Quality of care offered to children attending primary health care clinics in Johannesburg
Quality of care offered to children attending primary health care clinics in Johannesburg
复制标题
为在 约翰内斯堡 初级卫生保健诊所就诊的儿童提供的护理质量
DOI：
--
复制
发表时间：
2010
期刊：
影响因子：
--
通讯作者：
H. Saloojee
中科院分区：
文献类型：
--
作者：
K. Thandrayen;H. Saloojee
Objective.评估南非约翰内斯堡初级卫生保健机构提供的儿童卫生服务质量。设计在16个PHC诊所进行的观察性研究。使用了一个由研究人员根据国家准则和议定书编制的结构化清单。结果大多数设施设备齐全，药物储备充足。共观察到141名患病儿童和149名健康儿童的访问。护理人员经历了漫长的等待时间（平均135（标准差72）分钟）。许多常规检查程序进行得很差，141次咨询中有108次（77%）得到了充分的诊断，尽管卫生专业人员经验丰富，训练有素。伤员分类和对危险信号的注意力很差。在几乎一半的咨询中（65/141）开了抗生素，但在三分之一的病例中抗生素的使用是不必要的。在探访患病儿童时，健康促进活动（如生长监测）始终被忽视。无论是母亲还是孩子，很少有人询问或调查艾滋病毒状况。在健康儿童访问中，生长监测和营养咨询普遍不足，11名有资格获得食物补充的儿童中没有一人得到食物补充。在非洲最富有的城市，向儿童提供的初级保健质量很差，这是对保健服务提供者没有能力有意义地满足儿童保健需要的可悲控诉。要改变现状，就需要对儿童初级保健进行深思熟虑的彻底重组，明确界定和监测标准临床实践程序和规范。
Objective. To assess the quality of child health services provided at primary health care (PHC) facilities in Johannesburg, South Africa. Design. Observational study conducted at 16 PHC clinics. A researcher-developed structured checklist, based on national guidelines and protocols, was utilised. Results. The majority of facilities were adequately equipped and well stocked with drugs. A total of 141 sick child and 149 well child visits were observed. Caregivers experienced long waiting times (mean 135 (standard deviation 72) minutes). Many routine examination procedures were poorly performed, with an adequate diagnosis established in 108 of 141 consultations (77%), even though health professionals were experienced and well trained. Triage and attention to danger signs were poor. An antibiotic was prescribed in almost half (65/141) of the consultations, but antibiotic use was unwarranted in one-third of these cases. Health promotion activities (such as growth monitoring) were consistently ignored during sick child visits. HIV status was seldom asked about or investigated, for the mother or for the child. Growth monitoring and nutritional counselling at well child visits was generally inadequate, with not one of 11 children who qualified for food supplementation receiving it. Conclusion. The poor quality of PHC offered to children in the richest city in Africa is a sad indictment of the inability of health service providers to address children’s health needs meaningfully. A deliberate and radical restructuring of PHC for children, with clearly defined and monitored standard clinical practice routines and norms, is required to change the status quo.