Bazant Eva, Sarkar Supriya, Banda Joseph, Kanjipite Webby, Reinhardt Stephanie, Shasulwe Hildah, Mulilo Joyce Monica Chongo, Kim Young Mi
Jhpiego/Johns Hopkins University, 1615 Thames Street, Baltimore, MD 21231, USA.
Hum Resour Health. 2014 Dec 20;12:73. doi: 10.1186/1478-4491-12-73.
Human resource shortages and reforms in HIV-related care make it challenging for frontline health care providers in southern Africa to deliver high-quality services. At health facilities of the Zambian Defence Forces, a performance and quality improvement approach was implemented to improve HIV-related care and was evaluated in 2010/2011. Changes in providers' work environment and perceived quality of HIV-related care were assessed to complement data of provider performance.
The intervention involved on-site training, supportive supervision, and action planning focusing on detailed service delivery standards. The quasi-experimental evaluation collected pre- and post-intervention data from eight intervention and comparison facilities matched on defence force branch and baseline client volume. Overall, 101 providers responded to a 24-item questionnaire on the work environment, covering topics of drugs, supplies, and equipment; training, feedback, and supervision; compensation; staffing; safety; fulfilment; and HIV services quality. In bivariate analysis and multivariate analyses, we assessed changes within each study group and between the two groups.
In the bivariate analysis, the intervention group providers reported improvements in the work environment on adequacy of equipment, feeling safe from harm, confidence in clinical skills, and reduced isolation, while the comparison group reported worsening of the work environment on supplies, training, safety, and departmental morale.In the multivariate analysis, the intervention group's improvement and the comparison group's decline were significant on perceived adequacy of drugs, supplies, and equipment; constructive feedback received from supervisor and co-workers; and feeling safe from physical harm (all P <0.01, except P <0.04 for equipment). Further, the item "provider lacks confidence in some clinical skills" declined in the intervention group but increased in the comparison group (P = -0.005). In multivariate analysis, changes in perceived quality of HIV care did not differ between study groups. Provider perceptions were congruent with observations of preparing drugs, supplies, equipment, and in service delivery of prevention of mother-to-child transmission of HIV and antiretroviral therapy follow-up care.
The performance and quality improvement intervention implemented at Zambian Defence Forces' health facilities was associated with improvements in providers' perceptions of work environment consistent with the intervention's focus on commodities, skills acquisition, and receipt of constructive feedback.
人力资源短缺以及艾滋病相关护理方面的改革，使得南部非洲的一线医疗服务提供者难以提供高质量的服务。在赞比亚国防军的医疗机构中，实施了一项绩效与质量改进措施以改善艾滋病相关护理，并于2010/2011年进行了评估。对提供者的工作环境变化以及对艾滋病相关护理的感知质量进行了评估，以补充提供者绩效数据。
干预措施包括现场培训、支持性监督以及围绕详细服务提供标准的行动计划。准实验评估从八个干预设施和对照设施收集了干预前后的数据，这些设施在国防军分支和基线客户数量方面进行了匹配。总体而言，101名提供者对一份关于工作环境的24项问卷做出了回应，问卷涵盖药物、用品和设备；培训、反馈和监督；薪酬；人员配备；安全；成就感；以及艾滋病服务质量等主题。在双变量分析和多变量分析中，我们评估了每个研究组内部以及两组之间的变化。
在双变量分析中，干预组的提供者报告在设备充足性、免受伤害的安全感、临床技能信心以及减少孤立感方面工作环境有所改善，而对照组报告在用品、培训、安全和部门士气方面工作环境恶化。在多变量分析中，干预组的改善以及对照组的下降在药物、用品和设备的感知充足性；从上级和同事那里得到的建设性反馈；以及免受身体伤害的安全感方面均具有显著性（所有P<0.01，设备方面P<0.04除外）。此外，“提供者对某些临床技能缺乏信心”这一项目在干预组中下降，但在对照组中上升（P = -0.005）。在多变量分析中，研究组之间在艾滋病护理感知质量方面的变化没有差异。提供者的看法与药物、用品、设备准备以及艾滋病母婴传播预防和抗逆转录病毒治疗后续护理服务提供的观察结果一致。
赞比亚国防军医疗机构实施的绩效与质量改进干预措施与提供者对工作环境的看法改善相关，这与干预措施对物资、技能获取和建设性反馈的关注一致。
