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Coarasa J, Das J, Gummerson E, Bitton A. A systematic tale of two differing reviews: evaluating the evidence on public and private sector quality of primary care in low and middle income countries. Global Health 2017; 13:24. [PMID: 28403871 PMCID: PMC5389193 DOI: 10.1186/s12992-017-0246-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 03/16/2017] [Indexed: 11/10/2022] Open
Abstract
Systematic reviews are powerful tools for summarizing vast amounts of data in controversial areas; but their utility is limited by methodological choices and assumptions. Two systematic reviews of literature on the quality of private sector primary care in low and middle income countries (LMIC), published in the same journal within a year, reached conflicting conclusions. The difference in findings reflects different review methodologies, but more importantly, a weak underlying body of literature. A detailed examination of the literature cited in both reviews shows that only one of the underlying studies met the gold standard for methodological robustness. Given the current policy momentum on universal health coverage and primary health care reform across the globe, there is an urgent need for high quality empirical evidence on the quality of private versus public sector primary health care in LMIC.
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Affiliation(s)
- Jorge Coarasa
- World Bank, KK Birla Marg, Lodhi Estate, New Delhi, India 110003
| | - Jishnu Das
- World Bank, MSN MC3-311, 1818 H Street, NW, Washington, DC 20433 USA
- Center for Policy Research, New Delhi, India
| | - Elizabeth Gummerson
- The International Center for AIDS Care and Treatment Programs, Columbia University, Mailman School of Public Health, 722 W. 168th Street, 13th floor MSPH, Box 18, New York, NY 10032 USA
| | - Asaf Bitton
- Ariadne Labs, Harvard T.H. Chan School of Public Health and Brigham & Women’s Hospital, 401 Park Drive, Third Floor East, Boston, MA 02215 USA
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102
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Fitzpatrick A, Tumlinson K. Strategies for Optimal Implementation of Simulated Clients for Measuring Quality of Care in Low- and Middle-Income Countries. GLOBAL HEALTH: SCIENCE AND PRACTICE 2017; 5:108-114. [PMID: 28126970 PMCID: PMC5493448 DOI: 10.9745/ghsp-d-16-00266] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/22/2016] [Indexed: 11/17/2022]
Abstract
When properly implemented, use of simulated clients (“mystery clients”) can provide insight into actual experiences of real clients and evaluate quality of care. Successful implementation calls for recruiting mystery clients who represent the facility's clientele, have strong recall of recent events, and are comfortable being undercover data collectors. Developing training protocols and checklists to standardize mystery client behavior and responses is also key. The use of simulated clients or “mystery clients” is a data collection approach in which a study team member presents at a health care facility or outlet pretending to be a real customer, patient, or client. Following the visit, the shopper records her observations. The use of mystery clients can overcome challenges of obtaining accurate measures of health care quality and improve the validity of quality assessments, particularly in low- and middle-income countries. However, mystery client studies should be carefully designed and monitored to avoid problems inherent to this data collection approach. In this article, we discuss our experiences with the mystery client methodology in studies conducted in public- and private-sector health facilities in Kenya and in private-sector facilities in Uganda. We identify both the benefits and the challenges in using this methodology to guide other researchers interested in using this technique. Recruitment of appropriate mystery clients who accurately represent the facility's clientele, have strong recall of recent events, and are comfortable in their role as undercover data collectors are key to successful implementation of this methodology. Additionally, developing detailed training protocols can help ensure mystery clients behave identically and mimic real patrons accurately while short checklists can help ensure mystery client responses are standardized. Strict confidentiality and protocols to avoid unnecessary exams or procedures should also be stressed during training and monitored carefully throughout the study. Despite these challenges, researchers should consider mystery client designs to measure actual provider behavior and to supplement self-reported provider behavior. Data from mystery client studies can provide critical insight into the quality of service provision unavailable from other data collection methods. The unique information available from the mystery client approach far outweighs the cost.
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Affiliation(s)
- Anne Fitzpatrick
- Department of Economics, University of Massachusetts-Boston, Boston, MA, USA.
| | - Katherine Tumlinson
- The Office of Population Research, Wallace Hall, Princeton University, Princeton, NJ, USA. Now with the Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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103
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Mohanan M, Giardili S, Das V, Rabin TL, Raj SS, Schwartz JI, Seth A, Goldhaber-Fiebert JD, Miller G, Vera-Hernández M. Evaluation of a social franchising and telemedicine programme and the care provided for childhood diarrhoea and pneumonia, Bihar, India. Bull World Health Organ 2017; 95:343-352E. [PMID: 28479635 PMCID: PMC5418816 DOI: 10.2471/blt.16.179556] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 12/20/2016] [Accepted: 01/31/2017] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the impact on the quality of the care provided for childhood diarrhoea and pneumonia in Bihar, India, of a large-scale, social franchising and telemedicine programme – the World Health Partners’ Sky Program. Methods We investigated changes associated with the programme in the knowledge and performance of health-care providers by carrying out 810 assessments in a representative sample of providers in areas where the programme was and was not implemented. Providers were assessed using hypothetical patient vignettes and the standardized patient method both before and after programme implementation, in 2011 and 2014, respectively. Differences in providers’ performance between implementation and nonimplementation areas were assessed using multivariate difference-in-difference linear regression models. Findings The programme did not significantly improve health-care providers’ knowledge or performance with regard to childhood diarrhoea or pneumonia in Bihar. There was a persistent large gap between knowledge of appropriate care and the care actually delivered. Conclusion Social franchising has received attention globally as a model for delivering high-quality care in rural areas in the developing world but supporting data are scarce. Our findings emphasize the need for sound empirical evidence before social franchising programmes are scaled up.
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Affiliation(s)
- Manoj Mohanan
- Sanford School of Public Policy, Duke University, 302 Towerview Drive, 128 Rubenstein Hall, Durham, North Carolina, NC 27708, United States of America (USA)
| | - Soledad Giardili
- Department of Economics, Queen Mary University of London, London, England
| | - Veena Das
- Department of Anthropology, Johns Hopkins University, Baltimore, USA
| | - Tracy L Rabin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, USA
| | - Sunil S Raj
- Indian Institute of Public Health, New Delhi, India
| | - Jeremy I Schwartz
- Department of Internal Medicine, Yale University School of Medicine, New Haven, USA
| | - Aparna Seth
- Sambodhi Research and Communications Pvt. Ltd., New Delhi, India
| | - Jeremy D Goldhaber-Fiebert
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, USA
| | - Grant Miller
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, USA
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104
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Puri L, Das J, Pai M, Agrawal P, Fitzgerald JE, Kelley E, Kesler S, Mate K, Mohanan M, Okrainec A, Aggarwal R. Enhancing quality of medical care in low income and middle income countries through simulation-based initiatives: recommendations of the Simnovate Global Health Domain Group. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2017. [DOI: 10.1136/bmjstel-2016-000180] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BackgroundQuality of medical care in low income and middle income countries (LMICs) is variable, resulting in significant medical errors and adverse patient outcomes. Integration of simulation-based training and assessment may be considered to enhance quality of patient care in LMICs. The aim of this study was to consider the role of simulation in LMICs, to directly impact health professions education, measurement and assessment.MethodsThe Simnovate Global Health Domain Group undertook three teleconferences and a direct face-to-face meeting. A scoping review of published studies using simulation in LMICs was performed and, in addition, a detailed survey was sent to the World Directory of Medical Schools and selected known simulation centres in LMICs.ResultsStudies in LMICs employed low-tech manikins, standardised patients and procedural simulation methods. Low-technology manikins were the majority simulation method used in medical education (42%), and focused on knowledge and skills outcomes. Compared to HICs, the majority of studies evaluated baseline adherence to guidelines rather than focusing on improving medical knowledge through educational intervention. There were 46 respondents from the survey, representing 21 countries and 28 simulation centres. Within the 28 simulation centres, teachers and trainees were from across all healthcare professions.DiscussionBroad use of simulation is low in LMICs, and the full potential of simulation-based interventions for improved quality of care has yet to be realised. The use of simulation in LMICs could be a potentially untapped area that, if increased and/or improved, could positively impact patient safety and the quality of care.
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105
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Cazabon D, Alsdurf H, Satyanarayana S, Nathavitharana R, Subbaraman R, Daftary A, Pai M. Quality of tuberculosis care in high burden countries: the urgent need to address gaps in the care cascade. Int J Infect Dis 2017; 56:111-116. [PMID: 27794468 PMCID: PMC5346036 DOI: 10.1016/j.ijid.2016.10.016] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 10/14/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022] Open
Abstract
Despite the high coverage of directly observed treatment short-course (DOTS), tuberculosis (TB) continues to affect 10.4 million people each year, and kills 1.8 million. High TB mortality, the large number of missing TB cases, the emergence of severe forms of drug resistance, and the slow decline in TB incidence indicate that merely expanding the coverage of TB services is insufficient to end the epidemic. In the era of the End TB Strategy, we need to think beyond coverage and start focusing on the quality of TB care that is routinely offered to patients in high burden countries, in both public and private sectors. In this review, current evidence on the quality of TB care in high burden countries, major gaps in the quality of care, and some novel efforts to measure and improve the quality of care are described. Based on systematic reviews on the quality of TB care or surrogates of quality (e.g., TB diagnostic delays), analyses of TB care cascades, and newer studies that directly measure quality of care, it is shown that the quality of care in both the public and private sector falls short of international standards and urgently needs improvement. National TB programs will therefore need to systematically measure and improve quality of TB care and invest in quality improvement programs.
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Affiliation(s)
- Danielle Cazabon
- McGill International TB Centre, McGill University, 1020 Pine Ave West, Montreal, QC H3A 1A2, Canada
| | - Hannah Alsdurf
- McGill International TB Centre, McGill University, 1020 Pine Ave West, Montreal, QC H3A 1A2, Canada
| | - Srinath Satyanarayana
- McGill International TB Centre, McGill University, 1020 Pine Ave West, Montreal, QC H3A 1A2, Canada
| | - Ruvandhi Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ramnath Subbaraman
- Division of Infectious Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Amrita Daftary
- McGill International TB Centre, McGill University, 1020 Pine Ave West, Montreal, QC H3A 1A2, Canada; CAPRISA MRC HIV-TB Pathogenesis and Treatment Research Unit, University of KwaZulu-Natal, South Africa
| | - Madhukar Pai
- McGill International TB Centre, McGill University, 1020 Pine Ave West, Montreal, QC H3A 1A2, Canada; Manipal McGill Centre for Infectious Diseases, Manipal University, Manipal, India.
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106
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Mohanan M, Goldhaber-Fiebert JD, Giardili S, Vera-Hernández M. Providers' knowledge of diagnosis and treatment of tuberculosis using vignettes: evidence from rural Bihar, India. BMJ Glob Health 2016; 1:e000155. [PMID: 28588984 PMCID: PMC5321391 DOI: 10.1136/bmjgh-2016-000155] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/03/2016] [Accepted: 11/13/2016] [Indexed: 12/04/2022] Open
Abstract
Background Almost 25% of all new cases of tuberculosis (TB) worldwide are in India, where drug resistance and low quality of care remain key challenges. Methods We conducted an observational, cross-sectional study of healthcare providers' knowledge of diagnosis and treatment of TB in rural Bihar, India, from June to September 2012. Using data from vignette-based interviews with 395 most commonly visited healthcare providers in study areas, we scored providers' knowledge and used multivariable regression models to examine their relationship to providers' characteristics. Findings 80% of 395 providers had no formal medical qualifications. Overall, providers demonstrated low levels of knowledge: 64.9% (95% CI 59.8% to 69.8%) diagnosed correctly, and 21.7% (CI 16.8% to 27.1%) recommended correct treatment. Providers seldom asked diagnostic questions such as fever (31.4%, CI 26.8% to 36.2%) and bloody sputum (11.1%, CI 8.2% to 14.7%), or results from sputum microscopy (20.0%, CI: 16.2% to 24.3%). After controlling for whether providers treat TB, MBBS providers were not significantly different, from unqualified providers or those with alternative medical qualifications, on knowledge score or offering correct treatment. MBBS providers were, however, more likely to recommend referrals relative to complementary medicine and unqualified providers (23.2 and 37.7 percentage points, respectively). Interpretation Healthcare providers in rural areas in Bihar, India, have low levels of knowledge regarding TB diagnosis and treatment. Our findings highlight the need for policies to improve training, incentives, task shifting and regulation to improve knowledge and performance of existing providers. Further, more research is needed on the incentives providers face and the role of information on quality to help patients select providers who offer higher quality care.
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Affiliation(s)
- Manoj Mohanan
- Sanford School of Public Policy, Duke Global Health Institute, and Department of Economics, Duke University, Durham, North Carolina, USA
| | - Jeremy D Goldhaber-Fiebert
- Centers for Health Policy and Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California, USA
| | - Soledad Giardili
- School of Economics and Finance, Queen Mary University of London, London, UK
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107
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Rogawski ET, Platts-Mills JA, Seidman JC, John S, Mahfuz M, Ulak M, Shrestha SK, Soofi SB, Yori PP, Mduma E, Svensen E, Ahmed T, Lima AA, Bhutta ZA, Kosek MN, Lang DR, Gottlieb M, Zaidi AK, Kang G, Bessong PO, Houpt ER, Guerrant RL. Use of antibiotics in children younger than two years in eight countries: a prospective cohort study. Bull World Health Organ 2016; 95:49-61. [PMID: 28053364 PMCID: PMC5180352 DOI: 10.2471/blt.16.176123] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/31/2016] [Accepted: 10/03/2016] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To describe the frequency and factors associated with antibiotic use in early childhood, and estimate the proportion of diarrhoea and respiratory illnesses episodes treated with antibiotics. METHODS Between 2009 and 2014, we followed 2134 children from eight sites in Bangladesh, Brazil, India, Nepal, Pakistan, Peru, South Africa and the United Republic of Tanzania, enrolled in the MAL-ED birth cohort study. We documented all antibiotic use from mothers' reports at twice-weekly visits over the children's first two years of life. We estimated the incidence of antibiotic use and the associations of antibiotic use with child and household characteristics. We described treatment patterns for diarrhoea and respiratory illnesses, and identified factors associated with treatment and antibiotic class. FINDINGS Over 1 346 388 total days of observation, 16 913 courses of antibiotics were recorded (an incidence of 4.9 courses per child per year), with the highest use in South Asia. Antibiotic treatment was given for 375/499 (75.2%) episodes of bloody diarrhoea and for 4274/9661 (44.2%) episodes of diarrhoea without bloody stools. Antibiotics were used in 2384/3943 (60.5%) episodes of fieldworker-confirmed acute lower respiratory tract illness as well as in 6608/16742 (39.5%) episodes of upper respiratory illness. Penicillins were used most frequently for respiratory illness, while antibiotic classes for diarrhoea treatment varied within and between sites. CONCLUSION Repeated antibiotic exposure was common early in life, and treatment of non-bloody diarrhoea and non-specific respiratory illnesses was not consistent with international recommendations. Rational antibiotic use programmes may have the most impact in South Asia, where antibiotic use was highest.
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Affiliation(s)
- Elizabeth T Rogawski
- Division of Infectious Diseases and International Health, University of Virginia, PO Box 801379, Carter Harrison Research Bldg MR-6, 345 Crispell Drive, Room 2520, Charlottesville, Virginia 22908-1379, United States of America (USA)
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, PO Box 801379, Carter Harrison Research Bldg MR-6, 345 Crispell Drive, Room 2520, Charlottesville, Virginia 22908-1379, United States of America (USA)
| | - Jessica C Seidman
- Fogarty International Center, National Institutes of Health, Bethesda, USA
| | | | - Mustafa Mahfuz
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Manjeswori Ulak
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | | | | | - Estomih Mduma
- Haydom Lutheran Hospital, Haydom, United Republic of Tanzania
| | | | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Aldo Am Lima
- Clinical Research Unit and Institute of Biomedicine, Federal University of Ceara, Fortaleza, Brazil
| | | | - Margaret N Kosek
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Dennis R Lang
- Foundation for the National Institutes of Health, Bethesda, USA
| | | | | | | | | | - Eric R Houpt
- Division of Infectious Diseases and International Health, University of Virginia, PO Box 801379, Carter Harrison Research Bldg MR-6, 345 Crispell Drive, Room 2520, Charlottesville, Virginia 22908-1379, United States of America (USA)
| | - Richard L Guerrant
- Division of Infectious Diseases and International Health, University of Virginia, PO Box 801379, Carter Harrison Research Bldg MR-6, 345 Crispell Drive, Room 2520, Charlottesville, Virginia 22908-1379, United States of America (USA)
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108
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Miller S, Abalos E, Chamillard M, Ciapponi A, Colaci D, Comandé D, Diaz V, Geller S, Hanson C, Langer A, Manuelli V, Millar K, Morhason-Bello I, Castro CP, Pileggi VN, Robinson N, Skaer M, Souza JP, Vogel JP, Althabe F. Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. Lancet 2016; 388:2176-2192. [PMID: 27642019 DOI: 10.1016/s0140-6736(16)31472-6] [Citation(s) in RCA: 638] [Impact Index Per Article: 79.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/23/2016] [Accepted: 07/11/2016] [Indexed: 12/29/2022]
Abstract
On the continuum of maternal health care, two extreme situations exist: too little, too late (TLTL) and too much, too soon (TMTS). TLTL describes care with inadequate resources, below evidence-based standards, or care withheld or unavailable until too late to help. TLTL is an underlying problem associated with high maternal mortality and morbidity. TMTS describes the routine over-medicalisation of normal pregnancy and birth. TMTS includes unnecessary use of non-evidence-based interventions, as well as use of interventions that can be life saving when used appropriately, but harmful when applied routinely or overused. As facility births increase, so does the recognition that TMTS causes harm and increases health costs, and often concentrates disrespect and abuse. Although TMTS is typically ascribed to high-income countries and TLTL to low-income and middle-income ones, social and health inequities mean these extremes coexist in many countries. A global approach to quality and equitable maternal health, supporting the implementation of respectful, evidence-based care for all, is urgently needed. We present a systematic review of evidence-based clinical practice guidelines for routine antenatal, intrapartum, and postnatal care, categorising them as recommended, recommended only for clinical indications, and not recommended. We also present prevalence data from middle-income countries for specific clinical practices, which demonstrate TLTL and increasing TMTS. Health-care providers and health systems need to ensure that all women receive high-quality, evidence-based, equitable and respectful care. The right amount of care needs to be offered at the right time, and delivered in a manner that respects, protects, and promotes human rights.
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Affiliation(s)
- Suellen Miller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
| | - Edgardo Abalos
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | | | - Agustin Ciapponi
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Daniela Colaci
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Daniel Comandé
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Virginia Diaz
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | - Stacie Geller
- Center for Research on Women and Gender, University of Illinois, Chicago, IL, USA
| | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Ana Langer
- Maternal Health Task Force, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Victoria Manuelli
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Kathryn Millar
- Maternal Health Task Force, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Imran Morhason-Bello
- University of Ibadan, Ibadan, Nigeria; London School of Hygiene & Tropical Medicine, London, UK
| | - Cynthia Pileggi Castro
- GLIDE Technical Cooperation and Research, Ribeirão Preto, SP, Brazil; Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Vicky Nogueira Pileggi
- GLIDE Technical Cooperation and Research, Ribeirão Preto, SP, Brazil; Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | - João Paulo Souza
- GLIDE Technical Cooperation and Research, Ribeirão Preto, SP, Brazil; Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Joshua P Vogel
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Fernando Althabe
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
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109
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Das J, Chowdhury A, Hussam R, Banerjee AV. The impact of training informal health care providers in India: A randomized controlled trial. Science 2016; 354:354/6308/aaf7384. [DOI: 10.1126/science.aaf7384] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/25/2016] [Indexed: 11/02/2022]
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110
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Mohanan M, Babiarz KS, Goldhaber-Fiebert JD, Miller G, Vera-Hernández M. Effect Of A Large-Scale Social Franchising And Telemedicine Program On Childhood Diarrhea And Pneumonia Outcomes In India. Health Aff (Millwood) 2016; 35:1800-1809. [DOI: 10.1377/hlthaff.2016.0481] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Manoj Mohanan
- Manoj Mohanan is an assistant professor of public policy and economics in the Sanford School of Public Policy at Duke University, an assistant research professor at the Duke Global Health Institute, and faculty research scholar at the Duke Population Research Institute, all in Durham, North Carolina
| | - Kimberly S. Babiarz
- Kimberly S. Babiarz is a research associate in the Center for Primary Care and Outcomes Research (CHP/PCOR), School of Medicine, at Stanford University, in California
| | | | - Grant Miller
- Grant Miller is an associate professor at the School of Medicine, Stanford University; director of the Stanford Center for International Development; senior fellow, Freeman Spogli Institute for International Studies; senior fellow, Stanford Institute for Economic Policy Research; and a research associate at the National Bureau of Economic Research, in Cambridge, Massachusetts
| | - Marcos Vera-Hernández
- Marcos Vera-Hernández is a reader in economics at University College London and a research fellow at the Institute for Fiscal Studies, both in the United Kingdom
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111
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Banerjee R, Starke JR. What tuberculosis can teach us about combating multidrug-resistant Gram negative bacilli. J Clin Tuberc Other Mycobact Dis 2016; 3:28-34. [PMID: 31723682 PMCID: PMC6850263 DOI: 10.1016/j.jctube.2016.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/15/2016] [Accepted: 03/18/2016] [Indexed: 12/03/2022] Open
Abstract
There are striking similarities between the dual pandemics of multidrug-resistant tuberculosis (MDR TB) and multidrug-resistant Gram negative bacilli (MDR GNB) despite fundamental differences in the pathogenesis and epidemiology of these pathogens. In this perspective, we highlight several strategies that have been used by the global TB community to address the MDR TB problem, including approaches to: encourage appropriate use of anti-TB medications, enhance appropriate utilization of molecular diagnostic testing, facilitate development of new antimicrobial agents, and strengthen surveillance systems and infection control practices. Understanding the successes and challenges of these strategies for MDR TB control will be instructive for efforts to curb emergence and spread of MDR GNB.
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Affiliation(s)
- Ritu Banerjee
- Division of Pediatric Infectious Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Jeffrey R. Starke
- Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
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112
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Fisher Walker CL, Taneja S, Lamberti LM, Lefevre A, Black R, Mazumder S. Management of childhood diarrhea among private providers in Uttar Pradesh, India. J Glob Health 2016; 6:010402. [PMID: 26955470 PMCID: PMC4756640 DOI: 10.7189/jogh.06.010402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background In Uttar Pradesh (UP), India, a new initiative to introduce zinc and reinvigorate ORS for diarrhea treatment in the public and private sectors was rolled out in selected districts. We conducted an external evaluation of the program that included assessing the knowledge and practices of private sector providers 6 months after the initial program rollout. Methods We conducted interviews and direct observations among a randomly selected group of formal and informal private sector providers in 12 districts of UP. We calculated summary statistics for reported provider characteristics, diarrhea treatment knowledge and preferred treatments, as well as the treatments advised during consultation with a child with diarrhea. Results We interviewed 232 providers, of whom 67% reported receiving a diarrhea treatment training/drug detailing visit. In the interview, 14% of providers reported prescribing zinc to all children with diarrhea and 36% reported prescribing zinc to more than half of diarrhea cases. During direct observation, ORS and zinc were prescribed by 77.3% and 29.9% of providers, respectively. Treatments other than zinc and ORS were also commonly prescribed, including antibiotics (61.9%) and antidiarrheals (17.5%). Conclusion Adequate treatment of childhood diarrhea with zinc and ORS remains a challenge among private sector providers in rural UP, India. Additional training and knowledge transfer activities are needed to curb the overprescription of antibiotics and antidiarrheals and to increase the confidence of private providers in advising zinc and ORS. In addition, policymakers and program implementers must ensure collaborative efforts to target and meaningfully engage informal private providers who play a major role in childhood diarrhea treatment in hard–to–reach areas.
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Affiliation(s)
- Christa L Fisher Walker
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA
| | | | - Laura M Lamberti
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA
| | - Amnesty Lefevre
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA
| | - Robert Black
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA
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Assessing the quality of tuberculosis care in India - Authors' response. THE LANCET. INFECTIOUS DISEASES 2016; 16:22. [PMID: 26738832 DOI: 10.1016/s1473-3099(15)00491-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 11/24/2015] [Indexed: 11/20/2022]
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Das J, Kwan A, Daniels B, Satyanarayana S, Subbaraman R, Bergkvist S, Das RK, Das V, Pai M. Use of standardised patients to assess quality of tuberculosis care: a pilot, cross-sectional study. THE LANCET. INFECTIOUS DISEASES 2015; 15:1305-13. [PMID: 26268690 PMCID: PMC4633317 DOI: 10.1016/s1473-3099(15)00077-8] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/22/2015] [Accepted: 05/22/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Existing studies of the quality of tuberculosis care have relied on recall-based patient surveys, questionnaire surveys of knowledge, and prescription or medical record analysis, and the results mostly show the health-care provider's knowledge rather than actual practice. No study has used standardised patients to assess clinical practice. Therefore we aimed to assess quality of care for tuberculosis using such patients. METHODS We did a pilot, cross-sectional validation study of a convenience sample of consenting private health-care providers in low-income and middle-income areas of Delhi, India. We recruited standardised patients in apparently good health from the local community to present four cases (two of presumed tuberculosis and one each of confirmed tuberculosis and suspected multidrug-resistant tuberculosis) to a randomly allocated health-care provider. The key objective was to validate the standardised-patient method using three criteria: negligible risk and ability to avoid adverse events for providers and standardised patients, low detection rates of standardised patients by providers, and data accuracy across standardised patients and audio verification of standardised-patient recall. We also used medical vignettes to assess providers' knowledge of presumed tuberculosis. Correct case management was benchmarked using Standards for Tuberculosis Care in India (STCI). FINDINGS Between Feb 2, and March 28, 2014, we recruited and trained 17 standardised patients who had 250 interactions with 100 health-care providers, 29 of whom were qualified in allopathic medicine (ie, they had a Bachelor of Medicine & Surgery [MBBS] degree), 40 of whom practised alternative medicine, and 31 of whom were informal health-care providers with few or no qualifications. The interactions took place between April 1, and April 23, 2014. The proportion of detected standardised patients was low (11 [5%] detected out of 232 interactions among providers who completed the follow-up survey), and standardised patients' recall correlated highly with audio recordings (r=0·63 [95% CI 0·53-0·79]), with no safety concerns reported. The mean consultation length was 6 min (95% CI 5·5-6·6) with a mean of 6·18 (5·72-6·64) questions or examinations completed, representing 35% (33-38) of essential checklist items. Across all cases, only 52 (21% [16-26]) of 250 were correctly managed. Correct management was higher among MBBS-qualified doctors than other types of health-care provider (adjusted odds ratio 2·41 [95% CI 1·17-4·93]; p=0·0166). Of the 69 providers who completed the vignette, knowledge in the vignettes was more consistent with STCI than their actual clinical practice-eg, 50 (73%) ordered a chest radiograph or sputum test during the vignette compared with seven (10%) during the standardised-patient interaction; OR 0·04 (95% CI 0·02-0·11); p<0·0001. INTERPRETATION Standardised patients can be successfully implemented to assess tuberculosis care. Our data suggest a big gap between private provider knowledge and practice. Additional work is needed to substantiate our pilot data, understand the know-do gap in provider behaviour, and to identify the best approach to measure and improve the quality of tuberculosis care in India. FUNDING Grand Challenges Canada, the Bill & Melinda Gates Foundation, Knowledge for Change Program, and the World Bank Development Research Group.
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Affiliation(s)
- Jishnu Das
- Development Research Group, The World Bank, Washington, DC, USA; Center for Policy Research, New Delhi, India
| | - Ada Kwan
- Development Research Group, The World Bank, Washington, DC, USA
| | | | - Srinath Satyanarayana
- McGill International TB Centre, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Ramnath Subbaraman
- Division of Infectious Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Ranendra K Das
- Institute for Social and Economic Research on Development and Democracy, Delhi, India
| | - Veena Das
- Institute for Social and Economic Research on Development and Democracy, Delhi, India; Department of Anthropology, Johns Hopkins University, Baltimore, MD, USA
| | - Madhukar Pai
- McGill International TB Centre, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
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