Aujla Navneet, Chen Yen-Fu, Samarakoon Yasara, Wilson Anna, Grolmusová Natalia, Ayorinde Abimbola, Hofer Timothy P, Griffiths Frances, Brown Celia, Gill Paramjit, Mallen Christian, Sartori Jo, Lilford Richard J
W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
Department of Medicine, UM Institute for Health Policy and Innovation, Building 16 3rd Floor, North Campus Research Centre, University of Michigan Medical School, Ann Arbor, MI 48109-2800 USA.
Health Policy Plan. 2021 Apr 21;36(3):341-356. doi: 10.1093/heapol/czaa152.
Clinical records in primary healthcare settings in low- and middle-income countries (LMIC) are often lacking or of too poor quality to accurately assess what happens during the patient consultation. We examined the most common methods for assessing healthcare workers' clinical behaviour: direct observation, standardized patients and patient/healthcare worker exit interview. The comparative feasibility, acceptability, reliability, validity and practicalities of using these methods in this setting are unclear. We systematically review and synthesize the evidence to compare and contrast the advantages and disadvantages of each method. We include studies in LMICs where methods have been directly compared and systematic and narrative reviews of each method. We searched several electronic databases and focused on real-life (not educational) primary healthcare encounters. The most recent update to the search for direct comparison studies was November 2019. We updated the search for systematic and narrative reviews on the standardized patient method in March 2020 and expanded it to all methods. Search strategies combined indexed terms and keywords. We searched reference lists of eligible articles and sourced additional references from relevant review articles. Titles and abstracts were independently screened by two reviewers and discrepancies resolved through discussion. Data were iteratively coded according to pre-defined categories and synthesized. We included 12 direct comparison studies and eight systematic and narrative reviews. We found that no method was clearly superior to the others-each has pros and cons and may assess different aspects of quality of care provision by healthcare workers. All methods require careful preparation, though the exact domain of quality assessed and ethics and selection and training of personnel are nuanced and the methods were subject to different biases. The differential strengths suggest that individual methods should be used strategically based on the research question or in combination for comprehensive global assessments of quality.
低收入和中等收入国家（LMIC）基层医疗环境中的临床记录往往缺失或质量太差，无法准确评估患者就诊期间发生的情况。我们研究了评估医护人员临床行为的最常见方法：直接观察、标准化患者以及患者/医护人员离职访谈。在这种环境下使用这些方法的相对可行性、可接受性、可靠性、有效性和实用性尚不清楚。我们系统地回顾并综合证据，以比较和对比每种方法的优缺点。我们纳入了在低收入和中等收入国家中直接比较这些方法的研究，以及对每种方法的系统评价和叙述性综述。我们检索了几个电子数据库，并专注于现实生活（而非教育性）的基层医疗接触。对直接比较研究的检索最近更新至2019年11月。我们于2020年3月更新了对标准化患者方法的系统评价和叙述性综述的检索，并将其扩展至所有方法。检索策略结合了索引词和关键词。我们检索了符合条件文章的参考文献列表，并从相关综述文章中获取了额外的参考文献。两名评审员独立筛选标题和摘要，通过讨论解决分歧。数据根据预定义类别进行迭代编码并综合。我们纳入了12项直接比较研究以及8项系统评价和叙述性综述。我们发现没有一种方法明显优于其他方法——每种方法都有优缺点，可能评估医护人员提供的护理质量的不同方面。所有方法都需要仔细准备，尽管所评估的质量的确切领域以及伦理、人员的选择和培训都很细微，而且这些方法存在不同的偏差。不同方法的优势表明，应根据研究问题有策略地使用个别方法，或结合使用以对质量进行全面的全球评估。
