Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Putrajaya, Malaysia.
Family Health Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia.
PLoS One. 2021 Jan 11;16(1):e0245125. doi: 10.1371/journal.pone.0245125. eCollection 2021.
In combating the increasing trend of non-communicable diseases (NCDs) over the last two decades in the country, the Ministry of Health Malaysia developed the Enhanced Primary Health Care (EnPHC) initiative to improve care management across different levels of the public service delivery network. An evaluation research component was embedded to explore the implementation issues in terms of fidelity, feasibility, adaptation and benefit of the initiative's components which were triage, care coordination, screening, risk management and referral system.
A mixed methods study was conducted at 20 participating EnPHC clinics in Johor and Selangor, two months after the intervention was initiated. Data collected from self-reported forms and a structured observation checklist were descriptively analysed. In-depth interviews were also conducted with 20 participants across the clinics selected to clarify any information gaps observed in each clinic, and data were thematically analysed.
Evaluation showed that all components of EnPHC intervention had been successfully implemented except for the primary triage counter and visit checklist. The challenges were mainly discovered in terms of human resource and physical structure. Although human resource was a common implementation challenge across all interventions, clinic-specific issues could still be identified. Among the adaptive measures taken were task sharing among staff and workflow modification to match the clinic's capacity. Despite the challenges, early benefits of implementation were highlighted especially in terms of service outcomes.
The evaluation study disclosed issues of human resource and physical infrastructure when a supplementary intervention is implemented. To successfully achieve a scaled-up PHC service delivery model based on comprehensive management of NCDs patient-centred care, the adaptive measures in local clinic context highlight the importance of collaboration between good organisational process and good clinical practice and process.
在过去二十年中，马来西亚卫生部为应对非传染性疾病（NCD）发病率不断上升的趋势，制定了强化初级卫生保健（EnPHC）计划，以改善公共服务提供网络不同层级的护理管理。该计划嵌入了一项评估研究，以探索计划各项内容（分诊、护理协调、筛查、风险管理和转诊系统）的实施问题，包括忠实性、可行性、适应性和效益。
在干预启动两个月后，在柔佛州和雪兰莪州的 20 家参与 EnPHC 诊所进行了一项混合方法研究。从自我报告表和结构化观察清单中收集的数据进行了描述性分析。还对 20 名来自各诊所的参与者进行了深入访谈，以澄清在每个诊所观察到的任何信息差距，并对数据进行了主题分析。
评估表明，除了初级分诊柜台和就诊检查表外，EnPHC 干预的所有内容都已成功实施。挑战主要出现在人力资源和物理结构方面。尽管人力资源是所有干预措施中普遍存在的实施挑战，但仍能在诊所层面发现具体问题。所采取的适应措施包括工作人员之间的任务分担以及工作流程的修改，以适应诊所的能力。尽管存在挑战，但实施的早期效益得到了强调，特别是在服务成果方面。
评估研究揭示了在实施补充干预时人力资源和物理基础设施方面的问题。为了成功实现基于 NCD 患者为中心的全面管理的扩大化初级卫生保健服务提供模式，在当地诊所环境下采取的适应措施突出了良好组织流程和良好临床实践及流程之间合作的重要性。
