The high-quality health system 'revolution': Re-imagining tuberculosis infection prevention and control
The high-quality health system 'revolution': Re-imagining tuberculosis infection prevention and control
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DOI：
10.1016/j.jctube.2019.100118
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发表时间：
2019-12-01
影响因子：
2
通讯作者：
Ehrlich, Rodney
中科院分区：
文献类型：
--
作者：
Van der Westhuizen, Helene-Mari;Nathavitharana, Ruvandhi R.;Ehrlich, Rodney
《柳叶刀》高质量卫生系统委员会呼吁在低收入和中等收入国家开展医疗质量的“革命”。我们认为，这提供了一个有用的框架来展示如何将有效的结核病感染预防和控制（TB IPC）的实施与加强卫生系统联系起来，将其从国家结核病规划的筒仓中移开。利用这一框架，我们确定并讨论结核病IPC实施与患者安全、卫生人力资源、优先考虑以人为本的护理、在卫生系统中建立信任以及改进用于衡量结核病IPC实施的工具之间的联系。优先考虑患者体验是高质量护理定义的最新内容。在结核病高负担环境中，接触结核病IPC措施可能是结核病患者与卫生保健系统的首次接触，并可能导致污名化感。我们提倡重新设想我们实施结核病IPC的方式，通过结合使用卫生保健服务的人们的经验，借鉴以人为本的护理原则。患职业结核病的卫生工作者也提供了一个独特的视角：他们既经历过结核病IPC，也在其工作场所实施结核病IPC方面发挥了作用。他们可以成为以人为本的结核病IPC实施的有力倡导者。通过将结核病预防控制作为加强卫生系统的一部分，并有意识地在结核病预防控制设计、测量和指南中纳入以人为本的观点，我们希望影响未来的结核病预防控制研究和实践。
The Lancet Commission on High-Quality Health Systems called for a 'revolution' in the quality of care provided in low- and middle-income countries. We argue that this provides a helpful framework to demonstrate how effective tuberculosis infection prevention and control (TB IPC) implementation should be linked with health system strengthening, moving it from the silo of the national TB programmes. Using this framework, we identify and discuss links between TB IPC implementation and patient safety, human resources for health, prioritising person-centred care, building trust in health systems and refining the tools used to measure TB IPC implementation.Prioritising patient experience has been a recent addition to the definition of high-quality care. In high TB burden settings, the encounter with TB IPC measures may be a TB patient's initial contact with the healthcare system and may cause feelings of stigmatisation. We advocate for re-imagining the way we implement TB IPC, by drawing on the principles of person-centred care through incorporating the experiences of people using healthcare services. Health workers who developed occupational TB also offer a unique perspective: they have both experienced TB IPC and have played a role in implementing it in their workplace. They can be powerful advocates for person-centred TB IPC implementation. Through framing TB IPC as part of health system strengthening and consciously including person-centred perspectives in TB IPC design, measurement and guidelines, we hope to influence future TB IPC research and practice.