超越培训范式:在资源有限的环境中提供内窥镜检查服务的挑战与解决方案

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY
Sandie Thomson , Chris Hair , Ganiyat Kikelomo Oyeleke
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引用次数: 0

摘要

资源有限的环境给医疗服务的提供带来了问题。作者曾在非洲和太平洋岛屿的此类环境中执教和实践,他们介绍了提供内窥镜服务所面临挑战的经验和可能的解决方案。在一般医疗服务的背景下定义了资源有限环境的概念。详细介绍了内窥镜检查的提供情况,并讨论了人力、内窥镜检查设施、内窥镜和附件设备库存以及内窥镜检查报告等方面的独特挑战。医疗服务的质量与财富及其使用方式有关。简单地说,富裕意味着健康,贫穷意味着疾病。低收入和中低收入国家面临的挑战最大。其一是卫生专业人员队伍。在中上收入国家南非,每 10 万人中只有 0.33 名肠胃病学专家,而美国则有 3.9 名。因此,内窥镜检查由普通外科医生和内科医生提供。东非的上消化道内窥镜检查能力分别为每年每 10 万人 106 例和 45 例,是高收入国家的 10%。在大型教学医院之外,大多数内窥镜手术都是在非定制的单间里进行的,通常是在外科综合大楼里。内窥镜库存比美国昂贵,维护和修理也比美国昂贵,因为它们都在国外,导致许多单位的内窥镜库存低于持续提供服务所需的最低要求。电子报告系统很少,而且没有标准化。世界胃肠病学组织和世界内镜组织应成为支持公私合作伙伴关系的主要倡导者,并为可持续的库存采购制定解决方案。必须对内镜检查进行电子监控,以评估手术能力,并提供急需的信息来影响卫生政策。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Outside the Training Paradigm: Challenges and Solutions for Endoscopy Provision in Resource-Limited Settings

Limited-resource settings pose problems for the provision of health services. Experience with the challenges of the provision of endoscopy services and potential solutions are presented by authors who have taught and practiced in such settings in Africa and the Pacific Islands. The concept of limited-resource settings is defined in the context of health services in general. The situation regarding endoscopy provision details and discusses the unique challenges of manpower, endoscopy facilities, endoscope and accessory equipment inventory, and endoscopy reporting. Health services quality is related to wealth and how it is deployed. Simplistically wealth means health, and poverty illness. Low-income and Low middle–income countries have the biggest challenges. One is the health professional workforce. The number of gastroenterologists per 100,000 in South Africa, an upper middle–income country, is 0.33 compared with 3.9 in the United States. Hence, endoscopy provision is by general surgeons and physicians. Upper and lower gastrointestinal endoscopic capacity in East Africa was 106 and 45 procedures per 100,000 persons per year, respectively which is <10% of that reported from high-income countries. Outside major teaching hospitals, most endoscopy is practiced in uncustomized single rooms often in a surgery complex. Endoscope inventory is more expensive than in the United States as is maintenance and repair as they are out of the country resulting in many units being below the minimum requirements to run a sustained service. Electronic reporting systems are few and not standardized. The World Gastroenterology Organisation and the World Endoscopy Organization should be the overarching advocates to support public–private partnerships and develop solutions for sustainable inventory acquisition. Endoscopy must be monitored electronically to assess procedural competency and provide desperately needed information to influence health policy.

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CiteScore
2.10
自引率
50.00%
发文量
60
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