印度尼西亚私人医生遵守结核病指南的决定因素:一种定性研究
Bony Wiem Lestari1,2, Nur Afifah3, Susan McAllister4
1Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia bony.wiem@unpad.ac.id.
BMJ global health
|December 2, 2024
概括
印度尼西亚的私人医生在遵守国家结核病 (TB) 指南方面面临着许多挑战. 解决这些障碍对于改善结核病管理和高负担国家患者的治疗结果至关重要.
科学领域:
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
- 传染病管理 传染病管理
背景情况:
- 在像印度尼西亚这样的高负担国家,私人医生 (PPs) 管理大量的初始结核病 (TB) 访问.
- 印尼的公用事业单位对国家结核病指南的遵守程度较低,尽管在2019年启动了一项公私混合计划.
- 了解结核病管理中PP决策的决定因素对于改善国家结核病控制工作至关重要.
研究的目的:
- 调查影响印尼私人医生的结核管理决策的因素.
- 在印度尼西亚的私人从业者中发现遵守国家结核病指南的障碍.
主要方法:
- 半结构化的深度访谈和焦点小组讨论 (FGD) 与24个PP和6个利益相关者进行.
- 用Flottorp的检查清单分析了数据,涵盖了医疗保健专业实践的七个领域.
- 使用NVivo软件进行了定性数据分析.
主要成果:
- 在所有七个领域中都发现了遵守指南的障碍,包括指南不一致性,复杂的转诊/融资系统和有限的诊断/药物访问.
- 患者的偏好和对PP和政府利益相关者之间缺乏信任的感觉进一步阻碍了遵守.
- 结核病本身的固有复杂性也被发现使PP决策复杂化.
结论:
- 私人医生在遵守结核病指南时遇到多方面的挑战.
- 解决这些障碍对于优化临床决策和改善PPs的结核病管理至关重要.
- 加强PP与国家结核病控制战略的参与,需要采取全面的方法,针对已确定的决定因素.
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