Doctors experiences on the quality of care for pesticide poisoning patients in hospitals in Kampala, Uganda: a qualitative exploration using donabedian’s model

Abstract Background: Pesticides are responsible for a significant percentage of deaths globally with majority occurring in sub-Saharan Africa. Deaths due to pesticide poisoning can be reduced if poisoning cases are managed optimally. However, the quality of care given to pesticide poisoning patients is still insufficient especially in sub-Saharan Africa. This study was aimed at exploring doctors’ experiences on quality of care for pesticide poisoning cases in hospitals in Kampala, Uganda. Methods: Fifteen (15) in-depth interviews were conducted with doctors who were directly involved in management of pesticide poisoning patients in the accident and emergency, Medicine, Pediatrics and Intensive Care Unit wards in 5 hospitals in Kampala, Uganda. All interviews were transcribed and subjected to directed content analysis with the guidance of the Donabedian model of quality of care which emphasizes structure, process and outcome measures as pertinent ensuring quality care. Results: Doctors reported structural, process and outcome facets that support diagnosis and treatment of pesticide poisoning cases improved the quality of care provided by doctors. Among the structures includes hospital units such as Intensive Care Unit (ICU), pediatrics and internal medicine; equipment and clinical guidelines such as airway, breathing and consciousness (ABC) protocol; and doctors’ knowledge and experiences. Doctors relied on history, and signs and symptoms to establish the cause and severity of pesticide poisoning. However, some patients and caretakers provided inaccurate pesticide poisoning history. Due to its availability in hospitals, doctors largely relied on atropine to manage pesticide poisoning cases whether or not relevant to treat the actual pesticide poisoning. Although majority of the cases treated recovered, those due to suicide were further referred to the hospital psychiatrist. Sharing experiences of managing pesticide poisoning patients among health workers and engaging in sensitization outreaches against pesticide poisoning were reported as potential activities to improve quality of care for pesticide poisoning patients. Conclusion: Doctors reflected on the structure, process and outcome measures of quality of care given to pesticide poisoning patients. The implications of hospital structures and clinical process to the quality of the outcomes of care demonstrates their importance to improve management of pesticide poisoning cases in hospitals in Kampala, Uganda.

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Doctors experiences on the quality of care for pesticide poisoning patients in hospitals in Kampala, Uganda: a qualitative exploration using donabedian’s model

10.21203/rs.2.11480/v4 ◽

2020 ◽

Author(s):

Charles Ssemugabo ◽

Sarah Nalinya MPH ◽

Abdullah Ali Halage ◽

Ruth Mubeezi Neebye ◽

David Musoke ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Quality Of Care ◽

Outcome Measures ◽

Health Workers ◽

Sub Saharan Africa ◽

Pesticide Poisoning ◽

Process And Outcome ◽

Sub Saharan

Abstract Background Pesticides are responsible for a significant percentage of deaths globally with majority occurring in sub-Saharan Africa. Deaths due to pesticide poisoning can be reduced if poisoning cases are managed optimally. However, the quality of care given to pesticide poisoning patients is still insufficient especially in sub-Saharan Africa. This study was aimed at exploring doctors’ experiences on quality of care for pesticide poisoning cases in hospitals in Kampala, Uganda.Methods Fifteen (15) in-depth interviews were conducted with doctors who were directly involved in management of pesticide poisoning patients in the accident and emergency, Medicine, Pediatrics and Intensive Care Unit wards in 5 hospitals in Kampala, Uganda. All interviews were transcribed and subjected to directed content analysis with the guidance of the Donabedian model of quality of care which emphasizes structure, process and outcome measures as pertinent ensuring quality care.Results Doctors reported structural, process and outcome facets that support diagnosis and treatment of pesticide poisoning cases improved the quality of care provided by doctors. Among the structures includes hospital units such as Intensive Care Unit (ICU), pediatrics and internal medicine; equipment and clinical guidelines such as airway, breathing and consciousness (ABC) protocol; and doctors’ knowledge and experiences. Doctors relied on history, and signs and symptoms to establish the cause and severity of pesticide poisoning. However, some patients and caretakers provided inaccurate pesticide poisoning history. Due to its availability in hospitals, doctors largely relied on atropine to manage pesticide poisoning cases whether or not relevant to treat the actual pesticide poisoning. Although majority of the cases treated recovered, those due to suicide were further referred to the hospital psychiatrist. Sharing experiences of managing pesticide poisoning patients among health workers and engaging in sensitization outreaches against pesticide poisoning were reported as potential activities to improve quality of care for pesticide poisoning patients.Conclusion Doctors reflected on the structure, process and outcome measures of quality of care given to pesticide poisoning patients. The implications of hospital structures and clinical process to the quality of the outcomes of care demonstrates their importance to improve management of pesticide poisoning cases in hospitals in Kampala, Uganda.

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Doctors experiences on the quality of care for pesticide poisoning patients in hospitals in Kampala, Uganda: a qualitative exploration using donabedian’s model

BMC Health Services Research ◽

10.1186/s12913-020-4891-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Charles Ssemugabo ◽

Sarah Nalinya ◽

Abdullah Ali Halage ◽

Ruth Mubeezi Neebye ◽

David Musoke ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Quality Of Care ◽

Outcome Measures ◽

Health Workers ◽

Sub Saharan Africa ◽

Pesticide Poisoning ◽

Process And Outcome ◽

Sub Saharan

Abstract Background Pesticides are responsible for a significant percentage of deaths globally with majority occurring in sub-Saharan Africa. Deaths due to pesticide poisoning can be reduced if poisoning cases are managed optimally. However, the quality of care given to pesticide poisoning patients is still insufficient especially in sub-Saharan Africa. This study was aimed at exploring doctors’ experiences on quality of care for pesticide poisoning cases in hospitals in Kampala, Uganda. Methods Fifteen (15) in-depth interviews were conducted with doctors who were directly involved in management of pesticide poisoning patients in the accident and emergency, Medicine, Pediatrics and Intensive Care Unit wards in 5 hospitals in Kampala, Uganda. All interviews were transcribed and subjected to directed content analysis with the guidance of the Donabedian model of quality of care which emphasizes structure, process and outcome measures as pertinent to ensuring quality of care. Results Doctors reported structural, process and outcome facets that support diagnosis and treatment of pesticide poisoning cases that improved the quality of care they provided. Among the structures includes hospital units such as Intensive Care Unit (ICU), pediatrics and internal medicine; equipment and clinical guidelines such as airway, breathing and consciousness (ABC) protocol; and doctors’ knowledge and experiences. Doctors relied on history, and signs and symptoms to establish the cause and severity of pesticide poisoning. However, some patients and caretakers provided inaccurate pesticide poisoning history. Due to its availability in hospitals, doctors largely relied on atropine to manage pesticide poisoning cases whether or not relevant to treat the actual pesticide active ingredient responsible for the poisoning. Although majority of the cases treated recovered, those due to suicide were further referred to the hospital psychiatrist. Sharing experiences of managing pesticide poisoning patients among health workers and engaging in sensitization outreaches against pesticide poisoning were reported as potential activities to improve quality of care for pesticide poisoning patients. Conclusion Doctors reflected on the structure, process and outcome measures of quality of care given to pesticide poisoning patients. The implications of hospital structures and clinical process to the quality of the outcomes of care demonstrates their importance in improving management of pesticide poisoning cases in hospitals in Kampala, Uganda.

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Doctors experiences on the quality of care for pesticide poisoning patients in hospitals in Kampala, Uganda: a qualitative exploration using donabedian’s model

10.21203/rs.2.11480/v2 ◽

2019 ◽

Author(s):

Charles Ssemugabo ◽

Sarah Nalinya MPH ◽

Abdullah Ali Halage ◽

Ruth Mubeezi Neebye ◽

David Musoke ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Quality Of Care ◽

Outcome Measures ◽

Sub Saharan Africa ◽

Major Public Health Problem ◽

Pesticide Poisoning ◽

Process And Outcome ◽

Sub Saharan

Abstract Background Pesticide poisoning is a major public health problem in many Low-and-Middle Income Countries (LMICs). Pesticides are responsible for a significant percentage of deaths globally with majority occurring in sub-Saharan Africa. Majority of the pesticide related deaths can be averted if poisoning patients are managed well. However, the quality of care given to pesticide poisoning patients is still insufficient especially in sub-Saharan Africa. Therefore, this study was aimed at exploring doctors’ experiences on quality of care for pesticide poisoning cases in hospitals in Kampala, Uganda. Methods Fifteen (15) in-depth interviews were conducted with doctors who were directly involved in management of pesticide poisoning patients in the accident and emergency, Medicine, Pediatrics and Intensive Care Unit wards in 5 hospitals in Kampala, Uganda. All interviews were transcribed and subjected to directed content analysis with the guidance of the Donabedian model of quality of care which emphasizes structure, process and outcome measures as pertinent ensuring quality care. Results Presence of hospital units such as medical wards including Intensive Care Unit (ICU), pediatrics and internal medicine; availability of equipment and clinical guidelines such as airway, breathing and consciousness (ABC) protocol; and doctors’ knowledge and experiences improved the quality of care given to pesticide poisoning patients. Doctors relied on history, and signs and symptoms to establish the cause and severity of pesticide poisoning. However, some patients and caretakers provided inaccurate pesticide poisoning history. Due to its availability in hospitals, doctors largely relied on atropine to manage pesticide poisoning cases. Although majority of the cases treated recovered, those due to suicide were further referred to the hospital psychiatrist. Sharing experiences of managing pesticide poisoning patients among health workers and engaging in sensitization outreaches against pesticide poisoning were reported as potential activities to improve quality of care for pesticide poisoning patients. Conclusion Doctors reflected on the structure, process and outcome measures of quality of care given to pesticide poisoning patients. The implications of hospital structures and clinical process to the quality of the outcomes of care demonstrates their importance to improving management of pesticide poisoning cases in hospitals in Kampala, Uganda.

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Doctors experiences on the quality of care for pesticide poisoning patients in hospitals in Kampala, Uganda: a qualitative exploration using donabedian’s model

10.21203/rs.2.11480/v1 ◽

2019 ◽

Author(s):

Charles Ssemugabo ◽

Sarah Nalinya MPH ◽

Abdullah Ali Halage ◽

Ruth Mubeezi Neebye ◽

David Musoke ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Quality Of Care ◽

Outcome Measures ◽

Sub Saharan Africa ◽

Major Public Health Problem ◽

Pesticide Poisoning ◽

Process And Outcome ◽

Sub Saharan

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Faculty Opinions recommendation of Effect of 24-hour mandatory versus on-demand critical care specialist presence on quality of care and family and provider satisfaction in the intensive care unit of a teaching hospital.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1103924.561072 ◽

2008 ◽

Author(s):

Jim O'Brien

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Quality Of Care ◽

Teaching Hospital ◽

Provider Satisfaction ◽

On Demand ◽

Care Specialist

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Quality of care in the free maternal healthcare era in sub-Saharan Africa: a scoping review of providers’ and managers’ perceptions

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03701-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Monica Ansu-Mensah ◽

Frederick Inkum Danquah ◽

Vitalis Bawontuo ◽

Peter Ansu-Mensah ◽

Tahiru Mohammed ◽

...

Keyword(s):

Quality Of Care ◽

Research Question ◽

Healthcare Providers ◽

Poor Quality ◽

Sub Saharan Africa ◽

Healthcare Financing ◽

Maternal Healthcare ◽

Sub Saharan ◽

The Impact

Abstract Background Free maternal healthcare financing schemes play an essential role in the quality of services rendered to clients during antenatal care in sub-Saharan Africa (SSA). However, healthcare managers’ and providers’ perceptions of the healthcare financing scheme may influence the quality of care. This scoping review mapped evidence on managers’ and providers’ perspectives of free maternal healthcare and the quality of care in SSA. Methods We used Askey and O’Malley’s framework as a guide to conduct this review. To address the research question, we searched PubMed, CINAHL through EBSCOhost, ScienceDirect, Web of Science, and Google Scholar with no date limitation to May 2019 using keywords, Boolean terms, and Medical Subject Heading terms to retrieve relevant articles. Both abstract and full articles screening were conducted independently by two reviewers using the inclusion and exclusion criteria as a guide. All significant data were extracted, organized into themes, and a summary of the findings reported narratively. Results In all, 15 out of 390 articles met the inclusion criteria. These 15 studies were conducted in nine countries. That is, Ghana (4), Kenya (3), and Nigeria (2), Burkina Faso (1), Burundi (1), Niger (1), Sierra Leone (1), Tanzania (1), and Uganda (1). Of the 15 included studies, 14 reported poor quality of maternal healthcare from managers’ and providers’ perspectives. Factors contributing to the perception of poor maternal healthcare included: late reimbursement of funds, heavy workload of providers, lack of essential drugs and stock-out of medical supplies, lack of policy definition, out-of-pocket payment, and inequitable distribution of staff. Conclusion This study established evidence of existing literature on the quality of care based on healthcare providers’ and managers’ perspectives though very limited. This study indicates healthcare providers and managers perceive the quality of maternal healthcare under the free financing policy as poor. Nonetheless, the free maternal care policy is very much needed towards achieving universal health, and all efforts to sustain and improve the quality of care under it must be encouraged. Therefore, more research is needed to better understand the impact of their perceived poor quality of care on maternal health outcomes.

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