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báo cáo sinh học:" Task shifting in Mozambique: cross-sectional evaluation of non-physician clinicians’ performance in HIV/AIDS care"

Tuyển tập các báo cáo nghiên cứu về sinh học được đăng trên tạp chí sinh học quốc tế đề tài : Task shifting in Mozambique: cross-sectional evaluation of non-physician clinicians’ performance in HIV/AIDS care | Brentlinger et al. Human Resources for Health 2010 8 23 http www.human-resources-health.eom content 8 1 23 ffWJ HUMAN RESOURCES h Ể L J FOR HEALTH RESEARCH Open Access Task shifting in Mozambique cross-sectional evaluation of non-physician clinicians performance in HIV AIDS care 1 A A 2 2 1 3 Paula E Brentlinger Américo Assan Florindo Mudender Annette E Ghee José Vallejo Torres 73 v 4 f2 2 I5 r5 Pilar Martínez Martínez Oliver Bacon Rui Bastos Rolanda Manuel Lucy Ramirez Li Catherine McKinney Lisa J Nelson5 Abstract Background Many resource-constrained countries now train non-physician clinicians in HIV AIDS care a strategy known as task-shifting. There is as yet no evidence-based international standard for training these cadres. In 2007 the Mozambican Ministry of Health MOH conducted a nationwide evaluation of the quality of care delivered by non-physician clinicians técnicos de medicina or TMs after a two-week in-service training course emphasizing antiretroviral therapy ART . Methods Forty-four randomly selected TMs were directly observed by expert clinicians as they cared for HIV-infected patients in their usual worksites. Observed clinical performance was compared to national norms as taught in the course. Results In 127 directly observed patient encounters TMs assigned the correct WHO clinical stage in 37.6 and correctly managed co-trimoxazole prophylaxis in 71.6 and ART in 75.5 adjusted estimates . Correct management of all 5 main aspects of patient care staging co-trimoxazole ART opportunistic infections and adverse drug reactions was observed in 10.6 of encounters. The observed clinical errors were heterogeneous. Common errors included assignment of clinical stage before completing the relevant patient evaluation and initiation or continuation of co-trimoxazole or ART without indications or when contraindicated. Conclusions In Mozambique the in-service ART training was suspended. MOH subsequently revised the TMs scope of work in HIV AIDS care defined new .