Department of General Practice & Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, PO Box 56, Dunedin, 9010, New Zealand.
BMC Health Serv Res. 2024 Apr 13;24(1):465. doi: 10.1186/s12913-024-10871-x.
Early access to care for carpal tunnel syndrome (CTS) can avoid higher rates of surgery and permanent harm yet is often delayed, particularly for populations more likely to underutilise care.
We sought to explore patient experiences and perspectives of health service access for CTS to inform an equity-focussed co-design of a health service for improving early care access.
In this Normalisation Process Theory (NPT)-informed qualitative study we conducted semistructured in-depth interviews with 19 adults with experience of CTS. Recruitment prioritised New Zealand Māori, Pasifika, low-income, and rural populations. Data were analysed using deductive then inductive thematic analysis.
We identified five major themes: (1) the 'Significant Impact of CTS' of the sense-making and relational work to understand the condition, deciding when to get care, compelling clinicians to provide care, and garnering help from others; (2) 'Waiting and Paying for Care'- the enacting, relational, and appraising work to avoid long wait times unless paying privately, particularly where quality of care was low, employment relations poor, or injury compensation processes faltered; (3) circumstances of 'Occupation and CTS Onset' whereby the burden of proof to relate onset of CT symptoms to occupation created excessive relational and enacting work; (4) the 'Information Scarcity' of good information about CTS and the high relational and appraising work associated with using online resources; (5) 'Negotiating Telehealth Perspectives' where telehealth was valued if it meant earlier access for all despite the challenges it held for many.
Quality, culturally and linguistically responsive information and communication from clinicians and health services will improve equitable early access to CTS care including realising the potential of telehealth modes of care. Policy changes that reduce individual burden of proof in injury compensation claims processes, enable time off work to attend health appointments, and increase public funding for surgical resources would improve early access to CTS care particularly for Māori and Pacific populations and those in small and rural workplaces. NPT is valuable for understanding where opportunities lie to reduce inequitable delays to accessing care including the impact of racism, particularly for populations more likely to underutilise care.
早期获得腕管综合征（CTS）的治疗可以避免更高的手术率和永久性伤害，但往往会被延迟，特别是对于那些不太可能充分利用医疗服务的人群。
我们旨在探索患者对 CTS 获得医疗服务的体验和看法，以便为改善早期治疗机会的医疗服务提供以公平为重点的共同设计提供信息。
在这项正常化进程理论（NPT）指导的定性研究中，我们对 19 名有 CTS 经验的成年人进行了半结构化深入访谈。招聘优先考虑新西兰毛利人、太平洋岛民、低收入和农村人群。使用演绎和归纳主题分析对数据进行分析。
我们确定了五个主要主题：（1）“CTS 的显著影响”，即理解病情、决定何时就医、促使临床医生提供治疗以及寻求他人帮助的意义建构和关系工作；（2）“等待和支付医疗费用”，即在不支付私人费用的情况下避免长时间等待的实施、关系和评估工作，特别是在医疗质量低、雇佣关系差或伤害赔偿程序受阻的情况下；（3）“职业和 CTS 发病”的情况，即证明 CT 症状与职业有关的举证责任给患者带来了过多的关系和实施工作；（4）“信息匮乏”，即有关 CTS 的优质信息匮乏，以及使用在线资源所带来的高关系和评估工作；（5）“协商远程医疗观点”，尽管远程医疗对许多人来说存在挑战，但如果它意味着所有人都能更早获得治疗，那么远程医疗就具有价值。
临床医生和医疗服务机构提供优质、文化和语言响应的信息和沟通，将改善 CTS 治疗的公平早期获得，包括实现远程医疗模式治疗的潜力。减少伤害赔偿索赔过程中个人举证责任、允许休假参加健康预约以及增加用于手术资源的公共资金的政策变化将改善 CTS 治疗的早期获得，特别是对毛利人和太平洋岛民以及那些在小型和农村工作场所的人。NPT 对于了解减少获得医疗服务不公平延迟的机会非常有价值，包括种族主义的影响，特别是对于那些不太可能充分利用医疗服务的人群。
