Adapting a nurse-led primary care initiative to cardiovascular disease control in Ghana: a qualitative study
Adapting a nurse-led primary care initiative to cardiovascular disease control in Ghana: a qualitative study
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DOI：
10.1186/s12889-020-08529-4
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发表时间：
2020-05-24
影响因子：
4.5
通讯作者：
Heller, David J.
中科院分区：
文献类型：
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作者：
Haykin, Leah A.;Francke, Jordan A.;Heller, David J.
心血管疾病（CVD）是加纳发病率和死亡率不断上升的原因，加纳农村初级卫生保健主要由社区卫生规划和服务（CHPS）倡议提供。卫生和保健服务中心在社区一级的诊所安排护士提供基本的治疗和预防保健服务，并提供家庭和外展服务。但CHPS目前缺乏筛查或治疗CVD及其危险因素的能力。方法在两个农村地区，我们进行了深入的访谈，21名护士和10名护士主管，以确定制约或促进CVD筛查和治疗的因素。录音被转录，编码的内容，并分析的关键主题。结果受访者强调三个主题：社区对心血管疾病护理的需求;社区获得心血管疾病护理的机会;以及提供者提供心血管疾病护理的能力。护士和主管指出，社区成员往往不知道心血管疾病，尽管高报告的患病率的危险因素。社区成员一旦确诊，就无法前往护理或负担治疗费用。护士缺乏治疗高血压等疾病的相关培训和药物。受访者认识到心血管疾病护理的重要性，表示有兴趣获得进一步的培训，并强调需要改善初级保健业务的辅助支持。结论CHPS的工作人员表示多种限制CVD护理，但也列举了解决这些问题的行动：CVD为重点的培训，提供必要的设备和药品，社区教育活动，转诊和外展运输设备。结果证明，需要对这些干预措施进行试验，以评估其对心血管疾病风险因素（如高血压、抑郁症和酗酒）的影响。
Background Cardiovascular Disease (CVD) is a growing cause of morbidity and mortality in Ghana, where rural primary health care is provided mainly by the Community-based Health Planning and Services (CHPS) initiative. CHPS locates nurses in community-level clinics for basic curative and preventive health services and provides home and outreach services. But CHPS currently lacks capacity to screen for or treat CVD and its risk factors. Methods In two rural districts, we conducted in-depth interviews with 21 nurses and 10 nurse supervisors to identify factors constraining or facilitating CVD screening and treatment. Audio recordings were transcribed, coded for content, and analyzed for key themes. Results Respondents emphasized three themes: community demand for CVD care; community access to CVD care; and provider capacity to render CVD care. Nurses and supervisors noted that community members were often unaware of CVD, despite high reported prevalence of risk factors. Community members were unable to travel for care or afford treatment once diagnosed. Nurses lacked relevant training and medications for treating conditions such as hypertension. Respondents recognized the importance of CVD care, expressed interest in acquiring further training, and emphasized the need to improve ancillary support for primary care operations. Conclusions CHPS staff expressed multiple constraints to CVD care, but also cited actions to address them: CVD-focused training, provision of essential equipment and pharmaceuticals, community education campaigns, and referral and outreach transportation equipment. Results attest to the need for trial of these interventions to assess their impact on CVD risk factors such as hypertension, depression, and alcohol abuse.