Continuity of care for TB patients at a South African hospital: A qualitative participatory study of the experiences of hospital staff
Continuity of care for TB patients at a South African hospital: A qualitative participatory study of the experiences of hospital staff
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DOI：
10.1371/journal.pone.0222421
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发表时间：
2019-09-18
期刊：
影响因子：
3.7
通讯作者：
Dudley, Lilian Diana
中科院分区：
文献类型：
--
作者：
Marais, Frederick;Kallon, Idriss Ibrahim;Dudley, Lilian Diana
背景在南非，确保医院和初级卫生保健服务机构结核病治疗的有效临床管理和连续性仍然具有挑战性。结核病的高负担，加上许多卫生系统的问题，影响了医院工作人员提供的结核病护理。目的从医院工作人员的角度了解影响结核病患者临床管理和出院的因素，并提出建议，以改善结核病患者的护理连续性。设计性的行动研究是用来吸引医院工作人员与结核病患者入院到中央公立医院位于南非西开普省。资料收集透过八个焦点小组讨论与护士，初级医生和病房管理人员。使用迈尔斯和休伯曼的框架进行数据分析，以确定新出现的模式，并开发主题和次主题的类别。参与者影响了研究过程的各个阶段，以更好地了解结核病临床管理和出院规划的实践在hospital.ResultsThe新兴的主题和子主题被分为两个整体部分：临床护理管理过程和出院和转诊过程。由于临床和感染预防控制方面的挑战，护士表示担心接触结核病和耐多药结核病。临床层次，跨学科团队合作差，有限的任务转移和沟通不畅，有效的临床和出院流程的干扰。由于工作量大、工作人员短缺和技能不足，结核病患者及其护理人员获得的信息和健康教育不足。尽管意识到了患者的社会经济挑战，但护理的某些方面并不是以患者为中心，护理人员也没有被纳入出院计划。医院和转诊点之间的沟通效率低下，信息系统的支持也很差。医院工作人员建议改进医院的感染预防和控制措施以及跨学科团队合作，将患者的结核病教育与医院工作人员的职能相结合，以患者为中心制定出院计划，并改善医院和初级卫生保健水平之间的沟通。需要加强医院内部和与初级卫生保健服务的沟通，以改善结核病患者护理的连续性。需要进一步研究在类似的医院环境中促进结核病护理连续性的因素和改善结核病护理连续性的干预措施。
BackgroundEnsuring effective clinical management and continuity of TB care across hospital and primary health-care services remains challenging in South Africa. The high burden of TB, coupled with numerous health system problems, influence the TB care delivered by hospital staff.ObjectiveTo understand factors from the perspectives of hospital staff that influence the clinical management and discharge of TB patients, and to elicit recommendations to improve continuity of care for TB patients.DesignParticipatory action research was used to engage hospital staff working with TB patients admitted to a central public hospital in the Western Cape province, South Africa. Data were collected through eight focus group discussions with nurses, junior doctors and ward administrators. Data analysis was done using Miles and Huberman's framework to identify emerging patterns and to develop categories with themes and sub-themes. The participants influenced all phases of the research process to inform better practices in TB clinical management and discharge planning at the hospital.ResultsThe emerging themes and sub-themes were categorized into two overall sections: The clinical care management process and the discharge and referral process. Nurses expressed a fear of exposure to TB and MDR-TB due to challenges in clinical and infection-prevention control. Clinical hierarchies, poor interdisciplinary teamwork, limited task shifting and poor communication interfered with effective clinical and discharge processes. A high workload, staff shortages and inadequate skills resulted in insufficient information and health education for TB patients and their caregivers. Despite awareness of the patients' socio-economic challenges, some aspects of care were not patient-centered, and caregivers were not included in discharge planning. Communication between the hospital and referral points was inefficient and poorly supported by information systems. Hospital staff recommended improved infection prevention and control practices and interdisciplinary teamwork in the hospital, that TB education for patients be integrated with hospital staff functions, with more patient-centered discharge planning, and improved communication across hospitals and primary health care levels.ConclusionsInterdisciplinary teamwork, more patient-centered care, and better communication within the hospital and with primary health-care services are needed for improved continuity of care for TB patients. Further studies on factors contributing to, and interventions to improve, continuity of TB care in similar hospital settings are needed.