Affordability, availability and acceptability barriers to health care for the chronically ill: longitudinal case studies from South Africa.
Affordability, availability and acceptability barriers to health care for the chronically ill: longitudinal case studies from South Africa.
复制标题
DOI：
10.1186/1472-6963-9-75
复制
发表时间：
2009-05-09
影响因子：
2.8
通讯作者：
Mills A
中科院分区：
文献类型：
--
作者：
Goudge J;Gilson L;Russell S;Gumede T;Mills A
在低收入和中等收入国家，结核病/艾滋病毒以及非传染性疾病造成的慢性病负担日益加重。为满足慢性病患者的需要而组织的卫生系统很少，需要更好地了解患者对获得护理的困难的看法，特别是在资源贫乏的环境中，以实现这一目标。本文介绍了贫困家庭的经验，试图在南非农村地区获得慢性病护理。一个家庭调查（n = 1446人）相结合的定性纵向研究，随后30个案例研究家庭超过10个月。疾病叙述和日记提供了家庭与卫生系统互动的描述性文本数据。在调查中，74%报告的健康问题是“慢性”的，其中48%在上个月没有采取任何治疗措施。在个案研究的住户中，34名慢性病患者中，只有21名（62%）有对抗疗法诊断，只有12名（35%）接受定期治疗。由于以前的疾病和死亡、低收入和有限的社交网络，生计枯竭，无法进行咨询，每月重复咨询的支出高达收入的60%。药品供应中断，诊所一级的临床服务不足，需要转诊，以及缺乏救护车，进一步阻碍了获得护理。提供者与患者之间的互动不佳导致对疾病的理解不足，治疗行动不当，“治疗师购物”，有时合作破裂，患者“放弃"公共卫生系统。然而，富有成效的病人提供者的互动不仅促进了适当的治疗行动，但使病人能够证明他们需要的经济援助的家庭和邻居，因此获得照顾。此外，了解疾病的患者及其家属成为社区资源，可用于帮助他人。在加强公共部门方面，不仅要改善药品供应链、救护车服务、转诊系统和公共诊所的临床能力，解决社会弱势群体面临的财政困难，而且要考虑供应商如何以加强治疗联盟的方式与患者接触。
There is an increasing burden of chronic illness in low and middle income countries, driven by TB/HIV, as well as non-communicable diseases. Few health systems are organized to meet the needs of chronically ill patients, and patients' perspectives on the difficulties of accessing care need to be better understood, particularly in poor resourced settings, to achieve this end. This paper describes the experience of poor households attempting to access chronic care in a rural area of South Africa. A household survey (n = 1446 individuals) was combined with qualitative longitudinal research that followed 30 case study households over 10 months. Illness narratives and diaries provided descriptive textual data of household interactions with the health system. In the survey 74% of reported health problems were 'chronic', 48% of which had no treatment action taken in the previous month. Amongst the case study households, of the 34 cases of chronic illness, only 21 (62%) cases had an allopathic diagnosis and only 12 (35%) were receiving regular treatment. Livelihoods exhausted from previous illness and death, low income, and limited social networks, prevented consultation with monthly expenditure for repeated consultations as high as 60% of income. Interrupted drug supplies, insufficient clinical services at the clinic level necessitating referral, and a lack of ambulances further hampered access to care. Poor provider-patient interaction led to inadequate understanding of illness, inappropriate treatment action, 'healer shopping', and at times a break down in cooperation, with the patient 'giving up' on the public health system. However, productive patient-provider interactions not only facilitated appropriate treatment action but enabled patients to justify their need for financial assistance to family and neighbours, and so access care. In addition, patients and their families with understanding of a disease became a community resource drawn on to assist others. In strengthening the public sector it is important not only to improve drug supply chains, ambulance services, referral systems and clinical capacity at public clinics, and to address the financial constraints faced by the socially disadvantaged, but also to think through how providers can engage with patients in a way that strengthens the therapeutic alliance.
登录
查看更多内容
影响因子：
2.9
作者：
Alberti, Hugh;Boudriga, Nessiba;Nabli, Mounira
通讯作者：
Nabli, Mounira
影响因子：
6.4
作者：
Bedelu, Martha;Ford, Nathan;Reuter, Hermann
通讯作者：
Reuter, Hermann
影响因子：
6.9
作者：
Bebbington, A
通讯作者：
Bebbington, A
影响因子：
24.3
作者：
Cabral, ALB;Carvalho, WAF;Martins, MA
通讯作者：
Martins, MA
影响因子：
4.9
作者：
Barnighausen, Till;Bloom, David E.;Humair, Salal
通讯作者：
Humair, Salal