McDowell Andrew, Engel Nora, Daftary Amrita
Department of Anthropology, Tulane University, New Orleans, USA.
CERMES3, Institute National de la Santé et la Recherché Médicale, Paris, France.
J Clin Tuberc Other Mycobact Dis. 2019 Aug;16:100111. doi: 10.1016/j.jctube.2019.100111.
This paper outlines insights qualitative research brings to the study of quality of care. It advocates understanding care as sequential, interpersonal action aimed at improving health and documenting the networks in which care occurs. It assesses the strengths and weakness of contemporary quantitative and qualitative approaches to examining quality of care for tuberculosis (TB) before outlining three qualitative research programs aimed at understanding quality of TB in India. Three case studies focus on the diagnosis level in the cascade of TB care and use qualitative research to examine the clinical use of pharmaceuticals as diagnostics, the development of diagnostic tests, and the role of care providers in the utilization of diagnostic services. They show that 1) care must be understood as part of relationships over time, 2) the presence or absence of technologies does not always imply their expected use in care, 3) physicians' provision of care is often inflected by their perceptions of patient desires, and 4) effective care is not always perfectly aligned with global health priorities. Qualitative methods with a networked perspective on care provide novel findings that can and have been used when developing quality of care improvement interventions for TB.
本文概述了定性研究为医疗质量研究带来的见解。它主张将医疗理解为旨在改善健康状况的连续性人际行动，并记录医疗发生的网络。在概述旨在了解印度结核病医疗质量的三个定性研究项目之前，评估了当代定量和定性方法在检查结核病（TB）医疗质量方面的优缺点。三个案例研究聚焦于结核病医疗流程中的诊断环节，运用定性研究来考察药品作为诊断手段的临床应用、诊断测试的开发以及医护人员在诊断服务利用中的作用。这些研究表明：1）医疗必须被理解为长期关系的一部分；2）技术的有无并不总是意味着它们在医疗中的预期使用；3）医生提供医疗服务往往受其对患者需求认知的影响；4）有效的医疗并不总是与全球卫生重点完全契合。从医疗网络角度出发的定性方法提供了新颖的研究发现，这些发现能够且已经在为结核病医疗质量改善干预措施的制定中得到应用。
