Strengthening health human resources and improving clinical outcomes through an integrated guideline and educational outreach in resource-poor settings: a cluster-randomized trial

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dc.contributor.authorSchull, Michaelen_ZA
dc.contributor.authorBanda, Hastingsen_ZA
dc.contributor.authorKathyola, Damsonen_ZA
dc.contributor.authorFairall, Laraen_ZA
dc.contributor.authorMartiniuk, Alexandraen_ZA
dc.contributor.authorBurciul, Barryen_ZA
dc.contributor.authorZwarenstein, Merricken_ZA
dc.contributor.authorSodhi, Sumeeten_ZA
dc.contributor.authorThompson, Sandyen_ZA
dc.contributor.authorJoshua, Martiasen_ZA
dc.contributor.authorMondiwa, Marthaen_ZA
dc.contributor.authorBateman, Ericen_ZA
dc.date.accessioned2015-10-28T06:53:18Z
dc.date.available2015-10-28T06:53:18Z
dc.date.issued2010en_ZA
dc.description.abstractBACKGROUND:In low-income countries, only about a third of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) patients eligible for anti-retroviral treatment currently receive it. Providing decentralized treatment close to where patients live is crucial to a faster scale up, however, a key obstacle is limited health system capacity due to a shortage of trained health-care workers and challenges of integrating HIV/AIDS care with other primary care services (e.g. tuberculosis, malaria, respiratory conditions). This study will test an adapted primary care health care worker training and guideline intervention, Practical Approach to Lung Health and HIV/AIDS Malawi (PALM PLUS), on staff retention and satisfaction, and quality of patient care.METHODS/DESIGN:A cluster-randomized trial design is being used to compare usual care with a standardized clinical guideline and training intervention, PALM PLUS. The intervention targets middle-cadre health care workers (nurses, clinical officers, medical assistants) in 30 rural primary care health centres in a single district in Malawi. PALM PLUS is an integrated, symptom-based and user-friendly guideline consistent with Malawian national treatment protocols. Training is standardized and based on an educational outreach approach. Trainers will be front-line peer healthcare workers trained to provide outreach training and support to their fellow front-line healthcare workers during focused (1-2 hours), intermittent, interactive sessions on-site in health centers. Primary outcomes are health care worker retention and satisfaction. Secondary outcomes are clinical outcomes measured at the health centre level for HIV/AIDS, tuberculosis, prevention-of-mother-to-child-transmission of HIV and other primary care conditions. Effect sizes and 95% confidence intervals for outcomes will be presented. Assessment of outcomes will occur at 1 year post- implementation.DISCUSSION:The PALM PLUS trial aims to address a key problem: strengthening middle-cadre health care workers to support the broader scale up of HIV/AIDS services and their integration into primary care. The trial will test whether the PALM PLUS intervention improves staff satisfaction and retention, as well as the quality of patient care, when compared to usual practice.TRIAL REGISTRATION:Current controlled Trials: ISRCTN47805230en_ZA
dc.identifier.apacitationSchull, M., Banda, H., Kathyola, D., Fairall, L., Martiniuk, A., Burciul, B., ... Bateman, E. (2010). Strengthening health human resources and improving clinical outcomes through an integrated guideline and educational outreach in resource-poor settings: a cluster-randomized trial. <i>Trials</i>, http://hdl.handle.net/11427/14436en_ZA
dc.identifier.chicagocitationSchull, Michael, Hastings Banda, Damson Kathyola, Lara Fairall, Alexandra Martiniuk, Barry Burciul, Merrick Zwarenstein, et al "Strengthening health human resources and improving clinical outcomes through an integrated guideline and educational outreach in resource-poor settings: a cluster-randomized trial." <i>Trials</i> (2010) http://hdl.handle.net/11427/14436en_ZA
dc.identifier.citationSchull, M. J., Banda, H., Kathyola, D., Fairall, L., Martiniuk, A., Burciul, B., ... & Bateman, E. (2010). Strengthening health human resources and improving clinical outcomes through an integrated guideline and educational outreach in resource-poor settings: a cluster-randomized trial. Trials, 11(1), 118.en_ZA
dc.identifier.ris TY - Journal Article AU - Schull, Michael AU - Banda, Hastings AU - Kathyola, Damson AU - Fairall, Lara AU - Martiniuk, Alexandra AU - Burciul, Barry AU - Zwarenstein, Merrick AU - Sodhi, Sumeet AU - Thompson, Sandy AU - Joshua, Martias AU - Mondiwa, Martha AU - Bateman, Eric AB - BACKGROUND:In low-income countries, only about a third of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) patients eligible for anti-retroviral treatment currently receive it. Providing decentralized treatment close to where patients live is crucial to a faster scale up, however, a key obstacle is limited health system capacity due to a shortage of trained health-care workers and challenges of integrating HIV/AIDS care with other primary care services (e.g. tuberculosis, malaria, respiratory conditions). This study will test an adapted primary care health care worker training and guideline intervention, Practical Approach to Lung Health and HIV/AIDS Malawi (PALM PLUS), on staff retention and satisfaction, and quality of patient care.METHODS/DESIGN:A cluster-randomized trial design is being used to compare usual care with a standardized clinical guideline and training intervention, PALM PLUS. The intervention targets middle-cadre health care workers (nurses, clinical officers, medical assistants) in 30 rural primary care health centres in a single district in Malawi. PALM PLUS is an integrated, symptom-based and user-friendly guideline consistent with Malawian national treatment protocols. Training is standardized and based on an educational outreach approach. Trainers will be front-line peer healthcare workers trained to provide outreach training and support to their fellow front-line healthcare workers during focused (1-2 hours), intermittent, interactive sessions on-site in health centers. Primary outcomes are health care worker retention and satisfaction. Secondary outcomes are clinical outcomes measured at the health centre level for HIV/AIDS, tuberculosis, prevention-of-mother-to-child-transmission of HIV and other primary care conditions. Effect sizes and 95% confidence intervals for outcomes will be presented. Assessment of outcomes will occur at 1 year post- implementation.DISCUSSION:The PALM PLUS trial aims to address a key problem: strengthening middle-cadre health care workers to support the broader scale up of HIV/AIDS services and their integration into primary care. The trial will test whether the PALM PLUS intervention improves staff satisfaction and retention, as well as the quality of patient care, when compared to usual practice.TRIAL REGISTRATION:Current controlled Trials: ISRCTN47805230 DA - 2010 DB - OpenUCT DO - 10.1186/1745-6215-11-118 DP - University of Cape Town J1 - Trials LK - https://open.uct.ac.za PB - University of Cape Town PY - 2010 T1 - Strengthening health human resources and improving clinical outcomes through an integrated guideline and educational outreach in resource-poor settings: a cluster-randomized trial TI - Strengthening health human resources and improving clinical outcomes through an integrated guideline and educational outreach in resource-poor settings: a cluster-randomized trial UR - http://hdl.handle.net/11427/14436 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14436
dc.identifier.urihttp://dx.doi.org/10.1186/1745-6215-11-118
dc.identifier.vancouvercitationSchull M, Banda H, Kathyola D, Fairall L, Martiniuk A, Burciul B, et al. Strengthening health human resources and improving clinical outcomes through an integrated guideline and educational outreach in resource-poor settings: a cluster-randomized trial. Trials. 2010; http://hdl.handle.net/11427/14436.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDivision of Pulmonologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2010 Schull et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceTrialsen_ZA
dc.source.urihttp://www.trialsjournal.com/en_ZA
dc.subject.otherEthics, Medicalen_ZA
dc.subject.otherHealth Educationen_ZA
dc.subject.otherHealth Resourcesen_ZA
dc.titleStrengthening health human resources and improving clinical outcomes through an integrated guideline and educational outreach in resource-poor settings: a cluster-randomized trialen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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