Monitoring iCCM referral systems: Bugoye Integrated Community Case Management Initiative (BIMI) in Uganda
Monitoring iCCM referral systems: Bugoye Integrated Community Case Management Initiative (BIMI) in Uganda
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DOI：
10.1186/s12936-016-1300-z
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发表时间：
2016-04-29
期刊：
影响因子：
3
通讯作者：
Stone, Geren S.
中科院分区：
文献类型：
--
作者：
English, Lacey;Miller, James S.;Stone, Geren S.
背景：在乌干达，五岁以下儿童死亡率的一半以上归因于三种传染病：疟疾、肺炎和腹泻。综合社区病例管理（iCCM）培训乡村卫生工作者（VHWs）提供这些常见儿童疾病的家庭诊断和治疗。对于重病儿童，iCCM依赖于一个有效的转诊系统，以确保在医疗机构得到及时治疗。然而，转诊完成率在iCCM方案之间差异很大，难以监测。Bugoye综合社区病例管理倡议是在乌干达Bugoye分县实施的一个综合社区病例管理方案。本案例研究介绍了BIMI的经验，监测转介完成在Bugoye卫生中心III（BHC），并概述了改进iCCM转介systems.Methods内：本研究三角多个数据源，以评估的优势和差距BIMI转介系统。审查了三个定量数据来源：（1）转诊患者的VHW报告，（2）BHC的转诊表，（3）BHC患者记录。这些数据来源于2014年1月至12月进行了整理和三角测量。我们的目标是，以确定患者是否完成他们的转介，如果转介充分记录使用常规datasource.Results：从2014年1月至12月，有268例患者提到BHC，记录VHWs。然而，这些患者中只有52人在BHC储存了转诊表。在发现的52份转介表格中，其中22名患者也在诊所工作人员记录的BHC登记簿中找到。因此，研究发现VHW报告的患者转诊和BHC记录的转诊访视之间不匹配。这种差异可能表明几个差距：（1）转诊患者可能没有完成他们的转诊，（2）转诊表格可能会在BHC丢失，（3）转诊患者可能会去其他卫生设施或药店，而不是BHC，为他们的转诊。这项研究证明了有效监测iCCM转诊完成的挑战，鉴于已查明的局限性，如数据来源不一致、记录保存不完整和缺乏唯一标识符。需要创新和改进利用常规数据监测转诊遵守情况的方法，以提高完成转诊的百分比。通过研究和实地经验，本研究提出了方案和技术解决方案，以弥补面临类似挑战的iCCM方案中的这些差距。随着监测的改善，VHWs将有权提高转诊完成率，使重症儿童能够获得所需的卫生服务。
Background: In Uganda, over half of under-five child mortality is attributed to three infectious diseases: malaria, pneumonia and diarrhoea. Integrated community case management (iCCM) trains village health workers (VHWs) to provide in-home diagnosis and treatment of these common childhood illnesses. For severely ill children, iCCM relies on a functioning referral system to ensure timely treatment at a health facility. However, referral completion rates vary widely among iCCM programmes and are difficult to monitor. The Bugoye Integrated Community Case Management Initiative (BIMI) is an iCCM programme operating in Bugoye sub-county, Uganda. This case study describes BIMI's experience with monitoring referral completion at Bugoye Health Centre III (BHC), and outlines improvements to be made within iCCM referral systems.Methods: This study triangulated multiple data sources to evaluate the strengths and gaps in the BIMI referral system. Three quantitative data sources were reviewed: (1) VHW report of referred patients, (2) referral forms found at BHC, and (3) BHC patient records. These data sources were collated and triangulated from January-December 2014. The goal was to determine if patients were completing their referrals and if referrals were adequately documented using routine data sources.Results: From January-December 2014, there were 268 patients referred to BHC, as documented by VHWs. However, only 52 of these patients had referral forms stored at BHC. Of the 52 referral forms found, 22 of these patients were also found in BHC register books recorded by clinic staff. Thus, the study found a mismatch between VHW reports of patient referrals and the referral visits documented at BHC. This discrepancy may indicate several gaps: (1) referred patients may not be completing their referral, (2) referral forms may be getting lost at BHC, and, (3) referred patients may be going to other health facilities or drug shops, rather than BHC, for their referral.Conclusions: This study demonstrates the challenges of effectively monitoring iCCM referral completion, given identified limitations such as discordant data sources, incomplete record keeping and lack of unique identifiers. There is a need to innovate and improve the ways by which referral compliance is monitored using routine data, in order to improve the percentage of referrals completed. Through research and field experience, this study proposes programmatic and technological solutions to rectify these gaps within iCCM programmes facing similar challenges. With improved monitoring, VHWs will be empowered to increase referral completion, allowing critically ill children to access needed health services.