Delivering modern, high-quality, affordable pathology and laboratory medicine to low-income and middle-income countries: a call to action

Horton, Susan; Sullivan, Richard; Flanigan, John; Fleming, K. A.; Kuti, Modupe; Looi, Lai‐Meng; Pai, Sanjay A; Lawler, Mark

doi:10.1016/s0140-6736(18)30460-4

Cited by 86 publications

(81 citation statements)

References 45 publications

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“…The full‐text review showed that none of the publications approached EHR development, deployment, and use to serve the health information needs of health care providers, policymakers and program managers, and other key stakeholders. Instead, the focus was primarily on vertical disease programs and health information system (HIS) subsystems, such as pharmacy or pathology and laboratory medicine systems . For example, one of the publications described a study on EMR use by mobile medical service trips in remote settings, while another described the development, implementation, and use of iSanté, Haiti's national HIV care, and treatment EMR system .…”

Section: Resultsmentioning

confidence: 99%

Research evidence on strategies enabling integration of electronic health records in the health care systems of low‐ and middle‐income countries: A literature review

Kumar

Mostafa

2019

Health Planning & Management

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Summary Integration of electronic health records (EHRs) in the national health care systems of low‐ and middle‐income countries (LMICs) is vital for achieving the United Nations Sustainable Development Goal of ensuring healthy lives and promoting well‐being for all people of all ages. National EHR systems are increasing, but mostly in developed countries. Besides, there is limited research evidence on successful strategies for ensuring integration of national EHRs in the health care systems of LMICs. To fill this evidence gap, a comprehensive survey of literature was conducted using scientific electronic databases—PubMed, SCOPUS, Web of Science, and Global Health—and consultations with international experts. The review highlights the lack of evidence on strategies for integrating EHR systems, although there was ample evidence on implementation challenges and relevance of EHRs to vertical disease programs such as HIV. The findings describe the narrow focus of EHR implementation, the prominence of vertical disease programs in EHR adoption, testing of theoretical and conceptual models for EHR implementation and success, and strategies for EHR implementation. The review findings are further amplified through examples of EHR implementation in Sierra Leone, Malawi, and India. Unless evidence‐based strategies are identified and applied, integration of national EHRs in the health care systems of LMICs is difficult.

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Section: Resultsmentioning

confidence: 99%

Research evidence on strategies enabling integration of electronic health records in the health care systems of low‐ and middle‐income countries: A literature review

Kumar

Mostafa

2019

Health Planning & Management

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“…Some, such as pathologists, have been labeled “invisible,” that is, not providing adequate leadership, when it comes to, “Modern, affordable pathology and laboratory medicine systems…essential to achieve the 2030 Sustainable Development Goals for health in low-income and middle-income countries” (32–34). Academic leaders in China see such strong need for POCT, that they and the author (GK) have proposed a new field, “ Point of Careology ,” with its own dedicated professional staff.…”

Section: Discussionmentioning

confidence: 99%

Point-Of-Care Testing Curriculum and Accreditation for Public Health—Enabling Preparedness, Response, and Higher Standards of Care at Points of Need

Kost

Zadran

et al. 2019

Front. Public Health

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Objectives: To develop awareness of benefits of point-of-care testing (POCT) education in schools of public health, to identify learning objectives for teaching POCT, to enable public health professionals and emergency responders to perform evidence-based diagnosis and triage effectively and efficiently at points of need, and to better improve future standards of care for public health practice, including in limited-resource settings and crisis situations.Methods: We surveyed all U.S. schools of public health, colleges of public health, and public health schools accredited by the Council on Education in Public Health (CEPH). We included accredited public health programs, so that all states offering public health education were represented. We analyzed survey data, public health books, and board certification guidelines. We used PubMed to identify public health curriculum papers, and assessed 2019 CEPH accreditation requirements. We merged POCT knowledge bases to design a new curriculum for teaching public health students and practitioners the principles and practice of POCT.Results: Public health curricula, certification requirements, and textbooks generally do not include POCT instruction. Only one book, Global Point of Care: Strategies for Disasters, Emergencies, and Public Health Resilience, and one online course on public health preparedness address POCT and public health intervention issues. The topic, POC HIV/HCV ED testing, appeared in one course and POC diagnostics in local clinics, in another. Papers on public health curriculum have not incorporated POCT. No curriculum addresses POCT in isolation units during quarantine, despite evidence that recent Ebola virus disease cases in the U.S. and elsewhere proved unequivocally the need for POCT. The modular learning objectives identified in this paper were customized for public health students. Public health graduates can use boot camps, online credentialing, and self-study to acquire POCT skills.Conclusions: Enhancing accreditation requirements, academic training, board certification, and field experience will generate public health healthcare professionals who will rely upon evidence-based medical decision making at points of care, including during crises when time is of the essence. A POCT-enabled public health workforce can help prevent and stop outbreaks. Public health-based medical professionals urgently need the skills necessary to perform POCT and prepare America and other nations for threats portending significant adverse medical, economic, social, and cultural impact.

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“…1 However, access to quality-assured laboratory diagnosis has been a challenge in low-income and middle-income countries (LMICs) resulting in delayed or inaccurate diagnosis and ineffective treatment with consequences for patient safety. 1 In the new Lancet Series 2–4 on pathology and laboratory medicine (PALM) in LMICs, Michael Wilson and colleagues 2 provide a comprehensive analysis of the challenges and gaps that limit access to PALM services. Some of the challenges include the absence of essential infrastructure, laboratory supplies, basic equipment, skilled personnel, supply chain management, and equipment maintenance; reliance on empirical treatment; inadequate quality management systems; and no government standards for laboratory testing.…”

mentioning

confidence: 99%

“…Some of the challenges include the absence of essential infrastructure, laboratory supplies, basic equipment, skilled personnel, supply chain management, and equipment maintenance; reliance on empirical treatment; inadequate quality management systems; and no government standards for laboratory testing. In their Series paper, Shahin Sayed and colleagues 3 provide a roadmap to solutions for improving laboratory medicine, and Susan Horton and colleagues 4 call for all stakeholders to ensure the effective provision of PALM services in resource-limited settings.…”

mentioning

confidence: 99%

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Laboratory medicine in low-income and middle-income countries: progress and challenges

2018

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Delivering modern, high-quality, affordable pathology and laboratory medicine to low-income and middle-income countries: a call to action

Cited by 86 publications

References 45 publications

Research evidence on strategies enabling integration of electronic health records in the health care systems of low‐ and middle‐income countries: A literature review

Research evidence on strategies enabling integration of electronic health records in the health care systems of low‐ and middle‐income countries: A literature review

Point-Of-Care Testing Curriculum and Accreditation for Public Health—Enabling Preparedness, Response, and Higher Standards of Care at Points of Need

Laboratory medicine in low-income and middle-income countries: progress and challenges

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