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A survey of Ethiopian physicians’ experiences of bedside rationing: extensive resource scarcity, tough decisions and adverse consequences

BACKGROUND: Resource scarcity in health care is a universal challenge. In high-income settings, bedside rationing is commonly discussed and debated as a means to addressing scarcity. However, little is known about physicians’ experiences in resource-limited contexts in low- income countries. Here we...

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Autores principales: Defaye, Frehiwot Berhane, Desalegn, Dawit, Danis, Marion, Hurst, Samia, Berhane, Yemane, Norheim, Ole Frithjof, Miljeteig, Ingrid
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607248/
https://www.ncbi.nlm.nih.gov/pubmed/26467298
http://dx.doi.org/10.1186/s12913-015-1131-6
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author Defaye, Frehiwot Berhane
Desalegn, Dawit
Danis, Marion
Hurst, Samia
Berhane, Yemane
Norheim, Ole Frithjof
Miljeteig, Ingrid
author_facet Defaye, Frehiwot Berhane
Desalegn, Dawit
Danis, Marion
Hurst, Samia
Berhane, Yemane
Norheim, Ole Frithjof
Miljeteig, Ingrid
author_sort Defaye, Frehiwot Berhane
collection PubMed
description BACKGROUND: Resource scarcity in health care is a universal challenge. In high-income settings, bedside rationing is commonly discussed and debated as a means to addressing scarcity. However, little is known about physicians’ experiences in resource-limited contexts in low- income countries. Here we describe physicians’ experiences regarding scarcity of resources, bedside rationing, use of various strategies to save resources, and perceptions of the consequences of rationing in Ethiopia. METHODS: A national survey was conducted amongst physicians from 49 public hospitals using stratified, multi-stage sampling in six regions. All physicians in the selected hospitals were invited to respond to a self-administered questionnaire. Data were weighted and analyzed using descriptive statistics. RESULTS: In total, 587 physicians responded (91 % response rate). The majority had experienced system-wide shortages of various types of medical services. The services most frequently reported to be in short supply, either daily or weekly, were access to surgery, specialist and intensive care units, drug prescriptions and admission to hospital (52, 49, 46, 47 and 46 % respectively). The most common rationing strategies used daily or weekly were limiting laboratory tests, hospital drugs, radiological investigations and providing second best treatment (47, 47, 47 and 39 % respectively). Availability of institutional or national guidelines for whom to see and treat first was lacking. Almost all respondents had witnessed different adverse consequences of resource scarcity; 54 % reported seeing patients who, in their estimation, had died due to resource scarcity. Almost 9 out of 10 physicians were so troubled by limited resources that they often regretted their choice of profession. CONCLUSION: This study provides the first glimpses of the untold story of resource shortage and bedside rationing in Ethiopia. Physicians encounter numerous dilemmas due to resource scarcity, and they report they lack adequate guidance for how to handle them. The consequences for patients and the professionals are substantial. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-015-1131-6) contains supplementary material, which is available to authorized users.
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spelling pubmed-46072482015-10-16 A survey of Ethiopian physicians’ experiences of bedside rationing: extensive resource scarcity, tough decisions and adverse consequences Defaye, Frehiwot Berhane Desalegn, Dawit Danis, Marion Hurst, Samia Berhane, Yemane Norheim, Ole Frithjof Miljeteig, Ingrid BMC Health Serv Res Research Article BACKGROUND: Resource scarcity in health care is a universal challenge. In high-income settings, bedside rationing is commonly discussed and debated as a means to addressing scarcity. However, little is known about physicians’ experiences in resource-limited contexts in low- income countries. Here we describe physicians’ experiences regarding scarcity of resources, bedside rationing, use of various strategies to save resources, and perceptions of the consequences of rationing in Ethiopia. METHODS: A national survey was conducted amongst physicians from 49 public hospitals using stratified, multi-stage sampling in six regions. All physicians in the selected hospitals were invited to respond to a self-administered questionnaire. Data were weighted and analyzed using descriptive statistics. RESULTS: In total, 587 physicians responded (91 % response rate). The majority had experienced system-wide shortages of various types of medical services. The services most frequently reported to be in short supply, either daily or weekly, were access to surgery, specialist and intensive care units, drug prescriptions and admission to hospital (52, 49, 46, 47 and 46 % respectively). The most common rationing strategies used daily or weekly were limiting laboratory tests, hospital drugs, radiological investigations and providing second best treatment (47, 47, 47 and 39 % respectively). Availability of institutional or national guidelines for whom to see and treat first was lacking. Almost all respondents had witnessed different adverse consequences of resource scarcity; 54 % reported seeing patients who, in their estimation, had died due to resource scarcity. Almost 9 out of 10 physicians were so troubled by limited resources that they often regretted their choice of profession. CONCLUSION: This study provides the first glimpses of the untold story of resource shortage and bedside rationing in Ethiopia. Physicians encounter numerous dilemmas due to resource scarcity, and they report they lack adequate guidance for how to handle them. The consequences for patients and the professionals are substantial. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-015-1131-6) contains supplementary material, which is available to authorized users. BioMed Central 2015-10-14 /pmc/articles/PMC4607248/ /pubmed/26467298 http://dx.doi.org/10.1186/s12913-015-1131-6 Text en © Defaye et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Defaye, Frehiwot Berhane
Desalegn, Dawit
Danis, Marion
Hurst, Samia
Berhane, Yemane
Norheim, Ole Frithjof
Miljeteig, Ingrid
A survey of Ethiopian physicians’ experiences of bedside rationing: extensive resource scarcity, tough decisions and adverse consequences
title A survey of Ethiopian physicians’ experiences of bedside rationing: extensive resource scarcity, tough decisions and adverse consequences
title_full A survey of Ethiopian physicians’ experiences of bedside rationing: extensive resource scarcity, tough decisions and adverse consequences
title_fullStr A survey of Ethiopian physicians’ experiences of bedside rationing: extensive resource scarcity, tough decisions and adverse consequences
title_full_unstemmed A survey of Ethiopian physicians’ experiences of bedside rationing: extensive resource scarcity, tough decisions and adverse consequences
title_short A survey of Ethiopian physicians’ experiences of bedside rationing: extensive resource scarcity, tough decisions and adverse consequences
title_sort survey of ethiopian physicians’ experiences of bedside rationing: extensive resource scarcity, tough decisions and adverse consequences
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607248/
https://www.ncbi.nlm.nih.gov/pubmed/26467298
http://dx.doi.org/10.1186/s12913-015-1131-6
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