危地马拉最大公立肾病中心的肾脏护理提供面临的挑战：一项针对卫生专业人员的定性研究。
Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals.
机构信息
National Clinicians Scholars Program, Division of Hospital Medicine, University of Michigan, Ann Arbor, MI, USA.
Wuqu' Kawoq | Maya Health Alliance, Tecpán, Guatemala.
出版信息
BMC Nephrol. 2020 Feb 28;21(1):71. doi: 10.1186/s12882-020-01732-w.
BACKGROUND
Chronic kidney disease (CKD) is increasing worldwide, and the majority of the CKD burden is in low- and middle-income countries (LMICs). However, there is wide variability in global access to kidney care therapies such as dialysis and kidney transplantation. The challenges health professionals experience while providing kidney care in LMICs have not been well described. The goal of this study is to elicit health professionals' perceptions of providing kidney care in a resource-constrained environment, strategies for dealing with resource limitations, and suggestions for improving kidney care in Guatemala.
METHODS
Semi-structured interviews were performed with 21 health professionals recruited through convenience sampling at the largest public nephrology center in Guatemala. Health professionals included administrators, physicians, nurses, technicians, nutritionists, psychologists, laboratory personnel, and social workers. Interviews were recorded and transcribed in Spanish. Qualitative data from interviews were analyzed in NVivo using an inductive approach, allowing dominant themes to emerge from interview transcriptions.
RESULTS
Health professionals most frequently described challenges in providing high-quality care due to resource limitations. Reducing the frequency of hemodialysis, encouraging patients to opt for peritoneal dialysis rather than hemodialysis, and allocating resources based on clinical acuity were common strategies for reconciling high demand and limited resources. Providers experienced significant emotional challenges related to high patient volume and difficult decisions on resource allocation, leading to burnout and moral distress. To improve care, respondents suggested increased budgets for equipment and personnel, investments in preventative services, and decentralization of services.
CONCLUSIONS
Health professionals at the largest public nephrology center in Guatemala described multiple strategies to meet the rising demand for renal replacement therapy. Due to systems-level limitations, health professionals faced difficult choices on the stewardship of resources that are linked to sentiments of burnout and moral distress. This study offers important lessons in Guatemala and other countries seeking to build capacity to scale-up kidney care.
背景
慢性肾脏病（CKD）在全球范围内呈上升趋势，而大部分 CKD 负担都在中低收入国家（LMICs）。然而，全球获得透析和肾移植等肾脏治疗的机会存在很大差异。卫生专业人员在中低收入国家提供肾脏护理时所面临的挑战尚未得到很好的描述。本研究旨在了解卫生专业人员在资源有限的环境中提供肾脏护理的看法、处理资源限制的策略以及改善危地马拉肾脏护理的建议。
方法
通过便利抽样，在危地马拉最大的公立肾病中心招募了 21 名卫生专业人员进行半结构化访谈。卫生专业人员包括管理人员、医生、护士、技术人员、营养师、心理学家、实验室人员和社会工作者。访谈以西班牙语记录和转录。使用 NVivo 中的归纳方法对访谈的定性数据进行分析，允许从访谈记录中出现主要主题。
结果
卫生专业人员最常描述的是由于资源限制而难以提供高质量护理的挑战。减少血液透析的频率、鼓励患者选择腹膜透析而不是血液透析，以及根据临床严重程度分配资源是协调高需求和有限资源的常见策略。提供者在处理高患者量和资源分配方面面临着重大的情绪挑战，导致倦怠和道德困境。为了改善护理，受访者建议增加设备和人员预算、投资预防服务以及服务的去中心化。
结论
危地马拉最大的公立肾病中心的卫生专业人员描述了多种策略来满足对肾脏替代治疗不断增长的需求。由于系统层面的限制，卫生专业人员在资源管理方面面临着艰难的选择，这与倦怠和道德困境的情绪有关。这项研究为危地马拉和其他寻求建立能力以扩大肾脏护理规模的国家提供了重要的经验教训。
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