医疗工作者对低收入国家即时检验的认知——乌干达西南部的一项定性研究
Health care workers' perceptions of point-of-care testing in a low-income country-A qualitative study in Southwestern Uganda.
作者信息
Rasti Reza, Nanjebe Deborah, Karlström Jonas, Muchunguzi Charles, Mwanga-Amumpaire Juliet, Gantelius Jesper, Mårtensson Andreas, Rivas Lourdes, Galban Francesc, Reuterswärd Philippa, Andersson Svahn Helene, Alvesson Helle M, Boum Yap, Alfvén Tobias
机构信息
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden.
出版信息
PLoS One. 2017 Jul 27;12(7):e0182005. doi: 10.1371/journal.pone.0182005. eCollection 2017.
BACKGROUND
Point-of-care (POC) tests have become increasingly available and more widely used in recent years. They have been of particular importance to low-income settings, enabling them with clinical capacities that had previously been limited. POC testing programs hold a great potential for significant improvement in low-income health systems. However, as most POC tests are developed in high-income countries, disengagement between developers and end-users inhibit their full potential. This study explores perceptions of POC test end-users in a low-income setting, aiming to support the development of novel POC tests for low-income countries.
METHODS
A qualitative study was conducted in Mbarara District, Southwestern Uganda, in October 2014. Fifty health care workers were included in seven focus groups, comprising midwives, laboratory technicians, clinical and medical officers, junior and senior nurses, and medical doctors. Discussions were audio-recorded and transcribed verbatim. Transcripts were coded through a data-driven approach for qualitative content analysis.
RESULTS
Nineteen different POC tests were identified as currently being in use. While participants displayed being widely accustomed to and appreciative of the use of POC tests, they also assessed the use and characteristics of current tests as imperfect. An ideal POC test was characterized as being adapted to local conditions, thoughtfully implemented in the specific health system, and capable of improving the care of patients. Tests for specific medical conditions were requested. Opinions differed with regard to the ideal distribution of POC tests in the local health system.
CONCLUSION
POC tests are commonly used and greatly appreciated in this study setting. However, there are dissatisfactions with current POC tests and their use. To maximize benefit, stakeholders need to include end-user perspectives in the development and implementation of POC tests. Insights from this study will influence our ongoing efforts to develop POC tests that will be particularly usable in low-income settings.
背景
近年来，即时检验（POC）已越来越容易获得并得到更广泛的应用。它们对低收入地区尤为重要，使这些地区具备了以前受限的临床能力。POC检测项目在改善低收入卫生系统方面具有巨大潜力。然而，由于大多数POC检测是在高收入国家开发的，开发者与终端用户之间的脱节抑制了其全部潜力。本研究探讨了低收入地区POC检测终端用户的看法，旨在支持为低收入国家开发新型POC检测。
方法
2014年10月在乌干达西南部的姆巴拉拉区进行了一项定性研究。50名医护人员参与了7个焦点小组，包括助产士、实验室技术员、临床和医疗官员、初级和高级护士以及医生。讨论进行了录音并逐字转录。通过数据驱动的方法对转录本进行编码，以进行定性内容分析。
结果
目前正在使用的POC检测有19种不同类型。虽然参与者对POC检测的使用普遍习惯并表示赞赏，但他们也认为当前检测的使用和特性并不完美。理想的POC检测应适应当地条件，在特定卫生系统中得到精心实施，并能够改善患者护理。他们还要求提供针对特定医疗状况的检测。关于POC检测在当地卫生系统中的理想分布，各方意见不一。
结论
在本研究环境中，POC检测被普遍使用且广受赞赏。然而，对当前的POC检测及其使用仍存在不满。为了使利益最大化，利益相关者需要在POC检测的开发和实施中纳入终端用户的观点。本研究的见解将影响我们正在进行的开发特别适用于低收入环境的POC检测的努力。
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