Perception of the healthcare professionals towards the current trauma and emergency care system in Kabul, Afghanistan: a mixed method study.
Perception of the healthcare professionals towards the current trauma and emergency care system in Kabul, Afghanistan: a mixed method study.
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DOI：
10.1186/s12913-020-05845-8
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发表时间：
2020-10-29
影响因子：
2.8
通讯作者：
Siddiqi S
中科院分区：
文献类型：
--
作者：
Khudadad U;Aftab W;Ali A;Khan NU;Razzak J;Siddiqi S
在阿富汗，创伤和伤害占全因死亡的11%。这项研究旨在探讨医疗保健提供者(院前和住院期间)、医院管理人员和公共和私营卫生部门的政策制定者的看法，以确定在阿富汗喀布尔提供有效创伤护理方面的挑战。采用同步混合方法设计，包括2019年7月15日至9月25日期间创伤护理系统的关键信息者访谈(N = 18)和同步结构化紧急护理系统评估问卷(N = 35)。访谈采用内容分析法，并对结构化问卷数据进行描述性分析。确定了四个描述挑战的主题：1)院前护理，2)有凝聚力的创伤管理系统，3)物质和人力资源，4)管理。在更广泛的创伤护理系统中，发现了与现场和交通护理、医院护理和应急准备有关的一些关键挑战。只有不到25%的人口得到了院前救护车系统的覆盖(n = 23，65.7%)，卫生保健机构之间没有沟通程序来促进转移(n = 28，80%)。在需要紧急手术的受伤患者中，只有不到25%的患者能够在受伤后2小时内在配备工作人员的手术室获得外科护理(n = 19，54.2%)，并且没有对紧急护理系统动员资源(人力和物力)以应对灾难和其他大规模紧急情况的能力进行定期评估(n = 28，80%)。这项研究强调了在阿富汗喀布尔提供创伤护理服务方面的主要挑战。系统地改进工作人员培训、创伤护理系统的结构组织以及实施经外部验证的创伤管理临床指南，可能会加强现有创伤护理服务的功能。然而，一个综合的国营创伤护理系统将在阿富汗更广泛的医疗系统内更有效地解决当前创伤伤害的负担。
Trauma and injury contribute to 11% of the all-cause mortality in Afghanistan. The study aimed to explore the perceptions of the healthcare providers (pre and in-hospital), hospital managers and policy makers of the public and private health sectors to identify the challenges in the provision of an effective trauma care in Kabul, Afghanistan. A concurrent mixed method design was used, including key-informant interviews (healthcare providers, hospital managers and policy makers) of the trauma care system (N = 18) and simultaneous structured emergency care system assessment questionnaire (N = 35) from July 15 to September 25, 2019. Interviews were analyzed using content analysis approach and structured questionnaire data were descriptively analyzed. Four themes were identified that describe the challenges: 1) pre-hospital care, 2) cohesive trauma management system, 3) physical and human resources and 4) stewardship. Some key challenges were found related to scene and transportation care, in-hospital care and emergency preparedness within the wider trauma care system. Less than 25% of the population is covered by the pre-hospital ambulance system (n = 23, 65.7%) and there is no communication process between health care facilities to facilitate transfer (n = 28, 80%). Less than 25% of patients with an injury requiring emergent surgery have access to surgical care in a staffed operating theatre within 2 h of injury (n = 19, 54.2%) and there is no regular assessment of the ability of the emergency care system to mobilize resources (human and physical) to respond to disasters, and other large-scale emergencies (n = 28, 80%). This study highlighted major challenges in the delivery of trauma care services across Kabul, Afghanistan. Systematic improvement in the workforce training, structural organization of the trauma care system and implementing externally validated clinical guidelines for trauma management could possibly enhance the functions of the existing trauma care services. However, an integrated state-run trauma care system will address the current burden of traumatic injury more effectively within the wider healthcare system of Afghanistan.
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影响因子：
3.2
作者：
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通讯作者：
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DOI：
10.4997/jrcpe.2015.303
发表时间：
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影响因子：
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1994-05-01
影响因子：
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影响因子：
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