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Lopez-Barreda R, Schaigorodsky L, Rodríguez-Pinto C, Salas W, Muñoz Y, Betanco B, Angulo O, Huamán M, Lejbusiewicz G, Pedrero V, Pavlova M, Groot W, Ibla JC. Barriers to healthcare access for children with congenital heart disease in eight Latin American countries. Paediatr Anaesth 2024. [PMID: 38515426 DOI: 10.1111/pan.14880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 03/07/2024] [Accepted: 03/09/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Mortality from congenital heart disease has decreased considerably in the last two decades due to improvements in overall health care. However, there are barriers to access to healthcare in Latin America for this population, which could be related to factors such as healthcare system, policies, resources, geographic, cultural, educational, and psychological factors. Understanding the barriers to access to care is of paramount importance for the design and implementation of policies and facilitate the provision of care. AIM The aim of the study was to investigate the perception of barriers to access to health care on parents/guardians of children with congenital heart disease in selected Latin American countries. METHODS A descriptive, cross-sectional study, in which parents/guardians or primary caregivers of children with congenital heart disease was recruited to participate and surveyed. Once the informed consent process had been completed, a set of paper-based scales was used to collect data, namely socioeconomic and demographic information, the Barriers to Care for Children with Special Health Care Needs Questionnaire, and the General Health Questionnaire. RESULTS In total, 286 participants completed the surveys, with an average age of 34.81 years and 73.4% being female. Mean score of overall barriers was 54.45 (minimum score 39, maximum score 195, higher scores show greater perception of barriers). In Mexico, the parents/guardians of children perceived fewer barriers to access (46.69), while Peru is the country where the most barriers were perceived (69.91). Nonpoor participants showed higher overall barrier perception scores (57.34) than poor participants (52.58). The regression analysis demonstrated the overall perception of barriers was positively associated with individual and social factors, such as educational level, contract status, household monthly income, and psychological well-being and with the country of the participants. CONCLUSIONS Multiple factors are associated with the perception of barriers to accessing health care for children with congenital heart disease, including socioeconomic status, expectations, psychological well-being, and structural factors.
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Affiliation(s)
- Rodrigo Lopez-Barreda
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Maastricht Economic and Social Research Institute on Innovation and Technology, United Nations University, Maastricht, The Netherlands
| | | | | | - Wilbaldo Salas
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Bianca Betanco
- Hospital Maria Especialidades Pediatricas, Tegucigalpa, Honduras
| | - Oscar Angulo
- Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
| | - Marina Huamán
- Instituto Nacional de Cardiovascular, INCOR, Lima, Peru
| | | | - Victor Pedrero
- Faculty of Nursing, Universidad Andres Bello, Santiago, Chile
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Wim Groot
- Maastricht Economic and Social Research Institute on Innovation and Technology, United Nations University, Maastricht, The Netherlands
- Department of Health Services Research, CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
- School of Business and Economics, Maastricht University, Maastricht, The Netherlands
| | - Juan C Ibla
- Department of Anesthesiology, Critical Care and Pain Medicine and Harvard Medical School, Boston, Massachusetts, USA
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Riva J, Calviño J, Bouchacourt JP, Turconi L, Cavalleri F, Caetano NN, Enriquez L, Tonelotto B, Lema G, Motta P. Heterogeneity Among Countries in the Subspecialty of Cardiovascular Anesthesia in Latin America: Survey Results. J Cardiothorac Vasc Anesth 2024; 38:371-378. [PMID: 38212186 DOI: 10.1053/j.jvca.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/03/2023] [Accepted: 10/11/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVES To evaluate demographics, workload, training, facilities, and equipment in cardiovascular anesthesia (CVA) in Latin America (LA). DESIGN A descriptive cross-sectional study with data collected through a survey. SETTING A multicenter, international web-based questionnaire that included 37 multiple-choice questions. PARTICIPANTS Physicians and specialists in anesthesiology who regularly participated in cardiovascular surgeries and were members of the scientific societies of the Latin American Confederation of Anesthesiology. INTERVENTIONS None MEASUREMENTS AND MAIN RESULTS: A total of 484 completed questionnaires were collected. A total of 97.8% of the respondents had a university degree in anesthesiology. Most did not receive formal training in CVA, and only 41.5% received formal training. Moreover, most of them were trained in their own country, and a smaller percentage were trained abroad. Half of the respondents reported receiving <12 months of training. A third part of the respondents had received training in transesophageal echocardiography. Only 5.8% of the respondents worked exclusively in CVA, and a high percentage dedicated <60% of their weekly work hours to this subspecialty. A total of 80.6% of the centers had <3 cardiac surgery operating rooms. Only one-third of the centers performed heart/lung transplantation, venoarterial extracorporeal membrane oxygenation, venovenous extracorporeal membrane oxygenation, and ventricular assist device implantation. CONCLUSIONS A significant lack of training programs in anesthesiology practice and complex procedures in medical centers in LA are evident. Thus, basic accredited programs should be developed in medical centers in LA.
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Affiliation(s)
- Juan Riva
- Departamento de Anestesiología Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
| | - Jimena Calviño
- Departamento de Anestesiología Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
| | - Juan Pablo Bouchacourt
- Departamento de Anestesiología Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
| | - Leticia Turconi
- Departamento de Anestesiología Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay.
| | - Fiorella Cavalleri
- Departamento de Anestesiología Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
| | | | | | | | - Guillermo Lema
- División de Anestesiología, Facultad de Medicina, PUC, Santiago, Chile
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Vervoort D, Afzal AM, Ruiz GZL, Mutema C, Wijeysundera HC, Ouzounian M, Fremes SE. Barriers to Access to Cardiac Surgery: Canadian Situation and Global Context. Can J Cardiol 2023:S0828-282X(23)01888-3. [PMID: 37977275 DOI: 10.1016/j.cjca.2023.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023] Open
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Cardiovascular care spans primary, secondary, and tertiary prevention and care, whereby tertiary care is particularly prone to disparities in care. Challenges in access to care especially affect low- and middle-income countries (LMICs), however, multiple barriers also exist and persist across high-income countries. Canada is lauded for its universal health coverage but is faced with health care system challenges and substantial geographic barriers. Canada possesses 203 active cardiac surgeons, or 5.02 per million population, ranging from 3.70 per million in Newfoundland and Labrador to 7.48 in Nova Scotia. As such, Canada possesses fewer cardiac surgeons per million population than the average among high-income countries (7.15 per million), albeit more than the global average (1.64 per million) and far higher than the low-income country average (0.04 per million). In Canada, adult cardiac surgeons are active across 32 cardiac centres, representing 0.79 cardiac centres per million population, which is just above the global average (0.73 per million). In addition to centre and workforce variations, barriers to care exist in the form of waiting times, sociodemographic characteristics, insufficient virtual care infrastructure and electronic health record interoperability, and health care governance fragmentation. Meanwhile, Canada has highly favourable surgical outcomes, well established postacute cardiac care infrastructure, considerable spending on health, robust health administrative data, and effective health technology assessment agencies, which provides a foundation for continued improvements in care. In this narrative review, we describe successes and challenges surrounding access to cardiac surgery in Canada and globally.
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Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Abdul Muqtader Afzal
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Gabriela Zamunaro Lopes Ruiz
- Division of Cardiovascular Surgery, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Chileshe Mutema
- Division of Cardiothoracic Surgery, National Heart Hospital, Lusaka, Zambia
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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