Background: Worldwide Electronic Medical Records (EMR) when compared to a paper-based system has been proven to improve service delivering numerous health care facilities. However, no research has been described in the literature regarding the user's perception of the clinical electronic medical record (EMR) system in Rwanda. The objective of this study is to evaluate the health care consumer's perception of the Electronic Medical Record (EMR) OpenClinic regarding improving the quality of health care delivery within the hospital setting. How does the OpenClinic system affect the patients' waiting time? How complete is the information obtained from OpenClinic as compared to paper medical records, and the level of satisfaction of the users of OpenClinic. Method: A structured questionnaire was developed, validated and utilized in this quantitative research project. Quantitative data were collected from 170 participants while an interview guide was used to collect qualitative data from 6 key informants at a referral hospital in Kigali. The SPSS version 20.0 was used to analyze the quantitative data. The interviews transcribed verbatim; the data were thematically analyzed and categorized by pre-determined themes. Permission to conduct the study was approved from the ethics committee of the University of Rwanda, College of Health Sciences and the hospital. Results: The majority of the participants were satisfied with OpenClinic, (90%), while only a few (10%) did not perceive any advantage of a computer-based EMR and preferred paper based records. Conclusion: Openclinc EMR was seen to be an improvement in the data collection involving health care delivery in Kigali, Rwanda.

BackgroundRehabilitation is important for persons with disabilities as it contributes to their sense of autonomy, self-worth and social participation, and improves their quality of life. Improving the quality of rehabilitation services requires the dialogue of patients’ perceptions with those of service providers, in order to recommend informed reform.ObjectiveThe objective was to explore the experiences of persons with physical disabilities and service providers, regarding the multi-disciplinary rehabilitation services provided at a community-based out-patient rehabilitation centre.MethodsA qualitative, exploratory study design was used to collect the data. A focus group was conducted with conveniently selected persons with physical disabilities. Three in-depth interviews were conducted with purposively selected key informants. All ethical considerations were adhered to during the implementation of the study.ResultsPatients and service providers had different experiences regarding accessibility to rehabilitation services, and similar experiences with patient education and intensity of rehabilitation. Although the patients experienced that the service providers had sufficient knowledge and skills to manage them, services providers expressed that they lacked certain skills.ConclusionsThe experiences expressed highlighted the need to improve rehabilitation services in terms of increasing the capacity of service providers and providing transport services for persons with disabilities.

Background In low-resource settings, access to basic rehabilitation could be supplemented by community-level interventions provided by community health workers, health volunteers, or family caregivers. Yet, it is unclear whether basic physical rehabilitation interventions delivered to adults by non-professional alternative resources in the community, under task-shifting or task-sharing approaches, are effective as those delivered by skilled rehabilitation professionals. We aim to synthesize evidence on the effectiveness of community-level rehabilitation interventions delivered by non-professional community-level workers or informal caregivers to improve health outcomes for persons with physical impairments or disabilities. Methods We performed a systematic review with a PROSPERO registration. Eight databases were searched for (PubMed, CINAHL, Global Health, PDQ Evidence, Scopus, ProQuest, CENTRAL, and Web of Science), supplemented by snowballing and key-informant recommendations, with no time restrictions, applied. Controlled and non-controlled experiments were included if reporting the effects of interventions on mobility, activities of daily living (ADLs), quality of life, or social participation outcomes. Two independent investigators performed the eligibility decisions, data extraction, risk of bias, and assessed the quality of the evidence using the GRADE approach. Results Ten studies (five randomized controlled trials [RCTs]) involving 2149 participants were included. Most common targeted stroke survivors (n = 8); family caregivers were most frequently used to deliver the intervention (n = 4); and the intervention was usually provided in homes (n = 7), with training initiated in the hospital (n = 4). Of the four RCTs delivered by family caregivers, one demonstrated a statistically significant improvement in mobility (effect size: 0.3; confidence interval [CI] 121.81–122.19; [p = 0.04]) and another one in ADLs (effect size: 0.4; CI 25.92–35.08; [p = 0.03]). Of the five non-RCT studies by community health workers or volunteers, one demonstrated a statistically significant improvement in mobility (effect size: 0.3; CI 10.143–16.857; [p < 0.05]), while two demonstrated improved statistically significant improvement in ADLs (effect size: 0.2; CI 180.202–184.789 [p = 0.001]; 0.4; CI − 7.643–18.643; [p = 0.026]). However, the quality of evidence, based on GRADE criteria, was rated as low to very low. Conclusions While task-sharing is a possible strategy to meet basic rehabilitation needs in low-resource settings, the current evidence on the effectiveness of delivering rehabilitation interventions by non-professional community-level workers and informal caregivers is inconclusive. We can use the data and experiences from existing studies to better design studies and improve the implementation of interventions. Trial registration PROSPERO registration number: CRD42022319130

Background: The greatest mortality and disability from stroke occurs in low- and middle-income countries. A significant barrier to implementation of best stroke care practices in these settings is limited availability of specialized healthcare training. We conducted a systematic review to determine the most effective methods for the provision of speciality stroke care education for hospital-based healthcare professionals in low-resource settings. Methods: We followed the PRISMA guidelines for systematic reviews and searched PubMed, Web of Science and Scopus for original clinical research articles that described or evaluated stroke care education for hospital-based healthcare professionals in low-resource settings. Two reviewers screened titles/abstracts and then full text articles. Three reviewers critically appraised the articles selected for inclusion. Results: A total of 1,182 articles were identified and eight were eligible for inclusion in this review; three were randomized controlled trials, four were non-randomized studies, and one was a descriptive study. Most studies used several approaches to education. A “train-the-trainer” approach to education was found to have the most positive clinical outcomes (lower overall complications, lengths of stay in hospital, and clinical vascular events). When used for quality improvement, the “train-the-trainer” approach increased patient reception of eligible performance measures. When technology was used to provide stroke education there was an increased frequency in diagnosis of stroke and use of antithrombotic treatment, reduced door-to-needle times, and increased support for decision making in medication prescription was reported. Task-sharing workshops for non-neurologists improved knowledge of stroke and patient care. Multidimensional education demonstrated an overall care quality improvement and increased prescriptions for evidence-based therapies although there were no significant differences in secondary prevention efforts, stroke reoccurrence, or mortality rates. Discussion: The “train the trainer” approach is likely the most effective strategy for specialist stroke education, while technology is also useful if resources are available to support its development and use. If resources are limited, basic knowledge education should be considered at a minimum, and multidimensional training may not be as beneficial. Communities of practice, led by those in similar settings, may be helpful to develop educational initiatives with relevance to local contexts.