Improving prescribing practices with rapid diagnostic tests (RDTs): synthesis of 10 studies to explore reasons for variation in malaria RDT uptake and adherence.

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Improving prescribing practices with rapid diagnostic tests (RDTs): synthesis of 10 studies to explore reasons for variation in malaria RDT uptake and adherence.

Burchett, Helen E D (författare): London Sch Hyg & Trop Med, Dept Global Hlth & Dev, London, England.,London Sch Hyg & Trop Med, Dept Clin Res, London, England.

Leurent, Baptiste (författare): London Sch Hyg & Trop Med, Dept Infect Dis Epidemiol, London, England.

Baiden, Frank (författare): Ensign Coll Publ Hlth, Epidemiol Unit, Kpong, Ghana.

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Baltzell, Kimberly (författare): Univ Calif Berkeley, Dept Family Hlth Care Nursing & Global Hlth Sci, Berkeley, CA 94720 USA.

Björkman, Anders (författare): Karolinska Institutet,Karolinska Inst, Dept Microbiol Tumour & Cell Biol, Stockholm, Sweden.

Bruxvoort, Katia (författare): London Sch Hyg & Trop Med, Dept Global Hlth & Dev, London, England.

Clarke, Siân (författare): London Sch Hyg & Trop Med, Dis Control Dept, London, England.

DiLiberto, Deborah (författare)

Elfving, Kristina (författare): Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för pediatrik,Institutionen för biomedicin, avdelningen för infektionssjukdomar,Institute of Clinical Sciences, Department of Pediatrics,Institute of Biomedicine, Department of Infectious Medicine,Karolinska Inst, Dept Microbiol Tumour & Cell Biol, Stockholm, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Dept Infect Dis, Gothenburg, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Dept Pediat, Gothenburg, Sweden.

Goodman, Catherine (författare): London Sch Hyg & Trop Med, Dept Global Hlth & Dev, London, England.

Hopkins, Heidi (författare): London Sch Hyg & Trop Med, Dis Control Dept, London, England.

Lal, Sham (författare): London Sch Hyg & Trop Med, Dis Control Dept, London, England.

Liverani, Marco (författare): London Sch Hyg & Trop Med, Dept Global Hlth & Dev, London, England.

Magnussen, Pascal (författare): Univ Copenhagen, Fac Hlth & Med Sci, Ctr Med Parasitol, Copenhagen, Denmark.

Mårtensson, Andreas, 1963- (författare): Uppsala universitet,Internationell mödra- och barnhälsovård (IMCH)

Mbacham, Wilfred (författare): Univ Yaounde, Ctr Biotechnol, Lab Publ Hlth Res Biotechnol, Yaounde, Cameroon.

Mbonye, Anthony (författare): Makerere Univ, Sch Publ Hlth, Kampala, Uganda.;Minist Hlth, Commissioner Hlth Serv, Kampala, Uganda.

Onwujekwe, Obinna (författare): Univ Nigeria, Dept Therapeut & Pharmacol, Enugu Campus, Enugu, Nigeria.

Roth Allen, Denise (författare): Ctr Dis Control & Prevent CDC, Atlanta, GA USA.

Shakely, Delér (författare): Karolinska Inst, Dept Microbiol Tumour & Cell Biol, Stockholm, Sweden.;Kungalv Hosp, Dept Med, Kungalv, Sweden.

Staedke, Sarah (författare): London Sch Hyg & Trop Med, Dept Clin Res, London, England.,Univ Copenhagen, Ctr Med Parasitol, DK-1168 Copenhagen, Denmark.;Copenhagen Univ Hosp, Rigshosp, Copenhagen, Denmark.;Statens Serum Inst, Dept Infect Dis Epidemiol, Copenhagen, Denmark.

Vestergaard, Lasse S (författare)

Whitty, Christopher J M (författare): London Sch Hyg & Trop Med, Dept Clin Res, London, England.

Wiseman, Virginia (författare): London Sch Hyg & Trop Med, Dept Global Hlth & Dev, London, England.;Sch Publ Hlth & Community Med, Kensington, NSW, Australia.

Chandler, Clare I R (författare): London Sch Hyg & Trop Med, Dept Global Hlth & Dev, London, England.

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London Sch Hyg & Trop Med, Dept Global Hlth & Dev, London, England London Sch Hyg & Trop Med, Dept Clin Res, London, England. (creator_code:org_t)

2017-03-08
2017
Engelska.
Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 7:3

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Abstract Ämnesord

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The overuse of antimalarial drugs is widespread. Effective methods to improve prescribing practice remain unclear. We evaluated the impact of 10 interventions that introduced rapid diagnostic tests for malaria (mRDTs) on the use of tests and adherence to results in different contexts.A comparative case study approach, analysing variation in outcomes across different settings.Studies from the ACT Consortium evaluating mRDTs with a range of supporting interventions in 6 malaria endemic countries. Providers were governmental or non-governmental healthcare workers, private retail sector workers or community volunteers. Each study arm in a distinct setting was considered a case.28 cases from 10 studies were included, representing 148461 patients seeking care for suspected malaria.The interventions included different mRDT training packages, supervision, supplies and community sensitisation.Analysis explored variation in: (1) uptake of mRDTs (% febrile patients tested); (2) provider adherence to positive mRDTs (% Plasmodium falciparum positive prescribed/given Artemisinin Combination Treatment); (3) provider adherence to negative mRDTs (% P. falciparum negative not prescribed/given antimalarial).Outcomes varied widely across cases: 12-100% mRDT uptake; 44-98% adherence to positive mRDTs; 27-100% adherence to negative mRDTs. Providers appeared more motivated to perform well when mRDTs and intervention characteristics fitted with their own priorities. Goodness of fit of mRDTs with existing consultation and diagnostic practices appeared crucial to maximising the impact of mRDTs on care, as did prior familiarity with malaria testing; adequate human resources and supplies; possible alternative treatments for mRDT-negative patients; a more directive intervention approach and local preferences for ACTs.Basic training and resources are essential but insufficient to maximise the potential of mRDTs in many contexts. Programme design should respond to assessments of provider priorities, expectations and capacities. As mRDTs become established, the intensity of supporting interventions required seems likely to reduce.

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin

MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Infektionsmedici ...

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Av lärosätet: Göteborgs universitet; Karolinska Institutet; Uppsala universitet

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Improving prescribing practices with rapid diagnostic tests (RDTs): synthesis of 10 studies to explore reasons for variation in malaria RDT uptake and adherence.

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