Diagnostics barriers and innovations in rural areas: insights from junior medical doctors on the frontlines of rural care in Peru.
Diagnostics barriers and innovations in rural areas: insights from junior medical doctors on the frontlines of rural care in Peru.
复制标题
DOI：
10.1186/s12913-015-1114-7
复制
发表时间：
2015-10-05
影响因子：
2.8
通讯作者：
Paz-Soldan VA
中科院分区：
文献类型：
--
作者：
Anticona Huaynate CF;Pajuelo Travezaño MJ;Correa M;Mayta Malpartida H;Oberhelman R;Murphy LL;Paz-Soldan VA
在世界范围内，农村社区在获得卫生服务方面面临障碍。为此，许多举措侧重于促进技术创新、新的管理办法和保健政策。研究表明，最成功的创新是那些涉及各级利益相关者的创新。然而，很少有证据表明当地卫生服务提供者的意见可能有助于进一步的创新开发和研究。本研究的目的是探讨在秘鲁农村地区工作的医生对影响诊断过程的障碍的看法，以及可以帮助他们的诊断创新的想法。通过三次焦点小组讨论（FGG）和18次个人半结构化访谈（SSI）收集的数据，对过去两年中在秘鲁农村地区完成医疗服务的医学博士进行了专题分析。出现了三种类型的障碍。第一个障碍是获得护理点（POC）诊断工具的机会有限。需要进行以下测试：1)疟疾与肺炎的鉴别诊断；2)登革热与钩端螺旋体病；3)结核病；4)阴道感染和宫颈癌；5)神经囊虫病；6)重金属毒性。超声诊断需要产科和腹腔内的条件。还存在与卫生系统有关的障碍，如诊断服务资金有限、专家短缺、实验室服务和电信服务有限以及缺乏机构支持。最后，第三类障碍包括与患者相关的障碍，以遵循诊断转诊。提出的创新想法包括POC设备和测试以及远程医疗。由于获得诊断工具的机会有限，秘鲁农村初级卫生机构的医学博士面临着难以克服的诊断挑战。由于保健服务组织的缺陷和阻碍患者前往遥远的保健设施的障碍，转诊到专门设施受到限制。与会者建议的技术创新，如POC诊断工具和移动保健（移动保健）应用，可帮助解决部分问题。然而，解决社会、适应和政策问题的其他类型的创新也不应被忽视。
Worldwide, rural communities face barriers when accessing health services. In response, numerous initiatives have focused on fostering technological innovations, new management approaches and health policies. Research suggests that the most successful innovations are those involving stakeholders at all levels. However, there is little evidence exploring the opinions of local health providers that could contribute with further innovation development and research. The aims of this study were to explore the perspectives of medical doctors (MDs) working in rural areas of Peru, regarding the barriers impacting the diagnostic process, and ideas for diagnostic innovations that could assist them. Data gathered through three focus group discussions (FGG) and 18 individual semi-structured interviews (SSI) with MDs who had completed their medical service in rural areas of Peru in the last two years were analyzed using thematic analysis. Three types of barriers emerged. The first barrier was the limited access to point of care (POC) diagnostic tools. Tests were needed for: i) the differential diagnosis of malaria vs. pneumonia, ii) dengue vs. leptospirosis, iii) tuberculosis, iv) vaginal infections and cervical cancer, v) neurocysticercosis, and vi) heavy metal toxicity. Ultrasound was needed for the diagnosis of obstetric and intra-abdominal conditions. There were also health system-related barriers such as limited funding for diagnostic services, shortage of specialists, limited laboratory services and access to telecommunications, and lack of institutional support. Finally, the third type of barriers included patient related-barriers to follow through with diagnostic referrals. Ideas for innovations proposed included POC equipment and tests, and telemedicine. MDs at primary health facilities in rural Peru face diagnostic challenges that are difficult to overcome due to a limited access to diagnostic tools. Referrals to specialized facilities are constrained by deficiencies in the organization of health services and by barriers that impede the patients’ travel to distant health facilities. Technological innovations suggested by the participants such as POC diagnostic tools and mobile-health (m-health) applications could help address part of the problem. However, other types of innovation to address social, adaptation and policy issues should not be dismissed.