Iribarren Sarah J, Rubinstein Fernando, Discacciati Vilda, Pearce Patricia F
School of Nursing, Columbia University, 630 West 168 Street, New York, NY 10032, USA ; Institute for Clinical Effectiveness and Healthcare Policy, Dr. Emilio Ravignani 2024, C1414CPT Buenos Aires, Argentina.
Institute for Clinical Effectiveness and Healthcare Policy, Dr. Emilio Ravignani 2024, C1414CPT Buenos Aires, Argentina.
Tuberc Res Treat. 2014;2014:135823. doi: 10.1155/2014/135823. Epub 2014 Sep 28.
Purpose. In Argentina, tuberculosis (TB) control measures have not achieved key treatment targets. The purpose of this study was to identify modes of treatment delivery and explore patient and healthcare personnel perceptions of barriers and facilitators to treatment success. Methods. We used semistructured group and individual interviews for this descriptive qualitative study. Eight high burden municipalities were purposively selected. Patients in treatment for active TB (n = 16), multidisciplinary TB team members (n = 26), and TB program directors (n = 12) at local, municipal, regional, and national levels were interviewed. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. Results. Modes of treatment delivery varied across municipalities and types of healthcare facility and were highly negotiated with patients. Self-administration of treatment was common in hospital-based and some community clinics. Barriers to TB treatment success were concentrated at the system level. This level relied heavily on individual personal commitment, and many system facilitators were operating in isolation or in limited settings. Conclusions. We outline experiences and perspectives of the facilitating and challenging factors at the individual, structural, social, and organizational levels. Establishing strong patient-healthcare personnel relationships, responding to patient needs, capitalizing on community resources, and maximizing established decentralized system could mitigate some of the barriers.
目的。在阿根廷，结核病控制措施尚未实现关键治疗目标。本研究的目的是确定治疗提供模式，并探讨患者及医护人员对治疗成功的障碍和促进因素的看法。方法。我们采用半结构化小组访谈和个人访谈进行这项描述性定性研究。有目的地选择了八个高负担城市。对正在接受活动性结核病治疗的患者（n = 16）、多学科结核病团队成员（n = 26）以及地方、市、区域和国家层面的结核病项目主任（n = 12）进行了访谈。访谈进行了录音，逐字转录，并采用主题分析法进行分析。结果。治疗提供模式因城市和医疗机构类型而异，并且与患者进行了大量协商。在医院和一些社区诊所，自我给药很常见。结核病治疗成功的障碍集中在系统层面。这一层面严重依赖个人的个人承诺，许多系统促进因素在孤立或有限的环境中运作。结论。我们概述了个人、结构、社会和组织层面的促进因素和挑战因素的经验及观点。建立牢固的患者与医护人员关系、回应患者需求、利用社区资源以及最大限度地发挥既定的分散系统的作用，可以减轻一些障碍。
