Listening to Those at the Frontline: Patient and Healthcare Personnel Perspectives on Tuberculosis Treatment Barriers and Facilitators in High TB Burden Regions of Argentina.
Listening to Those at the Frontline: Patient and Healthcare Personnel Perspectives on Tuberculosis Treatment Barriers and Facilitators in High TB Burden Regions of Argentina.
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DOI：
10.1155/2014/135823
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发表时间：
2014
影响因子：
--
通讯作者：
Pearce PF
中科院分区：
文献类型：
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作者：
Iribarren SJ;Rubinstein F;Discacciati V;Pearce PF
目的。在阿根廷，结核病控制措施尚未实现关键的治疗目标。本研究的目的是确定治疗提供模式，并探讨患者和医护人员对治疗成功的障碍和促进因素的看法。方法。我们采用半结构化的团体访谈和个人访谈进行描述性质的研究。有目的地选择了8个高负担城市。对当地、市、地区和国家各级正在接受活动性结核病治疗的患者（n = 16）、多学科结核病团队成员（n = 26）和结核病项目主任（n = 12）进行了访谈。访谈被记录下来，逐字转录，并使用主题分析进行分析。结果。不同城市和不同类型的保健设施提供不同的治疗模式，并与患者进行了高度协商。在以医院为基础的诊所和一些社区诊所，自我给予治疗是很常见的。结核病治疗成功的障碍集中在系统层面。这一水平在很大程度上依赖于个人的承诺，许多系统促进者是孤立地或在有限的环境中工作的。结论。我们在个人、结构、社会和组织层面概述了促进和挑战因素的经验和观点。建立牢固的患者-医疗保健人员关系，响应患者需求，利用社区资源，并最大限度地利用已建立的分散系统，可以减轻一些障碍。
Purpose. In Argentina, tuberculosis (TB) control measures have not achieved key treatment targets. The purpose of this study was to identify modes of treatment delivery and explore patient and healthcare personnel perceptions of barriers and facilitators to treatment success. Methods. We used semistructured group and individual interviews for this descriptive qualitative study. Eight high burden municipalities were purposively selected. Patients in treatment for active TB (n = 16), multidisciplinary TB team members (n = 26), and TB program directors (n = 12) at local, municipal, regional, and national levels were interviewed. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. Results. Modes of treatment delivery varied across municipalities and types of healthcare facility and were highly negotiated with patients. Self-administration of treatment was common in hospital-based and some community clinics. Barriers to TB treatment success were concentrated at the system level. This level relied heavily on individual personal commitment, and many system facilitators were operating in isolation or in limited settings. Conclusions. We outline experiences and perspectives of the facilitating and challenging factors at the individual, structural, social, and organizational levels. Establishing strong patient-healthcare personnel relationships, responding to patient needs, capitalizing on community resources, and maximizing established decentralized system could mitigate some of the barriers.