Impact of rapid diagnostic tests for the diagnosis and treatment of malaria at a peripheral health facility in Western Uganda: an interrupted time series analysis.
Impact of rapid diagnostic tests for the diagnosis and treatment of malaria at a peripheral health facility in Western Uganda: an interrupted time series analysis.
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DOI：
10.1186/s12936-015-0725-0
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发表时间：
2015-05-15
期刊：
影响因子：
3
通讯作者：
Siedner MJ
中科院分区：
文献类型：
--
作者：
Boyce RM;Muiru A;Reyes R;Ntaro M;Mulogo E;Matte M;Siedner MJ
世界卫生组织建议，所有疟疾疑似病例在接受青蒿素类复方疗法治疗之前，都要接受寄生虫学诊断。最近对评价RDT用于发热患者管理的临床试验进行的一项荟萃分析发现，当卫生工作者遵守基于测试结果的治疗方案时，抗疟疾处方大幅减少。然而，很少有研究报告RDT对研究环境以外的卫生系统的影响。该研究包括一项回顾性中断时间序列分析，比较在乌干达西部农村的一个外围卫生设施引入RDT前后的疟疾诊断率、治疗率和资源利用率。在整个研究期间，疟疾诊断测试的使用以图形方式描述，并拟合回归模型以确定三个感兴趣结果的相关性：（1）住院时间（2）转诊到更高级别卫生机构的患者比例，以及（3）抗生素的管理。在研究期间，14，357人接受了RDT（9，807人）或显微镜（4，550人）的疟疾诊断检测。在引入RDT后，基于寄生虫诊断的患者比例增加了两倍多，达到34%。RDTs在很大程度上取代了显微镜作为诊断方法的选择。与在RDT前阶段收治的患者相比，在RDT后阶段收治的疟疾患者被转介到另一个保健中心的几率显著降低（AOR = 0.49，P = 0.038），接受抗生素治疗（AOR = 0.42，P < 0.001），平均住院时间显著缩短（β = −0.32天，95%CI −0.52至−0.13）。这项研究是为数不多的，以证明在乌干达的农村卫生设施的疟疾诊断RDTs引入后，临床结果和过程措施的显着改善。结果显示，即使抗生素处方频率降低，转诊率也降低，平均住院LOS缩短。这一变化大大增加了实验室的吞吐量和由此产生的比例的病人接受寄生虫为基础的诊断。
The World Health Organization recommends that all suspected malaria cases receive a parasitological diagnosis prior to treatment with artemisinin-based combination therapy. A recent meta-analysis of clinical trials evaluating RDTs for the management of patients with fever found substantial reductions in anti-malarial prescriptions when health workers adhered to treatment protocols based on test results. However few studies have reported on the impact of RDTs on health systems outside research settings. The study comprised a retrospective interrupted time series analysis, comparing rates of malaria diagnosis, treatment, and resource utilization before and after introduction of RDTs at a peripheral health facility in rural Western Uganda. The use of malaria diagnostic tests was graphically depicted throughout the study period and fit regression models to identify correlates of three outcomes of interest: (1) length of stay (2) the proportion of patients referred to a higher-level health facility, and (3) administration of antibiotics. Over the course of the study period, 14,357 individuals underwent diagnostic testing for malaria with either a RDT (9,807) or microscopy (4,550). The proportion of patients with parasite-based diagnoses more than tripled to 34 % after the introduction of RDTs. RDTs largely replaced microscopy as the diagnostic method of choice. Compared to patients admitted during the pre-RDT period, patients admitted to the health centre with malaria in the post-RDT period had significantly reduced odds of being referred to another health centre (AOR = 0.49, P = 0.038), receiving antibiotics (AOR = 0.42, P < 0.001), and a significantly shorter mean length of stay (β = −0.32 days, 95 %CI −0.52 to −0.13). This study is one of the few to demonstrate significant improvement in clinical outcomes and process measures following the introduction of RDTs for the diagnosis of malaria at a rural health facility in Uganda. The results show a reduction in referrals and shorter mean inpatient LOS even as antibiotics were prescribed less frequently. This change greatly increased laboratory throughput and the resultant proportion of patients receiving a parasite-based diagnosis.
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影响因子：
8.4
作者：
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通讯作者：
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DOI：
10.1016/j.trstmh.2008.10.003
发表时间：
2009-04-01
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2000-09-01
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