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Research Article

Electronic Clinical Decision Support Tools to Manage Patients with Lower Respiratory Tract Infection: Clinicians’ Perspectives in Sri Lanka

Warsha De Zoysa Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;
Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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Dhammika Palangasinghe Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;
Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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Champica Bodinayake Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;
Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;
Duke Global Health Institute, Duke University, Durham, North Carolina;

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Ajith Nagahawatte Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;
Duke Global Health Institute, Duke University, Durham, North Carolina;
Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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Jayani Gamage Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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Maria Iglesias-Ussel Department of Medicine, School of Medicine, Duke University, Durham, North Carolina;

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Stefany Olague Duke Clinical Research Institute, Duke University, Durham, North Carolina;

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Christina Galdieri Duke Clinical Research Institute, Duke University, Durham, North Carolina;

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Ruvini Kurukulasooriya Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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Senali Weerasinghe Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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Madureka Premamali Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;

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James Ngocho Kilimanjaro Christian Medical Centre, Moshi, Tanzania;

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Armstrong Obale Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;
Duke Global Health Institute, Duke University, Durham, North Carolina;

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Hrishikesh Chakraborty Department of Medicine, School of Medicine, Duke University, Durham, North Carolina;
Duke Clinical Research Institute, Duke University, Durham, North Carolina;

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Truls Ostbye Department of Family Medicine, Duke University, Durham, North Carolina;

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Susanna Naggie Department of Medicine, School of Medicine, Duke University, Durham, North Carolina;
Duke Clinical Research Institute, Duke University, Durham, North Carolina;

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Christopher W. Woods Duke Global Health Institute, Duke University, Durham, North Carolina;
Department of Medicine, School of Medicine, Duke University, Durham, North Carolina;

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Evan Myers Department of Medicine, School of Medicine, Duke University, Durham, North Carolina;
Duke Clinical Research Institute, Duke University, Durham, North Carolina;

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Melissa H. Watt Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, Utah

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L. Gayani Tillekeratne Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;
Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka;
Duke Global Health Institute, Duke University, Durham, North Carolina;

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DOI:
https://doi.org/10.4269/ajtmh.24-0576
Volume/Issue:
Ahead of Print
Open access
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In low-resource settings, providers often manage lower respiratory tract infections (LRTIs) without diagnostic tests, which may cause antibacterial overuse. Electronic clinical decision support tools (eCDSTs) can support evidence-based decision-making and judicious use of antibacterials. This study aimed to explore the potential of an eCDST to help providers in Sri Lanka effectively manage LRTI. Semi-structured interviews were conducted with 15 clinicians, including 10 males and five females, with an average of 11.6 years (range: 4–25 years) of clinical practice. The interview guide covered clinicians’ interest in an eCDST to manage LRTI and their feedback regarding the desired features of such a tool. Interviews were audio-recorded, transcribed, and coded for themes related to: interest in an eCDST for LRTI, desired tool capabilities, development concerns, and tool design characteristics. All expressed interest in incorporating eCDSTs into their practice. However, the majority emphasized that clinical judgment must supersede recommendations from an eCDST. Four themes emerged regarding desired tool capabilities: information about the pathogen, treatment recommendations, severity of the LRTI, and monitoring of patient progress. Six themes emerged regarding tool development considerations: validated algorithms, regional specificity, seasonality, inclusion of patient’s risk factors, scalability, and the importance of updated and locally relevant recommendations. Participants stressed that the tool design should be simple, timesaving, and internet-independent. Electronic clinical decision support tools are capable of improving patient care and reduce antibiotic overuse, which may impact downstream antibacterial resistance. Future research should develop an eCDST for LRTI with local input and evaluate its impact on appropriate antibacterial use and patient outcomes.

Author Notes

Financial support: This study was funded by a grant from the U.S. National Institute of Allergy and Infectious Diseases (Grant no. R01 AI168420).

Current contact Information: Warsha De Zoysa, Dhammika Palangasinghe, and Champica Bodinayake, Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, E-mails: warshadez@gmail.com, drpalangasinghe1984@gmail.com, and bodinayake@gmail.com. Ajith Nagahawatte, Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, E-mail: ajithnagahawatte@yahoo.co.uk. Jayani Gamage, Ruvini Kurukulasooriya, Senali Weerasinghe, and Madureka Premamali, Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, E-mails: jayanigdukeruh@gmail.com, duke.ruhuna@gmail.com, senalidukeruh@gmail.com, and madurekadukedukerhu@gmail.com. Maria Iglesias-Ussel, Hrishikesh Chakraborty, Susanna Naggie, and Evan Myers, Department of Medicine, School of Medicine, Duke University, Durham, NC, E-mails: maria.iglesiasdeussel@duke.edu, hrishikesh.chakraborty@duke.edu, susanna.naggie@duke.edu, and evan.myers@duke.edu. Stefany Olague and Christina Galdieri, Duke Clinical Research Institute, Duke University, Durham, NC, E-mails: stefany.olague@duke.edu and christina.galdieri@duke.edu. James Ngocho, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, E-mail: james.ngocho@kcmuco.ac.tz. Armstrong Obale, Christopher W. Woods, and L. Gayani Tillekeratne, Duke Global Health Institute, Duke University, Durham, NC, E-mails: mbi.obale@duke.edu, chris.woods@duke.edu, and gayani.tillekeratne@duke.edu. Truls Ostbye, Department of Family Medicine, Duke University, Moshi, Tanzania, E-mail: truls.ostbye@duke.edu. Melissa H. Watt, Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, UT, E-mail: melissa.watt@hsc.utah.edu.

Address correspondence to Warsha De Zoysa, Department of Medicine, Faculty of Medicine, University of Ruhuna, P.O. Box 70, Galle 80000, Sri Lanka. E-mail: warshadez@gmail.com
Copyright:
© The author(s) 2025
Received:
27 Aug 2024
|
Accepted:
15 Dec 2024
|
Published Online:
11 Mar 2025
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645

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