Addressing the quality of paediatric primary care: health worker and caregiver perspectives from a process evaluation of PACK child, a health systems intervention in South Africa.
Addressing the quality of paediatric primary care: health worker and caregiver perspectives from a process evaluation of PACK child, a health systems intervention in South Africa.
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DOI：
10.1186/s12887-021-02512-7
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发表时间：
2021-01-28
期刊：
影响因子：
2.4
通讯作者：
Fairall L
中科院分区：
文献类型：
--
作者：
Curran R;Murdoch J;Bachmann M;Bateman E;Cornick R;Picken S;Simelane ML;Fairall L
世卫组织的儿童疾病综合管理在解决婴儿和儿童死亡率方面取得了进展。然而，儿童的需求未得到满足继续对初级保健服务构成负担。所提供的服务能力和护理质量需要更大的支持，以满足这些需求，办法是扩大和整合对有长期健康状况的儿童和5岁以上儿童的治疗和预防护理，这些在儿童疾病综合管理中没有列为优先事项。针对这些需求，2017年10月至2019年2月在南非西开普省制定并试点了PACK儿童干预措施。我们报告了卫生工作者和护理人员对现有儿科初级保健背景的看法，以及PACK儿童在当前当地医疗保健系统中解决感知问题的程度。该过程评估包括52次对护理人员的个人访谈，10次对卫生工作者的焦点小组讨论，3次对培训人员的个人访谈，以及31次培训观察。访谈和焦点小组探讨了参与者在儿科初级保健方面的经历、PACK儿童干预措施的观点以及在每种情况下实施的紧张关系。采用归纳主题分析对逐字访谈和讨论文本进行分析。护理人员和卫生工作者的观点建议将儿科初级保健的重点制度化，将儿童症状作为急性发作性疾病进行治疗。卫生工作者的报告暗示，这一重点是通过诸如疾病综合管理政策、文件驱动的咨询、过度拥挤的诊所和垂直护理等背景特征之间的相互作用而持续存在的。虽然这些背景条件限制了卫生工作者将PACK儿童培训中发展的技能转化为实践的能力，但干预措施扩大了对0-13岁儿童和长期健康状况儿童的护理，提高了专业能力，改善了团队合作和转诊，简化了分诊，并促进了对心理社会风险的探索。儿童保健计划似乎正在促进儿科初级保健，以满足儿童的更广泛需求，包括长期健康状况和确定心理社会问题。然而，为了最大限度地提高这一点，初级保健需要重新定位，从就诊当天的风险最小化转向在诊所就诊当天之后对儿童的看法。在线版本包含补充材料，可在10.1186/s12887-021-02512-7获得。
The WHO’s Integrated Management of Childhood Illness (IMCI) has resulted in progress in addressing infant and child mortality. However, unmet needs of children continue to present a burden upon primary healthcare services. The capacity of services and quality of care offered require greater support to address these needs by extending and integrating curative and preventive care for the child with a long-term health condition and the child older than 5, not prioritised in IMCI. In response to these needs, the PACK Child intervention was developed and piloted in October 2017–February 2019 in the Western Cape Province of South Africa. We report health worker and caregiver perspectives of the existing paediatric primary care context as well as the extent to which PACK Child functions to address perceived problems within the current local healthcare system. This process evaluation involved 52 individual interviews with caregivers, 10 focus group discussions with health workers, 3 individual interviews with trainers, and 31 training observations. Interviews and focus groups explored participants’ experiences of paediatric primary care, perspectives of the PACK Child intervention, and tensions with implementation in each context. Inductive thematic analysis was used to analyse verbatim interview and discussion transcripts. Perspectives of caregivers and health workers suggest an institutionalised focus of paediatric primary care to treating children’s symptoms as acute episodic conditions. Health workers’ reports imply that this focus is perpetuated by interactions between contextual features such as, IMCI policy, documentation-driven consultations, overcrowded clinics and verticalised care. Whilst these contextual conditions constrained health workers’ ability to translate skills developed within PACK Child training into practice, the intervention initiated expanded care of children 0–13 years and those with long-term health conditions, enhanced professional competence, improved teamwork and referrals, streamlined triaging, and facilitated probing for psychosocial risk. PACK Child appears to be catalysing paediatric primary care to address the broader needs of children, including long-term health conditions and the identification of psychosocial problems. However, to maximise this requires primary care to re-orientate from risk minimisation on the day of attendance towards a view of the child beyond the day of presentation at clinics. The online version contains supplementary material available at 10.1186/s12887-021-02512-7.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
DOI：
10.1136/bmj.h1258
发表时间：
2015-03-19
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Moore GF;Audrey S;Barker M;Bond L;Bonell C;Hardeman W;Moore L;O'Cathain A;Tinati T;Wight D;Baird J
通讯作者：
Baird J
影响因子：
3.7
作者：
Horwood C;Vermaak K;Rollins N;Haskins L;Nkosi P;Qazi S
通讯作者：
Qazi S
影响因子：
8.1
作者：
Picken S;Hannington J;Fairall L;Doherty T;Bateman E;Richards M;Wattrus C;Cornick R
通讯作者：
Cornick R
影响因子：
5.2
作者：
Chopra, Mickey;Binkin, Nancy J.;Wolfheim, Cathy
通讯作者：
Wolfheim, Cathy