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津巴布韦卫生工作者中高血压和糖尿病筛查后获得护理的障碍与促进因素:一项混合方法研究

Barriers to and facilitators of linkage to care following hypertension and diabetes screening among health workers in Zimbabwe: A mixed method study.

作者信息

Larsson Leyla, Chingono Rudo M S, Calderwood Claire J, Nzvere Farirai P, Marambire Edson T, Kavenga Fungai, Sibanda Sibusisiwe, Kanengoni Bridget, Redzo Nicol, Simms Victoria, Ndhlovu Chiratidzo E, Mujuru Hilda, Rusakaniko Simbarashe, Ferrand Rashida A, Sabapathy Kalpana, Kranzer Katharina

机构信息

Institute of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich, Munich, Germany.

The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.

出版信息

PLOS Glob Public Health. 2025 Apr 29;5(4):e0004513. doi: 10.1371/journal.pgph.0004513. eCollection 2025.


DOI:10.1371/journal.pgph.0004513
PMID:40300032
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12040240/
Abstract

The benefits of screening for any condition are only realised if individuals who screen positive link to care services. We investigated linkage to hypertension and diabetes care by healthcare workers accessing a comprehensive health check service. We also explored facilitators and barriers to linkage to care. Between July 2020 and June 2022, a health check with referral and follow-up was offered to healthcare workers (clients) in Zimbabwe. We aimed to understand the proportion that linked to care after referral for an elevated blood pressure and/or HbA1c, assessed by follow-up phone calls. Linkage to care was defined as self-report of having seen a health professional within 30-60 days of the positive screening test result. In-depth interviews were conducted with 15 clients to understand associated facilitators and barriers. Overall, 3,143 clients accessed screening services. The majority were women (75.7%), and median age was 37 (IQR: 28-46) years. 785 (25.0%) clients screened positive for hypertension and 279 (8.9%) screened positive for diabetes. Clients referred for diabetes were more likely to accept referral (n=212, 72.0%) than those referred for hypertension (n=323, 41.1%). Among those referred and successfully contacted for follow-up, 131/182 (72.0%) reported having linked to care for diabetes and 218/269 (81.0%) for hypertension. Distance, accessibility, and travel costs to the facility they were referred to, influenced the decision and ability to link to care. While linkage to care for hypertension and diabetes was high among those who accepted referral, many healthcare workers did not accept referral. Greater awareness among healthcare providers regarding the importance of NCD care to improve acceptance of referral is required and every step of the care cascade must be affordable, accessible, and patient-centred.

摘要

只有筛查呈阳性的个体与护理服务建立联系,对任何疾病进行筛查的益处才能得以实现。我们通过医护人员利用综合健康检查服务来调查与高血压和糖尿病护理的联系情况。我们还探讨了与护理建立联系的促进因素和障碍。在2020年7月至2022年6月期间,为津巴布韦的医护人员(客户)提供了带有转诊和随访的健康检查。我们旨在了解通过后续电话评估,在因血压升高和/或糖化血红蛋白水平升高而被转诊后与护理建立联系的比例。与护理建立联系的定义为在筛查测试结果呈阳性后的30至60天内自我报告曾看过健康专业人员。对15名客户进行了深入访谈,以了解相关的促进因素和障碍。总体而言,3143名客户接受了筛查服务。大多数为女性(75.7%),年龄中位数为37岁(四分位距:28 - 46岁)。785名(25.0%)客户高血压筛查呈阳性,279名(8.9%)客户糖尿病筛查呈阳性。被转诊去看糖尿病的客户比被转诊去看高血压的客户更有可能接受转诊(糖尿病组n = 212,72.0%;高血压组n = 323,41.1%)。在那些被转诊并成功联系进行随访的人中,131/182(72.0%)报告已与糖尿病护理建立联系,218/269(81.0%)报告已与高血压护理建立联系。到他们被转诊去的机构的距离、可及性和交通成本影响了与护理建立联系的决定和能力。虽然在接受转诊的人中与高血压和糖尿病护理建立联系的比例很高,但许多医护人员不接受转诊。需要提高医疗服务提供者对非传染性疾病护理重要性的认识,以提高对转诊的接受度,并且护理级联的每一步都必须是负担得起的、可及的且以患者为中心。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3bd/12040240/cef3167bdf75/pgph.0004513.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3bd/12040240/d2ceb1229ac1/pgph.0004513.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3bd/12040240/cd910f113b4b/pgph.0004513.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3bd/12040240/2da0eb7b02aa/pgph.0004513.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3bd/12040240/cef3167bdf75/pgph.0004513.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3bd/12040240/d2ceb1229ac1/pgph.0004513.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3bd/12040240/cd910f113b4b/pgph.0004513.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3bd/12040240/2da0eb7b02aa/pgph.0004513.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3bd/12040240/cef3167bdf75/pgph.0004513.g004.jpg

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本文引用的文献

[1]
Prevalence of chronic conditions and multimorbidity among healthcare workers in Zimbabwe: Results from a screening intervention.

PLOS Glob Public Health. 2024-1-23

[2]
Evaluation of a comprehensive health check offered to frontline health workers in Zimbabwe.

PLOS Glob Public Health. 2024-1-8

[3]
Inequality and private health insurance in Zimbabwe: history, politics and performance.

Int J Equity Health. 2023-3-29

[4]
Linkage to HIV care and hypertension and diabetes control in rural South Africa: Results from the population-based Vukuzazi Study.

PLOS Glob Public Health. 2022-11-2

[5]
Effect of a one-time financial incentive on linkage to chronic hypertension care in Kenya and Uganda: A randomized controlled trial.

PLoS One. 2022

[6]
Cost-Effectiveness of Population Screening Programs for Cardiovascular Diseases and Diabetes in Low- and Middle-Income Countries: A Systematic Review.

Front Public Health. 2022

[7]
Barriers to the provision of non-communicable disease care in Zimbabwe: a qualitative study of primary health care nurses.

BMC Nurs. 2022-3-18

[8]
Comprehensive occupational health services for healthcare workers in Zimbabwe during the SARS-CoV-2 pandemic.

PLoS One. 2021

[9]
Integration of non-communicable disease and HIV/AIDS management: a review of healthcare policies and plans in East Africa.

BMJ Glob Health. 2021-5

[10]
Cost-effectiveness of Interventions to Manage Diabetes: Has the Evidence Changed Since 2008?

Diabetes Care. 2020-7

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