Does stewardship make a difference in the quality of care? Evidence from clinics and pharmacies in Kenya and Ghana

Spreng, Connor P.; Ojo, Ifelayo; Burger, Nicholas; Sood, Neeraj; Peabody, John; DeMaria, Lisa

doi:10.1093/intqhc/mzu054

Cited by 9 publications

(16 citation statements)

References 16 publications

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“…Trauma care vignettes for assessing care quality in LMICs is novel, however, they have been increasingly employed for other conditions. These include TB care in India [32,43], obstetric and newborn care in Ghana and Bangladesh [31,42] and diarrhoea in Kenya, Ghana and India [44,45].…”

Section: Discussionmentioning

confidence: 99%

“…Vignettes have also been used to gauge patient expectations of poor quality care (anchoring) [46] in health system care quality research studies. As in our study, scenarios are commonly developed from and scored against corresponding best practice guidance [31,42,45]. Some vignettes only reveal clinical findings when specifically requested by the provider [43], whilst others provide all required information within the scenario [17,42,45] whether or not specifically requested.…”

Section: Discussionmentioning

confidence: 99%

“…As in our study, scenarios are commonly developed from and scored against corresponding best practice guidance [31,42,45]. Some vignettes only reveal clinical findings when specifically requested by the provider [43], whilst others provide all required information within the scenario [17,42,45] whether or not specifically requested. We opted to provide sufficient follow up information to allow providers opportunity to describe subsequent best treatment.…”

Section: Discussionmentioning

confidence: 99%

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Development and use of clinical vignettes to assess injury care quality in Northern Malawi

Whitaker

Chirwa

Munthali

et al. 2021

Injury

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Development and use of clinical vignettes to assess injury care quality in Northern Malawi

Whitaker

Chirwa

Munthali

et al. 2021

Injury

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“…Third, this project used a vignette-based design with online panel samples. Although numerous cross-cultural studies have successfully used scenarios, 103,104 validation in a clinical setting should be considered. Fourth, recognizing that few studies have examined cross-cultural differences in AD decision making, samples representing Western individualist and Eastern collectivist cultures were used.…”

Section: Limitations and Future Directionsmentioning

confidence: 99%

Improving Patient Preparedness and Confidence in Discussing Advance Directives for End-of-Life Care with Health Care Providers in the United States and Japan

Friend

Alden

2020

Med Decis Making

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Background The low completion rate of advance directives (ADs) has received attention in Japan and the United States, as policy makers and health care professionals face aging populations with multiple comorbidities. Among the barriers to AD planning, cultural values and attitudes appear to be particularly influential. A comparison of culturally distinct societies provides a deeper understanding of these barriers. Through such an approach, this study identifies strategies for increasing AD planning among late-middle-age Japanese and US individuals. Methods After giving informed consent for the Institutional Review Board–approved study, Japanese and US respondents (45–65 y; 50% female) without ADs completed a language-appropriate online survey. Participants were asked to review a decision aid as part of a scenario-based physician consultation regarding artificial nutrition and hydration (ANH). Hypotheses were analyzed using multigroup structural equation modeling. Results Important similarities were identified across the 2 groups. After reviewing the decision aid, both samples strongly preferred “no ANH.” Respondents who strongly valued either self-reliance or interpersonal relationships experienced greater preparedness for AD planning. In both countries, greater decision preparedness and positive death attitude predicted greater confidence to discuss care options with a provider. Finally, cultural values predicted preference for family participation: respondents with a strong interdependent self-concept desired more family involvement, whereas high independents preferred less. Conclusions Findings indicate the importance of documenting care preferences and accounting for individual differences. To increase AD adoption, providers should identify patient segments likely to benefit most from the interventions. Targeting individuals in both countries who value self-reliance and interpersonal relationships appears to be a good place to begin. Such individuals can be identified clinically through administration of validated measures used in this study.

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“…Recent studies have demonstrated that healthcare provider adherence to well-established clinical guidelines is poor across both the public and private sectors in numerous LMICs [2, 3, 4]. Suboptimal quality has been documented in both inpatient and outpatient settings, and has been attributed to multiple factors, including the environment of care (lack of necessary medications and fractured supply chain), insufficient and poorly trained healthcare providers, and lack of systems technology that supports adherence to best practices.…”

Section: Introductionmentioning

confidence: 99%

Brief educational interventions to improve performance on novel quality metrics in ambulatory settings in Kenya: A multi-site pre-post effectiveness trial

et al. 2017

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BackgroundThe quality of primary care delivered in resource-limited settings is low. While some progress has been made using educational interventions, it is not yet clear how to sustainably improve care for common acute illnesses in the outpatient setting. Management of urinary tract infection is particularly important in resource-limited settings, where it is commonly diagnosed and associated with high levels of antimicrobial resistance. We describe an educational programme targeting non-physician health care providers and its effects on various clinical quality metrics for urinary tract infection.MethodsWe used a series of educational interventions including 1) formal introduction of a clinical practice guideline, 2) peer-to-peer chart review, and 3) peer-reviewed literature describing local antimicrobial resistance patterns. Interventions were conducted for clinical officers (N = 24) at two outpatient centers near Nairobi, Kenya over a one-year period. The medical records of 474 patients with urinary tract infections were scored on five clinical quality metrics, with the primary outcome being the proportion of cases in which the guideline-recommended antibiotic was prescribed. The results at baseline and following each intervention were compared using chi-squared tests and unpaired two-tailed T-tests for significance. Logistic regression analysis was used to assess for possible confounders.FindingsClinician adherence to the guideline-recommended antibiotic improved significantly during the study period, from 19% at baseline to 68% following all interventions (Χ2 = 150.7, p < 0.001). The secondary outcome of composite quality score also improved significantly from an average of 2.16 to 3.00 on a five-point scale (t = 6.58, p < 0.001). Interventions had different effects at different clinical sites; the primary outcome of appropriate antibiotic prescription was met 83% of the time at Penda Health, and 50% of the time at AICKH, possibly reflecting differences in onboarding and management of clinical officers. Logistic regression analysis showed that intervention stage and clinical site were independent predictors of the primary outcome (p < 0.0001), while all other features, including provider and patient age, were not significant at a conservative threshold of p < 0.05.ConclusionThis study shows that brief educational interventions can dramatically improve the quality of care for routine acute illnesses in the outpatient setting. Measurement of quality metrics allows for further targeting of educational interventions depending on the needs of the providers and the community. Further study is needed to expand routine measurement of quality metrics and to identify the interventions that are most effective in improving quality of care.

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Does stewardship make a difference in the quality of care? Evidence from clinics and pharmacies in Kenya and Ghana

Abstract: Government stewardship appears to have some cumulative association with quality for clinics, suggesting that comprehensive engagement with providers may influence quality. However, our research indicates that continued medical education (CME) by itself is not associated with improved care.

Cited by 9 publications

References 16 publications

Development and use of clinical vignettes to assess injury care quality in Northern Malawi

Development and use of clinical vignettes to assess injury care quality in Northern Malawi

Improving Patient Preparedness and Confidence in Discussing Advance Directives for End-of-Life Care with Health Care Providers in the United States and Japan

Brief educational interventions to improve performance on novel quality metrics in ambulatory settings in Kenya: A multi-site pre-post effectiveness trial

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