Health service providers' perceptions of barriers to tuberculosis care in Russia
Health service providers' perceptions of barriers to tuberculosis care in Russia
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DOI：
10.1093/heapol/czl014
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发表时间：
2006-07-01
影响因子：
3.2
通讯作者：
Coker, R.
中科院分区：
文献类型：
--
作者：
Dimitrova, B.;Balabanova, D.;Coker, R.
在过去十年中，俄罗斯联邦的结核病发病率显著上升。公共卫生结核病控制机构仍然大致沿用1990年前的模式，尽管在实施世界卫生组织的“直接监督短程治疗”(DOTS)战略方面实施了大量的投资和宣传方案。2002年，我们开展了一项定性研究，以探索卫生保健提供者对俄罗斯萨马拉奥布拉斯市现有获得结核病服务障碍的看法。与来自城市和农村地区设施的医生和护士进行了六次焦点小组讨论。使用应用政策研究的框架方法对数据进行分析。在相互关联的领域中确定了获得护理的障碍：与卫生保健系统有关的障碍、与护理程序有关的障碍、与更广泛的背景问题有关的障碍、与患者个人特征和行为有关的障碍。在卫生保健系统中，资金不足被认为是导致筛查覆盖率下降、工资低、工作人员短缺、药品供应不规范和基础设施陈旧的根本问题。与一般保健服务和社会服务的次优协作限制了向患者提供护理和社会支持的机会。日益恶化的社会经济条件既被视为结核病的原因，也被视为获得护理的主要障碍。行为特征被认为是有效护理和治疗的重要障碍，卫生工作人员支持对“不顺从”的患者进行强制治疗，并让警察参与追查违规者。结核病与耻辱有着深刻的联系，这导致获得护理的延迟和确保治疗成功的障碍。
The Russian Federation has witnessed a marked rise in rates of tuberculosis (TB) over the past decade. Public health TB control institutions remain broadly modelled along pre-1990 lines despite substantial programmes of investment and advocacy in implementing the World Health Organization's 'Directly Observed Treatment-short course' (DOTS) strategy. In 2002, we undertook a qualitative study to explore health care providers' perceptions of existing barriers to access to TB services in Samara Oblast in Russia. Six focus group discussions were conducted with physicians and nurses from facilities in urban and rural areas. Data were analyzed using a framework approach for applied policy research. Barriers to access to care were identified in interconnected areas: barriers associated with the health care system, care process barriers, barriers related to wider contextual issues, and barriers associated with patients' personal characteristics and behaviour. In the health care system, insufficient funding was identified as an underlying problem resulting in a decrease in screening coverage, low salaries, staff shortages, irregularities in drug supplies and outdated infrastructure. Suboptimal collaboration with general health services and social services limits opportunities for care and social support to patients. Worsening socioeconomic conditions were seen both as a cause of TB and a major obstacle to access to care. Behavioural characteristics were identified as an important barrier to effective care and treatment, and health staff favoured compulsory treatment for 'noncompliant' patients and involvement of the police in defaulter tracing. TB was profoundly associated with stigma and this resulted in delays in accessing care and barriers to ensuring treatment success.