FIND, Geneva, Switzerland.
Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria.
BMC Prim Care. 2024 Oct 11;25(1):362. doi: 10.1186/s12875-024-02604-0.
Access to essential diagnostics is crucial for primary healthcare (PHC) in low-and-middle income countries (LMICs). Many LMICs have invested in equipping PHC with point-of-care (PoC) diagnostics for infectious diseases, however there has been no similar investment to improve PHC capacities for clinical chemistry. The biochemistry gap is among the deterrents to universal health coverage.
A social sciences project was conducted with the aim to understand the key PHC stakeholders' insights on the pertinence of PoC biochemistry for PHC in LMICs. Data generation was conducted between July-November 2023 in Mongolia, Nigeria and Peru. Decision-makers in healthcare delivery, healthcare professionals, and patient and community advocates were engaged using a combination of sampling techniques. Unstructured individual and group conversations, and non-participant observation were conducted. Analysis involved an inductive line-by-line coding on printed transcripts, followed by a deductive coding and theme-by-theme analysis on digitized transcripts.
Fifteen, 51 and 20 informants from Mongolia, Nigeria and Peru, respectively, participated. Fifty-five of the 94 informants were female. Most informants considered that PoC biochemistry in PHC would be pertinent, from a clinical and a resources-saving perspective. Those households that currently bear the burden of referrals (i.e., the poor, the bedridden, the older adults) would benefit the most from the deployment of PoC biochemistry for essential biochemistry parameters. Improved access to PoC glycated hemoglobin (HbA1c), lipid, liver and kidney profile was perceived as helpful to inform clinicians' decision-taking. The value of PoC biochemistry for the management of noncommunicable diseases (diabetes, hypertension) and infectious conditions (dengue, malaria, tuberculosis), to improve child health outcomes (severe dehydration in children with diarrhea and/or malnutrition) and to reduce preventable causes of death (dengue-related renal failure) was highlighted.
PoC biochemistry holds potential to revert the impact that the biochemistry gap has for patient care in some LMICs' PHC settings. PoC equipment for parameters such as HbA1c, urea, creatinine or electrolytes could enhance community-level management of preventable causes of mortality, improve service delivery for patients affected by locally-prevalent infectious conditions, and improve the psychosocial and economic wellbeing of patients facing the burden of referrals to remote biochemistry-equipped centers.
Not applicable.
在中低收入国家（LMICs），获得基本诊断是初级医疗保健（PHC）的关键。许多 LMICs 已经投资为 PHC 配备即时诊断（PoC）用于传染病，但没有类似的投资来提高 PHC 的临床化学能力。生物化学差距是实现全民健康覆盖的障碍之一。
进行了一项社会科学项目，旨在了解 PHC 主要利益相关者对 PoC 生物化学在 LMICs 中用于 PHC 的相关性的看法。数据生成于 2023 年 7 月至 11 月在蒙古、尼日利亚和秘鲁进行。使用混合抽样技术，与医疗保健提供决策者、医疗保健专业人员、患者和社区倡导者进行了接触。进行了非结构化的个人和小组对话以及非参与式观察。分析包括对打印的转录本进行逐行归纳编码，然后对数字化的转录本进行演绎编码和主题分析。
来自蒙古、尼日利亚和秘鲁的 15、51 和 20 名知情者分别参与。94 名知情者中有 55 名是女性。大多数知情者认为，从临床和资源节约的角度来看，PoC 生物化学在 PHC 中是相关的。那些目前承担转诊负担的家庭（即穷人、卧床不起的人、老年人）将从部署用于基本生物化学参数的 PoC 生物化学中受益最多。更好地获得即时糖化血红蛋白（HbA1c）、脂质、肝脏和肾脏检查结果，被认为有助于为临床医生的决策提供信息。即时 PoC 生物化学用于管理非传染性疾病（糖尿病、高血压）和传染病（登革热、疟疾、结核病），改善儿童健康结果（腹泻和/或营养不良儿童严重脱水）以及减少可预防的死亡原因（登革热相关肾衰竭）的价值得到了强调。
即时 PoC 生物化学有可能扭转生物化学差距对一些 LMICs PHC 环境中患者护理的影响。用于 HbA1c、尿素、肌酐或电解质等参数的即时设备可以增强社区一级对可预防死亡率原因的管理，改善受当地流行传染病影响的患者的服务提供，并改善面临转诊到远程配备生物化学设备的中心的负担的患者的心理社会和经济福祉。
不适用。
