Factors influencing utilization of international quality care system for clinical decision support in Hiv care clinics in Nakuru county, Kenya

Abstract

Electronic medical records (EMR) are computerized medical information systems that are used to collect, store, and display patient information. EMR systems can strengthen pathways of care and close gaps in patient tracking, care, and management of chronic diseases such as HIV&AIDS. Conventionally, health care workers (HCWs) face difficulties in locating, sorting, and identifying key information in paper records. To counter these challenges, in the year 2010 the Ministry of Health in Kenya approved the use of two EMR platforms, namely the International Quality Care (IQCare) system and the Kenya EMR. These systems were initially set to support HIV&AIDS clinical decision making. In 2014, Nakuru County was among the first counties to roll out the utilization of IQCare system for clinical decision support (CDS). In its implementation, appropriate support was provided, which included human resource and ICT infrastructure. Despite the substantial investment in IQCare in Nakuru County, its utilization for CDS remained low. As such, the main aim of this study was to investigate the factors that influence the utilization of the IQCare system for CDS in HIV care clinics in Nakuru County. Specifically, the study set out to determine the influence of human resource availability, ICT infrastructure and HCWs perspective on the utilization of IQCare for CDS in the provision of HIV&AIDS care services in health facilities in Nakuru County. This cross-sectional study was conducted in 13 health facilities where IQCare had been deployed since January 2014 and enrolled 81 HCWs. Data was collected using questionnaires and focus group discussions. The results from the study revealed a significant association between human resource availability and utilization of IQCare for CDS; with IQCare training (p=0.023) and mentorship support (p=0.049) being significantly associated with use of IQCare for CDS. A binary regression analysis revealed linking of computers via local area network (LAN) (p=0.012), and internet connectivity (p=0.026) influenced the utilization of IQCare for CDS. Further, IQCare simplifying the work of HCWs (p=0.023), clinicians having control in decision making (p=0.008) and protecting patient confidentiality (p=0.005) are some of the HCWs perspectives which showed significance to utilization of the IQCare for CDS. The results presented showed that training of staff on IQCare, mentorship support, Computers linked via LAN and internet connectivity are drivers to utilization of IQCare for CDS in Nakuru County. The study recommends that decision-makers at facility, County and national level should invest in HCWs training, mentorship support, avail computer networking and internet connectivity devices to guarantee optimal utilization of IQCare systems for CDS.