Client and Provider Perspectives of the Efficiency and Quality of Care in the Context of Rapid Scale-Up of Antiretroviral Therapy
Client and Provider Perspectives of the Efficiency and Quality of Care in the Context of Rapid Scale-Up of Antiretroviral Therapy
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DOI：
10.1089/apc.2010.0108
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发表时间：
2010-11-01
影响因子：
4.9
通讯作者：
Wagner, Glenn
中科院分区：
文献类型：
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作者：
Amanyire, Gideon;Wanyenze, Rhoda;Wagner, Glenn
全球扩大抗逆转录病毒疗法的重点是临床结果，很少关注其对现有卫生系统的影响。2008年6月至8月，我们对乌干达三家诊所的抗逆转录病毒治疗规模扩大和诊所运作进行了形成性评估，以总结经验教训，为政策和更大的公共卫生保健系统提供信息。现场访问和半结构化访谈10个ART客户和6个供应商在每个诊所被用来检查效率的诊所业务（病人流量，工作人员分配到适当的职责，安排诊所访问，记录管理）和护理质量（出席客户和供应商的需求，并提供支持治疗依从性和保留）。客户报告等待时间长，但对护理质量普遍满意。供应商报告良好的患者依从性和保留，并为客户提供支持机制。与客户一样，提供者提到等待时间长和工作量大是诊所扩张的主要挑战。提供者呼吁提供更多的人力资源和压力释放机制，以防止工作人员精疲力竭。提供者和客户都认为这些诊所提供优质护理，尽管承认诊所拥挤和等待时间长。这些调查结果突出表明，需要解决诊所效率以及在快速扩大规模的背景下对提供者的支持。
Global scale-up of antiretroviral therapy (ART) has focused on clinical outcomes with little attention on its impact on existing health systems. In June-August 2008, we conducted a formative evaluation on ART scale-up and clinic operations at three clinics in Uganda to generate lessons for informing policy and larger public health care systems. Site visits and semistructured interviews with 10 ART clients and 6 providers at each clinic were used to examine efficiency of clinic operations (patient flow, staff allocation to appropriate duties, scheduling of clinic visits, record management) and quality of care (attending to both client and provider needs, and providing support for treatment adherence and retention). Clients reported long waiting times but otherwise general satisfaction with the quality of care. Providers reported good patient adherence and retention, and support mechanisms for clients. Like clients, providers mentioned long waiting times and high workload as major challenges to clinic expansion. Providers called for more human resources and stress-release mechanisms to prevent staff burnout. Both providers and clients perceive these clinics to be delivering good quality care, despite the recognition of congested clinics and long waiting times. These findings highlight the need to address clinic efficiency as well as support for providers in the context of rapid scale-up.