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首页> 外文期刊>Trials >Strengthening health human resources and improving clinical outcomes through an integrated guideline and educational outreach in resource-poor settings: a cluster-randomized trial
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Strengthening health human resources and improving clinical outcomes through an integrated guideline and educational outreach in resource-poor settings: a cluster-randomized trial

机译：在资源匮乏地区通过综合指南和教育推广来加强卫生人力资源并改善临床结果：一项整群随机试验

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Background In low-income countries, only about a third of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) patients eligible for anti-retroviral treatment currently receive it. Providing decentralized treatment close to where patients live is crucial to a faster scale up, however, a key obstacle is limited health system capacity due to a shortage of trained health-care workers and challenges of integrating HIV/AIDS care with other primary care services (e.g. tuberculosis, malaria, respiratory conditions). This study will test an adapted primary care health care worker training and guideline intervention, Practical Approach to Lung Health and HIV/AIDS Malawi (PALM PLUS), on staff retention and satisfaction, and quality of patient care. Methods/Design A cluster-randomized trial design is being used to compare usual care with a standardized clinical guideline and training intervention, PALM PLUS. The intervention targets middle-cadre health care workers (nurses, clinical officers, medical assistants) in 30 rural primary care health centres in a single district in Malawi. PALM PLUS is an integrated, symptom-based and user-friendly guideline consistent with Malawian national treatment protocols. Training is standardized and based on an educational outreach approach. Trainers will be front-line peer healthcare workers trained to provide outreach training and support to their fellow front-line healthcare workers during focused (1-2 hours), intermittent, interactive sessions on-site in health centers. Primary outcomes are health care worker retention and satisfaction. Secondary outcomes are clinical outcomes measured at the health centre level for HIV/AIDS, tuberculosis, prevention-of-mother-to-child-transmission of HIV and other primary care conditions. Effect sizes and 95% confidence intervals for outcomes will be presented. Assessment of outcomes will occur at 1 year post- implementation. Discussion The PALM PLUS trial aims to address a key problem: strengthening middle-cadre health care workers to support the broader scale up of HIV/AIDS services and their integration into primary care. The trial will test whether the PALM PLUS intervention improves staff satisfaction and retention, as well as the quality of patient care, when compared to usual practice. Trial Registration Current controlled Trials: ISRCTN47805230
机译：背景技术在低收入国家/地区，目前只有大约三分之一的符合抗逆转录病毒治疗要求的人免疫缺陷病毒/后天免疫机能丧失综合症（HIV / AIDS）患者接受该药物。在患者居住的地方附近提供分散治疗对于加快扩大规模至关重要，但是，关键的障碍是由于缺乏训练有素的医护人员以及将艾滋病毒/艾滋病护理与其他初级护理服务相结合所带来的挑战，卫生系统的能力受到限制（例如肺结核，疟疾，呼吸系统疾病）。这项研究将测试经过改编的初级保健医护人员的培训和指南干预，关于肺部疾病和马拉维艾滋病毒/艾滋病的实用方法（PALM PLUS），人员保留和满意度以及患者护理质量。方法/设计采用整群随机试验设计，将常规护理与标准化临床指南和培训干预措施PALM PLUS进行比较。该干预的目标是马拉维一个地区的30个农村初级保健中心的中层保健工作者（护士，临床官员，医疗助理）。 PALM PLUS是一个综合的，基于症状的，易于使用的指南，符合马拉维国民治疗方案。培训是标准化的，并基于教育宣传方法。培训人员将是经过培训的一线同伴医疗保健人员，以便在保健中心现场（1-2小时），间歇性，互动式会议中向其一线同伴提供外展培训和支持。主要结果是医护人员的保留和满意度。次要结果是在卫生中心一级针对艾滋病毒/艾滋病，结核病，预防母婴传播艾滋病毒和其他初级保健状况而测得的临床结果。将显示效果大小和结果的95％置信区间。成果评估将在实施后1年进行。讨论PALM PLUS试验旨在解决一个关键问题：加强中层干部医护人员，以支持更广泛的HIV / AIDS服务规模以及将其整合到初级保健中。与常规做法相比，该试验将测试PALM PLUS干预措施是否能提高员工满意度和保留率，以及患者护理质量。试用注册当前受控的试用：ISRCTN47805230

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