Linked Life Data

8045136

Source:http://linkedlifedata.com/resource/pubmed/id/8045136

Statements in which the resource exists as a subject.
PredicateObject
rdf:type
lifeskim:mentions
pubmed:issue
5
pubmed:dateCreated
1994-8-30
pubmed:abstractText
This paper discusses the technical dimensions of "quality of care" in contraceptive service delivery in both the Cyclofem Introductory Trial, as well as in routine service delivery of other injectables in Indonesia. Although the quality of care in the Cyclofem trial was generally acceptable, substantial weaknesses in screening, clinical technique, the management of side-effects, and knowledge concerning re-injection time frames were identified in the provision of injectable contraceptives in routine service delivery. The findings suggest that in order for Cyclofem and other injectables to be delivered in the routine program with an adequate standard of care, considerable managerial adaptation and strengthening of providers' technical capabilities would be necessary prior to actual introduction. This would include providing training and updated technical guidelines concerning both Cyclofem and other contraceptives to providers, with an emphasis on technical issues including contraceptive indications and contraindications, re-injection time frames, maintenance of asepsis and the management of side-effects. Strengthening the existing management information system and logistics systems to facilitate differentiation between injectable contraceptives provided by the program so as to ensure sufficient supplies of both contraceptives and associated materials such as needles and syringes will also be necessary.
pubmed:keyword
http://linkedlifedata.com/resource/pubmed/keyword/Asia, http://linkedlifedata.com/resource/pubmed/keyword/Contraception, http://linkedlifedata.com/resource/pubmed/keyword/Contraceptive Methods, http://linkedlifedata.com/resource/pubmed/keyword/Delivery Of Health Care, http://linkedlifedata.com/resource/pubmed/keyword/Developing Countries, http://linkedlifedata.com/resource/pubmed/keyword/Evaluation Report, http://linkedlifedata.com/resource/pubmed/keyword/Family Planning, http://linkedlifedata.com/resource/pubmed/keyword/Family Planning Programs, http://linkedlifedata.com/resource/pubmed/keyword/Health, http://linkedlifedata.com/resource/pubmed/keyword/Health Services Evaluation, http://linkedlifedata.com/resource/pubmed/keyword/INDONESIA, http://linkedlifedata.com/resource/pubmed/keyword/Injectables, http://linkedlifedata.com/resource/pubmed/keyword/Program Evaluation, http://linkedlifedata.com/resource/pubmed/keyword/Programs, http://linkedlifedata.com/resource/pubmed/keyword/Quality Of Health Care, http://linkedlifedata.com/resource/pubmed/keyword/Southeastern Asia
pubmed:language
eng
pubmed:journal
pubmed:citationSubset
IM
pubmed:chemical
pubmed:status
MEDLINE
pubmed:month
May
pubmed:issn
0010-7824
pubmed:author
pubmed:issnType
Print
pubmed:volume
49
pubmed:owner
NLM
pubmed:authorsComplete
Y
pubmed:pagination
527-41
pubmed:dateRevised
2009-11-19
pubmed:otherAbstract
PIP: The aim was to examine the implications for service delivery in Indonesian national family planning programs introducing a new method, the injectable Cyclofem. Observations were made in 28 clinics and with in-depth interviews in Jakarta, West Java, and West Sumatra. The clinics included introductory trial clinics, nontrial health centers, community-based health posts, and private sector settings. Observations focused on the logistics of clients moving through the clinic and on all methods provided. In-depth interviews were conducted among national leaders, provincial and district program managers, public and private providers of services, community leaders, and clients. Quality of care issues focused on indications and contraindications, clinical technique, management of side effects, and appropriate follow-up in service delivery. Observations revealed that the clinical record form K-IV was not used very well for ascertaining client's needs for spacing methods. The form also did not differentiate between injectables and oral pills. Screening for contraindications was limited. Several patterns emerged on use of syringes and needles, including single use and multiple use. All used alcohol to swab the injection site, but one center reused cotton swabs. Hands were rarely washed before providing services. Many service centers were without running water in the service area. Gloves were reused without disinfection. Insertion instruments for IUDS were not properly sterilized. Written materials were only in one language. Side effects discussions were taken out of context and used to motivate clients. When symptoms were reported, complaints were dismissed, and assessment of the seriousness of bleeding or amenorrhea was not made. Clients were told to come back on a specific day. Mistiming of returns for injection resulted in mistiming of injections and a variety of inappropriate responses for assurance of contraceptive coverage. Most clients were responsible and returned on the appointed date. There were management problems that interfered with quality of care delivery: supply shortages, inadequate knowledge by staff of the importance of asepsis and technical information, heavy case loads, provider fears of discussing side effects with clients, lack of technical supervision, and general lack of attention to quality of care issues. Recommendations were to provide technical guidelines and instructions that are periodically updates, training for all service providers, written manuals or guidelines, a functional supervisory system, revision of reporting forms, refinement of logistics to assure one syringe and needle per client, and balanced staff and equipment for case load management.
pubmed:meshHeading
pubmed:year
1994
pubmed:articleTitle
Maintaining technical quality of care in the introduction of Cyclofem in a national family planning program: findings from Indonesia.
pubmed:affiliation
Yayasan Kusuma Buana, Jakarta, Indonesia.
pubmed:publicationType
Journal Article, Clinical Trial, Research Support, Non-U.S. Gov't