Task shifting in Mozambique: cross-sectional evaluation of non-physician clinicians' performance in HIV/AIDS care.
Task shifting in Mozambique: cross-sectional evaluation of non-physician clinicians' performance in HIV/AIDS care.
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DOI：
10.1186/1478-4491-8-23
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发表时间：
2010-10-12
影响因子：
4.5
通讯作者：
Nelson LJ
中科院分区：
文献类型：
--
作者：
Brentlinger PE;Assan A;Mudender F;Ghee AE;Vallejo Torres J;Martínez Martínez P;Bacon O;Bastos R;Manuel R;Ramirez Li L;McKinney C;Nelson LJ
许多资源有限的国家现在都在培训非医生临床医生进行艾滋病毒/艾滋病护理，这是一种被称为“任务转移”的策略。目前还没有一个以证据为基础的培训这些干部的国际标准。2007年，莫桑比克卫生部在为期两周的强调抗逆转录病毒疗法（ART）的在职培训课程后，对非医师临床医生（TMs）提供的护理质量进行了全国性评估。当44名随机选择的TMs在他们通常的工作场所照顾hiv感染患者时，由专家临床医生直接观察。将观察到的临床表现与课程中讲授的国家规范进行比较。在127例直接观察到的患者就诊中，37.6%的TMs指定了正确的世卫组织临床分期，71.6%的TMs正确管理复方新诺明预防，75.5%的TMs正确管理抗逆转录病毒治疗（调整后的估计）。10.6%的患者正确管理了患者护理的所有5个主要方面（分期、复方新诺明、抗逆转录病毒治疗、机会性感染和药物不良反应）。观察到的临床错误具有异质性。常见的错误包括在完成相关患者评估之前分配临床阶段，以及在没有适应症或禁忌时开始或继续使用复方新诺明或抗逆转录病毒治疗。在莫桑比克，在职抗逆转录病毒治疗培训暂停。卫生部随后修订了TMs在艾滋病毒/艾滋病护理方面的工作范围，制定了新的临床指南，并为这些卫生专业人员启动了一项全国性的再培训和临床指导方案。需要进一步研究确定临床有效的保健工作者培训方法，以支持莫桑比克和同样资源有限的环境中的艾滋病毒/艾滋病护理。
Many resource-constrained countries now train non-physician clinicians in HIV/AIDS care, a strategy known as 'task-shifting.' There is as yet no evidence-based international standard for training these cadres. In 2007, the Mozambican Ministry of Health (MOH) conducted a nationwide evaluation of the quality of care delivered by non-physician clinicians (técnicos de medicina, or TMs), after a two-week in-service training course emphasizing antiretroviral therapy (ART). Forty-four randomly selected TMs were directly observed by expert clinicians as they cared for HIV-infected patients in their usual worksites. Observed clinical performance was compared to national norms as taught in the course. In 127 directly observed patient encounters, TMs assigned the correct WHO clinical stage in 37.6%, and correctly managed co-trimoxazole prophylaxis in 71.6% and ART in 75.5% (adjusted estimates). Correct management of all 5 main aspects of patient care (staging, co-trimoxazole, ART, opportunistic infections, and adverse drug reactions) was observed in 10.6% of encounters. The observed clinical errors were heterogeneous. Common errors included assignment of clinical stage before completing the relevant patient evaluation, and initiation or continuation of co-trimoxazole or ART without indications or when contraindicated. In Mozambique, the in-service ART training was suspended. MOH subsequently revised the TMs' scope of work in HIV/AIDS care, defined new clinical guidelines, and initiated a nationwide re-training and clinical mentoring program for these health professionals. Further research is required to define clinically effective methods of health-worker training to support HIV/AIDS care in Mozambique and similarly resource-constrained environments.
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影响因子：
12.7
作者：
Bryce, J;Victora, CG;Black, RE
通讯作者：
Black, RE
影响因子：
6.4
作者：
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通讯作者：
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影响因子：
168.9
作者：
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通讯作者：
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DOI：
10.1016/j.ijgo.2004.01.005
发表时间：
2004-05-01
影响因子：
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作者：
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通讯作者：
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影响因子：
168.9
作者：
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