Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda.
Yale School of Medicine, New Haven, Connecticut.
J Surg Res. 2019 Oct;242:193-199. doi: 10.1016/j.jss.2019.03.058. Epub 2019 May 11.
We sought to understand the challenges in accessing pediatric surgical care in the context of the "three delays" model at the Pediatric Surgery Outpatient Clinic (PSOPC) at a tertiary hospital in Kampala, Uganda.
An outpatient database was established at the weekly PSOPC. A survey regarding prior healthcare visits and barriers to care was additionally administered to clinic patients and inpatients.
Patients first sought healthcare a median of 56 d before the current visit to the PSOPC. A majority (52%) of patients first sought care at another health facility, and 17% of those surveyed had presented to the PSOPC three or more times for their current medical issue. Of 240 patients with a new issue or due for their next surgery, 10% were admitted to the ward, with only 54% receiving definitive care. Included in the most commonly needed surgeries for PSOPC patients were herniotomy (16% inguinal; 14.9% umbilical), orchiopexy (6.3%), posterior sagittal anorectoplasty (6.3%), and colostomy closure (4.4%), with the range of patient ages at the time of presentation reflecting delays in care. Patient expenditures associated with travel to the hospital showed inpatients coming from significantly further away, with higher costs of travel and need to borrow or sell assets to cover travel costs, when compared with PSOPC patients.
Patients face significant delays in accessing and receiving definitive surgical care. Associated burdens associated with these delays place patients at risk for catastrophic health expenditures. Infrastructure and capacity development are necessary for improvement in pediatric surgical care.
我们试图了解乌干达坎帕拉一家三级医院的小儿外门诊（PSOPC）中“三个延迟”模型背景下获取小儿外科护理的挑战。
每周在 PSOPC 建立门诊数据库。此外，还向诊所患者和住院患者进行了有关先前医疗就诊和护理障碍的调查。
患者首次寻求医疗护理的中位数为当前就诊 PSOPC 前 56 天。大多数（52%）患者首先在另一家医疗机构寻求医疗护理，17%的调查患者为当前医疗问题已在 PSOPC 就诊过三次或更多次。在 240 名有新问题或即将进行下一次手术的患者中，有 10%住院，只有 54%接受了明确的治疗。PSOPC 患者最常需要进行的手术包括疝修补术（腹股沟 16%；脐部 14.9%）、睾丸固定术（6.3%）、后矢状直肠肛门成形术（6.3%）和结肠造口关闭术（4.4%），当时就诊的患者年龄范围反映了护理延迟。与前往医院相关的患者旅行支出表明，与 PSOPC 患者相比，住院患者来自更远的地方，旅行费用更高，需要借款或出售资产来支付旅行费用。
患者在获得和接受明确手术护理方面面临重大延迟。与这些延迟相关的负担使患者面临灾难性医疗支出的风险。基础设施和能力发展是改善小儿外科护理所必需的。
