The importance of behavioural science in advancing health in low-and middle-income countries (LMICs) was highlighted in a journal funded by the US Agency for International Development (Global Health Science and Practice). [1] In particular, the authors outlined six domains of behaviour change that were building blocks of global health. One of these domains was 'provider behaviour' and included understanding healthcare workers' capabilities, opportunities and motivations to provide high-quality care. We propose that understanding provider behaviour is most urgent in the areas of healthcare that have been shown to impact greatly on patient mortality and morbidity, e.g. management of the critically ill patient. Management of the deteriorating and critically ill patient is a key activity in acute healthcare facilities. Firth and Ttendo [2] emphasised the need for recognition, assessment and management of the critically ill in Uganda and other low-income countries. This need is great because many patients present to hospital in a critical state owing to certain factors, including underlying health issues (e.g. malnutrition); present to hospital at a late stage owing to the time taken to travel to hospital; and seek help at a late stage of an illness because of the need to pay fees. A systematic review of critical care in LMICs found that many health professional students had limited training in the assessment and management of acutely ill patients. [3] It is clear, therefore, that there is a need to educate and train staff in the management of acute illness in LMICs. There are many courses that teach the recognition and management of acutely ill people. Examples are the 1-day Acute Illness Management (AIM) Background. Understanding the drivers of 'provider behaviour' has been highlighted as one of the six domains of behaviour change in strengthening healthcare systems. Objectives. To assess changes in healthcare provider behaviour, i.e. use of the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach in acute illness management, after participating in a 1-day course on the assessment and management of acutely ill patients. We aimed to assess whether changes in psychological determinants of the ABCDE approach were associated with changes in the use of the approach. Methods. We used a pre-post design to study self-reported change in behaviour after a 1-day training course from pre-course to follow-up 1 month later. We also measured psychological determinants of behaviour immediately before and after and at 1-month follow-up. We explored if changes in psychological determinants were associated with change in practice 1 month later. Results. We found the following: firstly, use of the ABCDE approach increased at 1 month post-course from a median use of 50-90%. Secondly, the increase in the ABCDE approach was associated with a positive change in only one of the determinants of practice from pre-to post-course: perception of environmental determinants (r=0.323; p<0.05). Finally, there were no other significa...
Background Disparity exists in anesthesia practices between high- and low-to-middle income countries, and awareness has been raised within the global health community to improve the standards of anesthesia care and patient safety. The establishment of international collaborations and appropriate practice guidelines may help address clinical care deficiencies. This report’s aim was to assess the impact of a multiyear collaboration on obstetric anesthesia practices in the Republic of Armenia. Methods An invited multinational team of physicians conducted six visits to Armenia between 2006 and 2015 to observe current practice and establish standards of obstetric anesthesia care. The Armenian Society of Anaesthesiologists and Intensive Care specialists collected data on the numbers of vaginal delivery, cesarean delivery, and neuraxial anesthesia use in maternity units during the period. Data were analyzed with the Fisher exact or chi-square test, as appropriate. Results Neuraxial anesthesia use for cesarean delivery increased significantly (P < 0.0001) in all 10 maternity hospitals within the capital city of Yerevan. For epidural labor analgesia, there was sustained or increased use in only two hospitals. For hospitals located outside the capital city, there was a similar increase in the use of neuraxial anesthesia for cesarean delivery that was greater in hospitals that were visited by an external team (P < 0.0001); however, use of epidural labor analgesia was not increased significantly. Over the course of the collaboration, guidelines for obstetric anesthesia were drafted and approved by the Armenian Ministry of Health. Conclusions Collaboration between Armenian anesthesiologists and dedicated visiting physicians to update and standardize obstetric anesthesia practices led to national practice guidelines and sustained improvements in clinical care in the Republic of Armenia.
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