Clinical mentoring to improve quality of care provided at three NIM-ART facilities: A mixed methods study
| Autor: | Gert J.O. Marincowitz, Jacqueline Elizabeth Wolvaardt, David Cameron, C.A. Visser |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
HIV
AIDS Male Quality management lcsh:Medicine Nurses HIV Infections Ambulatory Care Facilities Health Services Accessibility South Africa 0302 clinical medicine Medicine 030212 general & internal medicine Salary media_common Original Research Practice Patterns Nurses' NIM-ART lcsh:Public aspects of medicine 030503 health policy & services Workload General Medicine Focus Groups Middle Aged Quality Improvement quality Patient Satisfaction Female Clinical Competence 0305 other medical science Family Practice Adult medicine.medical_specialty Anti-HIV Agents media_common.quotation_subject Audit mentor 03 medical and health sciences Young Adult Patient satisfaction Acquired immunodeficiency syndrome (AIDS) Humans Quality (business) Quality of Health Care Primary Health Care business.industry Salaries and Fringe Benefits lcsh:R Mentors Public Health Environmental and Occupational Health Mentoring lcsh:RA1-1270 medicine.disease Focus group action research Family medicine business |
| Zdroj: | African Journal of Primary Health Care & Family Medicine African Journal of Primary Health Care & Family Medicine, Volume: 10, Issue: 1, Pages: 1-7, Published: 2018 African Journal of Primary Health Care & Family Medicine, Vol 10, Iss 1, Pp e1-e7 (2018) |
| ISSN: | 2071-2936 |
| Popis: | Background: The South African Department of Health implemented the nurse-initiated management of antiretroviral treatment (NIM-ART) programme as a policy to decentralise services. Increasing access to ART through nurse initiation results in significant consequences. Aim: This study evaluated the quality of care provided, the barriers to the effective rollout of antiretroviral services and the role of a clinical mentor. Setting: The study was conducted at three NIM-ART facilities in South Africa. One clinic provided a high standard of care, one had a high defaulter rate, and at the third clinic, treatment failures were missed, and routine bloods were not collected. Methods: A mixed methods study design was used. Data were collected using patient satisfaction surveys, review of clinical records, facility audits, focus group interviews, field notes and a reflection diary. Results: NIM-ART nurses prescribed rationally and followed antiretroviral guidelines.Mortality rates and loss to follow-up rates were lower than those at the surrounding hospitals, and 91.1% of nurse-monitored patients had an undetectable viral load after a year. The quality of care provided was comparable to doctor-monitored care. The facility audits found recurrent shortages of essential drugs. Patients indicated a high level of satisfaction. Salary challenges, excessive workload, a lack of trained nurses and infrastructural barriers were identified as barriers. On-going mentoring and support by a clinical mentor strengthened each of the facilities, facilitated quality improvement and stimulated health workers to address constraints. Conclusion: Clinical mentors are the key to addressing institutional treatment barriers and ensuring quality of patient care. |
| Databáze: | OpenAIRE |
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