MSFeCARE: an electronic algorithm to improve antibiotic prescription in the management of childhood illness in primary health care
*Clotilde Rambaud-Althaus, Franck-Adonis Boninga, Sergio Cabral, Nicolas Peyraud, Maya Shah, Michel Quere, Micaela Serafini, Marie-Claude Bottineau
Médecins Sans Frontières (MSF), Geneva, Switzerland
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Introduction
MSFeCARE is an electronic clinical decision support system designed to improve the quality of care and rational use of antibiotics for childhood illnesses in children <5 years in primary health care settings. Following a feasibility study in Gety, Democratic Republic of the Congo, we implemented MSFeCARE in peripheral health centres supported by MSF around Berberati, Central African Republic, with the aim of further assessing operational feasibility, acceptability, and impact on consultation and supervision processes.
Methods
In November, 2016, we implemented MSFeCARE in three MSF-supported rural health centres without Internet access. Following a 1-day training, 24 health workers were asked to conduct paediatric consultations with tablets running MSFeCARE. During monthly visits with users, we discussed clinical and technical issues and collected MSFeCARE data. We compared rates of antibiotic prescriptions pre- and post-intervention as reported in a sample of 200 consultations extracted from registers from January, 2016 and 2017. Appropriateness for clinical situations (coverage of problems encountered and user intent to follow recommendations) was assessed through analyses of MSFeCARE data.
Ethics
This description/evaluation of an innovation project involved human participants or their data, and has had ethics oversight from the medical director, Micaela Serafini, according to the MSF Ethics Framework for Innovation or equivalent.
Results
MSFeCARE was well accepted by MSF teams, communities, and users, who conducted 3355 consultations with the tool between Nov 24, 2016 and March 30, 2017. In February, 2017, >80% of all <5-year consultations were done using the app. The median duration of consultations was 6 minutes [IQR 4-10]. No major technical problems were reported. The nurse heeded the diagnosis and antibiotic prescription advised by MSFeCARE in 96% (3208/3355) and 99% (3339/3355) of consultations, respectively. The prescription of antibiotics reported in registers decreased from 47% (93/200) in January, 2016 to 22% (43/200) in January, 2017 (p<0.001). Analysis of MSFeCARE data enabled rapid identification and correction of errors in using the app. Users reported that the tool was easy to use, helped them make precise diagnoses and treatment decisions, and allowed them to translate training knowledge into practice.
Conclusion
MSFeCARE was reliable, easy to use, and well accepted in Berberati. It was correctly used with minimal training. MSFeCARE resulted in a >50% reduction in antibiotic prescription rates, and provided valuable information to guide clinical supervision. The tool holds immense potential to improve the quality of care and reduce irrational antibiotic prescription. Plans are underway for further implementation and continued monitoring.
Conflicts of interest
None declared.