Fasina-Ayoola Abiola, Adeyeye Adebisi, Tupetz Anna, Olajide Francis, Obi Abigail, Onabanjo SimileOluwa, Popoola Akinboade, Ojifinni Oludoyinmola, Vissoci Joao, Staton Catherine A
R Jolad Hospital, 14 Safaratu Sekoni Street, Gbagada, Lagos, Nigeria.
Emergency Healthcare Consultants, 364 Borno Way, Yaba, Lagos, Nigeria.
BMC Health Serv Res. 2025 Aug 27;25(1):1133. doi: 10.1186/s12913-025-13110-z.
Sepsis remains a leading cause of death among hospitalized and critically ill patients in Nigeria. Despite progress in antimicrobial therapy access and emergency resuscitative care, it continues to account for a significant proportion of death and disability in low and middle-income countries and represents a significant burden of disease. This study aimed to define the factors impacting patient care-seeking and clinician emergency care practices for septic patients at a private hospital in Lagos, Nigeria.
The study explored barriers to providing care among clinicians in group discussions using the three-delays model. Patients or caregivers completed in-depth interviews to explain barriers to seeking care. The study used pilot-tested, semi-structured group/interview guides to facilitate data collection from patients and clinicians. Interviews/group discussions were audiotaped, transcribed, and coded. Data was collected and analyzed until thematic saturation was achieved.
A total of 15 clinicians and 30 patients or caregivers participated. Delays in seeking appropriate care (Delay 1) included seeking alternative sources of care, communal or family decision-making issues, and symptom and illness perception. For delay 2 (reaching appropriate care), work schedule considerations, proximity to the healthcare facility, mode of transportation, and patients' time preference for hospital presentation emerged as common themes. In delay 3 (receiving appropriate care), the clinical condition at presentation, the selected clinical approach to management, system delays at the hospital, and financial considerations impacted the time to provision of definitive care.
Delays in patient healthcare-seeking and clinician delivery of emergency stabilization in sepsis occur in Nigeria and align with the three-delays model. The decision to seek care (delay1) is frequently made communally with family and friends. Patients initially prefer alternative sources of care for convenience. Upon arriving at the hospital for appropriate care (delay 2), work schedule considerations, long commute times to the hospital, and long waiting times impacted patients' time to arrival. Finally, receiving definitive care (delay 3) was affected by financial considerations, clinicians' knowledge of sepsis symptom management and treatment, and delays in completing diagnostic laboratory investigations.
在尼日利亚，脓毒症仍然是住院患者和重症患者死亡的主要原因。尽管在抗菌治疗可及性和紧急复苏护理方面取得了进展，但在低收入和中等收入国家，脓毒症仍然占死亡和残疾的很大比例，是一项重大的疾病负担。本研究旨在确定影响尼日利亚拉各斯一家私立医院脓毒症患者寻求医疗服务和临床医生急诊护理实践的因素。
该研究使用三延误模型，通过小组讨论探讨临床医生提供护理的障碍。患者或护理人员完成深入访谈，以解释寻求护理的障碍。该研究使用经过预试验的半结构化小组/访谈指南，以促进从患者和临床医生处收集数据。访谈/小组讨论进行录音、转录和编码。持续收集和分析数据，直至达到主题饱和。
共有15名临床医生以及30名患者或护理人员参与。寻求适当护理的延误（延误1）包括寻求其他护理来源、社区或家庭决策问题以及症状和疾病认知。对于延误2（获得适当护理），工作时间表考虑因素、与医疗机构的距离、交通方式以及患者对前往医院就诊的时间偏好成为常见主题。在延误3（接受适当护理）方面，就诊时的临床状况、所选的临床管理方法、医院的系统延误以及财务考虑因素影响了提供确定性护理的时间。
在尼日利亚，脓毒症患者寻求医疗服务以及临床医生进行紧急稳定治疗存在延误，这与三延误模型相符。寻求护理的决定（延误1）通常是与家人和朋友共同做出的。患者最初为方便起见更喜欢其他护理来源。在前往医院接受适当护理时（延误2），工作时间表考虑因素、前往医院的通勤时间长以及等待时间长影响了患者到达的时间。最后，接受确定性护理（延误3）受到财务考虑因素、临床医生对脓毒症症状管理和治疗的知识以及完成诊断实验室检查的延误的影响。
