Is enhancing the professionalism of healthcare providers critical to tackling antimicrobial resistance in low- and middle-income countries?
Is enhancing the professionalism of healthcare providers critical to tackling antimicrobial resistance in low- and middle-income countries?
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DOI：
10.1186/s12960-020-0452-7
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发表时间：
2020-02-11
影响因子：
4.5
通讯作者：
Saphonn, Vonthanak
中科院分区：
文献类型：
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作者：
Khan, Mishal S.;Bory, Sothavireak;Saphonn, Vonthanak
背景医疗保健提供者（HCP）的专业精神是指他们的承诺和能力，以回应他们所服务的社区的健康需求，并采取行动，在病人的最佳利益。尽管人们注意到增加低收入和中等收入国家（LMIC）的HCP数量，但向HCP提供的专业教育质量及其所产生的专业精神却被忽视了。抗生素耐药性全球行动计划（AMR）旨在通过敦促患者仅通过合格的HCP获得抗生素来减少抗生素的不适当使用，前提是合格的HCP将比不合格的HCP更负责和称职地监管抗生素的获得。方法：我们调查HCP专业性的弱点是否导致合格HCP和不合格提供者之间的界限模糊，以及这些弱点如何影响两个LMIC中HCP不适当提供抗生素，并增加AMR-巴基斯坦和柬埔寨。我们对HCP、政策制定者和制药行业代表进行了85次深入访谈。我们的专题分析是基于专业精神的四个组成部分的概念框架，并侧重于确定在这两个国家反复出现的调查结果。结果尽管柬埔寨和巴基斯坦之间存在许多文化和社会人口差异，但一致的发现是，许多合格的HCP的行为并不反映他们的专业教育。我们的分析确定了加强HCP教育可以提高专业性并减少抗生素的不适当使用的五个领域：更新课程以更好地涵盖抗生素的适当使用;传授更强的沟通技能以管理患者对药物的需求;灌输基本的职业道德;建立医生，药剂师和非专业HCP之间有效合作所需的技能;并确保获得（公正的）继续医学教育。结论根据HCP专业性的弱点，我们得出结论，敦促患者只在合格的HCP寻求护理的全球指南应考虑HCP专业教育是否使他们能够以患者和社会的最佳利益行事。我们的研究结果表明，HCP专业教育迫切需要改进，这些不仅应关注课程内容和学习方法，而且还应关注毕业生的社会目的。
Background Healthcare providers' (HCPs) professionalism refers to their commitment and ability to respond to the health needs of the communities they serve and to act in the best interest of patients. Despite attention to increasing the number of HCPs in low- and middle-income countries (LMIC), the quality of professional education delivered to HCPs and their resulting professionalism has been neglected. The Global Action Plan on Antimicrobial Resistance (AMR) seeks to reduce inappropriate use of antibiotics by urging patients to access antibiotics only through qualified HCPs, on the premise that qualified HCPs will act as more responsible and competent gatekeepers of access to antibiotics than unqualified HCPs. Methods We investigate whether weaknesses in HCP professionalism result in boundaries between qualified HCPs and unqualified providers being blurred, and how these weaknesses impact inappropriate provision of antibiotics by HCPs in two LMIC with increasing AMR-Pakistan and Cambodia. We conducted 85 in-depth interviews with HCPs, policymakers, and pharmaceutical industry representatives. Our thematic analysis was based on a conceptual framework of four components of professionalism and focused on identifying recurring findings in both countries. Results Despite many cultural and sociodemographic differences between Cambodia and Pakistan, there was a consistent finding that the behaviour of many qualified HCPs did not reflect their professional education. Our analysis identified five areas in which strengthening HCP education could enhance professionalism and reduce the inappropriate use of antibiotics: updating curricula to better cover the need for appropriate use of antibiotics; imparting stronger communication skills to manage patient demand for medications; inculcating essential professional ethics; building skills required for effective collaboration between doctors, pharmacists, and lay HCPs; and ensuring access to (unbiased) continuing medical education. Conclusions In light of the weaknesses in HCP professionalism identified, we conclude that global guidelines urging patients to only seek care at qualified HCPs should consider whether HCP professional education is equipping them to act in the best interest of the patient and society. Our findings suggest that improvements to HCP professional education are needed urgently and that these should focus not only on the curriculum content and learning methods, but also on the social purpose of graduates.