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dc.contributor.authorVasan, Ashwinen_US
dc.contributor.authorAnatole, Manzien_US
dc.contributor.authorMezzacappa, Catherineen_US
dc.contributor.authorHedt-Gauthier, Bethany Len_US
dc.contributor.authorHirschhorn, Lisa Ren_US
dc.contributor.authorNkikabahizi, Fulgenceen_US
dc.contributor.authorHagenimana, Marcen_US
dc.contributor.authorNdayisaba, Aphrodisen_US
dc.contributor.authorCyamatare, Felix Ren_US
dc.contributor.authorNzeyimana, Bonaventureen_US
dc.contributor.authorDrobac, Peteren_US
dc.contributor.authorGupta, Neilen_US
dc.date.accessioned2014-03-11T13:27:52Z
dc.date.issued2013en_US
dc.identifier.citationVasan, A., M. Anatole, C. Mezzacappa, B. L. Hedt-Gauthier, L. R. Hirschhorn, F. Nkikabahizi, M. Hagenimana, et al. 2013. “Baseline assessment of adult and adolescent primary care delivery in Rwanda: an opportunity for quality improvement.” BMC Health Services Research 13 (1): 518. doi:10.1186/1472-6963-13-518. http://dx.doi.org/10.1186/1472-6963-13-518.en
dc.identifier.issn1472-6963en
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:11879720
dc.description.abstractBackground: 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.en
dc.language.isoen_USen
dc.publisherBioMed Centralen
dc.relation.isversionofdoi:10.1186/1472-6963-13-518en
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3878570/pdf/en
dash.licenseLAAen_US
dc.subjectPrimary careen
dc.subjectAfricaen
dc.subjectResource-limited settingsen
dc.subjectQuality improvementen
dc.subjectTrainingen
dc.subjectIntegrationen
dc.subjectIMAIen
dc.subjectOutpatient departmenten
dc.subjectNursesen
dc.titleBaseline assessment of adult and adolescent primary care delivery in Rwanda: an opportunity for quality improvementen
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden
dc.relation.journalBMC Health Services Researchen
dash.depositing.authorHirschhorn, Lisa Ren_US
dc.date.available2014-03-11T13:27:52Z
dc.identifier.doi10.1186/1472-6963-13-518*
dash.authorsorderedfalse
dash.contributor.affiliatedGupta, Neil
dash.contributor.affiliatedHirschhorn, Lisa
dash.contributor.affiliatedDrobac, Peter


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