Task-sharing spinal anaesthesia care in three rural Indian hospitals: a non-inferiority randomised controlled clinical trial.

Autor:	Menon N; ASHWINI Gudalur Adivasi Hospital, Gudalur, Tamil Nadu, India., George R; Tribal Health Initiative, Sittilingi, Tamil Nadu, India., Kataria R; Jan Swasthya Sahyog, Bilaspur, Chhattisgarh, India., Manoharan R; Tribal Health Initiative, Sittilingi, Tamil Nadu, India., Brooks MB; Boston University School of Public Health, Boston, Massachusetts, USA.; Department of Global Health, Harvard Medical School, Boston, Massachusetts, USA., Pendleton A; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.; Department of Vascular and Endovascular Surgery, University of Rochester, Rochester, New York, USA., Sheshadri V; ASHWINI Gudalur Adivasi Hospital, Gudalur, Tamil Nadu, India., Chatterjee S; Jan Swasthya Sahyog, Bilaspur, Chhattisgarh, India., Rajaleelan W; ASHWINI Gudalur Adivasi Hospital, Gudalur, Tamil Nadu, India.; Department of Anesthesia and Perioperative Medicine, University of Ottawa, Ottawa, Ontario, Canada., Krishnan J; ASHWINI Gudalur Adivasi Hospital, Gudalur, Tamil Nadu, India., Sandler S; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA., Saluja S; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.; Department of Surgery, Weill Cornell Medical College, New York, New York, USA., Ljungman D; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.; Department of Surgery at the Institute of Clinical Sciences, University of Gothenburg, Goteborg, Sweden., Raykar N; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA., Svensson E; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.; Department of Clinical Sciences Lund, Lund University, Lund, Sweden., Wasserman I; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA., Zorigtbaatar A; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.; Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada., Jesudian G; Karunya Rural Community Hospital, Coimbatore, Tamil Nadu, India., Afshar S; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA., Meara JG; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA., Peters AW; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.; Department of Surgery, Weill Cornell Medical College, New York, New York, USA., McClain CD; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA craig.mcclain@childrens.harvard.edu.; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	BMJ global health [BMJ Glob Health] 2024 Aug 16; Vol. 9 (8). Date of Electronic Publication: 2024 Aug 16.
DOI:	10.1136/bmjgh-2023-014170
Abstrakt:	Background: Task-sharing of spinal anaesthesia care by non-specialist graduate physicians, termed medical officers (MOs), is commonly practised in rural Indian healthcare facilities to mitigate workforce constraints. We sought to assess whether spinal anaesthesia failure rates of MOs were non-inferior to those of consultant anaesthesiologists (CA) following a standardised educational curriculum. Methods: We performed a randomised, non-inferiority trial in three rural hospitals in Tamil Nadu and Chhattisgarh, India. Patients aged over 18 years with low perioperative risk (ASA I & II) were randomised to receive MO or CA care. Prior to the trial, MOs underwent task-based anaesthesia training, inclusive of remotely accessed lectures, simulation-based training and directly observed anaesthetic procedures and intraoperative care. The primary outcome measure was spinal anaesthesia failure with a non-inferiority margin of 5%. Secondary outcome measures consisted of incidence of perioperative and postoperative complications. Findings: Between 12 July 2019 and 8 June 2020, a total of 422 patients undergoing surgical procedures amenable to spinal anaesthesia care were randomised to receive either MO (231, 54.7%) or CA care (191, 45.2%). Spinal anaesthesia failure rate for MOs (7, 3.0%) was non-inferior to those of CA (5, 2.6%); difference in success rate of 0.4% (95% CI=0.36-0.43%; p=0.80). Additionally, there were no statistically significant differences observed between the two groups for intraoperative or postoperative complications, or patients' experience of pain during the procedure. Interpretation: This study demonstrates that failure rates of spinal anaesthesia care provided by trained MOs are non-inferior to care provided by CAs in low-risk surgical patients. This may support policy measures that use task-sharing as a means of expanding anaesthesia care capacity in rural Indian hospitals. Trial Registration Number: NCT04438811. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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