Behan Justine, Kabajaasi Olive, Derksen Brooklyn, Sendegye George, Kugumikiriza Brenda, Komugisha Clare, Sundararajan Radhika, Jacob Shevin T, Kenya-Mugisha Nathan, Wiens Matthew O
Institute for Global Health, BC Children's Hospital and BC Women's Hospital + Health Centre, Vancouver, Canada.
Walimu, Kampala, Uganda.
PLoS One. 2024 Oct 2;19(10):e0307089. doi: 10.1371/journal.pone.0307089. eCollection 2024.
Sepsis arises when the body's response to an infection injures its own tissues and organs. Among children hospitalized with suspected sepsis in low-income country settings, mortality rates following discharge are high, similar to mortality rates in hospital. The Smart Discharges Program uses a mobile health (mHealth) platform to identify children at high risk of post-discharge mortality to receive enhanced post-discharge care. This study sought to explore the perceptions and experiences of the caregivers and nurses of children enrolled into the Smart Discharges Program and the program's effect on post-discharge care. We conducted an exploratory qualitative study, which included in-person focus group discussions (FGDs) with 30 caregivers of pediatric patients enrolled in the Smart Discharges Program and individual, semi-structured interviews with eight Smart Discharges Program nurses. The study was carried out at four hospitals in Uganda in 2019. Following thematic analysis, three key themes pertaining to the Smart Discharges program were identified: (1) Facilitators and barriers to follow-up care after discharge; (2) Changed caregiver behavior following discharge; and (3) Increased involvement of male caregivers. Facilitators included telephone/text message reminders, positive nurse-patient relationship, and the complementary aspects of the program. Barriers included resource constraints and negative experiences during post-discharge care seeking. With regards to behavior, when provided with relevant and well-timed information, caregivers reported increased knowledge about post-discharge care and improvements in their ability to care for their child. Enrolment in the Smart Discharges Program also increased male caregiver involvement, increased provision of resources and improved communication within the family and with the healthcare system. The Smart Discharges approach is an impactful strategy to improve pediatric post-discharge care, and similar approaches should be considered to improve the hospital to home transition in similar low-income country settings.
当身体对感染的反应损伤自身组织和器官时，就会发生脓毒症。在低收入国家，因疑似脓毒症住院的儿童出院后的死亡率很高，与住院期间的死亡率相似。智能出院计划使用移动健康（mHealth）平台来识别出院后死亡风险高的儿童，以便他们获得强化的出院后护理。本研究旨在探讨参与智能出院计划的儿童的照顾者和护士的看法与经历，以及该计划对出院后护理的影响。我们进行了一项探索性定性研究，包括与30名参与智能出院计划的儿科患者的照顾者进行面对面焦点小组讨论（FGD），以及与8名智能出院计划护士进行单独的半结构化访谈。该研究于2019年在乌干达的四家医院开展。经过主题分析，确定了与智能出院计划相关的三个关键主题：（1）出院后随访护理的促进因素和障碍；（2）出院后照顾者行为的改变；（3）男性照顾者参与度的提高。促进因素包括电话/短信提醒、良好的护患关系以及该计划的互补性方面。障碍包括资源限制和寻求出院后护理期间的负面经历。在行为方面，当获得相关且及时的信息时，照顾者报告称他们对出院后护理的了解有所增加，照顾孩子的能力也有所提高。参与智能出院计划还增加了男性照顾者的参与度，增加了资源的提供，并改善了家庭内部以及与医疗系统的沟通。智能出院方法是改善儿科出院后护理的一项有效策略，在类似的低收入国家环境中，应考虑采用类似方法来改善从医院到家的过渡。
