Malik Asmat U, Willis Cameron D, Hamid Saima, Ulikpan Anar, Hill Peter S
Integrated Health Services, House 1-B, Street 50, Sector F-8/4, Islamabad, Pakistan.
Health Res Policy Syst. 2014 Aug 26;12:43. doi: 10.1186/1478-4505-12-43.
Using measles and tuberculosis as case examples, with a systems thinking approach, this study examines the human advice-seeking behavior of primary health care (PHC) physicians in a rural district of Pakistan. This study analyzes the degree to which the existing PHC system supports their access to human advice, and explores in what ways this system might be strengthened to better meet provider needs.
The study was conducted in a rural district of Pakistan and, with a cross-sectional study design, it employed a range of research methods, namely extensive document review for mapping existing information systems, social network analysis of physicians' advice-seeking practice, and key stakeholder interviews for an in-depth understanding of the experience of physicians. Illustrations were prepared for information flow mechanism, sociographs were generated for analyzing social networks, and content analysis of qualitative findings was carried out for in-depth interpretation of underlying meanings.
The findings of this study reveal that non-availability of competent supervisory staff, a focus on improving performance indicators rather than clinical guidance, and a lack of a functional referral system have collectively created an environment in which PHC physicians have developed their own strategies to overcome these constraints. They are well aware of the human expertise available within and outside the district. However, their advice-seeking behavior was dependent upon existence of informal social interaction with the senior specialists. Despite the limitations of the system, the physicians proactively used their professional linkages to seek advice and also to refer patients to the referral center based on their experience and the facilities that they trusted.
The absence of functional referral systems, limited effective linkages between PHC and higher levels of care, and a focus on programmatic targets rather than clinical care have each contributed to the isolation of physicians and reactive information seeking behavior. The study findings underscore the need for a functional information system comprising context sensitive knowledge management and translation opportunities for physicians working in PHC centers. Such an information system needs to link people and resources in ways that transcend geography and discipline, and that builds on existing expertise, interpersonal relationships, and trust.
本研究以麻疹和结核病为例，采用系统思维方法，考察了巴基斯坦一个农村地区初级卫生保健（PHC）医生的寻求建议行为。本研究分析了现有的初级卫生保健系统在多大程度上支持他们获取人力建议，并探讨了如何加强该系统以更好地满足提供者的需求。
该研究在巴基斯坦的一个农村地区进行，采用横断面研究设计，运用了一系列研究方法，即通过广泛的文献回顾来绘制现有信息系统，对医生的寻求建议行为进行社会网络分析，以及对关键利益相关者进行访谈以深入了解医生的经历。绘制了信息流机制图，生成了社会关系图以分析社会网络，并对定性研究结果进行了内容分析以深入解读潜在含义。
本研究结果表明，缺乏称职的监督人员、注重绩效指标而非临床指导以及缺乏有效的转诊系统，共同营造了一种环境，使得初级卫生保健医生制定了自己的策略来克服这些限制。他们清楚地知道该地区内外可用的专业知识。然而，他们的寻求建议行为依赖于与资深专家的非正式社会互动。尽管系统存在局限性，但医生们积极利用他们的专业联系来寻求建议，并根据自己的经验和信任的设施将患者转诊至转诊中心。
缺乏有效的转诊系统、初级卫生保健与更高层次医疗之间有限的有效联系以及注重项目目标而非临床护理，都导致了医生的孤立和被动的信息寻求行为。研究结果强调需要一个功能性信息系统，为在初级卫生保健中心工作的医生提供情境敏感的知识管理和转化机会。这样一个信息系统需要以超越地理和学科的方式连接人员和资源，并建立在现有专业知识、人际关系和信任的基础上。
