The Ministry of Health, Ghana, in accordance with global policy, recommends that all suspected malaria cases be confirmed parasitologically before treatment. Not all clinicians, however, base their treatment on test results. Patients also spend a lot of time at health facilities waiting to consult a clinician before being asked to go for testing and to see a clinician with test results. The purpose of the study was to determine if testing all children aged 6 to 59 months with fever reporting at an outpatients department (OPD) for malaria before consultation with a clinician (pre-consultation testing) will influence clinicians to adhere to test results and also reduce the time spent by such patients. A quasi-experimental study design was used involving two randomly selected government-owned hospitals in the Northern Volta, Ghana. In each hospital, 439 children were recruited between November 2018 and January 2019. The intervention hospital implemented pre-consultation testing. In the comparator arm, standard practices, which involved patients seeing the clinician before he/she decides whether to send the patient for testing or not, were maintained. Out of 878 children screened the overall prevalence of malaria was 31.9% by malaria rapid diagnostic test (RDT) and 26.7% by microscopy. Clinicians in the intervention arm adhered more to the malaria test results than those in the comparator arm (93.2 vs. 84.3%; p < 0.001). The proportion of children who tested negative but were still diagnosed with malaria was significantly lower in the intervention arm compared to the comparator arm (8.4 vs. 21.2%: p < 0.001). Clinicians and mothers/caregivers in both arms preferred pre-consulting testing. Six out of every 10 mothers/caregivers in the comparator arm viewed the waiting time as ‘too long’’ compared to 4 out of every 10 mothers in the intervention arm. On average, patient waiting time was significantly lower in the intervention arm (2.61 h) than in the comparator arm (3.42 h). Pre-consultation testing significantly improves clinicians’ adherence to malaria test results, shortens patients’ waiting time and leads to overall patient satisfaction. There is a need to establish RDT corners at OPDs of health facilities to implement pre-consultation testing.

中文翻译：

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预咨询测试对加纳沃尔特地区北部地区 5 岁以下儿童临床医生遵守疟疾测试结果和等待时间的影响


加纳卫生部根据全球政策，建议所有疑似疟疾病例在治疗前进行寄生虫学确诊。然而，并非所有临床医生都根据测试结果进行治疗。患者还花费大量时间在医疗机构等待咨询临床医生，然后才被要求进行检测并带着检测结果去看临床医生。该研究的目的是确定在与临床医生会诊之前（会诊前检测）对门诊部 (OPD) 报告发烧的所有 6 至 59 个月的所有儿童进行疟疾检测是否会影响临床医生遵守检测结果，并且减少此类患者花费的时间。采用了准实验研究设计，涉及加纳北沃尔特的两家随机选择的政府医院。 2018年11月至2019年1月期间，各医院共招募了439名儿童。干预医院实施了会诊前测试。在比较组中，保留了标准做法，即患者在临床医生决定是否送患者进行检测之前先见医生。在接受筛查的 878 名儿童中，通过疟疾快速诊断测试 (RDT) 得出的疟疾总体患病率为 31.9%，通过显微镜检查得出的疟疾总体患病率为 26.7%。干预组的临床医生比比较组的临床医生更坚持疟疾检测结果（93.2% vs. 84.3%；p < 0.001）。与对照组相比，干预组中检测结果呈阴性但仍被诊断患有疟疾的儿童比例显着较低（8.4% vs. 21.2%：p < 0.001）。双臂的临床医生和母亲/护理人员更喜欢咨询前测试。 比较组中每 10 名母亲/护理人员中有 6 人认为等待时间“太长”，而干预组中每 10 名母亲/护理人员中有 4 人认为等待时间“太长”。平均而言，干预组的患者等待时间（2.61 小时）显着低于比较组（3.42 小时）。预咨询检测显着提高了临床医生对疟疾检测结果的依从性，缩短了患者的等待时间并提高了患者的总体满意度。有必要在卫生机构的OPD设立RDT角，以实施会诊前检测。