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Barriers to Quality Perioperative Care Delivery in Low- and Middle-Income Countries: A Qualitative Rapid Appraisal Study.
Bedwell, Gillian J; Dias, Priyanthi; Hahnle, Lina; Anaeli, Amani; Baker, Tim; Beane, Abi; Biccard, Bruce M; Bulamba, Fred; Delgado-Ramirez, Martha B; Dullewe, Nilmini P; Echeverri-Mallarino, Veronica; Haniffa, Rashan; Hewitt-Smith, Adam; Hoyos, Alejandra Sanin; Mboya, Erick A; Nanimambi, Juliana; Pearse, Rupert; Pratheepan, Anton Premadas; Sunguya, Bruno; Tolppa, Timo; Uruthirakumar, Powsiga; Vengadasalam, Sutharshan; Vindrola-Padros, Cecilia; Stephens, Timothy J.
Afiliação
  • Bedwell GJ; From the Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa.
  • Dias P; Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.
  • Hahnle L; From the Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa.
  • Anaeli A; Departments of Development Studies.
  • Baker T; Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
  • Beane A; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
  • Biccard BM; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
  • Bulamba F; Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.
  • Delgado-Ramirez MB; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
  • Dullewe NP; Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
  • Echeverri-Mallarino V; Departments of Clinical Epidemiology and Biostatistics.
  • Haniffa R; Anesthesia, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio Bogota, Bogota, Colombia.
  • Hewitt-Smith A; Post Basic School of Nursing, Colombo, Sri Lanka.
  • Hoyos AS; Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.
  • Mboya EA; Elgon Centre for Health, Research and Innovation, Mbale' Uganda.
  • Nanimambi J; Anesthesia, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio Bogota, Bogota, Colombia.
  • Pearse R; Elgon Centre for Health, Research and Innovation, Mbale' Uganda.
  • Pratheepan AP; Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
  • Sunguya B; Anesthesia, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio Bogota, Bogota, Colombia.
  • Tolppa T; Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
  • Uruthirakumar P; Department of Anaesthesia and Critical Care, Faculty of Health Sciences, Busitema University, Mbale, Uganda.
  • Vengadasalam S; Elgon Centre for Health, Research and Innovation, Mbale' Uganda.
  • Vindrola-Padros C; Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.
  • Stephens TJ; Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.
Anesth Analg ; 135(6): 1217-1232, 2022 12 01.
Article em En | MEDLINE | ID: mdl-36005395
ABSTRACT

BACKGROUND:

Provision of timely, safe, and affordable surgical care is an essential component of any high-quality health system. Increasingly, it is recognized that poor quality of care in the perioperative period (before, during, and after surgery) may contribute to significant excess mortality and morbidity. Therefore, improving access to surgical procedures alone will not address the disparities in surgical outcomes globally until the quality of perioperative care is addressed. We aimed to identify key barriers to quality perioperative care delivery for 3 "Bellwether" procedures (cesarean delivery, emergency laparotomy, and long-bone fracture fixation) in 5 low- and middle-income countries (LMICs).

METHODS:

Ten hospitals representing secondary and tertiary facilities from 5 LMICs were purposefully selected 2 upper-middle income (Colombia and South Africa); 2 lower-middle income (Sri Lanka and Tanzania); and 1 lower income (Uganda). We used a rapid appraisal design (pathway mapping, ethnography, and interviews) to map out and explore the complexities of the perioperative pathway and care delivery for the Bellwether procedures. The framework approach was used for data analysis, with triangulation across different data sources to identify barriers in the country and pattern matching to identify common barriers across the 5 LMICs.

RESULTS:

We developed 25 pathway maps, undertook >30 periods of observation, and held >40 interviews with patients and clinical staff. Although the extent and impact of the barriers varied across the LMIC settings, 4 key common barriers to safe and effective perioperative care were identified (1) the fragmented nature of the care pathways, (2) the limited human and structural resources available for the provision of care, (3) the direct and indirect costs of care for patients (even in health systems for which care is ostensibly free of charge), and (4) patients' low expectations of care.

CONCLUSIONS:

We identified key barriers to effective perioperative care in LMICs. Addressing these barriers is important if LMIC health systems are to provide safe, timely, and affordable provision of the Bellwether procedures.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Qualidade da Assistência à Saúde / Países em Desenvolvimento Tipo de estudo: Guideline / Qualitative_research Limite: Female / Humans / Pregnancy Idioma: En Revista: Anesth Analg Ano de publicação: 2022 Tipo de documento: Article País de afiliação: África do Sul

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Qualidade da Assistência à Saúde / Países em Desenvolvimento Tipo de estudo: Guideline / Qualitative_research Limite: Female / Humans / Pregnancy Idioma: En Revista: Anesth Analg Ano de publicação: 2022 Tipo de documento: Article País de afiliação: África do Sul