Mansouri Alireza, Ku Jerry C, Khu Kathleen J, Mahmud Muhammad R, Sedney Cara, Ammar Ahmed, Godoy Bruno L, Abbasian Aram, Bernstein Mark
Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada; Neuro-Oncology Branch (NOB), National Institutes of Health (NIH), Bethesda, Maryland, USA.
Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.
World Neurosurg. 2018 Sep;117:e679-e691. doi: 10.1016/j.wneu.2018.06.111. Epub 2018 Jun 26.
In low- and middle-income countries (LMICs), 11.8% of the need for neurosurgical care is met. Delays in seeking and receiving care may further exacerbate this situation. Objective analysis of delay and its consequences is contingent on reference to established resource-appropriate acceptable timeframes. This study sought to 1) establish an estimate of the landscape of care provided in LMICs and 2) explore reasonable timeframes for various stages of patient-health care interaction.
Consensus input from neurosurgeons in select LMICs was collected; 1 high-income country was included for comparison. In phase 1, participants were asked to select neurosurgical procedures performed at their centers. In phase 2, based on procedures shared among all LMICs, representative case scenarios were generated and participants provided input on acceptable timeframes for each stage of patient-health care interaction: 1) presentation to health services, 2) diagnosis by primary care physician, 3) referral to neurosurgical specialist care, and 4) definitive neurosurgical management.
Twenty neurosurgeons across 18 centers were identified; 12 participated in phase 1 and 7 in phase 2. The range of procedures offered was broad, similar in scope to high-income countries, and included pediatric and adult neurosurgery, trauma, degenerative spine, and hemorrhagic stroke. Acceptable timeframes had wide ranges in certain cases; however, the overall trend showed agreement between the participants.
This exploratory analysis identified reasonable timeframes for the provision of neurosurgical care in LMICs. If validated, these data can be used to more objectively assess the prevalence of delay in neurosurgical care in individual LMICs, along with its consequences.
在低收入和中等收入国家（LMICs），仅满足了11.8%的神经外科护理需求。寻求和接受护理的延迟可能会进一步加剧这种情况。对延迟及其后果进行客观分析取决于参照既定的适合资源情况的可接受时间框架。本研究旨在：1）对低收入和中等收入国家提供的护理情况进行估计；2）探索患者与医疗保健互动各个阶段的合理时间框架。
收集了选定低收入和中等收入国家神经外科医生的共识性意见；纳入了1个高收入国家作为对照。在第一阶段，要求参与者选择其中心所进行的神经外科手术。在第二阶段，基于所有低收入和中等收入国家共同的手术，生成了代表性病例场景，参与者针对患者与医疗保健互动的每个阶段提供了可接受时间框架的意见：1）向卫生服务机构就诊；2）由初级保健医生诊断；3）转诊至神经外科专科护理；4）确定性神经外科治疗。
确定了来自18个中心的20名神经外科医生；12人参与了第一阶段，7人参与了第二阶段。所提供的手术范围广泛，与高收入国家的范围相似，包括儿科和成人神经外科、创伤、退行性脊柱疾病和出血性中风。在某些情况下，可接受时间框架范围很广；然而，总体趋势显示参与者之间意见一致。
这项探索性分析确定了低收入和中等收入国家提供神经外科护理的合理时间框架。如果得到验证，这些数据可用于更客观地评估各个低收入和中等收入国家神经外科护理延迟的发生率及其后果。
