Hansen Kristoffer Lund, Bratholm Åsmund, Pradhan Manohar, Mikkelsen Søren, Milling Louise
The Prehospital Research Unit, Region of Southern Denmark, Institute of Regional Health Research, University of Southern Denmark & Odense University Hospital, Odense, Denmark.
Department of General Practice & Emergency Medicine, College of Medical Sciences Teaching Hospital, Bharatpur, Nepal.
Int J Emerg Med. 2022 Nov 8;15(1):61. doi: 10.1186/s12245-022-00466-w.
Emergency medical care, including prehospital treatment, forms an important component of any healthcare system. Like most low-middle-income countries, Nepal has an emergency medical system that can be described as underdeveloped. Emergency physicians navigating this system may experience challenges or barriers in their treatment of patients. This study aimed to investigate physicians' perspectives on emergency and prehospital patient management in a low-income country, Nepal, and to understand the challenges and barriers they perceive in emergency treatment including both the prehospital treatment and the immediate in-hospital treatment at the emergency department.
Using a qualitative study, eight semi-structured interviews with physicians working in a Nepalese emergency department were performed. The interviews were conducted between September and November 2021 and were audio-recorded and transcribed verbatim. Data were subsequently analyzed using the systematic text condensation method.
Four main themes and associated sub-themes were identified: (1) patients' sociocultural, educational, and financial factors (such as financial issues and financial inequality) and regional differences; (2) emergency department's organization and resources concerning human and material resources, protocols, and guidelines; (3) problems with the emergency department (ED) service's qualities and availability caused by an insufficient integration of the ED and the EMS, prehospital resources, and financial interests in the EMS; and (4) surrounding healthcare system's impact on the ED where, especially, the levels of organized primary care, governmental responsibilities, and healthcare structure were addressed.
The physicians identified numerous regularly encountered challenges and barriers. These challenges stretched beyond the ED and into various aspects of society. The patients' financial problems were described as the greatest problem, restricting the treatment due to a given patient's inability or unwillingness to pay for the required procedures. The physicians were thus restricted in completing their duties to the desired levels. The low quality of prehospital care and a lack of education and awareness of common diseases and symptoms in a significant proportion of patients were identified by many participants as being significant issues. The aforementioned challenges or barriers directly resulted in patients arriving in critical conditions that could have been avoided if the disease were treated earlier.
包括院前治疗在内的急诊医疗服务是任何医疗体系的重要组成部分。与大多数中低收入国家一样，尼泊尔的急诊医疗系统尚不完善。在这个系统中工作的急诊医生在治疗患者时可能会遇到挑战或障碍。本研究旨在调查尼泊尔这个低收入国家的医生对急诊和院前患者管理的看法，并了解他们在急诊治疗（包括院前治疗和急诊科的院内即刻治疗）中所感受到的挑战和障碍。
采用定性研究方法，对尼泊尔一家急诊科的医生进行了8次半结构化访谈。访谈于2021年9月至11月进行，进行了录音并逐字转录。随后使用系统文本浓缩法对数据进行分析。
确定了四个主要主题及相关子主题：（1）患者的社会文化、教育和经济因素（如经济问题和经济不平等）以及地区差异；（2）急诊科在人力和物力资源、规程和指南方面的组织和资源情况；（3）急诊科与紧急医疗服务（EMS）、院前资源以及EMS中的经济利益整合不足导致的急诊科服务质量和可及性问题；（4）周边医疗系统对急诊科的影响，尤其涉及有组织的初级保健水平、政府职责和医疗结构。
医生们指出了许多经常遇到的挑战和障碍。这些挑战不仅限于急诊科，还涉及社会的各个方面。患者的经济问题被描述为最大的问题，由于患者无力或不愿支付所需治疗费用而限制了治疗。因此，医生履行职责的能力受到限制。许多参与者认为，院前护理质量低下以及很大一部分患者对常见疾病和症状缺乏教育和认知是重大问题。上述挑战或障碍直接导致患者在病情危急时才前来就诊，而如果疾病能更早得到治疗，这些情况本可避免。
