背景:卫生人力资源(HRH)短缺是公平获得医疗保健的主要限制。尽管传染性和非传染性疾病(NCD)负担不断增加,但非洲国家的HRH短缺最严重。任务转移为填补非洲HRH短缺的空白提供了机会。这次范围界定审查的目的是评估任务转移的角色,解决非洲人群肾脏和心血管(CV)健康问题的干预措施和结果。
方法:我们进行了范围界定审查,以回答以下问题:“角色是什么,非洲CV和肾脏健康的任务转移策略的干预措施和结果?“在搜索MEDLINE(Ovid)后选择了符合条件的研究,Embase(Ovid),CINAHL,ISIWebofScience,和非洲在线杂志(AJOL)。我们对数据进行了描述性分析。
结果:33项研究,在10个非洲国家进行(南非,尼日利亚,加纳,肯尼亚,喀麦隆,刚果民主共和国,埃塞俄比亚,马拉维,卢旺达,和乌干达)有资格被列入名单。很少有随机对照试验(n=6;18.2%),与糖尿病(n=16;48.5%)相比,高血压(n=27;81.8%)的任务大多转移。与药剂师(n=6;18.2%)或社区卫生工作者(n=5;15.2%)相比,更多的任务转移给护士(n=19;57.6%)。在所有研究中,HRH在任务转移中最常见的作用是治疗和依从性(n=28;84.9%),其次是筛查和检测(n=24;72.7%),教育和咨询(n=24;72.7%),和分诊(n=13;39.4%)。78.6%的人报告血压水平改善,66.7%,80.0%与高血压相关的任务将角色转变为护士,药剂师,和CHWs,分别。改善的血糖指数报告为66.7%,50.0%,66.7%的糖尿病相关任务将角色转移给护士,药剂师,和CHWs,分别。
结论:尽管非洲在CV和肾脏健康方面存在许多HRH挑战,这项研究表明,任务转移举措可以改善护理措施(获取和效率)和识别的过程,该地区对CV和肾脏疾病的认识和治疗。任务转移对肾脏和心血管疾病长期结局的影响以及基于任务转移的NCD计划的可持续性仍有待确定。
BACKGROUND: Human resources for health (HRH) shortages are a major limitation to equitable access to healthcare. African countries have the most severe shortage of HRH in the world despite rising communicable and non-communicable disease (NCD) burden. Task shifting provides an opportunity to fill the gaps in HRH shortage in Africa. The aim of this scoping
review is to evaluate task shifting roles, interventions and outcomes for addressing kidney and cardiovascular (CV) health problems in African populations.
METHODS: We conducted this scoping
review to answer the question: \"what are the roles, interventions and outcomes of task shifting strategies for CV and kidney health in Africa?\" Eligible studies were selected after searching MEDLINE (Ovid), Embase (Ovid), CINAHL, ISI Web of Science, and Africa journal online (AJOL). We analyzed the data descriptively.
RESULTS: Thirty-three studies, conducted in 10 African countries (South Africa, Nigeria, Ghana, Kenya, Cameroon, Democratic Republic of Congo, Ethiopia, Malawi, Rwanda, and Uganda) were eligible for inclusion. There were few randomized controlled trials (n = 6; 18.2%), and tasks were mostly shifted for hypertension (n = 27; 81.8%) than for diabetes (n = 16; 48.5%). More tasks were shifted to nurses (n = 19; 57.6%) than pharmacists (n = 6; 18.2%) or community health workers (n = 5; 15.2%). Across all studies, the most common role played by HRH in task shifting was for treatment and adherence (n = 28; 84.9%) followed by screening and detection (n = 24; 72.7%), education and counselling (n = 24; 72.7%), and triage (n = 13; 39.4%). Improved blood pressure levels were reported in 78.6%, 66.7%, and 80.0% for hypertension-related task shifting roles to nurses, pharmacists, and CHWs, respectively. Improved glycaemic indices were reported as 66.7%, 50.0%, and 66.7% for diabetes-related task shifting roles to nurses, pharmacists, and CHWs, respectively.
CONCLUSIONS: Despite the numerus HRH challenges that are present in Africa for CV and kidney health, this study suggests that task shifting initiatives can improve process of care measures (access and efficiency) as well as identification, awareness and treatment of CV and kidney disease in the region. The impact of task shifting on long-term outcomes of kidney and CV diseases and the sustainability of NCD programs based on task shifting remains to be determined.