Improving Nighttime Access to Care and Treatment (Part 2) (INACT2)

University of Florida

Status: Completed

Conditions: Acute Respiratory Infection; Acute Diarrhea; Acute Febrile Illness

Treatments: Other: MotoMeds Healthline- illness assessment and treatment recommendation for non-emergent cases by telephone

Study type: Observational

Funder types: Other; NIH

Identifiers

NCT03943654

DP5OD019893 (U.S. NIH Grant/Contract)

IRB201802920 -N

Details and patient eligibility

About

Children in resource-limited settings who develop illness at night are often isolated from pre-emergency care, resulting in progression to an emergency because families are forced to wait until morning to seek care. This is especially true in Haiti based on needs assessments (INACT Part 1; INACT1) surrounding access to healthcare. This study (INACT Part 2; INACT2) seeks to improve access to care by establishing a health hotline (healthline) and mobile pharmacy for families with children who become ill at nighttime. The healthline will be staffed by medical professionals and will provide phone based assessment and treatment recommendations based on standard of care practices according to Haitian and WHO guidelines. The healthline will focus on pre-emergency patients (those without danger signs as defined by WHO guidelines). Emergent patients will be advised to bypass the healthline and seek immediate care at the nearest medical facility. In the event that a non-emergent patient requires access to basic medications or fluids and is logistically accessible, the mobile pharmacy service will be offered.

The specific aims of the study are as follows: Aim I. Evaluate congruence between healthline assessment over the phone and in-person assessment of participants (patients using the healthline) 10 years of age and younger. The investigators hypothesize that in-person assessments based on WHO guidelines will be discordant with those made by the healthline because the physical aspects of the call-center assessment will be performed by an untrained parent/ guardian. The study focuses on acute diarrheal disease (ADD) and acute respiratory illness (ARI) but is not exclusive to these two chief complaints. Aim II: Identify determinants that correlate with seeking care at a medical facility over the 8-12 day follow up period after the initial call. The findings from this study will determine if a healthline model is a safe and accurate method of providing high quality access to nighttime healthcare, averting the progression of non-emergent cases to emergencies.

Enrollment: 391 patients

Sex: All

Ages: Under 10 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• age of patient must be 10 years or younger
• patient must reside inside the study delivery area
• consent/assent to participate

Exclusion criteria

• emergent illness (danger signs present)

Trial design

391 participants in 3 patient groups

Children living within study delivery area w/o danger signs

Description:

Families who call the healthline service about a sick child (no danger signs) and live within the mobile pharmacy delivery area will receive illness assessments and treatment recommendations over the phone. Immediately following calls a nurse will conduct household visits to complete in-person assessments of the children. Illness progression will be tracked with a 8-12 day follow up call. The phone and in-person assessments will be compared to evaluate safety and accuracy of the healthline.

Treatment:

Other: MotoMeds Healthline- illness assessment and treatment recommendation for non-emergent cases by telephone

Children living outside study delivery area w/o danger signs

Description:

Families who call the healthline service about a sick child (no danger signs) and live outside the delivery area will receive illness assessments and treatment recommendations over the phone. Illness progression will be tracked with a 8-12 day follow up call.

Treatment:

Other: MotoMeds Healthline- illness assessment and treatment recommendation for non-emergent cases by telephone

Children who are identified as having danger signs

Description:

Families who call the healthline service about a sick child and who are identified as having a danger sign will be directed to the nearest medical facility. Illness progression will be tracked with a 8-12 day follow up call.

Treatment:

Other: MotoMeds Healthline- illness assessment and treatment recommendation for non-emergent cases by telephone