Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda and Boston, USA.
BMC Health Serv Res. 2013 Dec 17;13:518. doi: 10.1186/1472-6963-13-518.
As resource-limited health systems evolve to address complex diseases, attention must be returned to basic primary care delivery. Limited data exists detailing the quality of general adult and adolescent primary care delivered at front-line facilities in these regions. Here we describe the baseline quality of care for adults and adolescents in rural Rwanda.
Patients aged 13 and older presenting to eight rural health center outpatient departments in one district in southeastern Rwanda between February and March 2011 were included. Routine nurse-delivered care was observed by clinical mentors trained in the WHO Integrated Management of Adolescent & Adult Illness (IMAI) protocol using standardized checklists, and compared to decisions made by the clinical mentor as the gold standard.
Four hundred and seventy consultations were observed. Of these, only 1.5% were screened and triaged for emergency conditions. Fewer than 10% of patients were routinely screened for chronic conditions including HIV, tuberculosis, anemia or malnutrition. Nurses correctly diagnosed 50.1% of patient complaints (95% CI: 45.7%-54.5%) and determined the correct treatment 44.9% of the time (95% CI: 40.6%-49.3%). Correct diagnosis and treatment varied significantly across health centers (p = 0.03 and p = 0.04, respectively).
Fundamental gaps exist in adult and adolescent primary care delivery in Rwanda, including triage, screening, diagnosis, and treatment, with significant variability across conditions and facilities. Research and innovation toward improving and standardizing primary care delivery in sub-Saharan Africa is required. IMAI, supported by routine mentorship, is one potentially important approach to establishing the standards necessary for high-quality care.
随着资源有限的卫生系统发展以应对复杂疾病，必须重新关注基本的初级保健服务。在这些地区的一线医疗机构中，关于一般成人和青少年初级保健服务质量的数据有限。本文描述了卢旺达农村地区成年人和青少年的初级保健服务质量基线。
2011 年 2 月至 3 月期间，我们纳入了在卢旺达东南部一个区的 8 个农村卫生中心门诊部门就诊的年龄在 13 岁及以上的患者。经过世卫组织综合管理青少年和成人疾病（IMAI）方案培训的临床导师使用标准化检查表观察常规护士提供的护理，并将其与临床导师作为金标准所做的决策进行比较。
共观察了 470 次就诊。其中，只有 1.5%的患者接受了紧急情况筛查和分诊。不到 10%的患者常规筛查慢性疾病，包括艾滋病毒、结核病、贫血或营养不良。护士正确诊断了 50.1%的患者的症状（95%置信区间：45.7%-54.5%），正确治疗的比例为 44.9%（95%置信区间：40.6%-49.3%）。不同卫生中心的正确诊断和治疗比例差异显著（p=0.03 和 p=0.04）。
卢旺达成人和青少年初级保健服务在分诊、筛查、诊断和治疗方面存在根本差距，不同条件和医疗机构之间存在显著差异。需要研究和创新来改善和规范撒哈拉以南非洲的初级保健服务。IMAI 得到常规指导的支持，是建立高质量护理所需标准的一种潜在重要方法。
