Results of a multi-country exploratory survey of approaches and methods for IMCI case management training.
Results of a multi-country exploratory survey of approaches and methods for IMCI case management training.
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DOI：
10.1186/1478-4505-7-18
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发表时间：
2009-07-17
影响因子：
4
通讯作者：
Mason EM
中科院分区：
文献类型：
--
作者：
Goga AE;Muhe LM;Forsyth K;Chopra M;Aboubaker S;Martines J;Mason EM
儿童疾病综合管理战略有效地改善了对患病儿童的管理，从而提高了儿童生存率。目前建议在职IMCI病例管理培训（ICMT）应超过11天;参与者：促进者比例应≤4：1，至少30%的ICMT时间用于临床实践。2006-2007年，在儿童疾病综合管理实施大约十年后，我们进行了一次多国探索性问卷调查，以记录各国在儿童疾病综合管理方面的经验，并确定缩短儿童疾病综合管理时间的可接受性。向27个专门选定的国家的儿童疾病综合管理协调人发送了调查材料（QA）。为了进一步调查，还向这些国家的课程主任或主持人和儿童疾病综合管理受训人员发送了问卷（分别为QB和QC），这些问卷是在采用预定标准后，通过滚雪球抽样选出的。调查问卷收集了定量和定性数据。从24个国家返回了33份QA、163份QB、272份QC和2份总结。所有国家都继续根据当地疾病负担调整课程内容。所有国家都提供较短的ICMT课程，从3-10天不等（最常见的是5-8天）。较短的ICMT课程提供更少的练习，更多的家庭作业，更少的个人反馈和减少的临床实践（<30%的时间）。虽然课程内容的改变通常是以证据为基础的，但随着扩大实施的压力越来越大，培训方法和课程期限也在变化。参与者对每门课程的自我报告技能和看法各不相同。然而，不同的方法和疾病管理的综合方法通常被认为是ICMT的优势，图表手册和临床实践会议被认为是ICMT的关键组成部分。定性工作提出了四个主题，即目前11天的课程费用太高，应缩短;应加强对儿童疾病综合管理的宣传;应定期更新内容，谨慎引入新的内容领域，应更加重视技能建设而不是知识积累。虽然仍然建议采用11天的国际儿童医学治疗课程，但随着为增加获得优质护理的机会和实现千年发展目标4所作努力的加强，包括参与性方法和适当临床实践在内的标准化短期国际儿童医学治疗课程可能在全球范围内得到接受。
The Integrated Management of Childhood Illness Strategy (IMCI) is effective in improving management of sick children, and thus child survival. It is currently recommended that in-service IMCI case management training (ICMT) occur over 11-days; that the participant: facilitator ratio should be ≤4:1 and that at least 30% of ICMT time be spent on clinical practice. In 2006–2007, approximately ten years after IMCI implementation, we conducted a multi-country exploratory questionnaire survey to document country experiences with ICMT, and to determine the acceptability of shortening duration of ICMT. Questionnaires (QA) were sent to national IMCI focal persons in 27 purposively-selected countries. To probe further, questionnaires (QB and QC respectively) were also sent to course-directors or facilitators and IMCI trainees, selected using snowball sampling after applying pre-defined criteria, in these countries. Questionnaires gathered quantitative and qualitative data. Thirty-three QA, 163 QB, 272 QC and two summaries were returned from 24 countries. All countries continued to adapt course content to local disease burden. All countries offer shorter ICMT courses, ranging from 3–10 days (commonest being 5–8 days). The shorter ICMT courses offer fewer exercises, more homework, less individual feedback and reduced clinical practice (<30% time). Whereas changes to course content were usually evidence-based, changes to training methodology and course duration evolved as pressure to expand implementation mounted. Participants varied in their self-reported skill and perception about each course. However, the varied methodology and integrated approach to management of illnesses were commonly cited as strengths of ICMT, and the chart booklet and clinical practice sessions were identified as critical components of ICMT. Four themes emerged from the qualitative work, viz. the current 11-day course is too expensive and should be shortened; advocacy around IMCI should increase; content should be regularly updated, new content areas should be introduced cautiously and more attention should be paid to skills-building rather than knowledge accumulation. Whilst the 11-day ICMT course is still recommended, as efforts intensify to increase access to quality care and meet MDG4, standardized shorter ICMT courses, that include participatory methodologies and adequate clinical practice, could be acceptable globally.