一项旨在为埃塞俄比亚提格雷地区肺结核诊断决策支持工具的开发提供信息的定性研究。
A qualitative study to inform the development of a decision support tool for the diagnosis of pulmonary tuberculosis in Tigray, Ethiopia.
机构信息
School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
Department of Internal Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
出版信息
BMC Med Inform Decis Mak. 2024 Nov 14;24(1):338. doi: 10.1186/s12911-024-02765-z.
BACKGROUND
Tuberculosis (TB) is Ethiopia's leading infectious killer disease. The war in the Tigray region of Ethiopia has resulted in the disruption of TB care services. Prediction models are recommended to aid the diagnosis of TB in resource-limited settings. However, the development of such decision-support tools without the participation of end users may not be successful. To inform the tool development, we described barriers to diagnosing TB and identified applicable and desirable parameters for the proposed tool.
METHODS
We conducted a qualitative study between February and June 2023 in two cities in Tigray, Northern Ethiopia. We conducted 12 in-depth interviews and four focus group discussions with healthcare workers (HCWs). Interviews were translated, coded, and analyzed to identify predefined and emergent themes during the thematic analysis.
RESULTS
Healthcare workers used symptoms, risk factors, signs, and investigations to diagnose TB. However, failure to ask about antibiotic use, the absence and non-affordability of investigations, and patient load were barriers affecting the diagnosis of TB. Most of the classic TB symptoms and their duration were sorted as very important, simple, reliable, generalizable, and desirable indices. In addition, a trial of antibiotics, being chronically sick-looking, having HIV, having a contact history with a TB patient, and an erythrocyte sedimentation rate fulfilled the above criteria.
CONCLUSIONS
In the TB diagnostic process, HCWs account for a variety of data, but they prefer the classic symptoms of TB to heighten their clinical suspicion. Antibiotic trials and some risk factors were also considered reasonable. However, when HCWs have a heavy workload and a shortage of investigations, they experience a suboptimal TB diagnostic process. Hence, appropriate context consideration and care providers' preferences for parameters will inform tool development.
背景
结核病（TB）是埃塞俄比亚主要的传染性致死疾病。埃塞俄比亚提格雷地区的战争导致结核病护理服务中断。预测模型被推荐用于帮助资源有限的环境中诊断结核病。然而，如果没有最终用户的参与来开发这些决策支持工具，可能不会成功。为了为工具开发提供信息，我们描述了诊断结核病的障碍，并确定了拟议工具的适用和理想参数。
方法
我们于 2023 年 2 月至 6 月在埃塞俄比亚北部提格雷的两个城市进行了一项定性研究。我们对医护人员（HCWs）进行了 12 次深入访谈和 4 次焦点小组讨论。访谈经过翻译、编码和分析，以在主题分析中识别预设和新兴主题。
结果
医护人员使用症状、危险因素、体征和检查来诊断结核病。然而，未能询问抗生素使用情况、缺乏和负担不起的检查以及患者数量过多是影响结核病诊断的障碍。大多数经典的结核病症状及其持续时间被归类为非常重要、简单、可靠、可推广和理想的指标。此外，抗生素试验、长期看起来病态、患有艾滋病病毒、与结核病患者有接触史以及红细胞沉降率符合上述标准。
结论
在结核病诊断过程中，HCWs 考虑了各种数据，但他们更倾向于使用结核病的经典症状来提高临床怀疑度。抗生素试验和一些危险因素也被认为是合理的。然而，当 HCWs 工作量大且缺乏检查时，他们的结核病诊断过程就会不理想。因此，适当的背景考虑和护理人员对参数的偏好将为工具开发提供信息。
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