Monitoring the impact of decentralised chronic care services on patient travel time in rural Africa - methods and results in Northern Malawi
Monitoring the impact of decentralised chronic care services on patient travel time in rural Africa - methods and results in Northern Malawi
复制标题
DOI：
10.1186/1476-072x-11-49
复制
发表时间：
2012-11-15
影响因子：
4.9
通讯作者：
Crampin, Amelia C.
中科院分区：
文献类型：
--
作者：
Houben, Rein M. G. J.;Van Boeckel, Thomas P.;Crampin, Amelia C.
背景：在资源有限的情况下，分散的卫生服务是慢性护理战略的关键部分，它缩短了病人和诊所之间的距离，从而减少了旅行所需的时间和费用。然而，几乎没有工具来评估去中心化对患者出行时间的影响，或者有多大比例的患者去最近的诊所就诊。在这里，我们利用抗逆转录病毒疗法(ART)在马拉维北部农村地区的推广数据，开发了监测旅行时间变化的方法。方法：将2005年7月至2009年7月期间在卡隆加区(北马拉维)获得抗逆转录病毒疗法(ART)服务的患者的家乡的诊所位置与GPS信息结合起来。潜在旅行时间被估计为个人前往最近诊所的旅行时间，而实际旅行时间被估计为前往诊所的时间。这使我们能够计算新诊所开业后潜在和实际出行时间的变化，并跟踪没有前往最近诊所的患者的比例和来源。结果：该模型显示了在卡龙加区开设更多ART诊所如何将潜在出行时间的中位数从83分钟减少到43分钟，以及实际出行时间的中位数从83分钟减少到47分钟。没有就近就诊的患者比例从两家诊所开业时的6%增加到四家诊所开业时的12%。讨论：将GPS信息与患者数据整合显示分散对旅行时间和诊所选择的影响，以便为政策和研究问题提供信息。在我们的案例研究中，旅行时间减少了，同时服务的接受度也增加了。然而，该模型也发现，越来越多的ART患者没有去最近的诊所就诊。
Background: Decentralised health services form a key part of chronic care strategies in resource-limited settings by reducing the distance between patient and clinic and thereby the time and costs involved in travelling. However, few tools exist to evaluate the impact of decentralisation on patient travel time or what proportion of patients attend their nearest clinic. Here we develop methods to monitor changes in travel time, using data from the antiretroviral therapy (ART) roll-out in a rural district in North Malawi.Methods: Clinic position was combined with GPS information on the home village of patients accessing ART services in Karonga District (North Malawi) between July 2005 and July 2009. Potential travel time was estimated as the travel time for an individual attending their nearest clinic, and estimated actual travel time as the time to the clinic attended. This allowed us to calculate changes in potential and actual travel time as new clinics opened and track the proportion and origin of patients not accessing their nearest clinic.Results: The model showed how the opening of further ART clinics in Karonga District reduced median potential travel time from 83 to 43 minutes, and median actual travel time fell from 83 to 47 minutes. The proportion of patients not attending their nearest clinic increased from 6% when two clinics were open, to 12% with four open.Discussion: Integrating GPS information with patient data shows the impact of decentralisation on travel time and clinic choice to inform policy and research questions. In our case study, travel time decreased, accompanied by an increased uptake of services. However, the model also identified an increasing proportion of ART patients did not attend their nearest clinic.