Feasibility and acceptability of mobile phone-based triage tool to identify discharged trauma patients in need of further care in Cameroon

Shannon Richardson; Rasheedat Oke; Mbiarikai A Mbianyor; Melissa Carvalho; Florentine Yakue; Frank Essomba; Golda E Mbuh; Alain Chichom-Mefire; Catherine Juillard; Sabrinah Ariane Christie

doi:10.1136/tsaco-2023-001157

Feasibility and acceptability of mobile phone-based triage tool to identify discharged trauma patients in need of further care in Cameroon

Trauma Surg Acute Care Open. 2023 Nov 20;8(1):e001157. doi: 10.1136/tsaco-2023-001157. eCollection 2023.

Affiliations

¹ David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
² Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California, USA.
³ Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon.

Abstract

Background: Lack of routine follow-up for trauma patients after hospital discharge likely contributes to high rates of injury-related complications in Cameroon. Mobile phone contact may facilitate timely follow-up and reduce disability for high-risk patients. A previous single-center study showed promising feasibility of mobile health (mHealth) triage, but generalizability remains unknown. We evaluated the feasibility and acceptability of implementing a postdischarge mHealth triage tool at four hospitals in Cameroon.

Methods: Trauma patients from four Cameroonian hospitals were contacted at 2 weeks, 1, 3, and 6 months postdischarge. Program feasibility was assessed by calculating the proportion of successful contacts and overall cost. Odds of successful contact were compared using generalized estimating equations across patient socioeconomic status. Acceptability was assessed using a structured patient survey at 2 weeks and 6 months postdischarge.

Results: Of 3896 trauma patients, 59% were successfully contacted at 2 weeks postdischarge. Of these, 87% (1370/1587), 86% (1139/1330), and 90% (967/1069) were successfully reached at the 1-month, 3-month, and 6-month timepoints, respectively. The median cost per patient contact was US$3.17 (IQR 2.29-4.29). Higher socioeconomic status was independently associated with successful contact; rural poor patients were the least likely to be reached (adjusted OR 0.11; 95% CI 0.04 to 0.35). Almost all surveyed patients reported phone-based triage to be an acceptable follow-up method.

Conclusion: Telephone contact is a feasible and acceptable means to triage postdischarge trauma patients in Cameroon. While scaling an mHealth follow-up program has considerable potential to decrease injury morbidity in this setting, further research is needed to optimize inclusion of socioeconomically marginalized groups.

Level of evidence: Level III, prospective observational study.

Keywords: Africa; global surgery; public health; wounds and injuries.

Grants and funding

R21 TW010956/TW/FIC NIH HHS/United States