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赞比亚针对基层医疗服务提供者的儿科癫痫培训项目的开发与评估

Development and Evaluation of a Pediatric Epilepsy Training Program for First Level Providers in Zambia.

作者信息

Patel Archana A, Ciccone Ornella, Nkole Kafula Lisa, Kalyelye Prisca, Sham Lauren, Kielian Agnieszka, Berger Tamar, Huff Hanalise V, Johnson Hannah F, Sulu Mercy, Mathews Manoj, Mazumdar Maitreyi

机构信息

Boston Children's Hospital, Department of Neurology, Harvard Medical School, Boston, MA, USA.

University of Zambia, School of Medicine, Department of Paediatrics and Child Health, Lusaka, Zambia.

出版信息

Glob Pediatr Health. 2020 Nov 2;7:2333794X20968718. doi: 10.1177/2333794X20968718. eCollection 2020.

Abstract

. The developing world continues to face challenges in closing the large treatment gap for epilepsy, due to a high burden of disease and few experienced providers to manage the condition. Children with epilepsy are susceptible to higher rates of developmental impairments and refractory disease due to delays or absence of appropriate management as a result. We demonstrated that a structured education intervention on pediatric epilepsy can improve knowledge, confidence, and impact clinical practice of first level providers in Zambia. . Three first-level facilities across Zambia were included. After initial pilot versions and revisions, the final course was implemented at each site. Pre- and post-intervention knowledge and confidence assessments were performed. Additionally, chart reviews were conducted prior to intervention and 4 months after completion of training at each site to assess change on management. . Twenty-three of the original 24 participants from all 3 sites completed the training; 48% clinical officers, 43% nurses, 9% other expertise. Of the 15 concepts tested by knowledge assessment, 12 showed trends in improvement, 7 of which were significant ( < .05). Chart reviews demonstrated significant improvement in documentation of seizure description ( = .008), seizure frequency ( = .00), and possible causes of seizures/epilepsy ( = .034). . Key elements of success to this program included hands on clinical skills building and case-based teaching, development of a program with direct and ongoing input from the target audience, and inclusion of assessments to monitor impact on clinical practice. Future studies looking at health outcomes are necessary to determine sustained impact.

摘要

发展中世界在缩小癫痫治疗差距方面仍面临挑战,这是由于疾病负担沉重且缺乏经验丰富的医疗人员来管理该病症。癫痫患儿由于未能及时获得或根本没有得到适当治疗,更容易出现发育障碍和难治性疾病。我们证明,针对小儿癫痫的结构化教育干预可以提高赞比亚基层医疗人员的知识水平、增强信心并影响其临床实践。

赞比亚的三家基层医疗机构参与了此项研究。经过初步试点版本和修订后,最终课程在每个地点实施。在干预前后分别进行了知识和信心评估。此外,在每个地点干预前和培训完成后4个月进行病历审查,以评估管理方面的变化。

来自所有三个地点的24名原始参与者中有23人完成了培训;其中48%为临床干事,43%为护士,9%为其他专业人员。在通过知识评估测试的15个概念中,12个显示出改善趋势,其中7个具有统计学意义(<0.05)。病历审查表明,在癫痫发作描述(=0.008)、癫痫发作频率(=0.00)以及癫痫发作/癫痫的可能病因(=0.034)的记录方面有显著改善。

该项目成功的关键要素包括实践临床技能培养和基于案例的教学、在目标受众的直接和持续参与下制定项目,以及纳入评估以监测对临床实践的影响。未来有必要开展关于健康结果的研究,以确定持续影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f333/7649896/e91752b12025/10.1177_2333794X20968718-fig1.jpg

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