赞比亚农村地区非医师临床医生提供手术服务的贡献：一项随机对照试验。
The contribution of non-physician clinicians to the provision of surgery in rural Zambia-a randomised controlled trial.
机构信息
Institute of Global Surgery, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland.
Department of Surgery, Surgical Society of Zambia, University Teaching Hospital, P.O. Box, 50110, Lusaka, Zambia.
出版信息
Hum Resour Health. 2019 Jul 22;17(1):60. doi: 10.1186/s12960-019-0398-9.
BACKGROUND
The global shortage of surgeons disproportionately impacts low- and middle-income countries. To mitigate this, Zambia introduced a 'task-shifting' solution and started to train non-physician clinicians (NPCs) called medical licentiates (ML) to perform surgery. The aim of this randomised controlled trial was to assess their contribution to the delivery of surgical care in rural hospitals in Zambia.
METHODS
Sixteen hospitals were randomly assigned to intervention and control arms of the study. Nine MLs were deployed to eight intervention sites. Crude numbers of selected major surgical procedures between intervention and control sites were compared before and after the intervention. Volume and outcomes of surgery were compared within intervention hospitals, between NPCs and surgically active medical doctors (MDs).
RESULTS
There was a significant increase in the numbers of caesarean sections (CS) in the intervention hospitals (+ 15.2%) and a drop by almost half in the control group (- 47%) (P = 0.015), between the two time periods. There were marginal shifts in the numbers of index procedures: a small drop in the intervention group (- 4.9%) and slight increase in the control arm (+ 4.8%) (P = 0.505). In all pairs, MLs had higher mean number of CS and other major surgical cases done in the intervention period compared with MDs. There was no significant difference in postoperative wound infection rates for CS (P = 0.884) and other major surgical cases (P = 0.33) at intervention hospitals between MLs and MDs.
CONCLUSION
This study provided evidence that the ML training programme in Zambia is an effective and safe way to bridge the gap in rural hospitals between the demand and the limited availability of surgically trained workforce in the country. Such evidence is greatly needed as more developing countries are developing national surgical plans.
TRIAL REGISTRATION
ISRCTN66099597 Registered: 07/01/2014.
背景
全球范围内外科医生短缺的问题严重影响了中低收入国家。为了解决这个问题，赞比亚引入了一种“任务转移”解决方案，并开始培训非医师临床医生（NPC），即医学执照持有者（ML），让他们来进行手术。本随机对照试验的目的是评估他们在赞比亚农村医院提供外科护理方面的贡献。
方法
16 家医院被随机分配到研究的干预组和对照组。9 名 ML 被部署到 8 个干预点。干预前后，比较干预和对照组选定的主要手术数量。在干预医院内，比较 NPC 和有手术经验的医生（MD）之间的手术量和结果。
结果
干预医院的剖宫产数量显著增加（+15.2%），对照组下降近一半（-47%）（P=0.015），两个时间段之间存在明显的变化。主要手术数量略有转移：干预组略有下降（-4.9%），对照组略有上升（+4.8%）（P=0.505）。在所有组合中，ML 在干预期内完成的剖宫产和其他主要手术数量均高于 MD。干预医院 ML 和 MD 的剖宫产和其他主要手术术后伤口感染率无显著差异（CS：P=0.884；其他主要手术：P=0.33）。
结论
本研究提供了证据表明，赞比亚的 ML 培训计划是一种有效和安全的方法，可以弥合该国农村医院在外科培训劳动力需求与有限供应之间的差距。随着越来越多的发展中国家制定国家外科计划，这种证据非常需要。
试验注册
ISRCTN66099597 注册：2014 年 7 月 1 日。
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