Baseline assessment of adult and adolescent primary care delivery in Rwanda: an opportunity for quality improvement

BMC Health Services Research

Neil Gupta⁴  Peter Drobac⁵  Bonaventure Nzeyimana³  Felix R Cyamatare¹  Aphrodis Ndayisaba¹  Marc Hagenimana³  Fulgence Nkikabahizi³  Lisa R Hirschhorn⁵  Bethany L Hedt-Gauthier⁴  Catherine Mezzacappa⁴  Manzi Anatole²  Ashwin Vasan⁶ 

[1] Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda and Boston, USA;University of Rwanda, College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda;Ministry of Health, Government of Rwanda, Kigali, Rwanda;Division of Global Health Equity, Brigham and Women’s Hospital, Boston, USA;Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA;Department of Medicine, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, USA

关键词: Nurses;    Outpatient department;    IMAI;    Integration;    Training;    Quality improvement;    Resource-limited settings;    Africa;    Primary care;   

Others  :  1134473
DOI  :  10.1186/1472-6963-13-518

 received in 2013-08-07, accepted in 2013-12-04,  发布年份 2013

【 摘 要 】

Background

As resource-limited health systems evolve to address complex diseases, attention must be returned to basic primary care delivery. Limited data exists detailing the quality of general adult and adolescent primary care delivered at front-line facilities in these regions. Here we describe the baseline quality of care for adults and adolescents in rural Rwanda.

Methods

Patients aged 13 and older presenting to eight rural health center outpatient departments in one district in southeastern Rwanda between February and March 2011 were included. Routine nurse-delivered care was observed by clinical mentors trained in the WHO Integrated Management of Adolescent & Adult Illness (IMAI) protocol using standardized checklists, and compared to decisions made by the clinical mentor as the gold standard.

Results

Four hundred and seventy consultations were observed. Of these, only 1.5% were screened and triaged for emergency conditions. Fewer than 10% of patients were routinely screened for chronic conditions including HIV, tuberculosis, anemia or malnutrition. Nurses correctly diagnosed 50.1% of patient complaints (95% CI: 45.7%-54.5%) and determined the correct treatment 44.9% of the time (95% CI: 40.6%-49.3%). Correct diagnosis and treatment varied significantly across health centers (p = 0.03 and p = 0.04, respectively).

Conclusion

Fundamental gaps exist in adult and adolescent primary care delivery in Rwanda, including triage, screening, diagnosis, and treatment, with significant variability across conditions and facilities. Research and innovation toward improving and standardizing primary care delivery in sub-Saharan Africa is required. IMAI, supported by routine mentorship, is one potentially important approach to establishing the standards necessary for high-quality care.

【 授权许可】

   
2013 Vasan et al.; licensee BioMed Central Ltd.

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