Chakraborty S, D'Souza S A, Northrup R S
The World Bank, Washington DC, USA, Kurji Holy Family Hospital, Bihar, India.
Health Policy Plan. 2000 Dec;15(4):400-7. doi: 10.1093/heapol/15.4.400.
Private practitioners are a major source of care for childhood illnesses in developing countries, but the care they provide is often of poor quality. This study tested the effectiveness of two new methods for improving the quality of private practitioner care of sick children: the verbal case review (VCR) and INFECTOM. The VCR is a method for evaluating private providers' quality of care based on mothers' reports and INFECTOM is a package of interventions for improving private providers' quality of care. The study was conducted in 110 villages of Bihar State, India, by three local non-governmental organizations (NGOs). First, the VCR was used for interviews with mothers of approximately 600 children sick with diarrhoea, ARI or fever in the past 2 weeks. The VCR identified practitioners consulted for the treatment of the sick children and recorded providers' case management practices as reported by the mothers. Based on the results of the VCR, the INFECTOM intervention was carried out. This consisted of INformation sessions for the providers regarding standard case management guidelines for ARI, diarrhoea and fever, FEedback to providers on their performance based on the results of the VCR, ConTracting with practitioners to gain their commitment to practice specific guidelines, and Ongoing Monitoring of practitioners' practices with feedback of the results to the practitioners and the community. Seven months after the interventions were initiated, another cross-sectional VCR survey of approximately 300 sick children was carried out to evaluate the impact of the activities on practitioners' case management practices. The results of the study show statistically significant improvements in private practitioners' history taking, examination and counselling practices for ARI, diarrhoea and fever. It was concluded that the VCR and INFECTOM were feasible for implementation by community-based NGOs, and were effective in improving the technical quality of care provided by private health practitioners in rural India.
在发展中国家，个体开业医生是儿童疾病护理的主要提供者，但他们提供的护理质量往往很差。本研究测试了两种提高个体开业医生对患病儿童护理质量的新方法的有效性：口头病例审查（VCR）和INFECTOM。VCR是一种基于母亲报告评估个体医疗服务提供者护理质量的方法，而INFECTOM是一套用于提高个体医疗服务提供者护理质量的干预措施。该研究由三个当地非政府组织在印度比哈尔邦的110个村庄进行。首先，VCR被用于采访过去两周内患有腹泻、急性呼吸道感染（ARI）或发烧的约600名儿童的母亲。VCR确定了为患病儿童治疗而咨询的医生，并记录了母亲报告的医疗服务提供者的病例管理做法。根据VCR的结果，实施了INFECTOM干预。这包括为医疗服务提供者举办关于ARI、腹泻和发烧的标准病例管理指南的信息会议，根据VCR的结果向医疗服务提供者反馈其表现，与医生签订合同以使其承诺遵循特定指南，并持续监测医生的做法并将结果反馈给医生和社区。干预措施启动七个月后，又对约300名患病儿童进行了一次横断面VCR调查，以评估这些活动对医生病例管理做法的影响。研究结果显示，个体开业医生在ARI、腹泻和发烧的病史采集、检查和咨询做法方面有统计学上的显著改善。得出的结论是，VCR和INFECTOM对于社区非政府组织实施是可行的，并且在提高印度农村个体开业医生提供的护理技术质量方面是有效的。
