title: An e-health decision support system for improving compliance of health workers to the maternity care protocols in South Africa.
abstract: BACKGROUND
  There are problems of quality in maternity services at primary health care level in South Africa. Many of these problems can be traced to non-adherence to the maternity care guidelines and lack of tools to support clinic staff and managers in their roles.
  
  
  OBJECTIVE
  The aim of this research was to investigate the utility of e-health (computerized) decision support systems at addressing the problem of compliance of health workers to the maternity care guidelines at primary health care in South Africa. At present there are no documented studies on e-health clinical decision support systems for primary health care in South Africa, though clinical decision support systems for primary health care are listed as part of the e-health strategy of the National Department of Health.
  
  
  METHODS
  An e-health decision support system named the Bacis (Basic Antenatal Care Information System) Program was developed, then implemented and evaluated at a primary health care clinic. The duration of the study was two years: this includes development, implementation and evaluation.
  
  
  CONCLUSIONS
  There was an overall improvement in compliance from 85.1 % to 89.3%. This result was not statistically significant. However when results were stratified into specific categories, the Bacis Program showed statistically significant improvement in compliance over the checklist system in three out of nine important categories. These are compliance at booking, patients younger than 18 years and patients booking after week 20. Further, insights and experience were also gained on development and implementation of clinical information systems at resource strained environments such as primary health care in South Africa. These results, insights and experience are invaluable for the implementation of the proposed e-health strategy in South Africa.
authors: V
authors: V
authors: Horner
authors: P
authors: P
authors: Rautenbach
authors: N
authors: N
authors: Mbananga
authors: T
authors: T
authors: Mashamba
authors: H
authors: H
authors: Kwinda
mesh_terms: D001291:Attitude of Health Personnel; D003661:Decision Support Techniques; D003695:Delivery of Health Care / Q000379:methods* / Q000592:standards*; D006282:Health Personnel; D006801:Humans; D009774:Obstetrics; D011785:Quality Assurance, Health Care; D018401:Sample Size; D013019:South Africa
keywords: Clinical decision support systems; guideline adherence; maternal health care; primary health care
references: BMJ. 1992 Nov 14;305(6863):1184-6
references: 1467720
references: Health Technol Assess. 2004 Feb;8(6):iii-iv, 1-72
references: 14960256
references: Am J Med. 1997 Jan;102(1):89-98
references: 9209205
references: J Am Med Inform Assoc. 1998 May-Jun;5(3):227-36
references: 9609492