Barriers to Accessing Surgical Care in Pakistan: Healthcare Barrier Model and Quantitative Systematic Review
Barriers to Accessing Surgical Care in Pakistan: Healthcare Barrier Model and Quantitative Systematic Review
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DOI：
10.1016/j.jss.2011.07.046
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发表时间：
2012-07-01
影响因子：
2.2
通讯作者：
Spiegel, David A.
中科院分区：
文献类型：
--
作者：
Irfan, Furqan B.;Irfan, Bismah B.;Spiegel, David A.
在巴基斯坦，手术服务不足导致各种疾病的发病率和死亡率增加。我们采用了修改的Andersen的模型的卫生服务利用和开发的“医疗保健障碍模型”，在发展中国家获得医疗保健的障碍的特点，在巴基斯坦的手术护理作为案例研究。我们从MEDLINE、EMBASE、CINAHL、SCOPUS、全球健康数据库和科克伦对照试验中心注册中心进行了文献检索，并从3113篇参考文献中选择了64篇进行分析。患者相关变量包括年龄（老年人）、性别（女性）、优先使用替代医疗服务提供者（Hakeem、传统治疗师等）、个人对疾病和治疗潜力的看法、贫困、个人医疗费用、缺乏社会支持、访问医疗机构的地理限制以及与外科疾病发展相关的一般健康状况受损。环境障碍包括治理缺陷、流离失所者或难民人口的负担以及影响治疗和转诊的法医系统的各个方面。与卫生系统有关的障碍包括能力（基础设施、物质资源、人力资源）和组织方面的缺陷，以及监测不足。与提供者有关的障碍包括缺乏知识和技能（以及持续的教育机会）、转诊延误、沟通不足以及为女性患者提供的女性保健提供者人数不足。医疗保健障碍模型解决了这一广泛的障碍，旨在帮助制定医疗保健障碍框架。要克服这些障碍，就需要作出多学科、多部门的努力，以加强卫生系统。(C)2012 Elsevier Inc. All rights reserved.
Inadequate access to surgical services results in increased morbidity and mortality from a spectrum of conditions in Pakistan. We employed a modification of Andersen's model of health services utilization and developed a 'Healthcare Barrier Model,' to characterize the barriers to accessing health care in developing countries, using surgical care in Pakistan as a case study. We performed a literature search from MEDLINE, EMBASE, CINAHL, SCOPUS, Global Health Database, and Cochrane Central Register of Controlled Trials, and selected 64 of 3113 references for analysis. Patient-related variables included age (elderly), gender (female), preferential use of alternative health providers (Hakeem, traditional healers, others), personal perceptions regarding disease and potential for treatment, poverty, personal expenses for healthcare, lack of social support, geographic constraints to accessing a health facility, and compromised general health status as it relates to the development of surgical disease. Environmental barriers include deficiencies in governance, the burden of displaced or refugee populations, and aspects of the medicolegal system, which impact treatment and referral. Barriers relating to the health system include deficiencies in capacity (infrastructure, physical resources, human resources) and organization, and inadequate monitoring. Provider-related barriers include deficiencies in knowledge and skills (and ongoing educational opportunities), delays in referral, deficient communication, and deficient numbers of female health providers for female patients. The Healthcare Barrier model addresses this broad spectrum of barriers and is designed to help formulate a framework of healthcare barriers. To overcome these barriers will require a multidisciplinary, multisectoral effort aimed at strengthening the health system. (C) 2012 Elsevier Inc. All rights reserved.