评估印度提供初级卫生保健的中级提供者的能力：恰蒂斯加尔邦的基于临床病例的研究。
Assessing competence of mid-level providers delivering primary health care in India: a clinical vignette-based study in Chhattisgarh state.
机构信息
State Health Resource Centre, Chhattisgarh, Raipur, India.
WHO, South East Asia Regional Office, New Delhi, India.
出版信息
Hum Resour Health. 2022 May 12;20(1):41. doi: 10.1186/s12960-022-00737-w.
BACKGROUND
The global commitment to primary health care (PHC) has been reconfirmed in the declaration of Astana, 2018. India has also seen an upswing in national commitment to implement PHC. Health and wellness centres (HWCs) have been introduced, one at every 5000 population, with the fundamental purpose of bringing a comprehensive range of primary care services closer to where people live. The key addition in each HWC is of a mid-level healthcare provider (MLHP). Nurses were provided a 6-month training to play this role as community health officers (CHOs). But no assessments are available of the clinical competence of this newly inducted cadre for delivering primary care. The current study was aimed at providing an assessment of competence of CHOs in the Indian state of Chhattisgarh.
METHODS
The assessment involved a comparison of CHOs with rural medical assistants (RMAs) and medical officers (MO), the two main existing clinical cadres providing primary care in Chhattisgarh. Standardized clinical vignettes were used to measure knowledge and clinical reasoning of providers. Ten ailments were included, based on primary care needs in Chhattisgarh. Each part of clinical vignettes was standardized using expert consultations and standard treatment guidelines. Sample size was adequate to detect 15% difference between scores of different cadres and the assessment covered 132 CHOs, 129 RMAs and 50 MOs.
RESULTS
The overall mean scores of CHOs, RMAs and MOs were 50.1%, 63.1% and 68.1%, respectively. They were statistically different (p < 0.05). The adjusted model also confirmed the above pattern. CHOs performed well in clinical management of non-communicable diseases and malaria. CHOs also scored well in clinical knowledge for diagnosis. Around 80% of prescriptions written by CHOs for hypertension and diabetes were found correct.
CONCLUSION
The non-physician MLHP cadre of CHOs deployed in rural facilities under the current PHC initiative in India exhibited the potential to manage ambulatory care for illnesses. Continuous training inputs, treatment protocols and medicines are needed to improve performance of MLHPs. Making comprehensive primary care services available close to people is essential to PHC and well-trained mid-level providers will be crucial for making it a reality in developing countries.
背景
2018 年，《阿斯塔纳宣言》再次确认了全球对初级卫生保健（PHC）的承诺。印度也加强了对实施 PHC 的国家承诺。已经引入了健康和保健中心（HWCs），每个中心服务 5000 人口，其基本目的是将全面的初级保健服务更贴近人们的生活。每个 HWC 的主要新增内容是中级医疗保健提供者（MLHP）。护士接受了为期 6 个月的培训，以作为社区卫生官员（CHOs）来扮演这一角色。但是，目前还没有评估这个新入职人员在提供初级保健方面的临床能力的评估。本研究旨在评估印度恰蒂斯加尔邦的 CHOs 的能力。
方法
评估包括将 CHOs 与农村医疗助理（RMA）和医疗官（MO）进行比较，这是恰蒂斯加尔邦提供初级保健的两个主要现有临床干部。使用标准化临床病例来衡量提供者的知识和临床推理能力。根据恰蒂斯加尔邦的初级保健需求，纳入了十种疾病。使用专家咨询和标准治疗指南对临床病例的各个部分进行了标准化。样本量足以检测不同干部得分之间 15%的差异，评估涵盖了 132 名 CHO、129 名 RMA 和 50 名 MO。
结果
CHO、RMA 和 MO 的总体平均得分为 50.1%、63.1%和 68.1%，分别。他们的得分有统计学差异（p<0.05）。调整后的模型也证实了上述模式。CHO 在非传染性疾病和疟疾的临床管理方面表现良好。CHO 在诊断的临床知识方面也得分很高。约 80%的 CHO 为高血压和糖尿病开具的处方是正确的。
结论
在印度当前的 PHC 倡议下，在农村设施中部署的非医师 MLHP 干部CHO 表现出管理门诊疾病的潜力。需要持续的培训投入、治疗方案和药物，以提高 MLHP 的绩效。使综合初级保健服务更贴近人们是 PHC 的关键，而训练有素的中级提供者将是发展中国家实现这一目标的关键。
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