Effective health information systems are essential to the delivery of high-quality community-based care for chronic disease which will be needed to address the changing healthcare needs of populations in low and middle-income country settings. Health management information systems (health service data collected at facility level) and electronic health records (data organised by individual patients) may support the measurement-based, collaborative approach that is central to the chronic care model, which has been adopted as the basis for task-shared models of care for mental health and non-communicable disease. We used the performance of routine information systems management to guide our commentary on the evidence-base about information systems to support chronic care. We found that, despite an appetite for using the information to support decision-making around service planning, this rarely happens in practice, reasons include that data is not perceived to be of good quality or fit for purpose. There is often a mismatch between technology design and the availability of specialised knowledge and infrastructure. However, when data collection is designed in collaboration with local stakeholders, there is some evidence of success, demonstrated by completion and accuracy of data forms. Whilst there are global targets for the development of health information systems and progress on these is undoubtedly being made, indicators for chronic disease are seldom prioritised by national governments and there is insufficient decentralisation to facilitate local data-driven decision-making. Our recommendations for future research and development, therefore, focus upon the need to integrate context into the design of information systems: through building strong multisectoral partnerships, ensuring newly developed indicators are well aligned to service models and using technology that is a good fit with local infrastructure. This approach will be necessary if information systems are to deliver on their potential to drive improvements in care for chronic disease.
With the current push towards using fewer antipsychotics and more non-pharmacological interventions in long-term care, it has become increasingly important for knowledge and best-practice sharing across the province. The “Good Ideas” project began in 2001 in the context of my work as a Royal Ottawa geriatric psychiatry behavioural support outreach nurse to long-term-care facilities in Ottawa. A toolkit was begun as various ideas and tools were found to be useful in the management of behavioural challenges in the care of long term care residents. These non-pharmacological tools can have a significant impact on the management of behavioural challenges. Some were discovered via “out-of-the-box” thinking, some as a result of exploring possibilities on the Web, others were shared with me by colleagues in various roles and settings. I have worked in geriatric psychiatry in various capacities as a nurse at The Royal Ottawa Health Care Group since 1986, and have had the opportunity to accumulate several “good ideas” over time. I found myself carrying various articles, pamphlets, booklets, photos in my workbag and noticed I was being contacted more frequently over time on how to obtain certain items. When these non-pharmacological approaches were implemented, and successful, a common response would be: “what a good idea!” Thus, the name given to the project came to be. Good Ideas has grown over the years as the information has been shared with outreach team members and utilized in their own practice. All contacts are encouraged to share any new “good ideas” they encounter so those too can be added. Originally a hardcopy handout with a list and the resources to outsource items was created and distributed. This evolved into a PowerPoint presentation explaining the usefulness of each tool in specific target behaviours and how to obtain the tool, as well as photos. Later a poster was made and a second version was produced more recently. Currently the project is in the process of being translated to French for our bilingual Ottawa area. The project has circulated among my teammates to be used in education sessions in their long-term-care facilities or as an adjunct to larger full day education sessions on the topic of dementia care. A large colorful hatbox also contains some sample items to add to the hard copies. Good Ideas has been presented at the Regional Geriatric Program Annual Meeting poster presentation Oct 12, 2013, with very positive feedback from participants. Good Ideas is a project in perpetuity, with no stop date planned. It is my hope it will continue to grow long after my retirement date. It promotes the concept of creative thinking about behavioural challenges in dementia care, while supporting that pharmacological intervention should most often be as a last resort.
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