定性系统动力学建模,支持南非初级卫生保健设施结核病感染预防和控制措施的设计和实施。

IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Karin Diaconu, Aaron Karat, Fiammetta Bozzani, Nicky McCreesh, Jennifer Falconer, Anna Voce, Anna Vassall, Alison D Grant, Karina Kielmann
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引用次数: 0

摘要

结核病感染预防和控制(TB IPC)措施是政策的基石,但措施多种多样,实施情况也各不相同。人们对影响这些措施成功实施的卫生系统环境关注有限。我们采用定性系统动力学和小组模型构建方法,1)绘制了南非初级卫生保健机构结核分枝杆菌(Mtb)传播相互关联驱动因素的定性因果关系图,这反过来又帮助我们2)确定了降低传播风险的可行IPC干预措施。2019 年,我们举办了两次为期一天的参与式研讨会,与会者包括国家和省级的政策制定者和决策者,以及诊所和地区一级的患者权益倡导者和医疗专业人员。与会者绘制了因果循环图,并由研究人员进行了合并。研究小组对图表进行了审查,以确定在初级卫生保健设施中造成巴氏杆菌院内传播的驱动因素。将参与者提出的干预措施映射到图表中,以确定预期的作用和效果机制。最终确定了三个系统性驱动因素:1)在特定时间内,病人流动的瓶颈导致了Mtb鼻内传播;2)IPC的实施和诊所流程被固定在员工的 "名义遵守文化 "中;3)政策层面有限的系统学习阻碍了诊所的有效管理和IPC的实施。研讨会与会者优先考虑的干预措施包括针对三个领域的基础设施、组织和行为战略:1) 改善空气质量;2) 改善个人防护设备的使用;3) 减少诊所内的人数。除核心机制外,与会者还阐述了有助于持续实施的其他具体推动因素。定性系统动力学建模(SDM)方法使我们能够捕捉利益相关者的观点和潜在解决方案,以解决结核病 IPC 实施效果不理想的问题。定性系统动力学建模的参与性元素促进了问题的解决,并纳入了在考虑实施时经常被忽视的多种因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Qualitative system dynamics modelling to support the design and implementation of tuberculosis infection prevention and control measures in South African primary healthcare facilities.

Tuberculosis infection prevention and control (TB IPC) measures are a cornerstone of policy, but measures are diverse and variably implemented. Limited attention has been paid to the health system environment, which influences successful implementation of these measures. We used qualitative system dynamics and group-model-building methods to (1) develop a qualitative causal map of the interlinked drivers of Mycobacterium tuberculosis (Mtb) transmission in South African primary healthcare facilities, which in turn helped us to (2) identify plausible IPC interventions to reduce risk of transmission. Two 1-day participatory workshops were held in 2019 with policymakers and decision makers at national and provincial levels and patient advocates and health professionals at clinic and district levels. Causal loop diagrams were generated by participants and combined by investigators. The research team reviewed diagrams to identify the drivers of nosocomial transmission of Mtb in primary healthcare facilities. Interventions proposed by participants were mapped onto diagrams to identify anticipated mechanisms of action and effect. Three systemic drivers were identified: (1) Mtb nosocomial transmission is driven by bottlenecks in patient flow at given times; (2) IPC implementation and clinic processes are anchored within a staff 'culture of nominal compliance'; and (3) limited systems learning at the policy level inhibits effective clinic management and IPC implementation. Interventions prioritized by workshop participants included infrastructural, organizational and behavioural strategies that target three areas: (1) improve air quality, (2) improve use of personal protective equipment and (3) reduce the number of individuals in the clinic. In addition to core mechanisms, participants elaborated specific additional enablers who would help sustain implementation. Qualitative system dynamics modelling methods allowed us to capture stakeholder views and potential solutions to address the problem of sub-optimal TB IPC implementation. The participatory elements of system dynamics modelling facilitated problem-solving and inclusion of multiple factors frequently neglected when considering implementation.

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来源期刊
Health policy and planning
Health policy and planning 医学-卫生保健
CiteScore
6.00
自引率
3.10%
发文量
98
审稿时长
6 months
期刊介绍: Health Policy and Planning publishes health policy and systems research focusing on low- and middle-income countries. Our journal provides an international forum for publishing original and high-quality research that addresses questions pertinent to policy-makers, public health researchers and practitioners. Health Policy and Planning is published 10 times a year.
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