インドにおける非公式医療提供者訓練の影響:ランダム化制御試験
Jishnu Das1,2, Abhijit Chowdhury3, Reshmaan Hussam4
1Development Research Group, The World Bank, 1818 H Street, NW, Washington, DC 20433, USA.
Science (New York, N.Y.)
|November 16, 2016
まとめ
インドの農村部における非公式の医療提供者への訓練は 患者の適切な管理を大幅に改善しました この多面的な医療訓練は,代替医療が乏しい地域において,初等医療の質を向上させるための効果的な戦略です.
科学分野:
- 世界保健
- 医療サービス研究
- 医学教育
背景:
- インドの農村部では 70%以上のプライマリケアが 非公式の医療機関によって提供されています
- 医療の質を向上させるための代替戦略が必要である.
- 訓練を受けていない医療従事者は 診断や治療に関する知識が不足しているため リスクを負うことがあります
研究 の 目的:
- 非公式の医療従事者の臨床実務に 構造化され,多面的な医療訓練プログラムが与える影響を評価する.
- 診断の正確性と一般的な疾患の適切な治療の改善における訓練の有効性を評価する.
- プライマリヘルスケアの強化のための戦略として,非公式の提供者の訓練の費用対効果を決定する.
主な方法:
- インドの田舎の304人の非公式の医療従事者を対象に ランダム化制御試験が行われました
- 152人の提供者が9ヶ月間にわたって72回の研修を受け,152人が対照群として働いた.
- 標準化された患者は 3つの異なる状態の臨床実務を評価するために使用され,提供者およびトレーナーは盲目化されました.
主要な成果:
- 訓練プログラムにより,適切なケース管理が 7.9 パーセントポイント (14.2%) 増加しました.
- 不必要な薬や抗生物質の使用に重大な影響は認められなかった.
- プログラムでは 研修生"人につき175ドルという費用が示されました
結論:
- マルチトピック医療訓練は 非公式の医療提供者が提供する プライマリケアの質を改善するための 効果的な短期戦略です
- ターゲットに絞ったトレーニングは 限られたリソースの環境で 臨床的意思決定と患者の成果を向上させることができます
- このような訓練介入の長期的な影響とスケーラビリティをさらに研究する必要があります.
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