Large-scale implementation of electronic Integrated Management of Childhood Illness (eIMCI) at the primary care level in Burkina Faso: a qualitative study on health worker perception of its medical content, usability and impact on antibiotic prescription and resistance.

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State: Public
Version: Final published version
License: CC BY 4.0
Serval ID
serval:BIB_3E9852659332
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Large-scale implementation of electronic Integrated Management of Childhood Illness (eIMCI) at the primary care level in Burkina Faso: a qualitative study on health worker perception of its medical content, usability and impact on antibiotic prescription and resistance.
Journal
BMC public health
Author(s)
Bessat C., Zonon N.A., D'Acremont V.
ISSN
1471-2458 (Electronic)
ISSN-L
1471-2458
Publication state
Published
Issued date
29/04/2019
Peer-reviewed
Oui
Volume
19
Number
1
Pages
449
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
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.
Keywords
Adult, Algorithms, Anti-Bacterial Agents/administration & dosage, Anti-Bacterial Agents/therapeutic use, Attitude of Health Personnel, Bacterial Infections/drug therapy, Bacterial Infections/microbiology, Burkina Faso/epidemiology, Child, Computers, Handheld/standards, Consumer Behavior, Decision Support Systems, Clinical/organization & administration, Decision Support Systems, Clinical/standards, Drug Resistance, Bacterial, Drug Utilization, Female, Fever/drug therapy, Fever/microbiology, Health Facilities, Humans, Interviews as Topic, Male, Middle Aged, Primary Health Care/organization & administration, Primary Health Care/standards, Qualitative Research, Virus Diseases/drug therapy, Virus Diseases/microbiology, Antibiotic use, Antimicrobial resistance, Clinician perception, Computerized decision support system, Diagnostic tools, Electronic clinical algorithms, Integrated management of childhood illness, Low-resource countries, Primary care, Tablets
Pubmed
Web of science
Open Access
Yes
Create date
06/05/2019 16:18
Last modification date
20/08/2019 13:35
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