Goodyear-Smith Felicity, Bazemore Andrew, Coffman Megan, Fortier Richard D W, Howe Amanda, Kidd Michael, Phillips Robert, Rouleau Katherine, van Weel Chris
Department of General Practice and Primary Health Care, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand.
Robert Graham Center Policy Studies in Family Medicine and Primary Care, Washington, District of Columbia, USA.
BMJ Glob Health. 2019 Aug 16;4(Suppl 8):e001482. doi: 10.1136/bmjgh-2019-001482. eCollection 2019.
Since the Alma-Ata Declaration 40 years ago, primary healthcare (PHC) has made great advances, but there is insufficient research on models of care and outcomes-particularly for low-income and middle-income countries (LMICs). Systematic efforts to identify these gaps and develop evidence-based strategies for improvement in LMICs has been lacking. We report on a global effort to identify and prioritise the knowledge needs of PHC practitioners and researchers in LMICs about PHC organisation.
Three-round modified Delphi using web-based surveys. PHC practitioners and academics and policy-makers from LMICs sampled from global networks. First round (pre-Delphi survey) collated possible research questions to address knowledge gaps about organisation. Responses were independently coded, collapsed and synthesised. Round 2 (Delphi round 1) invited panellists to rate importance of each question. In round 3 (Delphi round 2), panellists ranked questions into final order of importance. Literature review conducted on 36 questions and gap map generated.
Diverse range of practitioners and academics in LMICs from all global regions generated 744 questions for PHC organisation. In round 2, 36 synthesised questions on organisation were rated. In round 3, the top 16 questions were ranked to yield four prioritised questions in each area. Literature reviews confirmed gap in evidence on prioritised questions in LMICs.
In line with the 2018 Astana Declaration, this mixed-methods study has produced a unique list of essential gaps in our knowledge of how best to organise PHC, priority-ordered by LMIC expert informants capable of shaping their mitigation. Research teams in LMIC have developed implementation plans to answer the top four ranked research questions.
自40年前《阿拉木图宣言》发布以来，初级卫生保健（PHC）取得了巨大进展，但对于护理模式和结果的研究不足，尤其是在低收入和中等收入国家（LMICs）。在低收入和中等收入国家，一直缺乏系统地识别这些差距并制定基于证据的改进策略的努力。我们报告了一项全球努力，旨在识别和优先考虑低收入和中等收入国家初级卫生保健从业者和研究人员对初级卫生保健组织的知识需求。
采用基于网络调查的三轮改良德尔菲法。从全球网络中抽取低收入和中等收入国家的初级卫生保健从业者、学者和政策制定者。第一轮（预德尔菲调查）整理了可能的研究问题，以解决有关组织的知识差距。对回答进行独立编码、归纳和综合。第二轮（德尔菲第一轮）邀请小组成员对每个问题的重要性进行评分。在第三轮（德尔菲第二轮）中，小组成员将问题按重要性最终排序。对36个问题进行了文献综述，并生成了差距图。
来自全球所有地区的低收入和中等收入国家的不同类型的从业者和学者提出了744个关于初级卫生保健组织的问题。在第二轮中，对36个关于组织的综合问题进行了评分。在第三轮中，对前16个问题进行了排序，在每个领域产生了四个优先问题。文献综述证实了低收入和中等收入国家在优先问题证据方面存在差距。
根据2018年《阿斯塔纳宣言》，这项混合方法研究得出了一份独特的清单，列出了我们在如何最好地组织初级卫生保健方面的知识中存在的基本差距，并由有能力促成这些差距缓解的低收入和中等收入国家专家信息提供者进行了优先排序。低收入和中等收入国家的研究团队已经制定了实施计划，以回答排名前四的研究问题。
