the HCWs need to be actively consulted during all phases of design and testing of a CDSS to enhance its use.
Aims: The aims were to develop a CDSS to be used in rural Africa (I), to understand perceived needs and attitudes among HCWs to the use of a CDSS based on the WHO guidelines in maternal and neonatal care in Burkina Faso (II), and to explore the reasons why the HCWs failed to use the CDSS as expected (III).
Methods: The CDSS was programmed in java software language to be able to run on any hardware (I). The CDSS was part of an intervention to improve quality of care in six rural healthcare facilities in Burkina Faso for 24 months. A total of 45 HCWs were interviewed to capture perceived needs and attitudes to the CDSS. Data were analysed with content analysis (II). To understand any reduced use of the CDSS a workshop was organised (group discussions and a plenary session) with 13 HCWs with data analysed thematically (III). Socio-demographic data were analysed descriptively (II-III).
Results: The CDSS was designed with a user interface and an XML database for storing patient data (signs and symptoms) as well as an algorithm to provide advice on recommended care and actions based on WHO guideline information. The CDSS was developed with limited input from HCWs (I). The HCWs expressed willingness to use new technologies such as a CDSS and computers but reported a fear of extra workload as well as a fear that the CDSS should be complicated to use (II). After 12 months, the decreased use of the CDSS was partly explained by unreliable power supply and poor fit between the CDSS and the daily workflow. Still, the HCWs were enthusiastic to learn more by using the CDSS (III).
Conclusions: The CDSS was successfully developed and tested in rural Burkina Faso. Despite this, its use was unexpectedly low. It was found that: 1. the design and the implementation of a CDSS have to be contextualised; 2. the usage of the CDSS and the software performance need to be continuously monitored and 3. the HCWs need to be actively consulted during all phases of design and testing of a CDSS to enhance its use.
List of papers:
I. Blank A, Prytherch H, Kaltschmidt J, Krings A, Sukums F, Mensah N, Zakane A, Loukanova S, Gustafsson LL, Sauerborn R, Haefeli WE. Quality of prenatal and maternal care: bridging the know-do gap”(QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa. BMC Med Inform Decis Mak. 2013;13:44.
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II. Zakane SA, Gustafsson LL, Tomson G, Loukanova S, Sié A, Nasiell J, Bastholm-Rahmner P. Guidelines for maternal and neonatal “point of care”: needs of and attitudes towards a computerized clinical decision support system in rural Burkina Faso. IntJ Med Inf. 2014;83:459-69.
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III. Zakane SA, Gustafsson LL, Sie A, Tomson G, Loukanova S, Bastholm-Rahmner P. Opportunities and obstacles towards a clinical decision support system for maternal care in Burkina Faso. Online J Public Health Inform. 2017;9:7905.
Fulltext (DOI)
Pubmed
I. Blank A, Prytherch H, Kaltschmidt J, Krings A, Sukums F, Mensah N, Zakane A, Loukanova S, Gustafsson LL, Sauerborn R, Haefeli WE. Quality of prenatal and maternal care: bridging the know-do gap”(QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa. BMC Med Inform Decis Mak. 2013;13:44.
Fulltext (DOI)
Pubmed
View record in Web of Science®
II. Zakane SA, Gustafsson LL, Tomson G, Loukanova S, Sié A, Nasiell J, Bastholm-Rahmner P. Guidelines for maternal and neonatal “point of care”: needs of and attitudes towards a computerized clinical decision support system in rural Burkina Faso. IntJ Med Inf. 2014;83:459-69.
Fulltext (DOI)
Pubmed
View record in Web of Science®
III. Zakane SA, Gustafsson LL, Sie A, Tomson G, Loukanova S, Bastholm-Rahmner P. Opportunities and obstacles towards a clinical decision support system for maternal care in Burkina Faso. Online J Public Health Inform. 2017;9:7905.
Fulltext (DOI)
Pubmed
Institution: Karolinska Institutet
Supervisor: Gustafsson, Lars L
Co-supervisor: Bastholm-Rahmner, Pia; Tomson, Göran; Sié, Ali; Loukanova, Svetla
Issue date: 2017-12-15
Rights:
Publication year: 2017
ISBN: 978-91-7676-798-6
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