Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals
Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals
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DOI：
10.1186/s12882-020-01732-w
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发表时间：
2020-02-28
期刊：
影响因子：
2.3
通讯作者：
Chary, Anita
中科院分区：
文献类型：
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作者：
Flood, David;Wilcox, Katharine;Chary, Anita
背景慢性肾脏病（CKD）在全球范围内不断增加，并且大部分CKD负担发生在低收入和中等收入国家（LMIC）。然而，全球获得肾脏护理治疗（如透析和肾移植）的机会存在很大差异。卫生专业人员在中低收入国家提供肾脏护理时遇到的挑战尚未得到很好的描述。本研究的目标是引出卫生专业人员的看法，在资源有限的环境中提供肾脏护理，处理资源限制的策略，并为改善肾脏护理在Guatemala.MethodsSemi-structured interviews进行了21个卫生专业人员通过方便抽样在危地马拉最大的公共肾脏病中心招聘。卫生专业人员包括行政人员、医生、护士、技术人员、营养师、心理学家、实验室人员和社会工作者。访谈用西班牙语录音和誊写。从访谈的定性数据进行了分析，在NVivo中使用的归纳方法，允许主导主题出现从采访TranSmart.ResultsHealth专业人员最经常描述的挑战，由于资源的限制，提供高质量的护理。减少血液透析的频率，鼓励患者选择腹膜透析而不是血液透析，以及根据临床紧急程度分配资源是协调高需求和有限资源的常见策略。提供者经历了与高患者量和资源分配的困难决定相关的重大情感挑战，导致倦怠和道德困扰。为了改善护理，受访者建议增加设备和人员的预算，在预防性服务的投资，和分散的service.ConclusionsHealth专业人员在危地马拉最大的公共肾脏病中心描述了多种策略，以满足不断增长的需求肾脏替代治疗。由于系统层面的限制，卫生专业人员面临着困难的选择，对资源的管理与倦怠和道德困扰的情绪。这项研究为危地马拉和其他寻求扩大肾脏护理能力的国家提供了重要的经验教训。
BackgroundChronic kidney disease (CKD) is increasing worldwide, and the majority of the CKD burden is in low- and middle-income countries (LMICs). However, there is wide variability in global access to kidney care therapies such as dialysis and kidney transplantation. The challenges health professionals experience while providing kidney care in LMICs have not been well described. The goal of this study is to elicit health professionals' perceptions of providing kidney care in a resource-constrained environment, strategies for dealing with resource limitations, and suggestions for improving kidney care in Guatemala.MethodsSemi-structured interviews were performed with 21 health professionals recruited through convenience sampling at the largest public nephrology center in Guatemala. Health professionals included administrators, physicians, nurses, technicians, nutritionists, psychologists, laboratory personnel, and social workers. Interviews were recorded and transcribed in Spanish. Qualitative data from interviews were analyzed in NVivo using an inductive approach, allowing dominant themes to emerge from interview transcriptions.ResultsHealth professionals most frequently described challenges in providing high-quality care due to resource limitations. Reducing the frequency of hemodialysis, encouraging patients to opt for peritoneal dialysis rather than hemodialysis, and allocating resources based on clinical acuity were common strategies for reconciling high demand and limited resources. Providers experienced significant emotional challenges related to high patient volume and difficult decisions on resource allocation, leading to burnout and moral distress. To improve care, respondents suggested increased budgets for equipment and personnel, investments in preventative services, and decentralization of services.ConclusionsHealth professionals at the largest public nephrology center in Guatemala described multiple strategies to meet the rising demand for renal replacement therapy. Due to systems-level limitations, health professionals faced difficult choices on the stewardship of resources that are linked to sentiments of burnout and moral distress. This study offers important lessons in Guatemala and other countries seeking to build capacity to scale-up kidney care.