Effectiveness of an electronic clinical decision support system in improving the management of childhood illness in primary care in rural Nigeria: an observational study
Objectives To evaluate the impact of ALgorithm for the MANAgement of CHildhood illness (‘ALMANACH’), a digital clinical decision support system (CDSS) based on the Integrated Management of Childhood Illness, on health and quality of care outcomes for sick children attending primary healthcare (PHC)...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2022-07-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/7/e055315.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832577644392087552 |
|---|---|
| author | Marek Kwiatkowski Rodolfo Rossi Torsten Schmitz Fenella Beynon Capucine Musard Marco Landi Daniel Ishaya Jeremiah Zira Muazu Muazu Camille Renner Edwin Emmanuel Solomon Gideon Bulus |
| author_facet | Marek Kwiatkowski Rodolfo Rossi Torsten Schmitz Fenella Beynon Capucine Musard Marco Landi Daniel Ishaya Jeremiah Zira Muazu Muazu Camille Renner Edwin Emmanuel Solomon Gideon Bulus |
| author_sort | Marek Kwiatkowski |
| collection | DOAJ |
| description | Objectives To evaluate the impact of ALgorithm for the MANAgement of CHildhood illness (‘ALMANACH’), a digital clinical decision support system (CDSS) based on the Integrated Management of Childhood Illness, on health and quality of care outcomes for sick children attending primary healthcare (PHC) facilities.Design Observational study, comparing outcomes of children attending facilities implementing ALMANACH with control facilities not yet implementing ALMANACH.Setting PHC facilities in Adamawa State, North-Eastern Nigeria.Participants Children 2–59 months presenting with an acute illness. Children attending for routine care or nutrition visits (eg, immunisation, growth monitoring), physical trauma or mental health problems were excluded.Interventions The ALMANACH intervention package (CDSS implementation with training, mentorship and data feedback) was rolled out across Adamawa’s PHC facilities by the Adamawa State Primary Health Care Development Agency, in partnership with the International Committee of the Red Cross and the Swiss Tropical and Public Health Institute. Tablets were donated, but no additional support or incentives were provided. Intervention and control facilities received supportive supervision based on the national supervision protocol.Primary and secondary outcome measures The primary outcome was caregiver-reported recovery at day 7, collected over the phone. Secondary outcomes were antibiotic and antimalarial prescription, referral, and communication of diagnosis and follow-up advice, assessed at day 0 exit interview.Results We recruited 1929 children, of which 1021 (53%) attended ALMANACH facilities, between March and September 2020. Caregiver-reported recovery was significantly higher among children attending ALMANACH facilities (adjusted OR=2·63, 95% CI 1·60 to 4·32). We observed higher parenteral and lower oral antimicrobial prescription rates (adjusted OR=2·42 (1·00 to 5·85) and adjusted OR=0·40 (0·22 to 0·73), respectively) in ALMANACH facilities as well as markedly higher rates for referral, communication of diagnosis, and follow-up advice.Conclusion Implementation of digital CDSS with training, mentorship and feedback in primary care can improve quality of care and recovery of sick children in resource-constrained settings, likely mediated by better guideline adherence. These findings support the use of CDSS for health systems strengthening to progress towards universal health coverage. |
| format | Article |
| id | doaj-art-003b3a1213854aeaa2d262ac61a79a95 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-003b3a1213854aeaa2d262ac61a79a952025-01-30T17:15:09ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2021-055315Effectiveness of an electronic clinical decision support system in improving the management of childhood illness in primary care in rural Nigeria: an observational studyMarek Kwiatkowski0Rodolfo Rossi1Torsten Schmitz2Fenella Beynon3Capucine Musard4Marco Landi5Daniel Ishaya6Jeremiah Zira7Muazu Muazu8Camille Renner9Edwin Emmanuel10Solomon Gideon Bulus11University of Basel, Basel, SwitzerlandHealth Unit, International Committee of the Red Cross, Geneve, SwitzerlandUniversity of Basel, Basel, SwitzerlandUniversity of Basel, Basel, SwitzerlandUniversity of Basel, Basel, SwitzerlandRegional Delegation Nigeria, International Committee of the Red Cross, Jimeta Yola, NigeriaAdamawa State Primary Health Care Development Agency, Jimeta Yola, NigeriaAdamawa State Primary Health Care Development Agency, Jimeta Yola, NigeriaAdamawa State Primary Health Care Development Agency, Jimeta Yola, NigeriaUniversity of Basel, Basel, SwitzerlandRegional Delegation Nigeria, International Committee of the Red Cross, Jimeta Yola, NigeriaDepartment of Paediatrics, Federal Medical Centre, Yola, NigeriaObjectives To evaluate the impact of ALgorithm for the MANAgement of CHildhood illness (‘ALMANACH’), a digital clinical decision support system (CDSS) based on the Integrated Management of Childhood Illness, on health and quality of care outcomes for sick children attending primary healthcare (PHC) facilities.Design Observational study, comparing outcomes of children attending facilities implementing ALMANACH with control facilities not yet implementing ALMANACH.Setting PHC facilities in Adamawa State, North-Eastern Nigeria.Participants Children 2–59 months presenting with an acute illness. Children attending for routine care or nutrition visits (eg, immunisation, growth monitoring), physical trauma or mental health problems were excluded.Interventions The ALMANACH intervention package (CDSS implementation with training, mentorship and data feedback) was rolled out across Adamawa’s PHC facilities by the Adamawa State Primary Health Care Development Agency, in partnership with the International Committee of the Red Cross and the Swiss Tropical and Public Health Institute. Tablets were donated, but no additional support or incentives were provided. Intervention and control facilities received supportive supervision based on the national supervision protocol.Primary and secondary outcome measures The primary outcome was caregiver-reported recovery at day 7, collected over the phone. Secondary outcomes were antibiotic and antimalarial prescription, referral, and communication of diagnosis and follow-up advice, assessed at day 0 exit interview.Results We recruited 1929 children, of which 1021 (53%) attended ALMANACH facilities, between March and September 2020. Caregiver-reported recovery was significantly higher among children attending ALMANACH facilities (adjusted OR=2·63, 95% CI 1·60 to 4·32). We observed higher parenteral and lower oral antimicrobial prescription rates (adjusted OR=2·42 (1·00 to 5·85) and adjusted OR=0·40 (0·22 to 0·73), respectively) in ALMANACH facilities as well as markedly higher rates for referral, communication of diagnosis, and follow-up advice.Conclusion Implementation of digital CDSS with training, mentorship and feedback in primary care can improve quality of care and recovery of sick children in resource-constrained settings, likely mediated by better guideline adherence. These findings support the use of CDSS for health systems strengthening to progress towards universal health coverage.https://bmjopen.bmj.com/content/12/7/e055315.full |
| spellingShingle | Marek Kwiatkowski Rodolfo Rossi Torsten Schmitz Fenella Beynon Capucine Musard Marco Landi Daniel Ishaya Jeremiah Zira Muazu Muazu Camille Renner Edwin Emmanuel Solomon Gideon Bulus Effectiveness of an electronic clinical decision support system in improving the management of childhood illness in primary care in rural Nigeria: an observational study BMJ Open |
| title | Effectiveness of an electronic clinical decision support system in improving the management of childhood illness in primary care in rural Nigeria: an observational study |
| title_full | Effectiveness of an electronic clinical decision support system in improving the management of childhood illness in primary care in rural Nigeria: an observational study |
| title_fullStr | Effectiveness of an electronic clinical decision support system in improving the management of childhood illness in primary care in rural Nigeria: an observational study |
| title_full_unstemmed | Effectiveness of an electronic clinical decision support system in improving the management of childhood illness in primary care in rural Nigeria: an observational study |
| title_short | Effectiveness of an electronic clinical decision support system in improving the management of childhood illness in primary care in rural Nigeria: an observational study |
| title_sort | effectiveness of an electronic clinical decision support system in improving the management of childhood illness in primary care in rural nigeria an observational study |
| url | https://bmjopen.bmj.com/content/12/7/e055315.full |
| work_keys_str_mv | AT marekkwiatkowski effectivenessofanelectronicclinicaldecisionsupportsysteminimprovingthemanagementofchildhoodillnessinprimarycareinruralnigeriaanobservationalstudy AT rodolforossi effectivenessofanelectronicclinicaldecisionsupportsysteminimprovingthemanagementofchildhoodillnessinprimarycareinruralnigeriaanobservationalstudy AT torstenschmitz effectivenessofanelectronicclinicaldecisionsupportsysteminimprovingthemanagementofchildhoodillnessinprimarycareinruralnigeriaanobservationalstudy AT fenellabeynon effectivenessofanelectronicclinicaldecisionsupportsysteminimprovingthemanagementofchildhoodillnessinprimarycareinruralnigeriaanobservationalstudy AT capucinemusard effectivenessofanelectronicclinicaldecisionsupportsysteminimprovingthemanagementofchildhoodillnessinprimarycareinruralnigeriaanobservationalstudy AT marcolandi effectivenessofanelectronicclinicaldecisionsupportsysteminimprovingthemanagementofchildhoodillnessinprimarycareinruralnigeriaanobservationalstudy AT danielishaya effectivenessofanelectronicclinicaldecisionsupportsysteminimprovingthemanagementofchildhoodillnessinprimarycareinruralnigeriaanobservationalstudy AT jeremiahzira effectivenessofanelectronicclinicaldecisionsupportsysteminimprovingthemanagementofchildhoodillnessinprimarycareinruralnigeriaanobservationalstudy AT muazumuazu effectivenessofanelectronicclinicaldecisionsupportsysteminimprovingthemanagementofchildhoodillnessinprimarycareinruralnigeriaanobservationalstudy AT camillerenner effectivenessofanelectronicclinicaldecisionsupportsysteminimprovingthemanagementofchildhoodillnessinprimarycareinruralnigeriaanobservationalstudy AT edwinemmanuel effectivenessofanelectronicclinicaldecisionsupportsysteminimprovingthemanagementofchildhoodillnessinprimarycareinruralnigeriaanobservationalstudy AT solomongideonbulus effectivenessofanelectronicclinicaldecisionsupportsysteminimprovingthemanagementofchildhoodillnessinprimarycareinruralnigeriaanobservationalstudy |