MSFeCARE: an electronic algorithm to improve antibiotic prescription in the management of childhood illness in primary health care
Clotilde Rambaud-Althaus1,&, Franck Boninga1, Sergio Cabral1, Nicolas Peyraud1, Maya Shah1, Michel Quere1, Micaela Serafini1, Marie-Claude Bottineau1
1Médecins Sans Frontières (MSF), Geneva, Switzerland
Clotilde Rambaud-Althaus, Médecins Sans Frontières (MSF), Geneva, Switzerland
MSFeCARE is an electronic clinical decision support system designed to improve
quality of care and rational use of antibiotics for childhood illnesses in children < 5
years in primary health care. To assess operational feasibility, acceptability
and impact on consultation processes, MSFeCARE was implemented in Berberati,
Central African Republic.
in November, 2016, we implemented MSFeCARE in three MSF-supported rural health centres without Internet access. Following a 1-day training, 24 nurses were asked to conduct paediatric consultations with tablets running MSFeCARE. During monthly visits, 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. Coverage of problems encountered and user intent to follow recommendations were assessed through analyses of MSFeCARE data.
MSFeCARE was well accepted by MSF teams, communities, and users. During 2017
first semester, 74% (7496/10164) of under 5 consultations were done using
the app. The median duration of consultations was 6 minutes [IQR 4 - 9]. No
technical problems were reported. The nurse heeded the diagnosis and antibiotic
prescription advised by MSFeCARE in 97% (7258/7496) and 99% (7467/7496) of
consultations respectively. The prescription of antibiotics reported in registers
from 47% (93/200) in January, 2016 to 22% (43/200) in January, 2017 (p < 0.001).
Users reported the tool was easy to use, helped make precise diagnoses, treatment
decisions and allowed to translate training knowledge into practice.
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 prescriptions 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.
Dates: 15 Dec 17 - 16 Dec 17
Venue: Hotel Ngor Diarama
Contact person: Dr. Laurent Hiffler (firstname.lastname@example.org)