Involving private healthcare practitioners in an urban NCD sentinel surveillance system: lessons learned from Pune, India.
Involving private healthcare practitioners in an urban NCD sentinel surveillance system: lessons learned from Pune, India.
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DOI：
10.3402/gha.v9.32635
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发表时间：
2016
影响因子：
2.6
通讯作者：
Kraas F
中科院分区：
文献类型：
--
作者：
Kroll M;Phalkey R;Dutta S;Shukla S;Butsch C;Bharucha E;Kraas F
尽管非传染性疾病对印度公共卫生的影响越来越大，但缺乏高质量数据和常规监测阻碍了非传染性疾病预防和控制的规划进程。目前的监测方案主要侧重于传染病，没有充分包括作为城市主要医疗来源的私营医疗保健部门。本研究的目的是概念化、实施和评估在印度浦那提供初级保健的私人医疗从业人员中建立城市非传染性疾病哨点监测系统的原型。我们绘制了该市三个选定区域的所有私人医疗保健提供者的地图，对258名同意的从业人员进行了关于监测的知识、态度和实践调查，并评估了他们参与常规非传染性疾病监测系统的意愿。总共有127名从业者同意，并被纳入了为期6个月的监测研究。使用纸质登记，每月现场收集10种选定的非传染性疾病的首次诊断数据以及患者的基本人口和社会经济信息。进行描述性和回归分析。共记录病例1532例，主要为高血压（n=622，占41%）和糖尿病（n=460，占30%）。辍学率为10% （n=13）。每月报告的一致性相当稳定，大多数（n= 63,50%）在6个月内报告1-10例。平均提交病例数在对抗疗法从业者中最高（17.4）。大多数参与者（n= 104,91%）同意监控设计可以扩大到覆盖整个城市。该研究表明，私人初级保健提供者（对抗疗法和替代医学从业人员）在非传染性疾病的诊断和治疗中发挥着重要作用，如果解决了某些障碍，可以参与非传染性疾病的监测。观察到的主要障碍是缺乏对私营部门的监管，不同医学系统之间的交叉实践，有限的诊所基础设施以及疾病监测方面的知识差距。我们建议建立一个自愿的非传染性疾病哨点监测系统，包括所有级别的公共和私人医疗机构。
Despite the rising impact of non-communicable diseases (NCDs) on public health in India, lack of quality data and routine surveillance hampers the planning process for NCD prevention and control. Current surveillance programs focus largely on communicable diseases and do not adequately include the private healthcare sector as a major source of care in cities. The objective of the study was to conceptualize, implement, and evaluate a prototype for an urban NCD sentinel surveillance system among private healthcare practitioners providing primary care in Pune, India. We mapped all private healthcare providers in three selected areas of the city, conducted a knowledge, attitude, and practice survey with regard to surveillance among 258 consenting practitioners, and assessed their willingness to participate in a routine NCD surveillance system. In total, 127 practitioners agreed and were included in a 6-month surveillance study. Data on first-time diagnoses of 10 selected NCDs alongside basic demographic and socioeconomic patient information were collected onsite on a monthly basis using a paper-based register. Descriptive and regression analyses were performed. In total, 1,532 incident cases were recorded that mainly included hypertension (n=622, 41%) and diabetes (n=460, 30%). Dropout rate was 10% (n=13). The monthly reporting consistency was quite constant, with the majority (n=63, 50%) submitting 1–10 cases in 6 months. Average number of submitted cases was highest among allopathic practitioners (17.4). A majority of the participants (n=104, 91%) agreed that the surveillance design could be scaled up to cover the entire city. The study indicates that private primary healthcare providers (allopathic and alternate medicine practitioners) play an important role in the diagnosis and treatment of NCDs and can be involved in NCD surveillance, if certain barriers are addressed. Main barriers observed were lack of regulation of the private sector, cross-practices among different systems of medicine, limited clinic infrastructure, and knowledge gaps about disease surveillance. We suggest a voluntary augmented sentinel NCD surveillance system including public and private healthcare facilities at all levels of care.