Prescriber and patient-oriented behavioural interventions to improve use of malaria rapid diagnostic tests in Tanzania: facility-based cluster randomised trial.
Prescriber and patient-oriented behavioural interventions to improve use of malaria rapid diagnostic tests in Tanzania: facility-based cluster randomised trial.
复制标题
DOI：
10.1186/s12916-015-0346-z
复制
发表时间：
2015-05-15
期刊：
影响因子：
9.3
通讯作者：
Reyburn H
中科院分区：
文献类型：
--
作者：
Cundill B;Mbakilwa H;Chandler CI;Mtove G;Mtei F;Willetts A;Foster E;Muro F;Mwinyishehe R;Mandike R;Olomi R;Whitty CJ;Reyburn H
为区分疟疾和非疟疾发热而增加对疟疾快速诊断检测的投资，以及认识到需要改善非疟疾发热病例管理，表明迫切需要高质量的证据，说明如何最好地改善处方者的做法。2010年9月至2012年3月，在坦桑尼亚东北部两个疟疾传播一直在下降的农村地区的36个初级卫生保健机构进行了一项三臂分层整群随机试验。干预措施的指导下形成的混合方法的研究，并介绍了在阶段。所有设施的处方人员都接受了卫生部RDT的标准培训。来自卫生工作者（HW）和卫生工作者-患者（HWP）机构的处方者进一步参加了小型互动同行培训课程，HWP还收到了诊所海报和患者传单。性能反馈和激励性手机短信（SMS）被添加到硬件和HWP武器在以后的阶段。主要结果是非严重、非疟疾疾病患者错误地使用（推荐的）抗疟药的比例。次要结局研究RDT摄取、结果依从性和抗生素处方。标准RDT培训降低了试验前抗疟药物处方的水平，并在整个试验期间持续存在。两种干预措施都显著降低了推荐抗疟药的错误处方，（749/8，942），标准训练组为2% HW组（250/10，118）（调整后的RD（aRD）4%; 95%置信区间（CI）1%至6%; P = 0.008）和2%（184/10，163）（aRD 4%; 95% CI 1%至6%; P = 0.005）。小组训练和SMS逐渐有效。对RDT阴性患者的抗疟药处方也显著减少，但对接受ACT的RDT阳性患者没有影响。与试验前水平相比，HWP组的抗生素处方量显著降低，但所有组的抗生素处方量均增加。SMS的小组培训与处方者对RDT结果的依从性的增量和持续改善相关，并将抗疟药物的过度处方减少到接近零。这些干预措施可能变得越来越重要，以应对非洲急性发热性疾病患者更广泛的诊断和治疗选择。ClinicalTrials.gov 本文的在线版本（doi：10.1186/s12916 - 015 - 0346-z）包含补充材料，可供授权用户使用。
The increasing investment in malaria rapid diagnostic tests (RDTs) to differentiate malarial and non-malarial fevers, and an awareness of the need to improve case management of non-malarial fever, indicates an urgent need for high quality evidence on how best to improve prescribers’ practices. A three-arm stratified cluster-randomised trial was conducted in 36 primary healthcare facilities from September 2010 to March 2012 within two rural districts in northeast Tanzania where malaria transmission has been declining. Interventions were guided by formative mixed-methods research and were introduced in phases. Prescribing staff from all facilities received standard Ministry of Health RDT training. Prescribers from facilities in the health worker (HW) and health worker-patient (HWP) arms further participated in small interactive peer-group training sessions with the HWP additionally receiving clinic posters and patient leaflets. Performance feedback and motivational mobile-phone text messaging (SMS) were added to the HW and HWP arms in later phases. The primary outcome was the proportion of patients with a non-severe, non-malarial illness incorrectly prescribed a (recommended) antimalarial. Secondary outcomes investigated RDT uptake, adherence to results, and antibiotic prescribing. Standard RDT training reduced pre-trial levels of antimalarial prescribing, which was sustained throughout the trial. Both interventions significantly lowered incorrect prescribing of recommended antimalarials from 8% (749/8,942) in the standard training arm to 2% (250/10,118) in the HW arm (adjusted RD (aRD) 4%; 95% confidence interval (CI) 1% to 6%; P = 0.008) and 2% (184/10,163) in the HWP arm (aRD 4%; 95% CI 1% to 6%; P = 0.005). Small group training and SMS were incrementally effective. There was also a significant reduction in the prescribing of antimalarials to RDT-negatives but no effect on RDT-positives receiving an ACT. Antibiotic prescribing was significantly lower in the HWP arm but had increased in all arms compared with pre-trial levels. Small group training with SMS was associated with an incremental and sustained improvement in prescriber adherence to RDT results and reducing over-prescribing of antimalarials to close to zero. These interventions may become increasingly important to cope with the wider range of diagnostic and treatment options for patients with acute febrile illness in Africa. ClinicalTrials.gov (#NCT01292707) 29 January 2011. The online version of this article (doi:10.1186/s12916-015-0346-z) contains supplementary material, which is available to authorized users.
登录
查看更多内容
DOI：
10.1136/bmj.c930
发表时间：
2010-03-05
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Ansah EK;Narh-Bana S;Epokor M;Akanpigbiam S;Quartey AA;Gyapong J;Whitty CJ
通讯作者：
Whitty CJ
DOI：
10.1136/bmj.e4389
发表时间：
2012-07-24
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Leslie T;Mikhail A;Mayan I;Anwar M;Bakhtash S;Nader M;Chandler C;Whitty CJ;Rowland M
通讯作者：
Rowland M
影响因子：
7.2
作者：
McCambridge, Jim;Kypri, Kypros;Elbourne, Diana
通讯作者：
Elbourne, Diana
影响因子：
3
作者：
Mtove G;Amos B;Nadjm B;Hendriksen IC;Dondorp AM;Mwambuli A;Kim DR;Ochiai RL;Clemens JD;von Seidlein L;Reyburn H;Deen J
通讯作者：
Deen J
影响因子：
3
作者：
Chandler, Clare I. R.;Jones, Caroline;Whitty, Christopher J. M.
通讯作者：
Whitty, Christopher J. M.