Addressing antimicrobial resistance by improving access and quality of care-A review of the literature from East Africa.
Addressing antimicrobial resistance by improving access and quality of care-A review of the literature from East Africa.
复制标题
DOI：
10.1371/journal.pntd.0009529
复制
发表时间：
2021-07
影响因子：
3.8
通讯作者：
Lembo T
中科院分区：
文献类型：
--
作者：
Loosli K;Davis A;Muwonge A;Lembo T
普及医疗保健，包括优质药品，是一项基本人权，但对许多中低收入国家来说仍然遥不可及。一个现有的框架捕捉在低资源环境中获得医疗保健的变化包括5个方面：可用性，可及性，可负担性，充分性和可接受性。这一框架包括关键组成部分，包括卫生基础设施和获得卫生基础设施的手段以及服务组织、成本和影响用户满意度的因素。然而，在现实中，获得医疗保健的有效性是通过积极结果的可能性来衡量的。因此，我们建议扩大这一框架，以包括一个额外的层面，“质量方面”，纳入质量，这对获得的服务产生最佳健康结果的能力产生重大影响。在此框架内，我们探讨了东非可能与一系列LMIC背景相关的文献，主要集中在提供广泛使用的抗微生物药物，如抗疟药和抗生素。我们认为，主要的不足之处存在于所有6个方面的获取和质量的药物及其供应。虽然全球的重点是遏制抗生素的过度使用，以解决抗生素耐药性（AMR）危机，但围绕获取的主要限制因素影响了患者的就医决定，导致可能加剧AMR问题的潜在问题做法。我们主张采取全面的方法来解决这些不足之处，包括医疗保健的可及性和质量的各个方面，以改善健康结果，同时应对AMR危机。
Universal access to healthcare, including quality medicines, is a fundamental human right but is still out of reach for many in low- and middle-income countries (LMICs). An existing framework capturing variability of access to healthcare in low-resource settings includes the 5 dimensions: availability, accessibility, affordability, adequacy, and acceptability. This framework encompasses key components, including health infrastructure and means to access it as well as service organisation, costs, and factors that influence users’ satisfaction. However, in reality, the effectiveness of accessed healthcare is measured by the likelihood of a positive outcome. We therefore propose an expansion of this framework to include an additional dimension, “aspects of quality,” incorporating quality, which critically influences the ability of the accessed services to generate optimal health outcomes. Within this framework, we explore literature from East Africa likely relevant to a range of LMIC contexts, mainly focusing on the provision of widely used antimicrobials such as antimalarials and antibiotics. We argue that major inadequacies exist across all 6 dimensions of access and quality of drugs and their provision. While the global focus is on curbing excessive antimicrobial use to tackle the antimicrobial resistance (AMR) crisis, major constraints around access shape patients’ health-seeking decisions leading to potentially problematic practices that might exacerbate the AMR problem. We advocate for a holistic approach to tackling these inadequacies, encompassing all dimensions of access and quality of healthcare in order to improve health outcomes while simultaneously counteracting the AMR crisis.