Barriers to Point-of-Care Testing in India: Results from Qualitative Research across Different Settings, Users and Major Diseases
Barriers to Point-of-Care Testing in India: Results from Qualitative Research across Different Settings, Users and Major Diseases
复制标题
DOI：
10.1371/journal.pone.0135112
复制
发表时间：
2015-08-14
期刊：
影响因子：
3.7
通讯作者：
Pai, Madhukar
中科院分区：
文献类型：
--
作者：
Engel, Nora;Ganesh, Gayatri;Pai, Madhukar
背景成功的床旁检测，即确保在同一次就诊中完成检测和治疗周期，具有减少诊断和治疗延迟并影响患者结局的巨大潜力。然而，仅仅有快速检测是不够的，因为许多障碍可能会阻碍其在即时检测项目中的成功实施。诊断实践的定性研究可能有助于确定这种障碍在不同的医疗点在卫生system.MethodsIn这个探索性的定性研究，我们进行了78个半结构化的访谈和13个焦点小组讨论，在城市和农村地区的卡纳塔克邦，印度，与医疗保健提供者（医生、护士、专家、传统治疗师和非正式提供者）、患者、社区卫生工作者、测试制造商、实验室技术人员、项目经理和政策制定者。与会者有目的地抽样代表设置的医院，外围实验室，诊所，社区和家庭，在公共和私营sectors.ResultsIn印度的背景下，责任是对病人，以确保成功点的护理测试在整个家庭，诊所，实验室和医院，在不协调的供应商与不同的，往往是竞争的做法，在缺乏物质，金钱和人力资源的设置。我们确定了影响床旁检测的三个首要主题：主要主题是供应商之间以及供应商与患者之间的“关系”，受“基础设施”的交叉主题的影响。挑战与两者的结果在'修改的做法'往往有利于经验（对症）治疗的指导下testing.ConclusionsEven测试可以进行现场和基础设施的挑战已经得到解决，供应商之间的关系和患者和供应商之间的成功点的护理测试是至关重要的。此外，这些障碍不是孤立的，而是相互关联的，需要加以审查。此外，单靠测试克服这些困难的能力有限。测试开发人员、政策制定者、医疗保健提供者和资助者需要利用这些见解来克服床旁检测项目的障碍。
BackgroundSuccessful point-of-care testing, namely ensuring the completion of the test and treat cycle in the same encounter, has immense potential to reduce diagnostic and treatment delays, and impact patient outcomes. However, having rapid tests is not enough, as many barriers may prevent their successful implementation in point-of-care testing programs. Qualitative research on diagnostic practices may help identify such barriers across different points of care in health systems.MethodsIn this exploratory qualitative study, we conducted 78 semi-structured interviews and 13 focus group discussions in an urban and rural area of Karnataka, India, with healthcare providers (doctors, nurses, specialists, traditional healers, and informal providers), patients, community health workers, test manufacturers, laboratory technicians, program managers and policy-makers. Participants were purposively sampled to represent settings of hospitals, peripheral labs, clinics, communities and homes, in both the public and private sectors.ResultsIn the Indian context, the onus is on the patient to ensure successful point-of-care testing across homes, clinics, labs and hospitals, amidst uncoordinated providers with divergent and often competing practices, in settings lacking material, money and human resources. We identified three overarching themes affecting point-of-care testing: the main theme is 'relationships' among providers and between providers and patients, influenced by the cross-cutting theme of 'infrastructure'. Challenges with both result in 'modified practices' often favouring empirical (symptomatic) treatment over treatment guided by testing.ConclusionsEven if tests can be conducted on the spot and infrastructure challenges have been resolved, relationships among providers and between patients and providers are crucial for successful point-of-care testing. Furthermore, these barriers do not act in isolation, but are interlinked and need to be examined as such. Also, a test alone has only limited power to overcome those difficulties. Test developers, policy-makers, healthcare providers and funders need to use these insights in overcoming barriers to point-of-care testing programs.