1. The ALMANACH concept: protocols and guidelines at your fingertips
A. Bernasconi 1,2, F. Crabbé 1,2, A. Vanobberghen 1,2, R. Rossi3, S. Du Mortier3, M. Raab 1,2
1HTTU, Swiss TPH, Basel, Switzerland; 2University of Basel, Switzerland 3 PHC programs, ICRC, Genève, Switzerland
Introduction
Results
ALMANACH has been used for more than one year in three health facilities in Afghanistan and in twelve facilities in Nigeria, most of these are located in remote or unsafe areas children between 2 months and 5 years were managed with the ALMANACH.
Proper physical examination
For the patients, effective treatment and competent medical staff are the most important aspect of the care
The CPGs
Paper-based CPGs such as IMCI are complex and time consuming to navigate
BEFORE ALMANACH
AFTER ALMANACH
To ensure competency, the health care provided should be consistent with the current professional knowledge
The Healthcare Providers (HCPs)
HCPs are often reluctant about using CPGs because they perceive their knowledge to be questioned.
HCPs often overestimate their own ability vs CPGs
Proper therapy given
Current professional knowledge
relies on evidence based medicine (EBM)
The Health Program
Typical constraints associated with programs in low income countries:
Understaffed and under-funded health systems
Access to remote locations
staff with limited knowledge,
Irregular supervision,
Decisions made by health managers on the basis of patchy evidence
Children receiving no more than one antibiotic
Based on EBM, Clinical Practice Guidelines (CPGs) are used to improve the quality of care by providing scientific standardised information
By developing CPGs on the base of EBM, inappropriate care is reduced
Discussion
The benefits of ALMANACH:
Methodology
CPGs become CDSS*
ALMANACH (ALgorithm for the MANagement of Acute CHildhood illnesses) is an electronic and upgraded version of the Integrated Management of Childhood Illness available on tablets. During the consultation, ALMANACH recommends :
which examinations to perform,
when to refer,
when to use a rapid diagnostic test,
what treatment to prescribe and at what dosage,
What preventive services (deworming, vaccination, vitamin A) provide.
*CDSS: Clinical Decision Support Systems”: tools that analyses medical data to help healthcare providers to make clinical decisions at the point of care