A cluster randomized trial assessing the effect of a digital health algorithm on quality of care in Tanzania (DYNAMIC study).
Digital clinical decision support tools have contributed to improved quality of care at primary care level health facilities. However, data from real-world randomized trials are lacking. We conducted a cluster randomized, open-label trial in Tanzania evaluating the use of a digital clinical decision...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2024-12-01
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| Series: | PLOS Digital Health |
| Online Access: | https://doi.org/10.1371/journal.pdig.0000694 |
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| author | Rainer Tan Godfrey Kavishe Alexandra V Kulinkina Sabine Renggli Lameck B Luwanda Chacha Mangu Geofrey Ashery Margaret Jorram Ibrahim Evans Mtebene Peter Agrea Humphrey Mhagama Kristina Keitel Marie-Annick Le Pogam Nyanda Ntinginya Honorati Masanja Valérie D'Acremont |
| author_facet | Rainer Tan Godfrey Kavishe Alexandra V Kulinkina Sabine Renggli Lameck B Luwanda Chacha Mangu Geofrey Ashery Margaret Jorram Ibrahim Evans Mtebene Peter Agrea Humphrey Mhagama Kristina Keitel Marie-Annick Le Pogam Nyanda Ntinginya Honorati Masanja Valérie D'Acremont |
| author_sort | Rainer Tan |
| collection | DOAJ |
| description | Digital clinical decision support tools have contributed to improved quality of care at primary care level health facilities. However, data from real-world randomized trials are lacking. We conducted a cluster randomized, open-label trial in Tanzania evaluating the use of a digital clinical decision support algorithm (CDSA), enhanced by point-of-care tests, training and mentorship, compared with usual care, among sick children 2 to 59 months old presenting to primary care facilities for an acute illness in Tanzania (ClinicalTrials.gov NCT05144763). The primary outcome was the mean proportion of 14 major Integrated Management of Childhood Illness (IMCI) symptoms and signs assessed by clinicians. Secondary outcomes included antibiotic prescription, counseling provided, and the appropriateness of antimalarial and antibiotic prescriptions. A total of 450 consultations were observed in 9 intervention and 9 control health facilities. The mean proportion of major symptoms and signs assessed in intervention health facilities was 46.4% (range 7.7% to 91.7%) compared to 26.3% (range 0% to 66.7%) in control health facilities, an adjusted difference of 15.1% (95% confidence interval [CI] 4.8% to 25.4%). Only weight, height, and pallor were assessed statistically more often when using the digital CDSA compared to controls. Observed antibiotic prescription was 37.3% in intervention facilities, and 76.4% in control facilities (adjusted risk ratio 0.5; 95% CI 0.4 to 0.7; p<0.001). Appropriate antibiotic prescription was 81.9% in intervention facilities and 51.4% in control facilities (adjusted risk ratio 1.5; 95% CI 1.2 to 1.8; p = 0.003). The implementation of a digital CDSA improved the mean proportion of IMCI symptoms and signs assessed in consultations with sick children, however most symptoms and signs were assessed infrequently. Nonetheless, antibiotics were prescribed less often, and more appropriately. Innovative approaches to overcome barriers related to clinicians' motivation and work environment are needed. |
| format | Article |
| id | doaj-art-c71232e4a7994b4e892e16d02ada8f05 |
| institution | Kabale University |
| issn | 2767-3170 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLOS Digital Health |
| spelling | doaj-art-c71232e4a7994b4e892e16d02ada8f052025-01-08T05:34:12ZengPublic Library of Science (PLoS)PLOS Digital Health2767-31702024-12-01312e000069410.1371/journal.pdig.0000694A cluster randomized trial assessing the effect of a digital health algorithm on quality of care in Tanzania (DYNAMIC study).Rainer TanGodfrey KavisheAlexandra V KulinkinaSabine RenggliLameck B LuwandaChacha ManguGeofrey AsheryMargaret JorramIbrahim Evans MtebenePeter AgreaHumphrey MhagamaKristina KeitelMarie-Annick Le PogamNyanda NtinginyaHonorati MasanjaValérie D'AcremontDigital clinical decision support tools have contributed to improved quality of care at primary care level health facilities. However, data from real-world randomized trials are lacking. We conducted a cluster randomized, open-label trial in Tanzania evaluating the use of a digital clinical decision support algorithm (CDSA), enhanced by point-of-care tests, training and mentorship, compared with usual care, among sick children 2 to 59 months old presenting to primary care facilities for an acute illness in Tanzania (ClinicalTrials.gov NCT05144763). The primary outcome was the mean proportion of 14 major Integrated Management of Childhood Illness (IMCI) symptoms and signs assessed by clinicians. Secondary outcomes included antibiotic prescription, counseling provided, and the appropriateness of antimalarial and antibiotic prescriptions. A total of 450 consultations were observed in 9 intervention and 9 control health facilities. The mean proportion of major symptoms and signs assessed in intervention health facilities was 46.4% (range 7.7% to 91.7%) compared to 26.3% (range 0% to 66.7%) in control health facilities, an adjusted difference of 15.1% (95% confidence interval [CI] 4.8% to 25.4%). Only weight, height, and pallor were assessed statistically more often when using the digital CDSA compared to controls. Observed antibiotic prescription was 37.3% in intervention facilities, and 76.4% in control facilities (adjusted risk ratio 0.5; 95% CI 0.4 to 0.7; p<0.001). Appropriate antibiotic prescription was 81.9% in intervention facilities and 51.4% in control facilities (adjusted risk ratio 1.5; 95% CI 1.2 to 1.8; p = 0.003). The implementation of a digital CDSA improved the mean proportion of IMCI symptoms and signs assessed in consultations with sick children, however most symptoms and signs were assessed infrequently. Nonetheless, antibiotics were prescribed less often, and more appropriately. Innovative approaches to overcome barriers related to clinicians' motivation and work environment are needed.https://doi.org/10.1371/journal.pdig.0000694 |
| spellingShingle | Rainer Tan Godfrey Kavishe Alexandra V Kulinkina Sabine Renggli Lameck B Luwanda Chacha Mangu Geofrey Ashery Margaret Jorram Ibrahim Evans Mtebene Peter Agrea Humphrey Mhagama Kristina Keitel Marie-Annick Le Pogam Nyanda Ntinginya Honorati Masanja Valérie D'Acremont A cluster randomized trial assessing the effect of a digital health algorithm on quality of care in Tanzania (DYNAMIC study). PLOS Digital Health |
| title | A cluster randomized trial assessing the effect of a digital health algorithm on quality of care in Tanzania (DYNAMIC study). |
| title_full | A cluster randomized trial assessing the effect of a digital health algorithm on quality of care in Tanzania (DYNAMIC study). |
| title_fullStr | A cluster randomized trial assessing the effect of a digital health algorithm on quality of care in Tanzania (DYNAMIC study). |
| title_full_unstemmed | A cluster randomized trial assessing the effect of a digital health algorithm on quality of care in Tanzania (DYNAMIC study). |
| title_short | A cluster randomized trial assessing the effect of a digital health algorithm on quality of care in Tanzania (DYNAMIC study). |
| title_sort | cluster randomized trial assessing the effect of a digital health algorithm on quality of care in tanzania dynamic study |
| url | https://doi.org/10.1371/journal.pdig.0000694 |
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