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Physicians’ experiences and perceived challenges working in an emergency setting in Bharatpur, Nepal: a qualitative study

BACKGROUND: Emergency medical care, including prehospital treatment, forms an important component of any healthcare system. Like most low-middle-income countries, Nepal has an emergency medical system that can be described as underdeveloped. Emergency physicians navigating this system may experience...

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Autores principales: Hansen, Kristoffer Lund, Bratholm, Åsmund, Pradhan, Manohar, Mikkelsen, Søren, Milling, Louise
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9643944/
https://www.ncbi.nlm.nih.gov/pubmed/36348291
http://dx.doi.org/10.1186/s12245-022-00466-w
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author Hansen, Kristoffer Lund
Bratholm, Åsmund
Pradhan, Manohar
Mikkelsen, Søren
Milling, Louise
author_facet Hansen, Kristoffer Lund
Bratholm, Åsmund
Pradhan, Manohar
Mikkelsen, Søren
Milling, Louise
author_sort Hansen, Kristoffer Lund
collection PubMed
description BACKGROUND: Emergency medical care, including prehospital treatment, forms an important component of any healthcare system. Like most low-middle-income countries, Nepal has an emergency medical system that can be described as underdeveloped. Emergency physicians navigating this system may experience challenges or barriers in their treatment of patients. This study aimed to investigate physicians’ perspectives on emergency and prehospital patient management in a low-income country, Nepal, and to understand the challenges and barriers they perceive in emergency treatment including both the prehospital treatment and the immediate in-hospital treatment at the emergency department. METHODS: Using a qualitative study, eight semi-structured interviews with physicians working in a Nepalese emergency department were performed. The interviews were conducted between September and November 2021 and were audio-recorded and transcribed verbatim. Data were subsequently analyzed using the systematic text condensation method. RESULTS: Four main themes and associated sub-themes were identified: (1) patients’ sociocultural, educational, and financial factors (such as financial issues and financial inequality) and regional differences; (2) emergency department’s organization and resources concerning human and material resources, protocols, and guidelines; (3) problems with the emergency department (ED) service’s qualities and availability caused by an insufficient integration of the ED and the EMS, prehospital resources, and financial interests in the EMS; and (4) surrounding healthcare system’s impact on the ED where, especially, the levels of organized primary care, governmental responsibilities, and healthcare structure were addressed. CONCLUSIONS: The physicians identified numerous regularly encountered challenges and barriers. These challenges stretched beyond the ED and into various aspects of society. The patients’ financial problems were described as the greatest problem, restricting the treatment due to a given patient’s inability or unwillingness to pay for the required procedures. The physicians were thus restricted in completing their duties to the desired levels. The low quality of prehospital care and a lack of education and awareness of common diseases and symptoms in a significant proportion of patients were identified by many participants as being significant issues. The aforementioned challenges or barriers directly resulted in patients arriving in critical conditions that could have been avoided if the disease were treated earlier. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12245-022-00466-w.
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spelling pubmed-96439442022-11-14 Physicians’ experiences and perceived challenges working in an emergency setting in Bharatpur, Nepal: a qualitative study Hansen, Kristoffer Lund Bratholm, Åsmund Pradhan, Manohar Mikkelsen, Søren Milling, Louise Int J Emerg Med Research BACKGROUND: Emergency medical care, including prehospital treatment, forms an important component of any healthcare system. Like most low-middle-income countries, Nepal has an emergency medical system that can be described as underdeveloped. Emergency physicians navigating this system may experience challenges or barriers in their treatment of patients. This study aimed to investigate physicians’ perspectives on emergency and prehospital patient management in a low-income country, Nepal, and to understand the challenges and barriers they perceive in emergency treatment including both the prehospital treatment and the immediate in-hospital treatment at the emergency department. METHODS: Using a qualitative study, eight semi-structured interviews with physicians working in a Nepalese emergency department were performed. The interviews were conducted between September and November 2021 and were audio-recorded and transcribed verbatim. Data were subsequently analyzed using the systematic text condensation method. RESULTS: Four main themes and associated sub-themes were identified: (1) patients’ sociocultural, educational, and financial factors (such as financial issues and financial inequality) and regional differences; (2) emergency department’s organization and resources concerning human and material resources, protocols, and guidelines; (3) problems with the emergency department (ED) service’s qualities and availability caused by an insufficient integration of the ED and the EMS, prehospital resources, and financial interests in the EMS; and (4) surrounding healthcare system’s impact on the ED where, especially, the levels of organized primary care, governmental responsibilities, and healthcare structure were addressed. CONCLUSIONS: The physicians identified numerous regularly encountered challenges and barriers. These challenges stretched beyond the ED and into various aspects of society. The patients’ financial problems were described as the greatest problem, restricting the treatment due to a given patient’s inability or unwillingness to pay for the required procedures. The physicians were thus restricted in completing their duties to the desired levels. The low quality of prehospital care and a lack of education and awareness of common diseases and symptoms in a significant proportion of patients were identified by many participants as being significant issues. The aforementioned challenges or barriers directly resulted in patients arriving in critical conditions that could have been avoided if the disease were treated earlier. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12245-022-00466-w. Springer Berlin Heidelberg 2022-11-08 /pmc/articles/PMC9643944/ /pubmed/36348291 http://dx.doi.org/10.1186/s12245-022-00466-w Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Hansen, Kristoffer Lund
Bratholm, Åsmund
Pradhan, Manohar
Mikkelsen, Søren
Milling, Louise
Physicians’ experiences and perceived challenges working in an emergency setting in Bharatpur, Nepal: a qualitative study
title Physicians’ experiences and perceived challenges working in an emergency setting in Bharatpur, Nepal: a qualitative study
title_full Physicians’ experiences and perceived challenges working in an emergency setting in Bharatpur, Nepal: a qualitative study
title_fullStr Physicians’ experiences and perceived challenges working in an emergency setting in Bharatpur, Nepal: a qualitative study
title_full_unstemmed Physicians’ experiences and perceived challenges working in an emergency setting in Bharatpur, Nepal: a qualitative study
title_short Physicians’ experiences and perceived challenges working in an emergency setting in Bharatpur, Nepal: a qualitative study
title_sort physicians’ experiences and perceived challenges working in an emergency setting in bharatpur, nepal: a qualitative study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9643944/
https://www.ncbi.nlm.nih.gov/pubmed/36348291
http://dx.doi.org/10.1186/s12245-022-00466-w
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