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Barriers to accessing follow up care in post-hospitalized trauma patients in Moshi, Tanzania: A mixed methods study

Disproportionately high injury rates in Sub-Saharan Africa combined with limited access to care in both the acute injury phase and for injury patients requiring continued care after hospital discharge remains a challenge. We aimed to characterize barriers to transportation and access to care in a co...

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Autores principales: Joiner, Anjni Patel, Tupetz, Anna, Peter, Timothy Antipas, Raymond, Julius, Macha, Victoria Gerald, Vissoci, João Ricardo Nickenig, Staton, Catherine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021180/
https://www.ncbi.nlm.nih.gov/pubmed/36962378
http://dx.doi.org/10.1371/journal.pgph.0000277
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author Joiner, Anjni Patel
Tupetz, Anna
Peter, Timothy Antipas
Raymond, Julius
Macha, Victoria Gerald
Vissoci, João Ricardo Nickenig
Staton, Catherine
author_facet Joiner, Anjni Patel
Tupetz, Anna
Peter, Timothy Antipas
Raymond, Julius
Macha, Victoria Gerald
Vissoci, João Ricardo Nickenig
Staton, Catherine
author_sort Joiner, Anjni Patel
collection PubMed
description Disproportionately high injury rates in Sub-Saharan Africa combined with limited access to care in both the acute injury phase and for injury patients requiring continued care after hospital discharge remains a challenge. We aimed to characterize barriers to transportation and access to care in a cohort of post-hospitalized injury patients in Moshi, Tanzania. This was a mixed-methods study of a prospective cohort of trauma registry patients presenting to Kilimanjaro Christian Medical Center between August 2018 and January 2020. We conducted standardized patient/family surveys and in-depth interviews at a 2-week follow up visit after hospital discharge, and focus groups with healthcare providers. Quantitative results were analyzed using descriptive statistics and multivariable logistic regression using R statistical software. Qualitative results were analyzed using thematic analysis through an iterative process using NVivo software. A total of 1,365 patients were enrolled in the trauma registry, with 169 patients followed up at 2 weeks. Over half of patients at follow-up, 101 (59.8%), reported challenges in traveling. The majority of patients were male (80.3%). Difficulty in traveling since injury was associated with female gender (aOR 5.85 [95% CI 1.20–33.59]) and a need for non-family members escorts for travel (aOR 7.10 [95% CI 1.43–41.66]). Those who reported assault or fall as the mechanism of injury as compared to road traffic injury and had health insurance were less likely to report challenges in traveling (aOR 0.19 [95% CI 0.03–0.90]), 0.11 [95% CI 0.01–0.61], 0.14 [95% 0.02–0.80]). Transportation barriers that emerged from qualitative data included inability to use regular means of transportation, financial challenges, physical barriers, rigid compliance to physician orders, access to healthcare, and social support barriers. Our findings demonstrate several areas to address transportation barriers for post-injury patients in Tanzania. Educational interventions such as clarification of doctors’ orders of strict bedrest, provision of vouchers to support financial challenges and alternate means of transportation given physical barriers and reliance on social support may address some of these barriers.
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spelling pubmed-100211802023-03-17 Barriers to accessing follow up care in post-hospitalized trauma patients in Moshi, Tanzania: A mixed methods study Joiner, Anjni Patel Tupetz, Anna Peter, Timothy Antipas Raymond, Julius Macha, Victoria Gerald Vissoci, João Ricardo Nickenig Staton, Catherine PLOS Glob Public Health Research Article Disproportionately high injury rates in Sub-Saharan Africa combined with limited access to care in both the acute injury phase and for injury patients requiring continued care after hospital discharge remains a challenge. We aimed to characterize barriers to transportation and access to care in a cohort of post-hospitalized injury patients in Moshi, Tanzania. This was a mixed-methods study of a prospective cohort of trauma registry patients presenting to Kilimanjaro Christian Medical Center between August 2018 and January 2020. We conducted standardized patient/family surveys and in-depth interviews at a 2-week follow up visit after hospital discharge, and focus groups with healthcare providers. Quantitative results were analyzed using descriptive statistics and multivariable logistic regression using R statistical software. Qualitative results were analyzed using thematic analysis through an iterative process using NVivo software. A total of 1,365 patients were enrolled in the trauma registry, with 169 patients followed up at 2 weeks. Over half of patients at follow-up, 101 (59.8%), reported challenges in traveling. The majority of patients were male (80.3%). Difficulty in traveling since injury was associated with female gender (aOR 5.85 [95% CI 1.20–33.59]) and a need for non-family members escorts for travel (aOR 7.10 [95% CI 1.43–41.66]). Those who reported assault or fall as the mechanism of injury as compared to road traffic injury and had health insurance were less likely to report challenges in traveling (aOR 0.19 [95% CI 0.03–0.90]), 0.11 [95% CI 0.01–0.61], 0.14 [95% 0.02–0.80]). Transportation barriers that emerged from qualitative data included inability to use regular means of transportation, financial challenges, physical barriers, rigid compliance to physician orders, access to healthcare, and social support barriers. Our findings demonstrate several areas to address transportation barriers for post-injury patients in Tanzania. Educational interventions such as clarification of doctors’ orders of strict bedrest, provision of vouchers to support financial challenges and alternate means of transportation given physical barriers and reliance on social support may address some of these barriers. Public Library of Science 2022-06-13 /pmc/articles/PMC10021180/ /pubmed/36962378 http://dx.doi.org/10.1371/journal.pgph.0000277 Text en © 2022 Joiner et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Joiner, Anjni Patel
Tupetz, Anna
Peter, Timothy Antipas
Raymond, Julius
Macha, Victoria Gerald
Vissoci, João Ricardo Nickenig
Staton, Catherine
Barriers to accessing follow up care in post-hospitalized trauma patients in Moshi, Tanzania: A mixed methods study
title Barriers to accessing follow up care in post-hospitalized trauma patients in Moshi, Tanzania: A mixed methods study
title_full Barriers to accessing follow up care in post-hospitalized trauma patients in Moshi, Tanzania: A mixed methods study
title_fullStr Barriers to accessing follow up care in post-hospitalized trauma patients in Moshi, Tanzania: A mixed methods study
title_full_unstemmed Barriers to accessing follow up care in post-hospitalized trauma patients in Moshi, Tanzania: A mixed methods study
title_short Barriers to accessing follow up care in post-hospitalized trauma patients in Moshi, Tanzania: A mixed methods study
title_sort barriers to accessing follow up care in post-hospitalized trauma patients in moshi, tanzania: a mixed methods study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021180/
https://www.ncbi.nlm.nih.gov/pubmed/36962378
http://dx.doi.org/10.1371/journal.pgph.0000277
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