Pulford Justin, Saweri Olga P M, Jeffery Caroline, Siba Peter M, Mueller Ivo, Hetzel Manuel W
International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
BMJ Glob Health. 2018 Nov 16;3(6):e000915. doi: 10.1136/bmjgh-2018-000915. eCollection 2018.
The presumptive treatment of febrile illness with antimalarial medication is becoming less common in low-income and middle-income countries as access to reliable diagnostic tests improves. We explore whether the shift towards test-based antimalarial prescription, and the introduction of highly efficacious artemisinin combination therapies (ACTs), reduces critical delays in seeking treatment for febrile illness or increases patient satisfaction.
We conducted countrywide repeat, cross-sectional surveys in 118 randomly selected primary healthcare services in Papua New Guinea. The clinical case management of 1765 consecutively presenting febrile patients was observed and exit interviews were completed at discharge. This was done prior to implementation of test-based ACT prescription (2011) and at 12 (2012) and 60 months (2016) postimplementation. We conducted multiple logistic regressions. Treatment response time was dichotomised as <24 hours from symptom onset vs 24+ hours. Satisfaction was dichotomised as a 'high' vs 'low' rating based on participant response to a visual, 7-point Likert-type scale.
62% (322/517) of febrile patients reported seeking treatment within 24 hours of symptom onset in 2011 compared with 53% (230/434) in 2012 and 42% (339/814) in 2016. Adjusted ORs for reporting a treatment response time <24 hours in the postimplementation surveys were 0.77 (95% CI 0.48 to 1.26) and 0.45 (95% CI 0.31 to 0.65), respectively when compared with the preimplementation period. 53% (230/533) of febrile patients reported 'high' satisfaction with the service received in 2011 compared with 32% (143/449) in 2012 and 35% (278/803) in 2016. Adjusted ORs for reporting high satisfaction in the postimplementation surveys were 0.52 (95% CI 0.32 to 0.85) and 0.65 (95% CI 0.39 to 1.10), respectively when compared with the preimplementation period.
Nationwide implementation of test-based ACT prescription in Papua New Guinea has increased the likelihood of critical treatment seeking delays and decreased patient satisfaction with the service received.
随着低收入和中等收入国家获得可靠诊断检测的机会增加，使用抗疟药物对发热疾病进行推定治疗的情况越来越少见。我们探讨了向基于检测的抗疟药物处方的转变以及引入高效青蒿素联合疗法（ACTs）是否减少了发热疾病寻求治疗的严重延误或提高了患者满意度。
我们在巴布亚新几内亚随机选择的118个初级医疗服务机构中进行了全国范围的重复横断面调查。观察了1765名连续前来就诊的发热患者的临床病例管理情况，并在出院时完成了出院访谈。这是在基于检测的ACT处方实施前（2011年）以及实施后12个月（2012年）和60个月（2016年）进行的。我们进行了多项逻辑回归分析。治疗反应时间被分为症状出现后<24小时和24小时及以上。根据参与者对视觉7点李克特量表的回答，满意度被分为“高”和“低”评分。
2011年，62%（322/517）的发热患者报告在症状出现后24小时内寻求治疗，2012年为53%（230/434），2016年为42%（339/814）。与实施前相比，实施后调查中报告治疗反应时间<24小时的调整后比值比分别为0.77（95%置信区间0.48至1.26）和0.45（95%置信区间0.31至0.65）。2011年，53%（230/533）的发热患者报告对所接受的服务“高度”满意，2012年为32%（143/449），2016年为35%（278/803）。与实施前相比，实施后调查中报告高度满意的调整后比值比分别为0.52（95%置信区间0.32至0.85）和0.65（95%置信区间0.39至1.10）。
在巴布亚新几内亚全国范围内实施基于检测的ACT处方增加了寻求治疗严重延误的可能性，并降低了患者对所接受服务的满意度。
