在印度北方邦，烧伤患者求医的经历和延误：探索烧伤患者的医疗服务体系。

Navigating health systems for burn care: Patient journeys and delays in Uttar Pradesh, India.

机构信息

The George Institute for Global Health, India; The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.

School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The George Institute for Global Health, Sydney, Australia.

出版信息

Burns. 2023 Nov;49(7):1745-1755. doi: 10.1016/j.burns.2023.03.009. Epub 2023 Mar 17.

DOI:10.1016/j.burns.2023.03.009

PMID:37032275

Abstract

BACKGROUND

India has one of the highest burden of burns. The health systems response to burn care is sometimes patchy and highly influenced by social determinants. Delay in access to acute care and rehabilitation adversely affects recovery outcomes. Evidence on underlying factors for delays in care are limited. In this study, we aim to explore patients' journeys to analyse their experiences in accessing burn care in Uttar Pradesh, India.

METHODS

We conducted qualitative inquiry using the patient journey mapping approach and in-depth interviews (IDI). We purposively selected a referral burn centre in Uttar Pradesh, India and included a diverse group of patients. A chronological plot of the patient's journey was drawn and confirmed with respondents at the end of the interview. A detailed patient journey map was drawn for each patient based on interview transcripts and notes. Further analysis was done in NVivo 12 using a combination of inductive and deductive coding. Similar codes were categorised into sub-themes, which were distributed to one of the major themes of the 'three delays' framework.

RESULTS

Six major burns patients (4 female and 2 males) aged between 2 and 43 years were included in the study. Two patients had flame burns, and one had chemical, electric, hot liquid, and blast injury, respectively. Delay in seeking care (delay 1) was less common for acute care but was a concern for rehabilitation. Accessibility and availability of services, costs of care and lack of financial support influenced delay (1) for rehabilitation. Delay in reaching an appropriate facility (delay 2) was common due to multiple referrals before reaching an appropriate burn facility. Lack of clarity on referral systems and proper triaging influenced this delay. Delay in getting adequate care (delay 3) was mainly due to inadequate infrastructure at various levels of health facilities, shortage of skilled health providers, and high costs of care. COVID-19-related protocols and restrictions influenced all three delays.

CONCLUSIONS

Burn care pathways are adversely affected by barriers to timely access. We propose using the modified 3-delays framework to analyse delays in burns care. There is a need to strengthen referral linkage systems, ensure financial risk protection, and integrate burn care at all levels of health care delivery systems.

摘要

背景

印度是烧伤负担最重的国家之一。其卫生系统对烧伤护理的响应有时参差不齐，且深受社会决定因素的影响。获得急性治疗和康复的延迟会对康复结果产生不利影响。关于导致护理延迟的潜在因素的证据有限。在这项研究中，我们旨在探索患者的就医轨迹，以分析他们在印度北方邦获得烧伤护理的体验。

方法

我们使用患者就医轨迹图绘制方法和深入访谈（IDI）进行定性研究。我们在印度北方邦的一家转诊烧伤中心进行了有针对性的选择，并纳入了不同类型的患者。患者的就医轨迹以时间顺序绘制，并在访谈结束时与受访者确认。根据访谈记录和笔记，为每位患者绘制详细的患者就医轨迹图。进一步在 NVivo 12 中使用归纳和演绎编码相结合的方法进行分析。将相似的编码归入子主题，然后将其分配到“三个延迟”框架的一个主要主题中。

结果

研究纳入了 6 名主要烧伤患者（4 名女性和 2 名男性），年龄在 2 至 43 岁之间。其中 2 名患者为火焰烧伤，1 名患者为化学烧伤、电击伤、热液伤和爆炸伤。寻求急性治疗的护理延迟（第 1 延迟）不太常见，但康复护理的延迟值得关注。服务的可及性和可用性、护理费用以及缺乏经济支持会影响康复护理的延迟（1）。因多次转诊至适当的烧伤机构而导致难以到达适当机构（第 2 延迟）较为常见。转诊系统不明确和适当分诊也会导致这种延迟。获得充分护理的延迟（第 3 延迟）主要是由于各级卫生机构基础设施不足、熟练卫生提供者短缺以及护理费用高昂所致。与 COVID-19 相关的协议和限制会影响这三个延迟。