Identifying barriers to emergency care services

Cannoodt, Luk; Mock, Charles; Bucagu, Maurice

doi:10.1002/hpm.1098

Cited by 39 publications

(54 citation statements)

References 39 publications

(74 reference statements)

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“…As noted in other studies, the healthcare delivery system failures identified in our study contributed to these women’s deaths [21], [26], [41]. In a recent (2012) study in which 40 articles, spanning 15 years, were reviewed, a shortage of resources, supplies, equipment qualified human resources including lack of specialized training were all identified as significant barriers to utilizing emergency care [42]. Cannoodt and colleagues also identified articles that reported deficiencies within the organization of services as contributing factors for low utilization.…”

Section: Discussionsupporting

confidence: 63%

Piecing Together the Maternal Death Puzzle through Narratives: The Three Delays Model Revisited

2012

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BackgroundIn Malawi maternal mortality continues to be a major public health challenge. Going beyond the numbers to form a more complete view of why women die is critical to improving access to and quality of emergency obstetric care. The objective of the current study was to identify the socio-cultural and facility-based factors that contributed to maternal deaths in the district of Lilongwe, Malawi.MethodsRetrospectively, 32 maternal death cases that occurred between January 1, 2011 and June 30, 2011 were reviewed independently by two gynecologists/obstetricians. Interviews were conducted with healthcare staff, family members, neighbors, and traditional birth attendants. Guided by the grounded theory approach, interview transcripts were analyzed manually and continuously. Emerging, recurring themes were identified and excerpts from the transcripts were categorized according to the Three Delays Model (3Ds).ResultsSixteen deaths were due to direct obstetric complications, sepsis and hemorrhage being most common. Sixteen deaths were due to indirect causes with the main cause being anemia, followed by HIV and heart disease. Lack of recognizing signs, symptoms, and severity of the situation; using traditional Birth Attendant services; low female literacy level; delayed access to transport; hardship of long distance and physical terrain; delayed prompt quality emergency obstetric care; and delayed care while at the hospital due to patient refusal or concealment were observed. According to the 3Ds, the most common delay observed was in receiving treatment upon reaching the facility due to referral delays, missed diagnoses, lack of blood, lack of drugs, or inadequate care, and severe mismanagement.

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Section: Discussionsupporting

confidence: 63%

Piecing Together the Maternal Death Puzzle through Narratives: The Three Delays Model Revisited

2012

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“…The barrier domains and the EMS pathway barriers were defined a priori [ 9 , 19 ]. After the data was collected reviewers combined and reorganized these two concepts into the following themes: culture/community, infrastructure, communication/coordination, transport, equipment, and personnel.…”

Section: Methodsmentioning

confidence: 99%

“…trauma or obstetric care) [ 11 – 18 ]. Additionally, the most recent review that describes barriers to emergency care was conducted in 2012 [ 19 ]. While this study focuses on barriers to care in both high and low income countries, that study predominantly emphasized financial barriers to care delivery.…”

Section: Introductionmentioning

confidence: 99%

Identifying barriers for out of hospital emergency care in low and low-middle income countries: a systematic review

Kironji¹,

Hodkinson

Ramirez

et al. 2018

BMC Health Serv Res

165

178

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BackgroundOut-of-hospital emergency care (OHEC), also known as prehospital care, has been shown to reduce morbidity and mortality from serious illness. We sought to summarize literature for low and low-middle income countries to identify barriers to and key interventions for OHEC delivery.MethodsWe performed a systematic review of the peer reviewed literature from January 2005 to March 2015 in PubMed, Embase, Cochrane, and Web of Science. All articles referencing research from low and low-middle income countries addressing OHEC, emergency medical services, or transport/transfer of patients were included. We identified themes in the literature to form six categories of OHEC barriers. Data were collected using an electronic form and results were aggregated to produce a descriptive summary.ResultsA total 1927 titles were identified, 31 of which met inclusion criteria. Barriers to OHEC were divided into six categories that included: culture/community, infrastructure, communication/coordination, transport, equipment and personnel. Lack of transportation was a common problem, with 55% (17/31) of articles reporting this as a hindrance to OHEC. Ambulances were the most commonly mentioned (71%, 22/31) mode of transporting patients. However, many patients still relied on alternative means of transportation such as hired cars, and animal drawn carts. Sixty-one percent (19/31) of articles identified a lack of skilled personnel as a key barrier, with 32% (10/31) of OHEC being delivered by laypersons without formal training. Forty percent (12/31) of the systems identified in the review described a uniform access phone number for emergency medical service activation.ConclusionsPolicy makers and researchers seeking to improve OHEC in low and low-middle income countries should focus on increasing the availability of transport and trained providers while improving patient access to the OHEC system. The review yielded articles with a primary focus in Africa, highlighting a need for future research in diverse geographic areas.

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“…However, they are less confident with general surgical emergencies and trauma, so that these patients are often referred. Because of financial and other barriers, this practice often means that the patients do not receive the treatment they need (Cannoodt, Mock, and Bucagu 2012;Grimes and others 2011).…”

Section: Training and Distribution Of Staff Membersmentioning

confidence: 99%

General Surgical Emergencies

McCord

Ozgediz²,

Beard³

et al. 2015

Disease Control Priorities, Third Edition (Volume 1): Essential Surgery

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Acute abdominal conditions Incarcerated and Strangulated Inguinal Hernias Appendicitis Intestinal obstruction Complications of peptic ulcer, including perforated ulcer and bleeding ulcer Bleeding from esophageal varices Pelvic infections with abscesses Perforated typhoid ulcers Amebic liver abscess Gall bladder and bile duct disease Respiratory obstruction, foreign bodies, and pleural disease Urinary obstruction caused by stricture, stone, or prostatic enlargement Surgical infections of the skin, muscles, bones, and joints

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Identifying barriers to emergency care services

Cited by 39 publications

References 39 publications

Piecing Together the Maternal Death Puzzle through Narratives: The Three Delays Model Revisited

Piecing Together the Maternal Death Puzzle through Narratives: The Three Delays Model Revisited

Identifying barriers for out of hospital emergency care in low and low-middle income countries: a systematic review

General Surgical Emergencies

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