Sadeghi-Bazargani Homayoun, Amir-Behghadami Mehrdad, Gholizadeh Masoumeh, Janati Ali, Rahmani Farzad
Student Research Committee (SRC), Tabriz University of Medical Sciences, Tabriz, Iran.
Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
BMC Health Serv Res. 2020 Dec 7;20(1):1129. doi: 10.1186/s12913-020-05981-1.
Management of Life-threatening Emergency (LTE) patients in urban and rural areas is an important challenge, which can affect pre-hospital mortality rate. Therefore, Non-hospital Health Center (NHHC) must be prepared to manage such emergency cases that may occur in the geographic area where these centers act. The aim of this study was to explore domains related to the preparedness of NHHCs to manage LTE patients through resorting to healthcare providers' and experts' perspectives.
A qualitative exploratory study was applied using Semi-Structured Interviews (SSIs) and Focus Group Discussions (FGDs). Prior to beginning data collection, the study and its objectives were explained to the participants and their informed consents were obtained. Then, SSIs and FGDs were conducted by two trained researchers using an interview guide, which was developed through literature review and consulting experts. In total, 12 SSIs were done with the providers at different NHHCs in Tabriz. In addition, 2 FGDs were conducted with the specialists in Emergency Medicine (EM) and Primary Health Care (PHC), and the executives of health centers, with over 5 years of work experience, and Emergency Medical Services (EMS) experts. Purposive sampling method was used in this study. All SSIs and FGDs were audio recorded and subsequently transcribed. Framework Analysis was employed to manually analyze the interview transcripts from all the SSIs and FGDs.
The interview transcripts analysis resulted in the emergence of 3 themes and 11 sub-themes, categorized according to Donabedian's triple model. 5 sub-themes were related to input, including medical equipment and supplies, environmental infrastructures of the centers, emergency medicines, human resource, and protocols, guidelines and policies. 4 sub-themes were related to process, including providing clinical services, medicine storage capacity, maintenance of equipment, and management process. Finally, 2 sub-themes were related to outcome, which were patients' satisfaction with the quality of care and improved survival of LTE patients.
The results of this study can provide a new perspective for health managers and policy makers on how to evaluate the preparedness of NHHCs in managing LTE patients. In addition, it will be used to develop instruments to measure the preparedness of these centers.
城乡地区危及生命的紧急情况（LTE）患者的管理是一项重大挑战，这可能会影响院前死亡率。因此，非医院健康中心（NHHC）必须做好准备，以处理这些中心所在地理区域可能发生的此类紧急情况。本研究的目的是通过听取医疗服务提供者和专家的意见，探索与NHHC处理LTE患者的准备情况相关的领域。
采用定性探索性研究，使用半结构化访谈（SSI）和焦点小组讨论（FGD）。在开始数据收集之前，向参与者解释了研究及其目标，并获得了他们的知情同意。然后，由两名经过培训的研究人员使用通过文献综述和咨询专家制定的访谈指南进行SSI和FGD。总共对大不里士不同NHHC的提供者进行了12次SSI。此外，还与急诊医学（EM）和初级卫生保健（PHC）专家、有超过5年工作经验的健康中心管理人员以及紧急医疗服务（EMS）专家进行了2次FGD。本研究采用目的抽样法。所有SSI和FGD都进行了录音，随后进行了转录。采用框架分析法对所有SSI和FGD的访谈记录进行人工分析。
访谈记录分析产生了3个主题和11个子主题，根据唐纳贝迪安的三重模型进行分类。5个子主题与投入相关，包括医疗设备和用品、中心的环境基础设施、急救药品、人力资源以及规程、指南和政策。4个子主题与过程相关，包括提供临床服务、药品储存能力、设备维护和管理过程。最后，2个子主题与结果相关，即患者对护理质量的满意度和LTE患者生存率的提高。
本研究结果可为卫生管理人员和政策制定者提供一个新的视角，以评估NHHC在管理LTE患者方面的准备情况。此外，它将用于开发衡量这些中心准备情况的工具。
