A Multifaceted Intervention to Improve Health Worker Adherence to Integrated Management of Childhood Illness Guidelines in Benin
A Multifaceted Intervention to Improve Health Worker Adherence to Integrated Management of Childhood Illness Guidelines in Benin
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DOI：
10.2105/ajph.2008.134411
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发表时间：
2009-05-01
影响因子：
12.7
通讯作者：
Deming, Michael S.
中科院分区：
文献类型：
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作者：
Rowe, Alexander K.;Onikpo, Faustin;Deming, Michael S.
目标。我们评估了在儿童疾病综合管理 (IMCI) 培训后支持卫生工作者的干预措施，该策略可以通过鼓励工作人员使用基于证据的指南来管理儿童死亡的主要原因，从而改善发展中国家儿童的结局。方法。我们在贝宁进行了一项随机试验。我们于 1999 年进行了一项调查，以在 IMCI 培训之前评估医疗保健质量。然后，卫生工作者接受培训以及学习支持（工作援助、非经济激励以及对工人和主管的监督）或常规支持。 2001 年至 2004 年进行的随访调查评估了推荐治疗、推荐或充分治疗以及总体指南依从性指数。结果。我们分析了 1244 次咨询。干预组和对照组的表现均有所改善，但组间没有显着差异。然而，培训进展缓慢，未经 IMCI 培训的卫生工作者提供的低质量护理削弱了干预效果。按方案分析显示，接受 IMCI 培训加研究支持的工作人员比接受培训加常规支持的工作人员提供更好的护理（推荐治疗差异 27.3 个百分点；P
Objectives. We evaluated an intervention to support health workers after training in Integrated Management of Childhood Illness (IMCI), a strategy that can improve outcomes for children in developing countries by encouraging workers' use of evidence-based guidelines for managing the leading causes of child mortality.Methods. We conducted a randomized trial in Benin. We administered a survey in 1999 to assess health care quality before IMCI training. Health workers then received training plus either study supports (job aids, nonfinancial incentives, and supervision of workers and supervisors) or usual supports. Follow-up surveys conducted in 2001 to 2004 assessed recommended treatment, recommended or adequate treatment, and an index of overall guideline adherence.Results. We analyzed 1244 consultations. Performance improved in both intervention and control groups, with no significant differences between groups. However, training proceeded slowly, and low-quality care from health workers without IMCI training diluted intervention effects. Per-protocol analyses revealed that workers with IMCI training plus study supports provided better care than did those with training plus usual supports (27.3 percentage-point difference for recommended treatment; P