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乌干达西南部姆巴拉拉地区高血压和糖尿病老年患者肾病筛查的障碍与促进因素:医疗服务提供者的视角

Barriers and Facilitators to Screening for Kidney Disease Among Older Adults with Hypertension and Diabetes in Mbarara Southwestern Uganda: Healthcare Providers' Perspective.

作者信息

Owokuhaisa Judith, Abaasa Catherine N, Muhindo Rose, Musinguzi Pius, Rukundo Godfrey Zari

机构信息

Faculty of Medicine, Department of Physiotherapy, Mbarara University of Science and Technology, Mbarara, Uganda.

Faculty of Medicine, Department of Medical Laboratory Sciences, Mbarara University of Science and Technology, Mbarara, Uganda.

出版信息

J Multidiscip Healthc. 2024 Feb 29;17:855-865. doi: 10.2147/JMDH.S451533. eCollection 2024.


DOI:10.2147/JMDH.S451533
PMID:38476253
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10928919/
Abstract

BACKGROUND: Screening for kidney disease (KD) among high-risk patients (patients with hypertension or diabetes) allows early diagnosis, intervention and delayed progression of the disease. In low- and middle-income countries (LMIC), KD screening is still sub-optimal. This study explored the healthcare providers' perceived barriers and facilitators to KD screening among older adults with hypertension and diabetes in Mbarara southwestern Uganda. METHODS: This was a descriptive qualitative study among healthcare providers caring for older adults with diabetes mellitus and hypertension at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. In-depth interviews were conducted using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed to develop themes of barriers and facilitators. RESULTS: We conducted 30 in-depth interviews among healthcare providers. Barriers to screening for kidney disease included patient related factors according to healthcare providers (financial hardships, poor health seeking behavior, limited knowledge and awareness), healthcare factors (work overload, ineffective patient healthcare provider communication) and system/policy related factors (lack of laboratory supplies, lack of guidelines and poor medical record keeping and documentation). With respect to facilitators, we found formation of peer support groups, effective team, and continuous medical education (CME). CONCLUSION: Healthcare providers encounter substantial but modifiable barriers in screening older adults for KD. The identification of barriers and facilitators in timely KD detection gives us an outlook of the problem in Uganda and leads for proposals of action. Interventions that address these barriers and promote facilitators may improve the healthcare provider's effectiveness and capacity to care including screening for patients at risk of KD.

摘要

背景:在高危患者(高血压或糖尿病患者)中筛查肾脏疾病(KD)可实现疾病的早期诊断、干预并延缓疾病进展。在低收入和中等收入国家(LMIC),KD筛查仍未达到最佳状态。本研究探讨了乌干达西南部姆巴拉拉地区高血压和糖尿病老年患者的医疗服务提供者对KD筛查所感知到的障碍和促进因素。 方法:这是一项针对乌干达西南部姆巴拉拉地区转诊医院(MRRH)照顾糖尿病和高血压老年患者的医疗服务提供者的描述性定性研究。使用半结构化访谈指南进行深入访谈。访谈进行了录音,逐字转录,并进行主题分析以确定障碍和促进因素的主题。 结果:我们对医疗服务提供者进行了30次深入访谈。医疗服务提供者认为,KD筛查的障碍包括患者相关因素(经济困难、不良的就医行为、知识和意识有限)、医疗因素(工作负担过重、患者与医疗服务提供者之间的沟通无效)以及系统/政策相关因素(实验室用品短缺、缺乏指南以及病历记录和文档管理不善)。关于促进因素,我们发现了同伴支持小组的形成、有效的团队以及持续医学教育(CME)。 结论:医疗服务提供者在为老年人筛查KD时遇到了重大但可改变的障碍。及时发现KD的障碍和促进因素,使我们对乌干达的这一问题有了认识,并为行动建议提供了方向。解决这些障碍并促进促进因素的干预措施可能会提高医疗服务提供者的护理效果和能力,包括对KD高危患者的筛查。

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本文引用的文献

[1]
Screening for Kidney Disease in Low- and Middle-Income Countries.

Semin Nephrol. 2022-9

[2]
Healthcare provider perspectives on integrating peer support in non-dialysis-dependent chronic kidney disease care: a mixed methods study.

BMC Nephrol. 2022-4-18

[3]
Knowledge of physicians regarding the management of Type two Diabetes in a primary care setting: the impact of online continuous medical education.

BMC Med Educ. 2020-10-20

[4]
Perceived barriers and facilitators to chronic kidney disease care among patients in Singapore: a qualitative study.

BMJ Open. 2020-10-16

[5]
Understanding kidney disease in rural central Uganda - Findings from a qualitative study.

Glob Public Health. 2020-10

[6]
Barriers and Facilitators in Timely Detection of Chronic Kidney Disease: Evidences for Decision-Makers.

Arch Med Res. 2020-4-23

[7]
Detailed Review of Chronic Kidney Disease.

Kidney Dis (Basel). 2020-3

[8]
The impact of a quality improvement continuing medical education intervention on physicians' vaccination practice: a controlled study.

Hum Vaccin Immunother. 2020-11-1

[9]
Rural-urban health-seeking behaviours for non-communicable diseases in Sierra Leone.

BMJ Glob Health. 2020

[10]
The epidemiology of chronic kidney disease (CKD) in rural East Africa: A population-based study.

PLoS One. 2020-3-4

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