Improving Facility Performance in Infectious Disease Care in Uganda: A Mixed Design Study with Pre/Post and Cluster Randomized Trial Components

Weaver, Marcia R.; Burnett, Sarah M.; Crozier, Ian; Kinoti, Stephen N.; Kirunda, Ibrahim; Mbonye, Martin K.; Naikoba, Sarah; Ronald, Allan; Rubashembusya, Timothy; Zawedde, Stella; Willis, Kelly S.
August 2014
PLoS ONE;Aug2014, Vol. 9 Issue 8, p1
Academic Journal
Background: The effects of two interventions, Integrated Management of Infectious Disease (IMID) training program and On-Site Support (OSS), were tested on 23 facility performance indicators for emergency triage assessment and treatment (ETAT), malaria, pneumonia, tuberculosis, and HIV. Methods: The trial was implemented in 36 primary care facilities in Uganda. From April 2010, two mid-level practitioners per facility participated in IMID training. Eighteen of 36 facilities were randomly assigned to Arm A, and received OSS in 2010 (nine monthly two-day sessions); 18 facilities assigned to Arm B did not receive OSS in 2010. Data were collected from Nov 2009 to Dec 2010 using a revised Ministry of Health outpatient medical form and nine registers. We analyzed the effect of IMID training alone by measuring changes before and during IMID training in Arm B, the combined effect of IMID training and OSS by measuring changes in Arm A, and the incremental effect of OSS by comparing changes across Arms A and B. Results: IMID training was associated with statistically significant improvement in three indicators: outpatients triaged (adjusted relative risks (aRR) = 1.29, 99%CI = 1.01,1.64), emergency and priority patients admitted, detained, or referred (aRR = 1.59, 99%CI = 1.04,2.44), and pneumonia suspects assessed (aRR = 2.31, 99%CI = 1.50,3.55). IMID training and OSS combined was associated with improvements in six indicators: three ETAT indicators (outpatients triaged (aRR = 2.03, 99%CI = 1.13,3.64), emergency and priority patients admitted, detained or referred (aRR = 3.03, 99%CI = 1.40,6.56), and emergency patients receiving at least one appropriate treatment (aRR = 1.77, 99%CI = 1.10,2.84)); two malaria indicators (malaria cases receiving appropriate antimalarial (aRR = 1.50, 99%CI = 1.04,2.17), and patients with negative malaria test results prescribed antimalarial (aRR = 0.67, 99%CI = 0.46,0.97)); and enrollment in HIV care (aRR = 1.58, 99%CI = 1.32,1.89). OSS was associated with incremental improvement in emergency patients receiving at least one appropriate treatment (adjusted ratio of RR = 1.84,99%CI = 1.09,3.12). Conclusion: The trial showed that the OSS intervention significantly improved performance in one of 23 facility indicators.


Related Articles

  • Primary care management for isolated limb injury: Referral to orthopedic surgery in a trauma center. Rouleau, Dominique M.; Parent, Stefan; Feldman, Debbie Ehrmann // Clinical & Investigative Medicine;Apr2010, Vol. 33 Issue 2, pE99 

    Introduction: Musculoskeletal injuries affect up to 13% of adults annually. Despite this high incidence, quality of primary care, including analgesia, may be sub-optimal. The goal of this study is to describe the quality of primary care for ambulatory patients with isolated limb injury and to...

  • Alignment between Chronic Disease Policy and Practice: Case Study at a Primary Care Facility. Draper, Claire A.; Draper, Catherine E.; Bresick, Graham F. // PLoS ONE;Aug2014, Vol. 9 Issue 8, p1 

    Background: Chronic disease is by far the leading cause of death worldwide and of increasing concern in low- and middle-income countries, including South Africa, where chronic diseases disproportionately affect the poor living in urban settings. The Provincial Government of the Western Cape...

  • Clinical Correlates of Health Preference and Generic Health-Related Quality of Life in Patients with Colorectal Neoplasms. Wong, Carlos K. H.; Lam, Cindy L. K.; Poon, Jensen T. C.; Kwong, Dora L. W. // PLoS ONE;Mar2013, Vol. 8 Issue 3, p1 

    Background: The aims of the study were to assess the health preference and health-related quality of life (HRQOL) in patients with colorectal neoplasms (CRN), and to determine the clinical correlates that significantly influence the HRQOL of patients. Methods: Five hundred and fifty-four...

  • A study on revitalization of primary healthcare organizations through development of standard functions. Hyun-Jong Oh; Jeong-Sik Park; A.-Ryun Park; Sug-Won Pyun; Yang-Kyun Kim // Journal of the Korean Medical Association / Taehan Uisa Hyophoe ;Feb2011, Vol. 54 Issue 2, p205 

    Primary care lays the foundation of national healthcare systems, but it has been weak in playing its role correctly because of legal and environmental attributes surrounding the healthcare industry in Korea. This study is conducted to concretize the definition and scope of primary care and to...

  • Beyond Parity: Primary Care Physicians' Perspectives On Access To Mental Health Care. Cunningham, Peter J. // Health Affairs;May/Jun2009, Vol. 28 Issue 3, pw490 

    About two-thirds of primary care physicians (PCPs) reported in 2004-05 that they could not get outpatient mental health services for patients—a rate that was at least twice as high as that for other services. Shortages of mental health care providers, health plan barriers, and lack of...

  • Common ground on foreign soil. O'Keefe, Bev // New Zealand Doctor;5/4/2011, p47 

    The author discusses her experiences at the International Learning on Increasing the Value and Effectiveness of Primary Care (I LIVE PC) that was held in Washington D.C. in April 2011. She says that she is excited about the closer partnership between health policy, national standards and...

  • Million more outpatients heading for primary care.  // Pulse;4/7/2003, Vol. 63 Issue 14, p4 

    Reports that one million more outpatients will be seen in primary care when the new general practitioner contract is implemented, according to a British government dossier on future National Health Service funding.

  • Evaluating models of working at the interface between mental health services and primary care. Gask, Linda; Sibbald, Bonnie; Creed, Francis; Gask, L; Sibbald, B; Creed, F // British Journal of Psychiatry;Jan97, Vol. 170, p6 

    Background: This paper examines the feasibility of evaluating innovative models of working at the interface between primary care and secondary mental health services.Method: Methodological problems relevant to evaluation of innovative models of working at the interface...

  • Million outpatients to be offloaded on special-interest GPs.  // Pulse;3/17/2003, Vol. 63 Issue 11, p8 

    Reports on the British government's strategy to offload outpatient appointments on to primary and community care. Role of general practitioners in the strategy; Coverage of the proposed program.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics