Lu Ning, Zhao Li, Du Qing, Liu Yakun, Oprescu Florin I, Morcuende Jose A
Department of Orthopaedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA.
Iowa Orthop J. 2010;30:1-6.
In 2005, a nationwide clubfoot treatment program focused on the Ponseti method -an effective, affordable and minimally-invasive method- was initiated in China. The purpose of this study was to evaluate and identify barriers to the program. A qualitative study (rapid ethnographic study) was conducted using semi-structured interviews of 44 physicians who attended four of the 10 Ponseti training workshops, focus groups with parents of children with clubfoot, and observation. Several barriers to the Ponseti method are quite unique due to China's size, socio-economics, culture, politics, and healthcare systems. The barriers were classified into seven themes: (i) physician education, (ii) caregiver compliance, (iii) culture, (iv) public awareness, (v) poverty, (vi) financial constraints for physicians/hospitals, and (vii) challenges of the treatment process. A number of suggestions that could be helpful in reducing or eliminating the effects of these barriers were also identified: (i) pamphlets explaining clubfoot and treatment for caregivers, (ii) directories of Ponseti providers, (iii) funding/financial support, and (iv) improving public awareness. The information from this study provides healthcare planners with knowledge to assist in meeting the needs of the population and continued implementation of effective and culturally appropriate awareness and treatment programs for clubfoot throughout China.
2005年，中国启动了一项全国性的马蹄内翻足治疗项目，该项目聚焦于潘塞缇方法——一种有效、经济且微创的方法。本研究的目的是评估并找出该项目存在的障碍。通过对参加10期潘塞缇培训工作坊中4期的44名医生进行半结构化访谈、与马蹄内翻足患儿家长进行焦点小组讨论以及观察，开展了一项定性研究（快速人种志研究）。由于中国的规模、社会经济、文化、政治及医疗体系等因素，潘塞缇方法面临的一些障碍颇为独特。这些障碍被归为七个主题：（i）医生教育；（ii）照料者依从性；（iii）文化；（iv）公众意识；（v）贫困；（vi）医生/医院的资金限制；（vii）治疗过程中的挑战。还确定了一些有助于减少或消除这些障碍影响的建议：（i）为照料者提供解释马蹄内翻足及治疗方法的宣传册；（ii）潘塞缇治疗机构名录；（iii）资金/财政支持；（iv）提高公众意识。本研究所得信息为医疗规划者提供了知识，以协助满足民众需求，并在中国持续实施针对马蹄内翻足的有效且符合文化背景的宣传及治疗项目。
