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Global Health perspective on Antibiotic Resistance control in low-resource settings: an Intervention combining Telemedicine and Health Workforce Capacity Strengthening in Cape Verde
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No domínio das dinâmicas da Globalização, a Saúde Global demonstra ser transversal para com todos os restantes ramos de estudo. A Saúde Global tem emergido ao nível do debate científico, principalmente por dois motivos primordiais, enquanto problema de saúde e de segurança da saúde, e pela via da Saúde Digital, principalmente pela telemedicina, enquanto solução para a resposta a problemas e desafios que se interpõem aos sistemas de Saúde Global. O problema crescente da Resistência aos antibióticos (RA), agora agravado num contexto pandémico actual, apresenta-se como um desafio aos sistemas de saúde de uma forma global e abrangente, contemplando todos os ecossistemas. Sendo um problema multifactorial, do ponto de vista do prestador de cuidados de saúde, centra-se no comportamento e postura do profissional de saúde perante a problemática e a decisão prescritiva, mas também enquanto indivíduos, parte de colectivos, que enfrentam desafios organizacionais. A carga sociocultural que influencia, consciente e inconscientemente, estes actores dum sistema de mudança comportamental positiva na prescrição do medicamento, são de ser considerados durante todo o processo de estudo de intervenção. A Saúde Digital apresenta-se como uma plataforma para um mecanismo eficaz de resiliência dos estados e respectivos sistemas de saúde para enfrentar as complexidades e vulnerabilidades dos mesmos, dando os primeiros passos nesta problemática global. A Saúde Global assume hoje o papel de mecanismo de entreajuda entre os estados, rumo a uma resiliência e capacidade de resposta aos desafios da Saúde. Novas abordagens a esta problemática da RA, contemplam e assumem a evolução tecnológica, nomeadamente a Telemedicina, ao serviço da saúde. Apresenta-se aqui uma abordagem multi-metodológica, assente em diferentes camadas teóricas, numa proposição de perceber quais os factores sociais e culturais envolvidos num processo de desenvolvimento e implementação deste tipo de solução de saúde, compreendendo a adopção de uma estrutura de Saúde Digital, nomeadamente a telemedicina, e pressupondo a mudança positiva de comportamentos prescritivos de antibioterapia e abordagens à problemática da parte do profissional de saúde, de uma forma sustentável e com continuidade. Procurou-se perceber o problema e constituir um estudo de caso, apontando para soluções em desenvolvimento e aplicáveis, delineando-se as hipóteses de investigação em torno da (1) compreensão dos factores que influenciam percepções, acções e comportamentos do profissional de saúde, interagindo com o controlo da RA, em contexto de menos recursos, focando no caso específico do controlo de infecção nos hospitais de Cabo Verde, e da (2) compreensão do papel da Saúde Digital, nomeadamente a Telemedicina, no suporte ao profissional de saúde, ao nível do reforço da competência de decisor clínico e cuidador, por forma a proceder-se a uma intervenção sustentável, sob uma perspectiva de Saúde Global. Reconhecendo a complexidade e múltiplas dimensões a serem tidas em conta, traçou-se uma metodologia, tendo por base o Design Science Research Methodology segundo uma abordagem Participatory Action Research (DSRM/PAR), e sob um quadro metodológico Momentum (avaliação do ponto de situação da telemedicina), propondo abordar o problema de uma forma mais profunda, e permitindo evoluir à medida que se progredia no estudo. As lições aprendidas resultantes da translação do conhecimento entre contextos diferentes (de Portugal para Cabo Verde), em conjunto com o estudo etnográfico em Cabo Verde, permitiram constituir um Modelo Ecológico Multimodal em Saúde Digital Global que aborda, às diferentes escalas (desde a local à global) todos os principais factores condicionantes de uma mudança positiva comportamental para um serviço de gestão da prescrição de antibióticos (Antibiotic Stewardship, ABS). digital, por telemedicina. Educação, comunicação e a rede de suporte são pilares que sustentam a dinâmica de Saúde Digital, compreendendo os restantes factores de convergência, mas também de divergência entre os profissionais de saúde. A mudança positiva comportamental é possível, sendo que este estudo no seu todo informa os passos seguintes da implementação efectiva de um ABS digital, via telemedicina, contribuindo para um futuro Programa Nacional de Segurança do Doente.
In the domain of the dynamics of Globalization, Global Health proves to be transversal to all other branches of study. Global Health has emerged at the level of scientific debate, mainly for two main reasons, as health safety problem, and as a Digital Health challenge. Digital health, mainly through telemedicine, gives a solution to these problems. problems and challenges that arise in global health systems. The growing problem of antibiotic resistance (AR), now deepening in the current pandemic context, presents itself as a challenge to health systems in a global and comprehensive way, covering all ecosystems. It is clear that it is a multifactorial problem. From the point of view of the healthcare provider, it focuses on healthcare professional's behavior and attitude towards the RA problem and the prescriptive decision, but also as individuals, part of collectives, who face organizational challenges. Sociocultural cognitive constructs influences, consciously and unconsciously, these actors of a system for positive behavioral change in the antibiotherapy prescription. It must be considered throughout the intervention study process. Digital Health presents itself as a platform for an effective mechanism for the resilience of states and its health systems to face their complexities and vulnerabilities. Nowaday, Global Health assumes its role as a great mechanism for mutual assistance between states, towards resilience and capacity to tackle health challenges. New approaches to this AR problem contemplate and assume the technological evolution, namely Telemedicine, at the service of health. A multi-methodological approach is presented here. It considered different theoretical layers, in order to understand the social and cultural factors involved in a process of development and implementation of this type of health solution, including the adoption of a digital health structure, namely telemedicine, towards the positive and sustainable change of antibiotic prescriptive behaviors. The main objective was to understand the problem and constitute a case study, pointing to solutions in development and applicable, outlining the research hypotheses on: (1) understanding the factors that influence perceptions, actions and behaviors of the health professional, interacting with RA control, in less-resources settings, focusing on the specific case of infection control in Cape Verde hospitals; (2) understanding the role of Digital Health, namely Telemedicine, in supporting the health professional, strengthening its clinical decisions' skills and as caregivers, in order to carry out a sustainable intervention, from a Global Health perspective. Recognizing the complexity and multiple dimensions, Design Science Research Methodology under a Participatory Action Research (DSRM/PAR) approach was the methodology chosen, under the Momentum's framework (assessment of telemedicine), proposing to analyse the problem in a deeper way, and allowing to evolve as the study progresses. The lessons learnt resulting from the knowledge translation between different contexts (from Portugal to Cape Verde), together with the ethnographic study in Cape Verde, informed the development of a Multimodal Ecological Model in Global Digital Health, that addresses, at different scales (from local to global) all the main conditioning factors of a positive behavioral change towards a digital antibiotic stewardship (ABS), by telemedicine. Education, communication and the network of support are pillars for the dynamics of Digital Health, comprising the remaining factors of convergence, but also of divergence between healthcare professionals. Positive behavioral change is possible, and this study as a whole informs the next steps for the effective implementation of a digital ABS, via telemedicine, contributing to a future National Program for Patient Safety.
In the domain of the dynamics of Globalization, Global Health proves to be transversal to all other branches of study. Global Health has emerged at the level of scientific debate, mainly for two main reasons, as health safety problem, and as a Digital Health challenge. Digital health, mainly through telemedicine, gives a solution to these problems. problems and challenges that arise in global health systems. The growing problem of antibiotic resistance (AR), now deepening in the current pandemic context, presents itself as a challenge to health systems in a global and comprehensive way, covering all ecosystems. It is clear that it is a multifactorial problem. From the point of view of the healthcare provider, it focuses on healthcare professional's behavior and attitude towards the RA problem and the prescriptive decision, but also as individuals, part of collectives, who face organizational challenges. Sociocultural cognitive constructs influences, consciously and unconsciously, these actors of a system for positive behavioral change in the antibiotherapy prescription. It must be considered throughout the intervention study process. Digital Health presents itself as a platform for an effective mechanism for the resilience of states and its health systems to face their complexities and vulnerabilities. Nowaday, Global Health assumes its role as a great mechanism for mutual assistance between states, towards resilience and capacity to tackle health challenges. New approaches to this AR problem contemplate and assume the technological evolution, namely Telemedicine, at the service of health. A multi-methodological approach is presented here. It considered different theoretical layers, in order to understand the social and cultural factors involved in a process of development and implementation of this type of health solution, including the adoption of a digital health structure, namely telemedicine, towards the positive and sustainable change of antibiotic prescriptive behaviors. The main objective was to understand the problem and constitute a case study, pointing to solutions in development and applicable, outlining the research hypotheses on: (1) understanding the factors that influence perceptions, actions and behaviors of the health professional, interacting with RA control, in less-resources settings, focusing on the specific case of infection control in Cape Verde hospitals; (2) understanding the role of Digital Health, namely Telemedicine, in supporting the health professional, strengthening its clinical decisions' skills and as caregivers, in order to carry out a sustainable intervention, from a Global Health perspective. Recognizing the complexity and multiple dimensions, Design Science Research Methodology under a Participatory Action Research (DSRM/PAR) approach was the methodology chosen, under the Momentum's framework (assessment of telemedicine), proposing to analyse the problem in a deeper way, and allowing to evolve as the study progresses. The lessons learnt resulting from the knowledge translation between different contexts (from Portugal to Cape Verde), together with the ethnographic study in Cape Verde, informed the development of a Multimodal Ecological Model in Global Digital Health, that addresses, at different scales (from local to global) all the main conditioning factors of a positive behavioral change towards a digital antibiotic stewardship (ABS), by telemedicine. Education, communication and the network of support are pillars for the dynamics of Digital Health, comprising the remaining factors of convergence, but also of divergence between healthcare professionals. Positive behavioral change is possible, and this study as a whole informs the next steps for the effective implementation of a digital ABS, via telemedicine, contributing to a future National Program for Patient Safety.
Descrição
Palavras-chave
Global health Universal access Antibiotic stewardship Behavior change Telemedecine Low-resource setting Saúde Global Saúde Digital Telemedicina Resistência aos antibióticos Gestão de antibióticos Controlo de infecção Recursos humanos em Saúde Suporte à decisão Design science Participatory action research Digital Health Antibiotic stewardship Antibiotic resistance Infection control Health workforce Decision support Design science