Use of digital solutions to improve quality of care in primary health care for paediatric patients in LMIC

Define, apply and measure quality of care is a complex question that fed long and animated discussions. There are different conceptual approaches and measurement techniques, furthermore the concept spans on two levels: from the level of the individual patient to the level of the health system [1, 2] and the distinction between quality and performance is often unclear [1]. A broader definition provided by the American Institute of Medicine include as elements of proper quality of care effective and efficient good medical practice, safety, patient centred, timely and equitable care [3]. To ensure competency, the health care provided should be consistent with the current professional knowledge [3] that, in turn, it relies on evidence-based medicine (EBM) and, broadly, on the ability of science and technology to improve human health condition. At practical level, the effectiveness of clinical care depends on the effective application of knowledge-based care tailored on the community sensitivity, available resources and culturally acceptance. Clinical Practice Guidelines (CPGs), based on EBM, are considered the backbone to improve the quality of care by providing scientific standardized information that support physicians in their clinical decision [4], especially nowadays that they are facing an exponential increase of the medical knowledge [4, 5]. It is assumed that by developing CPGs on the base of good quality EBM, reflecting best practice, and fitting with the cultural context and the available resources, inappropriate care will be drastically reduced, with an improvement in patient care and patient health outcomes [4, 6]. Although this approach is feasible in the most industrialised/high income countries, it is really challenging in many low-middle income countries where scientific boards are understaffed, cultural acceptance is not always granted, health systems usually work in a sub standardized way and where recruitment, retention and training of health workers, especially in remote areas, is difficult. The analysis of the approaches in use by the most vulnerable health systems and the digital solutions to improve quality of care to their populations is the scope of this PhD. I will narrow my analysis to the under 5 care at Primary Health Care (PHC) level. I will consider, as a benchmark, the advantages of previous successful programs for child care like IMCI (IMCI is associated with a 15% reduction in child mortality [7]), their pitfalls and the newly digital health solutions proposed (ALMANACH, eCare, ePOCT, eIMCI, …). While digital health and Clinical Decision Support System (CDSS) are on the rising in the most industrialised countries, especially in North America, still very little information about their use, performance and limitations are available for the most fragile contexts despite preliminary results could be considered promising: as example several authors have proved a significant reduction in the common habit of over prescribing antibiotics through a proper use of CDSS, making of them a possible important tool to fight antibiotic resistance, one of the most concerning health issues of the close future. It is also very important to understand if the introduction of these new technologies reflects and fits with the principles identified in the Alma Ata Declaration (1978). The declaration supports the use of appropriate medical technology that should be accessible, affordable, feasible and culturally acceptable to the community. At the same time, it is requested that these new approaches have to be sustainable, patient centred, equitable and able to easily interact with other components of a sophisticated health care system (vertical programs, epidemiological surveillance, secondary health level, etc…). This PhD aims to fill these gaps.

Keywords:B680-public-health