Quality of Medical Laboratory Services in Resource-Limited Settings

Abstract Background As antiretroviral therapy (ART) programs expand access, there is an increase in burden to a healthcare system. These results are reduced provider-patient contact time and poor programmatic and patient outcomes. Quality management offers providers a standardized approach for addressing the appropriateness of care to be applied in resource-limited settings. This study aimed to determine the trend of performance on HIV/AIDS quality management indicators of health facilities providing ART over a period of 5 years. Methods The annual performance scores of quality of care (QoC) indicators of 31 health facilities providing ART was extracted from a database covering a period of 5 years (from October 2008 to September 2012). The data are percentages that indicate scores of each health facility assessed based on compliance to National ART guidelines categorized into several indicator domains. A Chi square statistic for the trend, as well as test for departure from the trend line was determined. The p value associated with each indicator provides the significant level for testing an alternative hypothesis that the rate of change over the period considered for that indicator does not equal to zero. The slope of the regression line also gives the magnitude of the rate of change for each indicator by healthcare level across the review period. Results Generally, performance trends showed improvement across most indicator domains. The highest improvement occurred for “3 month loss to follow-up” and “1 year no-visit”, with scores declining from 37 to 3%, and 42% to 12% respectively. However, there was a sharp decline in performance between 2010 and 2012 in weight monitoring of patients (p < 0.01), adherence assessment to ARVs (p < 0.01) and hematocrit measurements (p = 0.01). The aggregate rate of change β, as obtained from the slope of the trend line is highly significant (p < 0.01) for all the quality of care indicators considered, whether improving or declining. Conclusion Periodic assessment to determine HIV/AIDS quality of care can guide rapid scale-up of services to achieve universal coverage in resource-limited settings. Determining trends to understand patterns is very useful for improving programmatic and patient outcomes.

Download Full-text

Using Technology to Improve Quality of Cancer Care in Resource-Limited Settings

Journal of Global Oncology ◽

10.1200/jgo.19.21000 ◽

2019 ◽

Vol 5 (Supplement_1) ◽

pp. 12-12 ◽

Cited By ~ 1

Author(s):

O.A. Silas ◽

C.J. Achenbach ◽

L. Hou ◽

R.L. Murphy

Keyword(s):

Cancer Research ◽

Data Management ◽

Cancer Care ◽

Improve Quality ◽

Resource Limited Settings ◽

Middle Income ◽

Middle Income Countries ◽

Resource Limited ◽

Data Management Software

PURPOSE To highlight the importance of adapting affordable, holistic point-of-care technology (POCT) and data management software to improve quality of cancer care in resource-limited settings. Cancer is the second leading cause of death globally and was responsible for an estimated 9.6 million deaths in 2018, with low- and middle-income countries accounting for as much as 70% of these deaths. METHODS In 2004, the WHO outlined a set of criteria, called the ASSURED guidelines, to promote affordable, sensitive, specific, user-friendly, rapid, robust, equipment-free, and deliverable to end-user POCT. Although advances in POC cancer technology are relatively underexploited, early successes show that the field has significant potential to contribute to improving cancer detection, diagnosis, and treatment in low- and middle-income countries. RESULTS The current global disparity in cancer care can be addressed through mobilization of the research community to improve POCT, funding unique POCT concepts adapted for resource-limited settings, and training of scientists and engineers in designing robust data management software, such as the research electronic data capture for cancer research. CONCLUSION Improving cancer care holistically requires use of POCT with designs adapted to resource-limited settings and leveraging software with robust features for cancer research.

Download Full-text