印度尼西亚城市私人医生提供的结核病护理:来自标准化患者研究的结果
Bony Wiem Lestari1,2,3, Panji F Hadisoemarto1,2,4, Nur Afifah1
1Tuberculosis Working Group, Research Center for Care and Control of Infectious Diseases, Universitas Padjadjaran, Bandung, Indonesia.
PLOS global public health
|June 4, 2024
概括
印度尼西亚的私人医生经常绕过结核病 (TB) 诊断的唾液测试,更喜欢胸部X射线,有时会处方错误的结核病药物. 这凸显了对国家结核病指南进行更好的培训的需要.
科学领域:
- 公共卫生 公共卫生
- 传染病流行病学 传染病流行病学
- 医疗保健提供者实践评估评估
背景情况:
- 在印度尼西亚,社区卫生中心 (CHC) 负责初级结核病 (TB) 护理,但私人医生 (PP) 也管理许多结核病患者.
- 了解结核病管理中的PP实践对于有效的国家结核病控制至关重要.
- 目前关于PP遵守结核病指南的知识是有限的.
研究的目的:
- 评估私人医生遵守印度尼西亚国家结核病 (TB) 指南的情况.
- 将PP和CHC之间的结核病诊断和治疗实践进行比较.
- 为了识别由个人护理人员提供的结核病护理方面的差距.
主要方法:
- 利用标准化患者 (SPs) 来模拟向印尼班敦的PP和CHC提交的可疑结核病例.
- 为SPs开发了四个临床场景,不同液结果和结核病治疗史.
- 收集的数据来自341个SP访问了225个私人全科医生,29个私人专家和30个医疗保健中心.
主要成果:
- 当实验室结果无法获得时,PPs (31%的全科医生,20%的专家) 对唾液检查的坚持是低的,与CHCs (87%) 相比.
- 私立全科医生 (66%) 和专家 (84%) 经常要求进行胸部X射线 (CXR) 检查,而不是微生物检查,与CHC不同 (8%).
- 错误的结核病药物治疗方案在7%的私人GP访问和13%的专家访问中被处方,而在CHC中没有.
结论:
- 印度尼西亚的PP显示,他们更喜欢CXR,而不是用于结核病分类的微生物测试.
- 不适当的结核病药物处方是PP的担忧.
- 需要进行干预措施,以提高PP对微生物学测试的认识,并正确使用结核病药物,SP研究对影响评估有用.
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