Division of Health Systems and Public Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Western Cape Government: Health, Cape Town, South Africa.
PLoS One. 2019 Sep 18;14(9):e0222421. doi: 10.1371/journal.pone.0222421. eCollection 2019.
Ensuring effective clinical management and continuity of TB care across hospital and primary health-care services remains challenging in South Africa. The high burden of TB, coupled with numerous health system problems, influence the TB care delivered by hospital staff.
To understand factors from the perspectives of hospital staff that influence the clinical management and discharge of TB patients, and to elicit recommendations to improve continuity of care for TB patients.
Participatory action research was used to engage hospital staff working with TB patients admitted to a central public hospital in the Western Cape province, South Africa. Data were collected through eight focus group discussions with nurses, junior doctors and ward administrators. Data analysis was done using Miles and Huberman's framework to identify emerging patterns and to develop categories with themes and sub-themes. The participants influenced all phases of the research process to inform better practices in TB clinical management and discharge planning at the hospital.
The emerging themes and sub-themes were categorized into two overall sections: The clinical care management process and the discharge and referral process. Nurses expressed a fear of exposure to TB and MDR-TB due to challenges in clinical and infection-prevention control. Clinical hierarchies, poor interdisciplinary teamwork, limited task shifting and poor communication interfered with effective clinical and discharge processes. A high workload, staff shortages and inadequate skills resulted in insufficient information and health education for TB patients and their caregivers. Despite awareness of the patients' socio-economic challenges, some aspects of care were not patient-centered, and caregivers were not included in discharge planning. Communication between the hospital and referral points was inefficient and poorly supported by information systems. Hospital staff recommended improved infection prevention and control practices and interdisciplinary teamwork in the hospital, that TB education for patients be integrated with hospital staff functions, with more patient-centered discharge planning, and improved communication across hospitals and primary health care levels.
Interdisciplinary teamwork, more patient-centered care, and better communication within the hospital and with primary health-care services are needed for improved continuity of care for TB patients. Further studies on factors contributing to, and interventions to improve, continuity of TB care in similar hospital settings are needed.
在南非，确保医院和基层医疗服务之间有效的临床管理和结核病护理的连续性仍然具有挑战性。结核病负担沉重，加上众多卫生系统问题，影响了医院工作人员提供的结核病护理。
了解影响医院工作人员对结核病患者进行临床管理和出院的因素，并提出建议以改善结核病患者的护理连续性。
采用参与式行动研究方法，让在西开普省一家中央公立医院工作的结核病患者的医院工作人员参与其中。通过与护士、初级医生和病房管理员进行的八次焦点小组讨论收集数据。使用 Miles 和 Huberman 的框架进行数据分析，以确定新兴模式，并制定包含主题和子主题的类别。参与者影响了研究过程的所有阶段，以便为医院的结核病临床管理和出院计划提供更好的实践。
新兴的主题和子主题分为两个总体部分：临床护理管理过程和出院和转诊过程。护士表示由于临床和感染预防控制方面的挑战，他们担心接触结核病和耐多药结核病。临床等级制度、不良的跨学科团队合作、有限的任务转移和沟通不畅干扰了有效的临床和出院过程。高工作量、人员短缺和技能不足导致结核病患者及其照顾者的信息和健康教育不足。尽管意识到患者的社会经济挑战，但护理的某些方面不是以患者为中心的，并且没有让照顾者参与出院计划。医院与转诊点之间的沟通效率低下，信息系统支持不足。医院工作人员建议改善医院内的感染预防和控制措施以及跨学科团队合作，将结核病教育与医院工作人员的职能相结合，以更加以患者为中心的方式进行出院计划，并改善医院和基层医疗保健水平之间的沟通。
需要在医院内部和与基层医疗保健服务之间进行跨学科团队合作、更多以患者为中心的护理以及更好的沟通，以改善结核病患者的护理连续性。需要进一步研究导致连续性差的因素以及在类似医院环境中改善结核病护理连续性的干预措施。
