Barriers and Motivators of private hospitals' engagement in Tuberculosis care in Uganda.
Barriers and Motivators of private hospitals' engagement in Tuberculosis care in Uganda.
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DOI：
10.1007/s43477-021-00030-3
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发表时间：
2021-12
期刊：
影响因子：
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通讯作者：
Musiimenta A
中科院分区：
文献类型：
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作者：
Tumuhimbise W;Musiimenta A
在乌干达，私立医院参与结核病治疗的程度仍然有限。缺乏关于乌干达私立医院参与结核病护理的障碍和动机的文献。探讨民营医院参与结核病护理的障碍和激励因素。该研究采用了定性研究设计，对2020年6月从姆巴拉拉市四家城市私立医院积极参与结核病治疗的13名私人卫生保健工作者进行了深入访谈。在实施研究统一框架框架下，采用归纳、内容分析的方法进行分析。采访被转录和编码，以确定使用内容分析的关键主题。通过实施研究的综合框架，私立医院参与的障碍与成本、外部政策和激励、结构特征、网络和沟通以及对干预的认识和信念有关。这些问题包括对病人支付护理费用的关切；结核病管理的间接创收性质；缺乏药品、登记簿和诊断工具；缺乏乌干达卫生部的认可；收治肺结核病人的空间有限；缺乏适当的后续机制；缺乏培训和合格的人力资源；耽误了病人的就医时间。认为私立医院的护理质量高；隐私和保密问题；私立医院离病人较近；私立医院与政府之间合作关系的正规化是三个结构（相对优势、患者需求、资源和参与）产生的激励因素。私立医院参与结核病护理需要主要利益攸关方的承诺，并辅之以组织对这一变革的共同信念。有必要确保建立减少这些障碍的机制，以确保私立医院充分参与结核病护理。
The involvement of private hospitals in Tuberculosis care in Uganda is still limited. There is a lack of literature about the barriers and motivators to private hospitals’ engagement in Tuberculosis care in Uganda. To explore the barriers to and motivators of private hospitals’ engagement in Tuberculosis care. The study employed a qualitative study design that utilized in-depth interviews with 13 private healthcare workers purposively selected in June 2020 due to their active involvement in Tuberculosis care from four urban private hospitals in Mbarara Municipality. An inductive, content analytic approach framed by the Consolidated Framework for Implementation Research, was used for analysis. The interviews were transcribed and coded to identify key themes using content analysis. Focusing through the Consolidated Framework for Implementation Research, barriers to private hospitals’ engagement were related to cost, external policies and incentives, structure characteristics, networks and communications, and knowledge and beliefs about the intervention. These include concerns regarding the payment of care by patients; indirect income-generating nature of Tuberculosis management; lack of drugs, registers, and diagnostic tools; lack of accreditation from the Ugandan Ministry of Health; limited space for keeping Tuberculosis patients; lack of proper follow-up mechanism; lack of training and qualified human resources; and delayed seeking of health care by the patients. Perceived high quality of care in the private hospitals; privacy and confidentiality concerns; proximity of private hospitals to patients; and formalization of partnerships between private hospitals and the government were the motivators that arose from the three constructs (relative advantage, patient needs, and resources, and engaging). The engagement of private hospitals in Tuberculosis care requires commitment from key stakeholders supplemented with the organizational shared beliefs towards this change. There is a need for ensuring mechanisms for lessening these barriers to ensure full engagement of private hospitals in Tuberculosis care.