Abstract
BackgroundQuality of care is a difficult parameter to measure. With the introduction of digital algorithms based on the Integrated Management of Childhood Illness (IMCI), we are interested to understand if the adherence to the guidelines improved for a better quality of care for children under 5 years old.MethodsMore than one year after the introduction of digital algorithms, we carried out two cross sectional studies to assess the improvements in comparison with the situation prior to the implementation of the project, in two Basic Health Centres in Kabul province. One survey was carried out inside the consultation room and was based on the direct observation of 181 consultations of children aged 2 months to 5 years old, using a checklist completed by a senior physicians. The second survey queried 181 caretakers of children outside the health facility for their opinion about the consultation carried out through the tablet and prescriptions and medications given.ResultsWe measured the quality of care as adherence to the IMCI’s guidelines. The study evaluated the quality of the physical examination and the therapies prescribed with a special attention to antibiotic prescription. We noticed a dramatic improvement (p<0.05) of several indicators following the introduction of digital algorithms. The baseline physical examination was appropriate only for 23.8% [IC% 19.9–28.1] of the patients, 34.5% [IC% 30.0–39.2] received a correct treatment and 86.1% [IC% 82.4–89.2] received at least one antibiotic. With the introduction of digital algorithms, these indicators statistically improved respectively to 84.0% [IC% 77.9–88.6], >85% and less than 30%.ConclusionsOur findings suggest that digital algorithms improve quality of care by applying the guidelines more effectively. Our experience should encourage to test this tool in different settings and to scale up its use at province/state level.
Highlights
In 1999 the Institute of Medicine (IoM) alerted the healthcare industry in the US about the lack of consistency in the delivery of quality care to the American people [1]
With the introduction of digital algorithms based on the Integrated Management of Childhood Illness (IMCI), we are interested to understand if the adherence to the guidelines improved for a better quality of care for children under 5 years old
The study evaluated the quality of the physical examination and the therapies prescribed with a special attention to antibiotic prescription
Summary
In low-middle income countries people living below the poverty line are inclined to bypass local services when perceived as having lower quality and prefer to access public services which are either geographically far or incur costs by addressing their health issues to the private sector [5]. Clinical skills were highly valued by physicians, posing the perception of health providers and beneficiaries at the same level [6]. The health care provided should be consistent with current professional knowledge [7] which, in turn, relies on evidence based medicine (EBM). Based on EBM, Clinical Practice Guidelines (CPGs) improve the quality of care by providing scientific standardized information that supports physicians in their clinical decision [8], especially these days that they are facing an exponential increase of medical knowledge [8, 9].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
