Browsing by Author "Mendis, K.M."

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Cross sectional online survey: Perceived factors affecting the implementation of primary care classification of encounters to improve data recording practices among Sri Lankan doctors
(Sri Lanka Medical Association, 2019) Liyanaarachchi, N.P.; Mendis, K.M.; Perera, I.R.
INTRODUCTION & OBJECTIVES: There are over 100 million annual Primary Care (PC) encounters which do not translate into published information. Using Classification and Coding Systems (CCS) through electronic Information Systems (e-HIS) is a good strategy to optimize data recording. PC data recording practices(DRP) among doctors affect the reliable published information. The study was conducted to assess doctors' knowledge, attitude and practice on DRP using e-HIS. METHODS: A cross sectional, online survey was carried out among practicing PC doctors. The sample size was 243 while 9900 respondents were approached considering the response factors. Developed scales were colored by the Normalization Process Theory. They demonstrated high internal consistency and construct validity. The Composite Knowledge Score (CKS) and Composite Perception Score (CPS) were used to analyze the levels between groups using dichotomized outcome variables. RESULTS: The results showed a high degree of knowledge about basic concepts while less knowledge on processes of cave. No significant difference of CKS among age groups, qualification level, number of years of service and years Of service in PC. The same observation was made for CPS as well. The median for CPS was 0, indicated total absence of current/past experience on CCS. CONCLUSION: The overall conceptual knowledge about the DRP was good, despite the concept "processes of care" was less known. They perceived electronic recording and classification could be convenient, hence they are willing to carry out the data recording tasks. This seems an opportunity for e-HIS implementation. A proper training on CCS is essential and could be carried out as a general training to all levels of doctors.
A mixed method qualitative study to develop ICPC-2-SL: Dynamic, optimized and scalable version of the international classification of primary care for Sri Lanka
(Sri Lanka Medical Association, 2019) Liyanaarachchi, N.P.; Mendis, K.M.; Withana, S.S.
INTRODUCTION & OBJECTIVES: There is a paucity of current, reliable published information regarding primary care morbidity in Sri Lanka. Classification and Coding Systems (CCS) can improve the quality of recorded data through electronic Health Information systems (e-HIS). International Classification of Primary Care (ICPC-2) was specifically designed for primary care. A study was conducted to develop an optimized, dynamic, scalable and implementable version of ICPC-2 (ICPC-2-SL) for Sri Lanka. METHODS: A systematized review of literature (SRI.) done to ascertain factors affecting the implementation of CCS. A qualitative study (QS) was conducted (in-depth interviews) to yield perceived factors affecting implementation and to develop a framework. The ICPC-2-SL version 1.0 was developed by an optimization process (OP) using pooling and coding of the reason for encounters, problem definitions and also by amalgamating codes developed by a previous study in Sri Lanka. New set of codes developed for dental primary care encounters. Final code-set was reviewed, agreed upon using nominal panel technique. RESULTS: SRL informed that perceived benefit of data recording, burden, time constraints, training received, and existing knowledge affects the implementation success. The QS resulted the national level CCS implementation framework. The OP resulted in 103 country specific, 4th digit ICPC-2 codes and 37 new codes for dental primary care to develop the version1.0 of the ICPC-2-SL. CONCLUSION: The implementation framework developed can be validated and used to plan, carry out and monitor implementation activities. The ICPC-2-SL version 1.0 could be adopted and scaled-up after a proper demonstration project. The comprehensive set of dental care codes could be a valuable extension to the ICPC-2 in global context.
Why do people travel upto 70km to seek treatment from the Colombo North Teaching Hospital Outpatient Department? A qualitative study
(Sri Lanka Medical Association, 2018) Perera, D.P.; Withana, S.S.; Mendis, K.M.; Kasunjith, D.V.T.; Jayathilaka, W.T.S.; Wickramasuriya, S.W.; Govinthadas, S.; Kalansooriya, R.; Welhenage, C.
INTRODUCTION AND OBJECTIVES: Bypassing nearby primary care facilities to seek treatment from teaching/general hospital OPDs is a known challenge to the equitable distribution of healthcare. A 2017 morbidity study at CNTH OPD showed that 25.3% travelled distances more than lOkm to visit the OPD. Our aim was to understand why patients travel straight line distances more than lOkm to seek healthcare from the CNTH OPD.METHODS: Four trained medical student interviewers conducted individual in-depth interviews with patients attending the CNTH OPD from a distance of more than lOkm. Interviews were conducted in Sinhala/Tamil, recorded, transcribed and translated to English prior to inductive thematic analysis until there was saturation of themes.RESULTS: Participants were 13 female and 10 male patients from 24 to 68 years; from distances of 12km to 69km. Significant driving factors that emerged were a) trust in the quality of care arising from prior satisfactory experience and social perceptions, b) efficient administration and better facilities, c) perceived severity of the illness, d) reluctance to seek treatment from nearby healthcare facilities due to perceived inefficiencies in administration, lack of facilities and poor service delivery, e) ease of access using the train system, f) familiarity with the institution and personal connections with staff members and g) incidental visits to CNTH or Ragama town not related to healthcare.CONCLUSION: Patients appear to make calculated decisions on which healthcare facility to attend based on the desire to receive the best care possible. However, some visits were inappropriate and contributed to unnecessary overcrowding of the OPD.