Do primary healthcare workers using decision‐support tools via mobile devices give better quality care?

Posted on 7th November 2022 by Shreya Ramakrishnan

In this blog post I will summarize a 2021 Cochrane systematic review titled Decision‐support tools via mobile devices to improve quality of care in primary healthcare settings.

Introduction

Primary healthcare (PHC)  is the concept of making quality comprehensive healthcare available to those in need, in an equitable manner. It involves providing healthcare interventions throughout the life course of an individual. It is an umbrella term that covers services including prevention, treatment, rehabilitation, and palliative care as close as is feasible to people’s everyday environment [1].

To understand the meaning of primary healthcare better, please watch the video below from the World Health Organization (WHO):

What is a clinical decision support system (CDSS)?

Clinical decision support systems are systems that assist healthcare providers via a computer-based platform to facilitate implementation of evidence-based clinical decisions. The Community Preventive Services Task Force concluded that CDSS is effective, and reports also suggest that CDSS trials have been replicated with positive results. You can read more about CDSS in this article from the CDC: Implementing Clinical Decision Support Systems.

My Background

My interest in this particular topic stems from a similar idea of  providing home-based primary care by integrating various technologies developed at the HI Rapid Lab. We at HI rapid lab believe that personnel trained with our AI led, smart mobility supported digital platform can deliver universal primary health care service at home. This solution also makes primary health care accessible, adequate and efficient.  We have developed an icon-based interface for the app which eliminates the barrier of language. It also speeds up the data collection process. Our vision is to integrate skill development of the healthcare personnel who are directly dealing with the patients. This will be achieved via specially curated video content in the next version of our software.

If you would like to know more about our solution, please watch the video linked below:

Alternatively, you can also visit our official website: https://hirapidlab.com to read about the solution under the concept “DHARA”. For further enquiry, you can also write to us at contact@hirapidlab.com from your official email ID stating your query followed by your name and designation.

What was the aim of the Cochrane Review?

To assess the effects of digital clinical decision‐support systems (CDSS) accessible via mobile devices by primary healthcare providers in the context of primary care settings.

Types of participants

Studies of all cadres* of healthcare providers, including lay health workers and other individuals (administrative, managerial, and supervisory staff) involved in the delivery of primary healthcare services using clinical decision‐support tools were included. Additionally, studies of clients or patients receiving care from primary healthcare providers using digital decision‐support tools were also included.

(*cadre describes “a small group of people specially trained for a particular purpose or profession”).

Results

In this section I will be presenting some of the findings. For more information from the full systematic review, please go to: Decision‐support tools via mobile devices to improve quality of care in primary healthcare settings.

A total of eight randomized trials (RCTs) have been included in this review. These studies were from the USA, India, China, Guatemala, Ghana, and Kenya. These included a range of healthcare providers (facility and community‐based, formally trained, and lay workers) who used digital CDSS.

According to the findings in the review, this approach may slightly improve patients’ satisfaction with medical information. However, it is uncertain whether primary healthcare providers using mobile based CDSS are better at following recommended clinical practice due to very low quality evidence. A clear pattern of a positive or negative effect on patients’ or clients’ behaviour and on their health was also not observed.

Limitations

Firstly, these studies did not include a quality of care framework. Secondly, most of the studies focused on specific health areas. Lastly, none of the studies addressed whether this approach led primary healthcare workers to manage people’s health issues more quickly. These areas could be addressed by future studies to improve evidence.

Conclusion

In conclusion, limited evidence is available about the efficacy of CDSS on health outcomes. However, deleterious effects were not observed due to the use of CDSS. In future trials, unintentional consequences, equity, cost‐effectiveness, and quality of care framework of the intervention must be measured. The specific functions of CDSS driving the health impact should also be measured. Larger well-designed trials conducted beyond the pilot stage is necessary. Alternate study designs, such as longitudinal or cohort studies should be explored when randomized trials are not feasible. Lastly, it is important to evaluate CDSS interventions that are integrated with the broader health system, and address a range of health conditions that health care personnel routinely deal with in their clinical practice.

References

[1] World Health Organization. (2021, April 1). “Primary health care.” Retrieved from: https://www.who.int/news-room/fact-sheets/detail/primary-health-care

[2] Agarwal S, Glenton C, Tamrat T, Henschke N, Maayan N, Fønhus MS, Mehl GL, Lewin S. Decision‐support tools via mobile devices to improve quality of care in primary healthcare settings. Cochrane Database of Systematic Reviews 2021, Issue 7. Art. No.: CD012944. DOI: 10.1002/14651858.CD012944.pub2. Accessed 15 October 2022.

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