坦桑尼亚一项改善心肌梗死护理的干预措施的实施结果。

IF 3.2 4区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Annals of Global Health Pub Date : 2025-08-05 eCollection Date: 2025-01-01 DOI:10.5334/aogh.4651
Julian T Hertz, Francis M Sakita, Zaheer Rik Munshi, Faraan O Rahim, Daniel Mganga, Arafa Kachenje, James J Munisi, Abigail S Pyne, Prosper Bashaka, Adamu Kilungu, Ayshat Mussa Aboud, Hayden B Bosworth, Janet Prvu Bettger
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引用次数: 0

摘要

背景:坦桑尼亚对急性心肌梗死(AMI)的循证护理的接受程度有限。为了解决这个问题,一个跨学科团队共同设计了一种量身定制的干预措施,即改善急性心肌梗死护理的多组分干预(MIMIC)。目的:确定在坦桑尼亚急诊科(ED)实施MIMIC干预的试点试验的实施结果。方法:由急诊科工作人员实施为期一年的MIMIC干预。对每个干预组成部分的保真度、渗透率和成本进行了观察:指定的负责人对护理进行审计,为工作人员提供在线培训模块,为护士提供分诊卡,标记有AMI症状的患者,为医生提供总结AMI管理的袖珍卡,以及为患者提供教育小册子。登记后30天,通过电话联系患者参与者,询问他们是否阅读了小册子。结果:医师冠军和护士冠军在12个月的研究期间积极参与干预。对口袋卡的忠实度非常好,观察到所有22名(100%)医生都带着口袋卡上班,医生轮班的渗透率为96.1%(1835/1910)。培训模块由22名(91%)医生中的20名和32名(78%)护士中的25名开始。通过模块完成度来衡量,医生的渗透率是相同的(22 / 91%),但护士的渗透率较低(32 / 21,65.6%)。577例胸痛或呼吸困难患者中有453例(78.5%)使用了分诊卡。接受教育小册子的AMI患者的保真率为37.6%(141例中的53例)。39名收到小册子的AMI患者中,只有22名(56%)报告阅读了小册子,其余大多数报告不知道他们收到了小册子。MIMIC干预的年总成本为1324.24美元。结论:个体干预成分的保真度和穿透力有很大的可变性。未来的研究应该探索不完全渗透的原因,并分析在坦桑尼亚扩大努力的成本效益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Implementation Outcomes of an Intervention to Improve Myocardial Infarction Care in Tanzania.

Implementation Outcomes of an Intervention to Improve Myocardial Infarction Care in Tanzania.

Implementation Outcomes of an Intervention to Improve Myocardial Infarction Care in Tanzania.

Implementation Outcomes of an Intervention to Improve Myocardial Infarction Care in Tanzania.

Implementation Outcomes of an Intervention to Improve Myocardial Infarction Care in Tanzania.

Background: Uptake of evidence-based care for acute myocardial infarction (AMI) is limited in Tanzania. To address this, a tailored intervention, the Multicomponent Intervention to Improve Acute Myocardial Infarction Care (MIMIC), was co-designed by an interdisciplinary team. Objectives: To determine implementation outcomes from a pilot trial of the MIMIC intervention in a Tanzanian emergency department (ED). Methods: The MIMIC intervention was implemented by the ED staff for one year. Fidelity, penetration, and costs were observed for each of the intervention components: designated champions to audit care, an online training module for staff, a triage card for nurses to flag patients with AMI symptoms, pocket cards summarizing AMI management for physicians, and an educational pamphlet for patients. Thirty days following enrollment, patient participants were contacted via telephone to inquire whether they had read the pamphlet. Results: Physician champions and nurse champions were actively engaged in the intervention across the twelve-month study period. Fidelity to the pocket card was excellent, with all 22 (100%) physicians observed to have ever brought their pocket cards to work, and penetration across physician-shifts was 96.1% (1835/1910). The training module was started by 20 out of the 22 (91%) physicians and 25 of the 32 (78%) nurses observed. Penetration, measured by module completion, was the same for physicians (20 of 22, 91%) but lower among nurses (21 of 32, 65.6%). Triage cards were used for 453 out of the 577 (78.5%) patients with chest pain or dyspnea. Fidelity to patients with AMI receiving the educational pamphlet was 37.6% (53 of 141). Only 22 of the 39 (56%) surviving AMI patients who received the pamphlet reported reading it, with most of the rest reporting being unaware that they had received it. The total annual cost of the MIMIC intervention was USD 1324.24. Conclusions: There was high variability in fidelity and penetration of the individual intervention components. Future studies should explore reasons for incomplete penetration and analyze cost-effectiveness for scale-up efforts across Tanzania.

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来源期刊
Annals of Global Health
Annals of Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
5.30
自引率
3.40%
发文量
95
审稿时长
11 weeks
期刊介绍: ANNALS OF GLOBAL HEALTH is a peer-reviewed, open access journal focused on global health. The journal’s mission is to advance and disseminate knowledge of global health. Its goals are improve the health and well-being of all people, advance health equity and promote wise stewardship of the earth’s environment. The journal is published by the Boston College Global Public Health Program. It was founded in 1934 by the Icahn School of Medicine at Mount Sinai as the Mount Sinai Journal of Medicine. It is a partner journal of the Consortium of Universities for Global Health.
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