Rowe S Y, Olewe M A, Kleinbaum D G, McGowan J E, McFarland D A, Rochat R, Deming M S
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Trop Med Int Health. 2007 May;12(5):651-63. doi: 10.1111/j.1365-3156.2007.01824.x.
To investigate community health workers' (CHW) adherence over time to guidelines for treating ill children and to assess the effect of refresher training on adherence.
Analysis of 7151 ill-child consultations performed by 114 CHWs in their communities from March 1997-May 2002. Adherence was assessed with a score (percentage of recommended treatments that were prescribed), calculated for each consultation. Recommended treatments were those that were indicated based on CHW assessments. We used piecewise regression models to evaluate adherence before and after training.
The average adherence score was 79.4%. Multivariable analyses indicate that immediately after the first refresher training, the mean adherence level improved for patients with a severe illness, but worsened for patients without severe illness. Adherence scores declined rapidly during the 6 months after the second refresher training.
The first refresher was partially effective, the second refresher had an effect contrary to that intended, and patient characteristics had a strong influence on adherence patterns. Longitudinal studies are useful for monitoring the dynamics of CHW performance and evaluating effects of quality improvement interventions.
调查社区卫生工作者（CHW）随时间推移对治疗患病儿童指南的依从性，并评估进修培训对依从性的影响。
对1997年3月至2002年5月期间114名社区卫生工作者在其社区进行的7151例患病儿童会诊进行分析。通过为每次会诊计算的得分（所开处方的推荐治疗方法的百分比）来评估依从性。推荐的治疗方法是根据社区卫生工作者的评估确定的那些方法。我们使用分段回归模型来评估培训前后的依从性。
平均依从性得分为79.4%。多变量分析表明，在第一次进修培训后立即，重症患者的平均依从性水平有所提高，但非重症患者的依从性水平则有所下降。在第二次进修培训后的6个月内，依从性得分迅速下降。
第一次进修培训部分有效，第二次进修培训产生了与预期相反的效果，患者特征对依从性模式有很大影响。纵向研究有助于监测社区卫生工作者绩效的动态变化并评估质量改进干预措施的效果。
