Pascual Julianne Keane M, Loreche Arianna Maever, De Mesa Regine Ynez H, Fabian Noleen Marie C, Sanchez Josephine T, Panganiban Janelle Micaela S, Rey Mia P, Tan-Lim Carol Stephanie C, Javelosa Mark Anthony U, Paterno Ramon Pedro P, Casile Ray U, Dans Leonila F, Dans Antonio L
Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
National Clinical Trials and Translation Center, National Institutes of Health, University of the Philippines Manila, Manila, Philippines.
Acta Med Philipp. 2025 Jan 15;59(1):66-72. doi: 10.47895/amp.vi0.8869. eCollection 2025.
Primary care providers are key players in providing quality care to patients and advancing Universal Health Care (UHC). However, effective and quality healthcare delivery may be affected by inadequate knowledge and failure to adhere to evidence-based guidelines among providers. The Philippine Primary Care Studies (PPCS) is a five-year program that pilot tested interventions aimed at strengthening the primary care system in the country. Evidence-based training modules for healthcare providers were administered in Sorsogon and Bataan from the years 2018 to 2021. Module topics were selected based on common health conditions encountered by providers in rural and remote settings. This program aimed to evaluate the effectiveness of training in increasing provider knowledge.
A series of training workshops were conducted among 184 remote- and 210 rural-based primary care providers [nurses, midwives, barangay or village health workers (BHWs)]. They covered four modules: essential intrapartum and newborn care (EINC), integrated management of childhood illness (IMCI), non-communicable diseases (NCD), and geriatrics. A decision support system (UpToDate) was provided as a supplementary resource for all participants. We administered pre-tests and post-tests consisting of multiple-choice questions on common health conditions. Data was analyzed using paired one-tailed t-test, with an alpha of 0.05.
The knowledge of nurses, midwives, and BHWs improved after the training workshops were conducted. The largest increase from pre-test to post-test scores were observed among the midwives, with a mean difference (MD) of 32.9% (95% CI 23.9 to 41.9) on the EINC module, MD of 25.0% (95% CI 16.6 to 33.4) in the geriatrics module, and MD of 13.5% (95% CI 6.9 to 20.1) in the NCDs module. The nurses had the greatest improvement in the IMCI module (MD 10.8%, 95% CI 2.5 to 19.1). The knowledge of BHWs improved in all participated modules, with greatest improvement in the NCD module (MD 9.0%, 95% CI 5.77 to 12.14).
Primary care workshops, even if conducted as single-sessions and on a short-term basis, are effective in improving short-term knowledge of providers. However, this may not translate to long-term knowledge and application in practice. Furthermore, comparisons across provider categories cannot be made as participant composition for each training workshop varied. Ultimately, this study shows enhancing provider knowledge and competence in primary care will therefore require regular and diverse learning interventions and access to clinical decision support tools.
基层医疗服务提供者是为患者提供优质医疗服务以及推进全民健康覆盖（UHC）的关键角色。然而，有效的高质量医疗服务提供可能会受到提供者知识不足以及未能遵循循证指南的影响。菲律宾基层医疗研究（PPCS）是一个为期五年的项目，对旨在加强该国基层医疗系统的干预措施进行了试点测试。2018年至2021年期间，在索索贡和巴丹为医疗服务提供者实施了循证培训模块。模块主题是根据农村和偏远地区提供者遇到的常见健康状况选定的。该项目旨在评估培训在增加提供者知识方面的有效性。
对184名偏远地区和210名农村基层医疗服务提供者（护士、助产士、 barangay或乡村卫生工作者（BHWs））举办了一系列培训研讨会。这些研讨会涵盖四个模块：基本产时和新生儿护理（EINC）、儿童疾病综合管理（IMCI）、非传染性疾病（NCD）和老年医学。为所有参与者提供了一个决策支持系统（UpToDate）作为补充资源。我们进行了由关于常见健康状况的多项选择题组成的预测试和后测试。使用配对单尾t检验对数据进行分析，α值为0.05。
培训研讨会举办后，护士、助产士和BHWs的知识水平有所提高。从预测试到后测试分数增加幅度最大的是助产士，在EINC模块中平均差异（MD）为32.9%（95%CI 23.9至41.9），在老年医学模块中MD为25.0%（95%CI 16.6至33.4），在非传染性疾病模块中MD为13.5%（95%CI 6.9至20.1）。护士在IMCI模块中提高最大（MD 10.8%，95%CI 2.5至19.1）。BHWs在所有参与模块中的知识都有所提高，在非传染性疾病模块中提高最大（MD 9.0%，95%CI 5.77至12.14）。
基层医疗研讨会，即使是单场且短期举办的，在提高提供者的短期知识方面也是有效的。然而，这可能不会转化为长期知识以及在实践中的应用。此外，由于每个培训研讨会的参与者构成不同，无法对不同类别的提供者进行比较。最终，本研究表明，因此提高基层医疗提供者 的知识和能力将需要定期且多样的学习干预措施以及获得临床决策支持工具。
