Perialathan Komathi, Johari Mohammad Zabri, Jaafar Norrafizah, Yuke Lin Kong, Lee Lan Low, Sodri Nur Aliyah, Mohd Yunus Siti Nur Nabilah
Ministry of Health Malaysia, Setia Alam, Selangor, Malaysia.
J Prim Care Community Health. 2021 Jan-Dec;12:21501327211014096. doi: 10.1177/21501327211014096.
This study aimed to assess and explore perceived sustainability and challenges of the intervention among Health Care Providers (HCPs) who were involved.
The study applied mixed-method embedded design to analyze both quantitative and qualitative data. Quantitative approach was used to evaluate sustainability perception from 20 intervention clinics via self-reported assessment form whereas qualitative data were obtained through in-depth interview (IDI) and focus group discussions (FGDs) 14 health care professionals participated in IDI session and were either care coordinators, liaison officers (LOs)/clinic managers, or medical officers-in-charge for the clinic's intervention. Nine FGDs conducted comprised 58 HCPs from various categories.
HCPs from all the 20 clinics involved responded to each listed Enhanced Primary Healthcare (EnPHC) intervention components as being implemented but the perceived sustainability of these implementation varies between them. Quantitative feedback showed sustainable interventions included risk stratification, non-communicable disease (NCD) screening form, referral within clinics and hospitals, family health team (FHT), MTAC services and mechanisms and medical adherence status. Qualitative feedback highlighted implementation of each intervention components comes with its challenges, and most of it are related to inadequate resources and facilities in clinic. HCPs made initiatives to adapt based on clinical setting to implement the interventions at best level possible, whereby this seems to be one of the core values for sustainability.
Overall perceptions among HCPs on sustainability of EnPHC interventions are highly influenced by current experiences with existing resources. Components perceived to have inadequate resources are seen as a challenge to sustain. It's crucial for stakeholders to understand implications affecting implementation process if concerns raised are not addressed and allocation of needed resources to ensure overall successfulness and long term sustainability.
本研究旨在评估和探讨参与其中的医疗服务提供者（HCPs）对该干预措施的可持续性认知及挑战。
本研究采用混合方法嵌入式设计来分析定量和定性数据。定量方法用于通过自我报告评估表评估20家干预诊所的可持续性认知，而定性数据则通过深入访谈（IDI）和焦点小组讨论（FGDs）获得。14名医疗专业人员参加了IDI环节，他们要么是护理协调员、联络官（LOs）/诊所经理，要么是负责诊所干预措施的医疗主任。进行了9次FGDs，共有来自不同类别的58名HCPs参与。
参与的20家诊所的所有HCPs都对列出的每项强化初级医疗保健（EnPHC）干预措施表示正在实施，但这些实施的可持续性认知在他们之间有所不同。定量反馈显示，可持续的干预措施包括风险分层、非传染性疾病（NCD）筛查表、诊所和医院内部的转诊、家庭健康团队（FHT）、MTAC服务及机制以及医疗依从性状况。定性反馈强调，每项干预措施的实施都伴随着挑战，其中大部分与诊所资源和设施不足有关。HCPs主动根据临床环境进行调整，以尽可能最佳的水平实施干预措施，而这似乎是可持续性的核心价值观之一。
HCPs对EnPHC干预措施可持续性的总体认知受到当前现有资源经验的高度影响。被认为资源不足的措施被视为可持续性的挑战。如果所提出的问题得不到解决，利益相关者了解影响实施过程的影响并分配所需资源以确保总体成功和长期可持续性至关重要。
