Department of Economics, University of the Western Cape, Bellville 7535, South Africa.
Department of Economics, Stellenbosch University, Stellenbosch 7602, South Africa.
Int J Environ Res Public Health. 2018 Apr 12;15(4):729. doi: 10.3390/ijerph15040729.
This is the first multi-district Standardised Patient (SP) study in South Africa. It measures the quality of TB screening at primary healthcare (PHC) facilities. We hypothesise that TB screening protocols and best practices are poorly adhered to at the PHC level. The SP method allows researchers to observe how healthcare providers identify, test and advise presumptive TB patients, and whether this aligns with clinical protocols and best practice. The study was conducted at PHC facilities in two provinces and 143 interactions at 39 facilities were analysed. Only 43% of interactions resulted in SPs receiving a TB sputum test and being offered an HIV test. TB sputum tests were conducted routinely (84%) while HIV tests were offered less frequently (47%). Nurses frequently neglected to ask SPs whether their household contacts had confirmed TB (54%). Antibiotics were prescribed without taking temperatures in 8% of cases. The importance of returning to the facility to receive TB test results was only explained in 28%. The SP method has highlighted gaps in clinical practice, signalling missed opportunities. Early detection of sub-optimal TB care is instrumental in decreasing TB-related morbidity and mortality. The findings provide the rationale for further quality improvement work in TB management.
这是南非首例多地区标准化患者（SP）研究。它衡量了初级卫生保健（PHC）设施中的结核病筛查质量。我们假设 PHC 层面上的结核病筛查方案和最佳实践没有得到很好的遵守。SP 方法使研究人员能够观察医疗保健提供者如何识别、检测和建议疑似结核病患者，以及这是否符合临床方案和最佳实践。该研究在两个省份的 PHC 设施进行，对 39 个设施的 143 次互动进行了分析。只有 43%的互动导致 SP 接受结核病痰检并接受 HIV 检测。结核病痰检常规进行（84%），而 HIV 检测的提供频率较低（47%）。护士经常忽略询问 SP 是否有家庭接触者确诊结核病（54%）。在 8%的情况下，没有测量体温就开了抗生素。只有 28%的情况下解释了返回医疗机构接收结核病检测结果的重要性。SP 方法突出了临床实践中的差距，表明存在错失的机会。早期发现治疗效果不佳的结核病对于降低结核病相关发病率和死亡率至关重要。这些发现为进一步开展结核病管理质量改进工作提供了依据。
