Barriers to Accessing Surgical Care in Pakistan: Healthcare Barrier Model and Quantitative Systematic Review

Irfan, Furqan B.; Irfan, Bismah B.; Spiegel, David A.

doi:10.1016/j.jss.2011.07.046

Cited by 46 publications

(48 citation statements)

References 36 publications

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“…Access is an important indicator of health system performance and is commonly defined as “access to a service, a provider or an institution.” While some authors conceptualize access in terms of specific dimensions (eg, “acceptability, affordability, availability, accessibility, accommodation” included in Penchansky and Thomas's model), others have based their definition on health seeking behaviour (eg, Health Belief Model) . Andersen's behavioural model, which has been extensively used as a framework to understand the factors influencing the use of healthcare services, incorporates both individual and contextual determinants of healthcare service utilization .…”

Section: Introductionmentioning

confidence: 99%

“…17 While some authors conceptualize access in terms of specific dimensions (eg, "acceptability, affordability, availability, accessibility, accommodation" included in Penchansky and Thomas's model), 18 others have based their definition on health seeking behaviour (eg, Health Belief Model). 19,20 Andersen's behavioural model, which has been extensively used as a framework to understand the factors influencing the use of healthcare services, incorporates both individual and contextual determinants of healthcare service utilization. [21][22][23] In the current review, access is conceptualized within the Penchansky and Thomas's, 18 and Andersen's models.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Barriers and enablers to accessing dental services for people experiencing homelessness: A systematic review

Paisi

Kay

Plessas

et al. 2019

Comm Dent Oral Epid

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Objectives The aim of this systematic review was to identify and conceptualize the barriers and enablers to accessing dental services for people experiencing homelessness in the United Kingdom. Methods A literature search for studies relevant to homelessness and dental care was conducted. The PRISMA and ENTREQ guidelines were followed. Electronic databases (EMBASE, MEDLINE, DOSS, CINAHL, SOCINDEX and PsycINFO) and grey literature sources (Electronic Theses Online Service – EThOS, Kings Fund, NICE Evidence, Open Grey, Google and the Health Foundation) were searched up to 28 August 2018. The critical appraisal was conducted using CASP and an adjusted version of a JBI Critical Appraisal tool. Thematic analysis was used to develop the themes and domains. Results Twenty‐eight papers were included. Barriers to homeless people accessing dental care stemmed both from the lived experience of homelessness and the healthcare system. Within homelessness, the themes identified included complexity, emotions and knowledge. Regarding the healthcare system, identified themes included staff encounter, accessibility and organization issues. Conclusion Homelessness can actively contribute to both an increased need for dental care and barriers to accessing that care. The arrangement of dental healthcare services can also act as barriers to care. This is the first systematic review to conceptualize the factors associated with access to dental care for people who are homeless. It provides a set of recommendations for overcoming the main barriers for homeless people to accessing dental care. It also offers directions for future research, policy and commissioning.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Barriers and enablers to accessing dental services for people experiencing homelessness: A systematic review

Paisi

Kay

Plessas

et al. 2019

Comm Dent Oral Epid

View full text Add to dashboard Cite

show abstract

“…[6][7][8][9][10][11][12][13][14][15][16][17][18] While the underlying causes for disparities in access to health services are complex and contextual, barriers may include spatial accessibility, affordability, acceptability (cultural, religious and/or other factors), availability and quality. [19][20][21][22] Previous studies using a Situational Analysis Tool (SAT) 23 developed by members of the WHO's Global Initiative for Emergency and Essential Surgical Care have documented gross deficiencies in the availability of surgical services in a convenience sample of 505 health facilities in selected low income and middle income countries (LMICs), 9-16 24-27 focusing on infrastructure, equipment and supplies, human resources, and the availability of selected interventions. Deficiencies were most pronounced at the primary referral level.…”

Section: Introductionmentioning

confidence: 99%

Retrospective review of Surgical Availability and Readiness in 8 African countries

et al. 2017

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ObjectivesThe purpose of this study was to assess surgical availability and readiness in 8 African countries using the WHO's Service Availability and Readiness Assessment (SARA) tool.SettingWe analysed data for surgical services, including basic and comprehensive surgery, comprehensive obstetric care, blood transfusion, and infection prevention, obtained from the WHO's SARA surveys in Sierra Leone, Uganda, Mauritania, Benin, Zambia, Burkina Faso, Democratic Republic of Congo and Togo.Primary and secondary outcome measuresAmong the facilities that were expected to offer surgical services (N=3492), there were wide disparities between the countries in the number of facilities per 100 000 population that reported offering basic surgery (1.0–12.1), comprehensive surgery (0.1–0.8), comprehensive obstetric care (0.1–0.8) and blood transfusion (0.1–0.8). Only 0.1–0.3 facilities per 100 000 population had all three bellwether procedures available, namely laparotomy, open fracture management and caesarean section. In all the countries, the facilities that reported offering surgical services generally had a shortage of the necessary items for offering the services and this varied greatly between the countries, with the facilities having on average 27–53% of the items necessary for offering basic surgery, 56–83% for comprehensive surgery, 49–72% for comprehensive obstetric care and 54–80% for blood transfusion. Furthermore, few facilities had all the necessary items present. However, facilities that reported offering surgical services had on average most of the necessary items for the prevention of infection.ConclusionsThere are important gaps in the surgical services in the 8 African countries surveyed. Efforts are therefore urgently needed to address deficiencies in the availability and readiness to deliver surgical services in these nations, and this will require commitment from multiple stakeholders. SARA may be used to monitor availability and readiness at regular intervals, which will enable stakeholders to evaluate progress and identify gaps and areas for improvement.

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“…However, the increased frequency of emergency procedures for malignancy in LMICs may reflect barriers to accessing care and treatment for non‐communicable disease in LMICs. These may include limited implementation of screening programmes, inefficient referral pathways, the relatively high cost of investigations such as endoscopy, as well as some patients having limited access to health education or a preference to seek care from traditional healers. The greater burden of emergency surgery suggests that patients in LMICs may be more likely to delay a decision to seek healthcare until they have deteriorated with complicated, advanced disease.…”

Section: Discussionmentioning

confidence: 99%

Global variation in anastomosis and end colostomy formation following left‐sided colorectal resection

Collaborative

2019

BJS Open

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BackgroundEnd colostomy rates following colorectal resection vary across institutions in high‐income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left‐sided colorectal resection.MethodsThis study comprised an analysis of GlobalSurg‐1 and ‐2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left‐sided colorectal resection within discrete 2‐week windows. Countries were grouped into high‐, middle‐ and low‐income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model.ResultsIn total, 1635 patients from 242 hospitals in 57 countries undergoing left‐sided colorectal resection were included: 113 (6·9 per cent) from low‐HDI, 254 (15·5 per cent) from middle‐HDI and 1268 (77·6 per cent) from high‐HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low‐ compared with middle‐ and high‐HDI settings. The association with colostomy use in low‐HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001).ConclusionGlobal differences existed in the proportion of patients receiving end stomas after left‐sided colorectal resection based on income, which went beyond case mix alone.

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Barriers to Accessing Surgical Care in Pakistan: Healthcare Barrier Model and Quantitative Systematic Review

Cited by 46 publications

References 36 publications

Barriers and enablers to accessing dental services for people experiencing homelessness: A systematic review

Barriers and enablers to accessing dental services for people experiencing homelessness: A systematic review

Retrospective review of Surgical Availability and Readiness in 8 African countries

Global variation in anastomosis and end colostomy formation following left‐sided colorectal resection

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