Implementing essential diagnostics-learning from essential medicines: A scoping review.
Implementing essential diagnostics-learning from essential medicines: A scoping review.
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DOI：
10.1371/journal.pgph.0000827
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发表时间：
2022
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世界卫生组织（世卫组织）于2018年推出的基本体外诊断标准清单是对现有基本药物清单的补充，并提高了其对推进全民健康覆盖和改善健康结果的影响。我们对关于在非洲实施世卫组织基本清单的文献进行了范围审查，以便为最近引入的基本清单的实施提供信息。我们在8个电子数据库中检索了关于在非洲实施世卫组织电子教学大纲和电子教学大纲的研究报告。两位作者独立进行研究选择和数据提取，并通过讨论解决分歧。我们使用支持使用研究证据（SURE）框架来提取主题，并使用主题内容分析综合发现。我们使用混合方法评估工具（MMAT） 2018版来评估纳入研究的质量。在筛选了3,813篇文章的标题和摘要以及1,545篇全文论文后，我们纳入了172篇关于EDL和EML的研究。大多数（75%,n = 129）研究在设计上是纯粹定量的，包括描述性横断面设计（60%,n = 104）， 15% （n = 26）是纯粹定性的，10% （n = 17）采用混合方法。目前尚无关于EDL的定性或随机实验研究。EML和EDL面临的主要障碍是卫生设施设备不足，包括基本体外诊断和药物缺货或缺货。对卫生设施和工作人员的财政和非财政奖励是实施《基本行动计划》的关键推动因素；然而，它们的影响因环境而异。纳入的研究中只有56项（33%）是高质量的。卫生设施设备和库存不足仍然是基本诊断和药物的实施障碍。卫生系统干预措施，如改善其可得性的财政和非财政激励措施，可适用于不同情况。需要更多的实施研究设计，如实验和定性研究，来评估基本清单的有效性。
The World Health Organization (WHO) model list of Essential In vitro Diagnostic (EDL) introduced in 2018 complements the established Essential Medicines List (EML) and improves its impact on advancing universal health coverage and better health outcomes. We conducted a scoping review of the literature on implementing the WHO essential lists in Africa to inform the implementation of the recently introduced EDL. We searched eight electronic databases for studies reporting on implementing the WHO EDL and EML in Africa. Two authors independently conducted study selection and data extraction, with disagreements resolved through discussion. We used the Supporting the Use of Research Evidence (SURE) framework to extract themes and synthesised findings using thematic content analysis. We used the Mixed Method Appraisal Tool (MMAT) version 2018 to assess the quality of included studies. We included 172 studies reporting on EDL and EML after screening 3,813 articles titles and abstracts and 1,545 full-text papers. Most (75%, n = 129) studies were purely quantitative in design, comprising descriptive cross-sectional designs (60%, n = 104), 15% (n = 26) were purely qualitative, and 10% (n = 17) had mixed-methods approaches. There were no qualitative or randomised experimental studies about EDL. The main barrier facing the EML and EDL was poorly equipped health facilities—including unavailability or stock-outs of essential in vitro diagnostics and medicines. Financial and non-financial incentives to health facilities and workers were key enablers in implementing the EML; however, their impact differed from one context to another. Only fifty-six (33%) of the included studies were of high quality. Poorly equipped and stocked health facilities remain an implementation barrier to essential diagnostics and medicines. Health system interventions such as financial and non-financial incentives to improve their availability can be applied in different contexts. More implementation study designs, such as experimental and qualitative studies, are required to evaluate the effectiveness of essential lists.