Adoption of recommended practices and basic technologies in a low-income setting
Adoption of recommended practices and basic technologies in a low-income setting
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DOI：
10.1136/archdischild-2013-305561
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发表时间：
2014-05-01
影响因子：
5.2
通讯作者：
Nyamai, Rachel
中科院分区：
文献类型：
--
作者：
English, Mike;Gathara, David;Nyamai, Rachel
目标 在全球卫生领域，相当多的注意力集中在寻求创新上；然而，缺乏跟踪低收入国家常规医院环境采用情况的报告。 设计和设置 我们使用在肯尼亚四次独立的横断面医院调查中收集的一致指标组数据来跟踪 11 年期间（2002-2012 年）的变化。 主要结果指标 基本资源的可用性、诊断方法的使用和推荐做法的采用。 结果 28 种基本资源的可用率几乎没有变化（2002 年到 2012 年的中位数为 71%）。 2012 年为 82%），尽管针对严重营养不良的特定饲料和维生素 K 的供应有所改善。血糖和艾滋病毒检测的使用有所增加，但始终保持不适当的低水平。常见（疟疾）和不常见（腰椎穿刺）进行的诊断测试常常无法为实践提供信息，而脉搏血氧饱和度这种简单而廉价的技术即使在 2012 年也很少获得。然而，在 2006 年至 2012 年期间，人们对处方指南的遵守程度有所提高，在这段时间里，人们努力传播指南。结论 研究结果表明，临床实践的变化可能与合理规模的指南传播有关。然而，基本资源尚未实现完全可用，简单诊断和技术的潜在影响和实际影响之间可能存在重大差距，这代表了可用性、采用和成功利用方面的问题。这些发现与有关在低收入环境中扩大规模的辩论以及开发新型治疗或诊断干预措施的辩论相关。
Objective In global health considerable attention is focused on the search for innovations; however, reports tracking their adoption in routine hospital settings from low-income countries are absent.Design and setting We used data collected on a consistent panel of indicators during four separate cross-sectional, hospital surveys in Kenya to track changes over a period of 11 years (2002-2012).Main outcome measures Basic resource availability, use of diagnostics and uptake of recommended practices.Results There appeared little change in availability of a panel of 28 basic resources (median 71% in 2002 to 82% in 2012) although availability of specific feeds for severe malnutrition and vitamin K improved. Use of blood glucose and HIV testing increased but remained inappropriately low throughout. Commonly (malaria) and uncommonly (lumbar puncture) performed diagnostic tests frequently failed to inform practice while pulse oximetry, a simple and cheap technology, was rarely available even in 2012. However, increasing adherence to prescribing guidance occurred during a period from 2006 to 2012 in which efforts were made to disseminate guidelines.Conclusions Findings suggest changes in clinical practices possibly linked to dissemination of guidelines at reasonable scale. However, full availability of basic resources was not attained and major gaps likely exist between the potential and actual impacts of simple diagnostics and technologies representing problems with availability, adoption and successful utilisation. These findings are relevant to debates on scaling up in low-income settings and to those developing novel therapeutic or diagnostic interventions.