在薄弱的卫生系统中传播临床实践指南的挑战：以坦桑尼亚的艾滋病毒和婴儿喂养建议为例。
Challenges of disseminating clinical practice guidelines in a weak health system: the case of HIV and infant feeding recommendations in Tanzania.
机构信息
Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020 Bergen, Norway ; National Institute for Medical Research, PO Box 9653, Dar-es-Salaam, Tanzania.
Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, 5020 Bergen, Norway ; Department of Health Studies, University of Stavanger, 4036 Stavanger, Norway.
出版信息
Int Breastfeed J. 2014 Dec 23;9(1):188. doi: 10.1186/s13006-014-0024-3. eCollection 2014.
BACKGROUND
Clinical guidelines aim to improve patient outcomes by providing recommendations on appropriate healthcare for specific clinical conditions. Scientific evidence produced over time leads to change in clinical guidelines, and a serious challenge may emerge in the process of communicating the changes to healthcare practitioners and getting new practices adopted. There is very little information on the major barriers to implementing clinical guidelines in low-income settings. Looking at how continual updates to clinical guidelines within a particular health intervention are communicated may shed light on the processes at work. The aim of this paper is to explore how the content of a series of diverging infant feeding guidelines have been communicated to managers in the Prevention of Mother to Child Transmission of HIV Programme (PMTCT) with the aim of generating knowledge about both barriers and facilitating factors in the dissemination of new and updated knowledge in clinical guidelines in the context of weak healthcare systems.
METHODS
A total of 22 in-depth interviews and two focus group discussions were conducted in 2011. All informants were linked to the PMTCT programme in Tanzania. The informants included managers at regional and district levels and health workers at health facility level.
RESULTS
The informants demonstrated partial and incomplete knowledge about the recommendations. There was lack of scientific reasoning behind various infant feeding recommendations. The greatest challenges to the successful communication of the infant feeding guidelines were related to slowness of communication, inaccessible jargon-ridden English language in the manuals, lack of summaries, lack of supportive supervision to make the guidelines comprehensible, and the absence of a reading culture.
CONCLUSION
The study encountered substantial gaps in knowledge about the diverse HIV and infant feeding policies. These gaps were partly related to the challenges of communicating the clinical guidelines. There is a need for caution in assuming that important changes in guidelines for clinical practice can easily be translated to and implemented in local programme settings, not least in the context of weak healthcare systems.
背景
临床指南旨在通过为特定临床情况提供适当的医疗保健建议来改善患者的治疗效果。随着时间的推移，科学证据会导致临床指南发生变化，而在向医疗保健从业者传达这些变化并使其采用新的实践方法时，可能会出现一个严重的挑战。在资源匮乏的环境中，实施临床指南的主要障碍信息非常有限。研究特定卫生干预措施内的临床指南如何不断更新，可能有助于了解相关工作流程。本文旨在探讨在向预防母婴传播艾滋病毒项目（PMTCT）的管理人员传达一系列不同的婴儿喂养指南内容时，如何生成有关在薄弱医疗体系下传播新的和更新的临床指南知识的障碍和促进因素的相关知识。
方法
2011 年共进行了 22 次深入访谈和 2 次焦点小组讨论。所有参与者都与坦桑尼亚的 PMTCT 项目有关。参与者包括地区和地区一级的管理人员以及卫生机构一级的卫生工作者。
结果
参与者对建议的了解存在部分和不完整的情况。各种婴儿喂养建议缺乏科学依据。成功传达婴儿喂养指南的最大挑战与沟通缓慢、手册中难以理解的专业术语、缺乏摘要、缺乏支持性监督以使指南易于理解以及缺乏阅读文化有关。
结论
本研究发现有关不同艾滋病毒和婴儿喂养政策的知识存在相当大的差距。这些差距部分与传达临床指南的挑战有关。在假设临床实践指南的重要变化可以轻松转化并在当地方案环境中实施时，需要谨慎，尤其是在医疗体系薄弱的情况下。
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