The role of Clinical Officers in the Kenyan health system: a question of perspective.
The role of Clinical Officers in the Kenyan health system: a question of perspective.
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DOI：
10.1186/1478-4491-11-32
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发表时间：
2013-07-17
影响因子：
4.5
通讯作者：
English M
中科院分区：
文献类型：
--
作者：
Mbindyo P;Blaauw D;English M
尽管许多低收入国家对使用非医师临床医生越来越感兴趣，但对他们在典型卫生系统环境中发挥的作用知之甚少。之前的研究集中在评估他们与医生相比的技术能力。这项工作探讨了对肯尼亚非医师临床医生（临床官员（COs））角色的看法。定性方法包括深度访谈（与COs、护士、医生、医院管理层和政策制定者等）、参与者观察和文献分析。一个形态-具体的框架被用来检查机构和其中的个人之间的紧张关系。采用比较方法来检查机构与个人的CO角色概念，这些角色如何在政府和基于信仰的医院（FBH）环境中发挥作用，以及医院内CO的三种具体工作环境所产生的差异。主要发现是政策文件之间的差异，政策文件概述了科医生的广泛作用，包括技术和管理作用，而受访者则阐述了一个狭窄的技术作用，重点是病人的护理和管理。当被问及CO的角色时，受访者描述了各种各样的CO形象，从“过滤器”到“初级保健医生”。项目主管认为，他们的技术角色受到了限制，因此需要与初级保健相关的明确角色。与公立医院相比，FBH的设置进一步明确了CO的角色。据报道，CO角色的正式处方与实际实践之间存在紧张关系，并结合了对CO工作缺乏认识，专科CO之间的角色冲突以及角色模糊。尽管COs是重要的服务提供者，但他们的角色并不清楚，这导致了角色冲突。建议重新定义他们的角色，从“替代临床医生”转变为专业的“初级保健临床医生”，并得到卫生系统的支持。
Despite the increasing interest in using non-physician clinicians in many low-income countries, little is known about the roles they play in typical health system settings. Prior research has concentrated on evaluating their technical competencies compared to those of doctors. This work explored perceptions of the roles of Kenyan non-physician clinicians (Clinical Officers (COs). Qualitative methods including in-depth interviews (with COs, nurses, doctors, hospital management, and policymakers, among others), participant observation and document analysis were used. A nomothetic-idiographic framework was used to examine tensions between institutions and individuals within them. A comparative approach was used to examine institutional versus individual notions of CO roles, how these roles play out in government and faith-based hospital (FBH) settings as well as differences arising from three specific work settings for COs within hospitals. The main finding was the discrepancy between policy documents that outline a broad role for COs that covers both technical and managerial roles, while respondents articulated a narrow technical role that focused on patient care and management. Respondents described a variety of images of COs, ranging from ‘filter’ to ‘primary healthcare physician’, when asked about CO roles. COs argued for a defined role associated with primary healthcare, feeling constrained by their technical role. FBH settings were found to additionally clarify CO roles when compared with public hospitals. Tensions between formal prescriptions of CO roles and actual practice were reported and coalesced around lack of recognition over COs work, role conflict among specialist COs, and role ambiguity. Even though COs are important service providers their role is not clearly understood, which has resulted in role conflict. It is suggested that their role be redefined, moving from that of ‘substitute clinician’ to professional ‘primary care clinician’, with this being supported by the health system.
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影响因子：
3.2
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