Description
Introduction-Objective: The Digital System for Improved Refugee Health Management (SysRef) project, developed, validated and implemented a digital solution with a clinical decision support system (CDSS) as core element but also including an electronic monitoring for vaccinations and pre- and postnatal consultations. It was funded by Stanley Thomas Johnson Foundation and implemented by Swiss Tropical and Public Health Institute (Swiss TPH) in partnership with the Centre de Support en Santé Internationale (CSSI), the Ministry for Public Health and Prevention (MSPP) and the United Nations Refugee Agency (UNHCR). The tool was piloted in three health centers in southern Chad bordering Central African Republic. Our presentation will highlight the results of a user satisfaction study undertaken to evaluate the tool and improve its implementation through user feedback.
Methodology: We assessed five elements of successful CDSS implementation: adaptation, adoption, feasibility, acceptability and sustainability through a mixed methods approach. We conducted two in-depth surveys, 6 and 16 months after implementation of the tool, to assess user satisfaction over time. The quantitative component was mainly based on Likert-scale evaluation of elements, whilst we held focus group discussions for the qualitative assessment.
Results and discussion: Overall, 69 health workers participated in the study. Acceptability of the tool was very good and increased over time. Confidence in the advice given by the CDSS was high among both heath workers and care seekers. There are strong indications that the use of the CDSS leads to changes in clinical management and practice, for example in the structuring of consultations, compliance with prescription dosage and vaccination schedules and improved triage at the patient’s reception. The tool also shows potential to improve the relationship between patients and nurses through appropriate patient advice by health workers and improving adherence to treatment. One negative aspect reported was the double effort required for documentation, which increases the time per consultation. The fragile context of insecurity and poverty in the project area represented a challenge for adaptation of the tool. Major constraints and difficulties pertained to the lack of medico-technical resources and equipment, shortage and supply issues of medicines and data collection support. A positive factor for continued use was the outlook for extension to other health centers or even the national level, which was strongly desired by the users.
Conclusion: Our study underlines the importance of a long-term commitment in order to achieve sustainable appropriation of the new tool in the routine service. During the development and validation of the tool, particular attention was paid to adaptation to the local context and co-creation. This was probably one of the success factors that led to the high acceptance of the tool. The SysRef project continues under the acronym SANU-TD for "Santé Numérique au Tchad" (Digital Health in Chad) and is being extended to the national health system in the south of Chad through the Support project to health districts (PADS) funded by the Swiss agency for Development and Cooperation (SDC) as it is also offered to be used in other regions and by other partners.
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