社区案例管理加快马里获得医疗保健的机会:一个现实的过程评估,嵌入一个集群随机试验中
Caroline Whidden1,2, Amadou Beydi Cissé3, Faith Cole4,5
1Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
Health policy and planning
|July 26, 2024
概括
取消用户费用和专业化社区卫生工作者 (CHWs) 显著改善了马里儿童生存率和医疗保健准入. 医疗保健工作者主动的家庭访问显示了适度的效果,但与标准护理相比,没有进一步降低5岁以下的死亡率.
科学领域:
- 全球健康 全球健康
- 加强卫生系统 加强卫生系统
- 实施科学 实施科学
背景情况:
- 马里的积极社区病例管理 (ProCCM) 试验旨在改善儿童和母亲健康结果.
- 该试验涉及加强卫生系统,并将社区卫生工作者 (CHWs) 的主动家庭访问与标准的诊所服务进行比较.
研究的目的:
- 通过检查实施,机制和背景来解释ProCCM试验的观察结果.
- 了解卫生系统的加强和主动的CHW家庭访问如何影响医疗保健利用率和儿童死亡率.
主要方法:
- 一种混合方法的过程评估,使用与提供者和参与者进行深入访谈和调查.
- 临床数据的二次分析和嵌入式现实主义方法来开发和测试程序理论.
- 使用上下文-干预-行为者-机制-结果 (CIAMO) 节点来解释试验结果.
主要成果:
- 在这两项研究中,取消使用费,专业医疗保健中心和升级的初级卫生中心 (PHC) 增加了两倍的患病儿童治疗和产前访问,使5岁以下的死亡率下降了一半.
- 积极的CHW家庭访问对医疗保健利用有适度的影响,但与对照组相比,对5岁以下的死亡率没有重大影响.
- 关键机制包括由于用户费用和专业医疗保健服务的取消,促进访问,通过公平和优质的护理激励使用,并通过主动访问建立关系.
结论:
- 加强卫生系统,特别是取消使用费和专业化医疗保健中心,对于改善儿童生存率和医疗保健准入至关重要.
- 虽然主动的家庭访问激活了一些有益的机制,但它们的影响不如更广泛的系统变化那么明显.
- 解决结构性障碍和利用提供者和患者机构是实现两支机构积极健康结果的关键.
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