Electronic clinical decision algorithms for the integrated primary care management of febrile children in low-resource settings: review of existing tools.

Keitel, Kristina; D'Acremont, Valérie (2018). Electronic clinical decision algorithms for the integrated primary care management of febrile children in low-resource settings: review of existing tools. Clinical microbiology and infection, 24(8), pp. 845-855. Elsevier 10.1016/j.cmi.2018.04.014

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BACKGROUND

The lack of effective, integrated diagnostic tools poses a major challenge to the primary care management of febrile childhood illnesses. These limitations are especially evident in low-resource settings and are often inappropriately compensated by antimicrobial overprescription. Electronic clinical decision algorithms (eCDAs) have the potential to close these gaps by guiding antibiotic use and better identifying serious disease.

AIMS

This narrative review summarizes existing eCDAs, to provide an overview of their degree of validation and to identify gaps in current knowledge and prospects for future innovation.

SOURCES

Structured literature review in PubMed and Embase complemented by Google search and contact with developers.

CONTENT

Six integrated eCDAs were identified: three (eIMCI, REC and Bangladesh digital IMCI) based on Integrated Management of Childhood Illnesses (IMCI); four (SL electronic iCCM, MEDSINC, electronic iCCM and D-Tree electronic iCCM) on Integrated Community Case Management (iCCM); two (ALMANACH, MSFeCARE) with a modified IMCI content; and one (ePOCT) that integrates novel content with biomarker testing. The types of publications and evaluation studies varied greatly: the content and evidence base were published for two (ALMANACH and ePOCT) and ALMANACH and ePOCT were validated in efficacy studies. Other types of evaluations, such as compliance and acceptability, were available for D-Tree electronic iCCM, eIMCI and ALMANACH. Several evaluations are still ongoing. Future prospects include conducting effectiveness and impact studies using data gathered through larger studies to adapt the medical content to local epidemiology, improving the software and sensors, and assessing factors that influence compliance and scale-up.

IMPLICATIONS

eCDAs are valuable tools that have the potential to improve management of febrile children in primary care and increase the rational use of diagnostics and antimicrobials. Next steps in the evidence pathway should be larger effectiveness and impact studies (including cost analysis) and continuous integration of clinically useful diagnostic and treatment innovations.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine > Notfallzentrum für Kinder und Jugendliche
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine

UniBE Contributor:

Keitel, Kristina

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1469-0691

Publisher:

Elsevier

Language:

English

Submitter:

Anette van Dorland

Date Deposited:

07 Dec 2021 08:53

Last Modified:

05 Dec 2022 15:54

Publisher DOI:

10.1016/j.cmi.2018.04.014

PubMed ID:

29684634

Uncontrolled Keywords:

Acute febrile illness children computerized decision support system diagnostic tools electronic decision trees low-resource countries primary care

BORIS DOI:

10.48350/160512

URI:

https://boris.unibe.ch/id/eprint/160512

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