Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Social Behavioral Team, AMPATH, Moi University, P.O Box 4604-30100, Eldoret, Kenya.
Department of Media Studies, School of Literature, Language and Media, University of Witwatersrand, Johannesburg, South Africa.
BMC Health Serv Res. 2021 May 27;21(1):515. doi: 10.1186/s12913-021-06538-6.
Patient engagement is effective in promoting adherence to HIV care. In an effort to promote patient-centered care, we implemented an enhanced patient care (EPC) intervention that addresses a combination of system-level barriers including provider training, continuity of clinician-patient relationship, enhanced treatment dialogue and better clinic scheduling. We describe the initial implementation of the EPC intervention in a rural HIV clinic in Kenya, and the factors that facilitated its implementation.
The intervention occurred in one of the rural Academic Model Providing Healthcare (AMPATHplus) health facilities in Busia County in the western region of Kenya. Both qualitative and quantitative data were collected through training and meeting proceedings/minutes, a patient tracking tool, treatment dialogue and a peer confirmation tool. Qualitative data were coded and emerging themes on the implementation and adaptation of the intervention were developed. Descriptive analysis including percentages and means were performed on the quantitative data.
Our analysis identified four key factors that facilitated the implementation of this intervention. (1) The smooth integration of the intervention as part of care that was facilitated by provider training, biweekly meetings between the research and clinical team and having an intervention that promotes the health facility agenda. (2) Commitment of stakeholders including providers and patients to the intervention. (3) The adaptability of the intervention to the existing context while still maintaining fidelity to the intervention. (4) Embedding the intervention in a facility with adequate infrastructure to support its implementation.
This analysis demonstrates the value of using mixed methods approaches to study the implementation of an intervention. Our findings emphasize how critical local support, local infrastructure, and effective communication are to adapting a new intervention in a clinical care program.
患者参与对于促进艾滋病护理的依从性是有效的。为了努力促进以患者为中心的护理，我们实施了增强患者护理（EPC）干预措施，以解决包括提供者培训、临床医生与患者关系的连续性、增强治疗对话和更好的诊所预约在内的一系列系统障碍。我们描述了 EPC 干预措施在肯尼亚农村艾滋病诊所的初步实施情况，以及促进其实施的因素。
干预措施发生在肯尼亚西部布西亚县的一个农村学术模式提供医疗保健（AMPAThplus）医疗设施之一。通过培训和会议记录/会议记录、患者跟踪工具、治疗对话和同行确认工具，收集了定性和定量数据。对定性数据进行编码，并针对干预措施的实施和适应情况开发了新的主题。对定量数据进行描述性分析，包括百分比和平均值。
我们的分析确定了促进该干预措施实施的四个关键因素。（1）干预措施作为护理的一部分得到顺利整合，这得益于提供者培训、研究和临床团队之间的两周一次会议以及促进卫生设施议程的干预措施。（2）利益相关者，包括提供者和患者，对干预措施的承诺。（3）干预措施对现有环境的适应性，同时仍然保持对干预措施的保真度。（4）将干预措施嵌入具有足够基础设施的设施中，以支持其实施。
这项分析表明，使用混合方法来研究干预措施的实施具有重要价值。我们的研究结果强调了当地支持、当地基础设施和有效沟通对于在临床护理项目中适应新干预措施的重要性。
