Cargando…

Effect of Educational Outreach Timing and Duration on Facility Performance for Infectious Disease Care in Uganda: A Trial with Pre-Post and Cluster Randomized Controlled Components

BACKGROUND: Classroom-based learning is often insufficient to ensure high quality care and application of health care guidelines. Educational outreach is garnering attention as a supplemental method to enhance health care worker capacity, yet there is little information about the timing and duration...

Descripción completa

Detalles Bibliográficos
Autores principales: Burnett, Sarah M., Mbonye, Martin K., Naikoba, Sarah, Zawedde-Muyanja, Stella, Kinoti, Stephen N., Ronald, Allan, Rubashembusya, Timothy, Willis, Kelly S., Colebunders, Robert, Manabe, Yukari C., Weaver, Marcia R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4564214/
https://www.ncbi.nlm.nih.gov/pubmed/26352257
http://dx.doi.org/10.1371/journal.pone.0136966
_version_ 1782389397773090816
author Burnett, Sarah M.
Mbonye, Martin K.
Naikoba, Sarah
Zawedde-Muyanja, Stella
Kinoti, Stephen N.
Ronald, Allan
Rubashembusya, Timothy
Willis, Kelly S.
Colebunders, Robert
Manabe, Yukari C.
Weaver, Marcia R.
author_facet Burnett, Sarah M.
Mbonye, Martin K.
Naikoba, Sarah
Zawedde-Muyanja, Stella
Kinoti, Stephen N.
Ronald, Allan
Rubashembusya, Timothy
Willis, Kelly S.
Colebunders, Robert
Manabe, Yukari C.
Weaver, Marcia R.
author_sort Burnett, Sarah M.
collection PubMed
description BACKGROUND: Classroom-based learning is often insufficient to ensure high quality care and application of health care guidelines. Educational outreach is garnering attention as a supplemental method to enhance health care worker capacity, yet there is little information about the timing and duration required to improve facility performance. We sought to evaluate the effects of an infectious disease training program followed by either immediate or delayed on-site support (OSS), an educational outreach approach, on nine facility performance indicators for emergency triage, assessment, and treatment; malaria; and pneumonia. We also compared the effects of nine monthly OSS visits to extended OSS, with three additional visits over six months. METHODS: This study was conducted at 36 health facilities in Uganda, covering 1,275,960 outpatient visits over 23 months. From April 2010 to December 2010, 36 sites received infectious disease training; 18 randomly selected sites in arm A received nine monthly OSS visits (immediate OSS) and 18 sites in arm B did not. From March 2011 to September 2011, arm A sites received three additional visits every two months (extended OSS), while the arm B sites received eight monthly OSS visits (delayed OSS). We compared the combined effect of training and delayed OSS to training followed by immediate OSS to determine the effect of delaying OSS implementation by nine months. We also compared facility performance in arm A during the extended OSS to immediate OSS to examine the effect of additional, less frequent OSS. RESULTS: Delayed OSS, when combined with training, was associated with significant pre/post improvements in four indicators: outpatients triaged (44% vs. 87%, aRR = 1.54, 99% CI = 1.11, 2.15); emergency and priority patients admitted, detained, or referred (16% vs. 31%, aRR = 1.74, 99% CI = 1.10, 2.75); patients with a negative malaria test result prescribed an antimalarial (53% vs. 34%, aRR = 0.67, 99% CI = 0.55, 0.82); and pneumonia suspects assessed for pneumonia (6% vs. 27%, aRR = 2.97, 99% CI = 1.44, 6.17). Differences between the delayed OSS and immediate OSS arms were not statistically significant for any of the nine indicators (all adjusted relative RR (aRRR) between 0.76–1.44, all p>0.06). Extended OSS was associated with significant improvement in two indicators (outpatients triaged: aRR = 1.09, 99% CI = 1.01; emergency and priority patients admitted, detained, or referred: aRR = 1.22, 99% CI = 1.01, 1.38) and decline in one (pneumonia suspects assessed for pneumonia: aRR: 0.93; 99% CI = 0.88, 0.98). CONCLUSIONS: Educational outreach held up to nine months after training had similar effects on facility performance as educational outreach started within one month post-training. Six months of bi-monthly educational outreach maintained facility performance gains, but incremental improvements were heterogeneous.
format Online
Article
Text
id pubmed-4564214
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-45642142015-09-17 Effect of Educational Outreach Timing and Duration on Facility Performance for Infectious Disease Care in Uganda: A Trial with Pre-Post and Cluster Randomized Controlled Components Burnett, Sarah M. Mbonye, Martin K. Naikoba, Sarah Zawedde-Muyanja, Stella Kinoti, Stephen N. Ronald, Allan Rubashembusya, Timothy Willis, Kelly S. Colebunders, Robert Manabe, Yukari C. Weaver, Marcia R. PLoS One Research Article BACKGROUND: Classroom-based learning is often insufficient to ensure high quality care and application of health care guidelines. Educational outreach is garnering attention as a supplemental method to enhance health care worker capacity, yet there is little information about the timing and duration required to improve facility performance. We sought to evaluate the effects of an infectious disease training program followed by either immediate or delayed on-site support (OSS), an educational outreach approach, on nine facility performance indicators for emergency triage, assessment, and treatment; malaria; and pneumonia. We also compared the effects of nine monthly OSS visits to extended OSS, with three additional visits over six months. METHODS: This study was conducted at 36 health facilities in Uganda, covering 1,275,960 outpatient visits over 23 months. From April 2010 to December 2010, 36 sites received infectious disease training; 18 randomly selected sites in arm A received nine monthly OSS visits (immediate OSS) and 18 sites in arm B did not. From March 2011 to September 2011, arm A sites received three additional visits every two months (extended OSS), while the arm B sites received eight monthly OSS visits (delayed OSS). We compared the combined effect of training and delayed OSS to training followed by immediate OSS to determine the effect of delaying OSS implementation by nine months. We also compared facility performance in arm A during the extended OSS to immediate OSS to examine the effect of additional, less frequent OSS. RESULTS: Delayed OSS, when combined with training, was associated with significant pre/post improvements in four indicators: outpatients triaged (44% vs. 87%, aRR = 1.54, 99% CI = 1.11, 2.15); emergency and priority patients admitted, detained, or referred (16% vs. 31%, aRR = 1.74, 99% CI = 1.10, 2.75); patients with a negative malaria test result prescribed an antimalarial (53% vs. 34%, aRR = 0.67, 99% CI = 0.55, 0.82); and pneumonia suspects assessed for pneumonia (6% vs. 27%, aRR = 2.97, 99% CI = 1.44, 6.17). Differences between the delayed OSS and immediate OSS arms were not statistically significant for any of the nine indicators (all adjusted relative RR (aRRR) between 0.76–1.44, all p>0.06). Extended OSS was associated with significant improvement in two indicators (outpatients triaged: aRR = 1.09, 99% CI = 1.01; emergency and priority patients admitted, detained, or referred: aRR = 1.22, 99% CI = 1.01, 1.38) and decline in one (pneumonia suspects assessed for pneumonia: aRR: 0.93; 99% CI = 0.88, 0.98). CONCLUSIONS: Educational outreach held up to nine months after training had similar effects on facility performance as educational outreach started within one month post-training. Six months of bi-monthly educational outreach maintained facility performance gains, but incremental improvements were heterogeneous. Public Library of Science 2015-09-09 /pmc/articles/PMC4564214/ /pubmed/26352257 http://dx.doi.org/10.1371/journal.pone.0136966 Text en © 2015 Burnett et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Burnett, Sarah M.
Mbonye, Martin K.
Naikoba, Sarah
Zawedde-Muyanja, Stella
Kinoti, Stephen N.
Ronald, Allan
Rubashembusya, Timothy
Willis, Kelly S.
Colebunders, Robert
Manabe, Yukari C.
Weaver, Marcia R.
Effect of Educational Outreach Timing and Duration on Facility Performance for Infectious Disease Care in Uganda: A Trial with Pre-Post and Cluster Randomized Controlled Components
title Effect of Educational Outreach Timing and Duration on Facility Performance for Infectious Disease Care in Uganda: A Trial with Pre-Post and Cluster Randomized Controlled Components
title_full Effect of Educational Outreach Timing and Duration on Facility Performance for Infectious Disease Care in Uganda: A Trial with Pre-Post and Cluster Randomized Controlled Components
title_fullStr Effect of Educational Outreach Timing and Duration on Facility Performance for Infectious Disease Care in Uganda: A Trial with Pre-Post and Cluster Randomized Controlled Components
title_full_unstemmed Effect of Educational Outreach Timing and Duration on Facility Performance for Infectious Disease Care in Uganda: A Trial with Pre-Post and Cluster Randomized Controlled Components
title_short Effect of Educational Outreach Timing and Duration on Facility Performance for Infectious Disease Care in Uganda: A Trial with Pre-Post and Cluster Randomized Controlled Components
title_sort effect of educational outreach timing and duration on facility performance for infectious disease care in uganda: a trial with pre-post and cluster randomized controlled components
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4564214/
https://www.ncbi.nlm.nih.gov/pubmed/26352257
http://dx.doi.org/10.1371/journal.pone.0136966
work_keys_str_mv AT burnettsarahm effectofeducationaloutreachtiminganddurationonfacilityperformanceforinfectiousdiseasecareinugandaatrialwithprepostandclusterrandomizedcontrolledcomponents
AT mbonyemartink effectofeducationaloutreachtiminganddurationonfacilityperformanceforinfectiousdiseasecareinugandaatrialwithprepostandclusterrandomizedcontrolledcomponents
AT naikobasarah effectofeducationaloutreachtiminganddurationonfacilityperformanceforinfectiousdiseasecareinugandaatrialwithprepostandclusterrandomizedcontrolledcomponents
AT zaweddemuyanjastella effectofeducationaloutreachtiminganddurationonfacilityperformanceforinfectiousdiseasecareinugandaatrialwithprepostandclusterrandomizedcontrolledcomponents
AT kinotistephenn effectofeducationaloutreachtiminganddurationonfacilityperformanceforinfectiousdiseasecareinugandaatrialwithprepostandclusterrandomizedcontrolledcomponents
AT ronaldallan effectofeducationaloutreachtiminganddurationonfacilityperformanceforinfectiousdiseasecareinugandaatrialwithprepostandclusterrandomizedcontrolledcomponents
AT rubashembusyatimothy effectofeducationaloutreachtiminganddurationonfacilityperformanceforinfectiousdiseasecareinugandaatrialwithprepostandclusterrandomizedcontrolledcomponents
AT williskellys effectofeducationaloutreachtiminganddurationonfacilityperformanceforinfectiousdiseasecareinugandaatrialwithprepostandclusterrandomizedcontrolledcomponents
AT colebundersrobert effectofeducationaloutreachtiminganddurationonfacilityperformanceforinfectiousdiseasecareinugandaatrialwithprepostandclusterrandomizedcontrolledcomponents
AT manabeyukaric effectofeducationaloutreachtiminganddurationonfacilityperformanceforinfectiousdiseasecareinugandaatrialwithprepostandclusterrandomizedcontrolledcomponents
AT weavermarciar effectofeducationaloutreachtiminganddurationonfacilityperformanceforinfectiousdiseasecareinugandaatrialwithprepostandclusterrandomizedcontrolledcomponents