Opportunities to catalyse improved healthcare access in pluralistic systems: a cross-sectional study in Haiti.
Opportunities to catalyse improved healthcare access in pluralistic systems: a cross-sectional study in Haiti.
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DOI：
10.1136/bmjopen-2020-047367
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发表时间：
2021-11-22
期刊：
影响因子：
2.9
通讯作者：
Nelson EJ
中科院分区：
文献类型：
--
作者：
Klarman M;Schon J;Cajusma Y;Maples S;Beau de Rochars VEM;Baril C;Nelson EJ
确定在依赖传统和非传统提供者的多元化医疗保健系统中预期与实际就医行为的决定因素，并发现促进改善医疗保健服务的机会。横断面研究。在海地，对568个有5岁以下儿童的家庭（包括2900名成员）进行了地理随机抽样，并按人口密度分层。这些家庭确定了他们经常光顾的医疗服务提供者。在140个提供者中，找到并登记了65个。家庭问卷与标准化的情况下（意图）进行了比较，自我回忆的健康事件（行为）。家庭及其供应商的连通性通过网络分析确定。家庭在前一个月报告了636起健康事件。35%（n=220）的家庭寻求护理，44%（n=277）的家庭接受家庭治疗。严重事件寻求治疗的几率增加了217%（校正OR（aOR）=3.17; 95%CI 1.99 - 5.05; p<0.001）。随着距离的增加，寻求传统医疗服务提供者的几率增加了37%（aOR=1.37; 95%CI 1.06至1.79; p=0.016）。尽管声明有意向传统提供者寻求护理，但在实践中缺乏有利于非传统提供者的一致性（McNemar χ2检验p<0.001）。在三级网络中，68%（n=150）的病例寻求初级提供者的护理; 25%（n=38/150）为非传统护理。应优先考虑解决地理障碍（可能使用技术解决方案），以满足医疗保健需求，同时开发方法，在无法克服地理障碍时将非传统提供商连接到医疗保健网络。
To identify determinants of intended versus actual care-seeking behaviours in a pluralistic healthcare system that is reliant on both conventional and non-conventional providers and discover opportunities to catalyse improved healthcare access. Cross-sectional study. In Haiti 568 households (incorporating 2900 members) with children less than 5 years of age were randomly sampled geographically with stratifications for population density. These households identified the healthcare providers they frequented. Among 140 providers, 65 were located and enrolled. Household questionnaires with standardised cases (intentions) were compared with self-recall of health events (behaviours). The connectedness of households and their providers was determined by network analysis. Households reported 636 health events in the prior month. Households sought care for 35% (n=220) and treated with home remedies for 44% (n=277). The odds of seeking care increased 217% for severe events (adjusted OR (aOR)=3.17; 95% CI 1.99 to 5.05; p<0.001). The odds of seeking care from a conventional provider increased by 37% with increasing distance (aOR=1.37; 95% CI 1.06 to 1.79; p=0.016). Despite stating an intention to seek care from conventional providers, there was a lack of congruence in practice that favoured non-conventional providers (McNemar’s χ2 test p<0.001). Care was sought from primary providers for 68% (n=150) of cases within a three-tiered network; 25% (n=38/150) were non-conventional. Addressing geographic barriers, possibly with technology solutions, should be prioritised to meet healthcare seeking intentions while developing approaches to connect non-conventional providers into healthcare networks when geographic barriers cannot be overcome.
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影响因子：
2.8
作者：
Akinyemi, Joshua O.;Banda, Pamela;Odimegwu, Clifford O.
通讯作者：
Odimegwu, Clifford O.
影响因子：
5.4
作者：
Ellis, Amy A.;Winch, Peter;Swedberg, Eric
通讯作者：
Swedberg, Eric
DOI：
10.11604/pamj.2017.28.4.12589
发表时间：
2017
期刊：
The Pan African medical journal
影响因子：
--
作者：
Moise K;Bernard JJ;Henrys JH
通讯作者：
Henrys JH
DOI：
10.4269/ajtmh.12-0756
发表时间：
2013-07
期刊：
The American journal of tropical medicine and hygiene
影响因子：
--
作者：
Manna B;Nasrin D;Kanungo S;Roy S;Ramamurthy T;Kotloff KL;Levine MM;Sur D
通讯作者：
Sur D
影响因子：
5.4
作者：
Pepinsky, Thomas B.
通讯作者：
Pepinsky, Thomas B.