Barriers to accessing follow up care in post-hospitalized trauma patients in Moshi, Tanzania: A mixed methods study.
Barriers to accessing follow up care in post-hospitalized trauma patients in Moshi, Tanzania: A mixed methods study.
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DOI：
10.1371/journal.pgph.0000277
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Staton, Catherine
中科院分区：
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作者：
Joiner, Anjni Patel;Tupetz, Anna;Peter, Timothy Antipas;Raymond, Julius;Macha, Victoria Gerald;Vissoci, Joao Ricardo Nickenig;Staton, Catherine
在撒哈拉以南非洲，受伤率高得不成比例，加上在急性受伤阶段和受伤患者出院后需要继续护理的护理机会有限，这仍然是一个挑战。我们的目的是在坦桑尼亚莫希的一组住院后受伤患者中描述交通和获得护理的障碍。这是一项对2018年8月至2020年1月期间在基利曼哈罗基督教医疗中心就诊的创伤登记患者的前瞻性队列进行的混合方法研究。我们进行了标准化的患者/家庭调查，并在出院后的2周随访访视中进行了深入访谈，并与医疗保健提供者进行了焦点小组调查。定量结果采用描述性统计和R统计软件进行多变量logistic回归分析。使用NVivo软件通过迭代过程使用主题分析对定性结果进行分析。共有1，365名患者参加了创伤登记，其中169名患者在2周内随访。超过一半的患者（101例（59.8%））在随访中报告了旅行中的挑战。大多数患者为男性（80.3%）。受伤导致的旅行困难与女性（aOR 5.85 [95% CI 1.20-33.59]）和旅行需要非家庭成员陪同（aOR 7.10 [95% CI 1.43-41.66]）相关。与道路交通伤害相比，将袭击或跌倒作为伤害机制并有健康保险的人不太可能报告旅行中的挑战（aOR 0.19 [95% CI 0.03-0.90]，0.11 [95% CI 0.01-0.61]，0.14 [95% CI 0.02-0.80]）。定性数据中出现的交通障碍包括无法使用常规交通工具、财务挑战、物理障碍、严格遵守医嘱、获得医疗保健和社会支持障碍。我们的研究结果表明，有几个领域可以解决坦桑尼亚受伤后患者的运输障碍。教育干预措施，如澄清医生关于严格卧床休息的医嘱，提供代金券以支持经济挑战，以及考虑到身体障碍和对社会支持的依赖的替代交通工具，可以解决其中一些障碍。
Disproportionately high injury rates in Sub-Saharan Africa combined with limited access to care in both the acute injury phase and for injury patients requiring continued care after hospital discharge remains a challenge. We aimed to characterize barriers to transportation and access to care in a cohort of post-hospitalized injury patients in Moshi, Tanzania. This was a mixed-methods study of a prospective cohort of trauma registry patients presenting to Kilimanjaro Christian Medical Center between August 2018 and January 2020. We conducted standardized patient/family surveys and in-depth interviews at a 2-week follow up visit after hospital discharge, and focus groups with healthcare providers. Quantitative results were analyzed using descriptive statistics and multivariable logistic regression using R statistical software. Qualitative results were analyzed using thematic analysis through an iterative process using NVivo software. A total of 1,365 patients were enrolled in the trauma registry, with 169 patients followed up at 2 weeks. Over half of patients at follow-up, 101 (59.8%), reported challenges in traveling. The majority of patients were male (80.3%). Difficulty in traveling since injury was associated with female gender (aOR 5.85 [95% CI 1.20–33.59]) and a need for non-family members escorts for travel (aOR 7.10 [95% CI 1.43–41.66]). Those who reported assault or fall as the mechanism of injury as compared to road traffic injury and had health insurance were less likely to report challenges in traveling (aOR 0.19 [95% CI 0.03–0.90]), 0.11 [95% CI 0.01–0.61], 0.14 [95% 0.02–0.80]). Transportation barriers that emerged from qualitative data included inability to use regular means of transportation, financial challenges, physical barriers, rigid compliance to physician orders, access to healthcare, and social support barriers. Our findings demonstrate several areas to address transportation barriers for post-injury patients in Tanzania. Educational interventions such as clarification of doctors’ orders of strict bedrest, provision of vouchers to support financial challenges and alternate means of transportation given physical barriers and reliance on social support may address some of these barriers.