Doctors' practice and attitudes towards red blood cell transfusion at Mthatha Regional Hospital, Eastern Cape, South Africa: A mixed methods study.
Doctors' practice and attitudes towards red blood cell transfusion at Mthatha Regional Hospital, Eastern Cape, South Africa: A mixed methods study.
复制标题
医生在南非东开普省Mthatha地区医院对红细胞输血的实践和态度：一项混合方法研究。
DOI：
10.4102/phcfm.v13i1.2889
复制
发表时间：
2021-06-24
影响因子：
2
通讯作者：
Mabunda S
中科院分区：
文献类型：
--
作者：
Adedayo T;O'Mahony D;Adeleke O;Mabunda S
不必要的输血使受血者面临潜在的危害。本研究的目的是描述输血实践并探讨医生对输血的态度。提供1级和2级服务的医院。采用混合方法研究设计。在横断面描述性部分中，从2个月内输血的患者中采集样本。血液使用被分类为医学贫血或出血，以及适当与否。定性部分包括一个有目的的焦点小组和个人半结构化访谈的样本。在抽样的239名患者中，62%因医学贫血输血，38%因出血输血。在医学贫血组中，符合年龄适当的输血阈值的比例为69%。在医学贫血和出血中，分别有114名（77%）和85名（93.4%）接受者接受了≥ 2个红细胞（RBC）单位的订单。在≥ 18岁的医学贫血成人中，47.1%的订单将导致血红蛋白（Hb）> 8 g/dL。6名医生参加了焦点小组，11名医生参加了个人访谈。缺乏对机构输血指南的认识，对适当的RBC输血阈值存在分歧，并评论说应始终输注多个RBC单位。决定输血的因素包括资深同事的建议，缓解贫血症状和高昂的产品成本。大多数订单是两个或更多个单位。在医学贫血症中，医生对RBC输血阈值的遵守是合理的;然而，几乎一半的订单会导致过度输血。抽样医生的态度表明，他们的输血实践更多地受到制度价值观的影响，而不是正式的指导方针。
Unnecessary blood transfusion exposes recipients to potential harms. The aim of this study was to describe blood transfusion practice and explore doctors’ attitudes towards transfusion. A hospital providing level 1 and 2 services. A mixed-methods study design was used. In the cross-sectional descriptive component, a sample was taken from patients transfused over a 2-month period. Blood use was categorised as for medical anaemia or haemorrhage, and appropriate or not. The qualitative component comprised a purposeful sample for focus group and individual semi-structured interviews. Of 239 patients sampled, 62% were transfused for medical anaemia and 38% for haemorrhage. In the medical anaemia group, compliance with age-appropriate transfusion thresholds was 69%. In medical anaemia and haemorrhage, 114 (77%) and 85 (93.4%) of recipients had orders for ≥ 2 red blood cell (RBC) units, respectively. In adults ≥ 18 years old with medical anaemia, 47.1% of orders would have resulted in a haemoglobin (Hb) > 8 g/dL. Six doctors participated in focus group and eleven in individual interviews. There was a lack of awareness of institutional transfusion guidelines, disagreement on appropriate RBC transfusion thresholds and comments that more than one RBC unit should always be transfused. Factors informing decisions to transfuse included advice from senior colleagues, relieving symptoms of anaemia and high product costs. Most orders were for two or more units. In medical anaemia, doctors’ compliance with RBC transfusion thresholds was reasonable; however, almost half of the orders would have resulted in overtransfusion. The attitudes of doctors sampled suggest that their transfusion practice is influenced more by institutional values than formal guidelines.