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Patient perspectives on the promptness and quality of care of road traffic incident victims in Peru: a cross-sectional, active surveillance study.

Miranda JJ, Rosales-Mayor E, Quistberg DA, Paca-Palao A, Gianella C, Perel P, Lopez L, Luna D, Best P, Huicho L, PIAT Working Gro - F1000Res (2013)

Bottom Line: After adjustment for various factors, there was strong evidence of higher global dissatisfaction levels among those receiving care at public HCFs compared to private ones (odds ratio (OR) 5.05, 95% confidence interval (CI) 1.88-13.54).This difference was not observed when provincial sites were compared to Lima (OR 1.41, 95% CI 0.42-4.70).Overall, dissatisfaction was high, mainly at public institutions indicating much need for improvements in service provision.

View Article: PubMed Central - PubMed

Affiliation: Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; School of Medicine, Universisdad Peruana Cayetano Heredia, Lima, Peru ; CRONICAS, Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru ; EDHUCASALUD, Asociación Civil para la Educación en Derechos Humanos con Aplicación en Salud, Lima, Peru.

ABSTRACT

Background: Road injuries are the second-leading cause of disease and injury in the Andean region of South America. Adequate management of road traffic crash victims is important to prevent and reduce deaths and serious long-term injuries.

Objective: To evaluate the promptness of health care services provided to those injured in road traffic incidents (RTIs) and the satisfaction with those services during the pre-hospital and hospital periods.

Methods: We conducted a cross-sectional study with active surveillance to recruit participants in emergency departments at eight health care facilities in three Peruvian cities: a large metropolitan city (Lima) and two provincial cities (an urban center in the southern Andes and an urban center in the rainforest region), between August and September 2009. The main outcomes of interest were promptness of care, measured by time between injury and each service offered, as well as patient satisfaction measured by the Service Quality (SERVQUAL) survey. We explored the association between outcomes and city, type of health care facility (HCF), and type of provider.

Results: We recruited 644 adults seeking care for RTIs. This active surveillance strategy yielded 34% more events than anticipated, suggesting under-reporting in traditional registries. Median response time between a RTI and any care at a HCF was 33 minutes overall and only 62% of participants received professional care during the initial "golden" hour after the RTI. After adjustment for various factors, there was strong evidence of higher global dissatisfaction levels among those receiving care at public HCFs compared to private ones (odds ratio (OR) 5.05, 95% confidence interval (CI) 1.88-13.54). This difference was not observed when provincial sites were compared to Lima (OR 1.41, 95% CI 0.42-4.70).

Conclusions: Response time to RTIs was adequate overall, though a large proportion of RTI victims could have received more prompt care. Overall, dissatisfaction was high, mainly at public institutions indicating much need for improvements in service provision.

No MeSH data available.


Related in: MedlinePlus

Flowchart of study participation.* Victims admitted to emergency services of health care facilities (HCFs) included in the study. This includes all patients cared for in the emergency department and discharged with or without previous hospitalization. ** Altered states of consciousness and speech directly attributable to the road traffic incident (RTI; for example, encephalocranial traumas) or not (for example, alcohol intoxication, Alzheimer’s, dementia, senility, etc.) that affected the perception of the event and did not allow the respondent to answer the questionnaires.
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f1: Flowchart of study participation.* Victims admitted to emergency services of health care facilities (HCFs) included in the study. This includes all patients cared for in the emergency department and discharged with or without previous hospitalization. ** Altered states of consciousness and speech directly attributable to the road traffic incident (RTI; for example, encephalocranial traumas) or not (for example, alcohol intoxication, Alzheimer’s, dementia, senility, etc.) that affected the perception of the event and did not allow the respondent to answer the questionnaires.

Mentions: Six public HCFs, one in Ayacucho, two in Pucallpa and three in Lima; and two private HCFs, both in Lima, participated in the study. A total of 1064 RTI victims sought care in the eight emergency departments during the study period (Figure 1). Of them, 644 participated in the study: response rate 82%, 46% female, mean participant age 37.3 (SD 15.7 years), age range 18–88 years.


Patient perspectives on the promptness and quality of care of road traffic incident victims in Peru: a cross-sectional, active surveillance study.

Miranda JJ, Rosales-Mayor E, Quistberg DA, Paca-Palao A, Gianella C, Perel P, Lopez L, Luna D, Best P, Huicho L, PIAT Working Gro - F1000Res (2013)

Flowchart of study participation.* Victims admitted to emergency services of health care facilities (HCFs) included in the study. This includes all patients cared for in the emergency department and discharged with or without previous hospitalization. ** Altered states of consciousness and speech directly attributable to the road traffic incident (RTI; for example, encephalocranial traumas) or not (for example, alcohol intoxication, Alzheimer’s, dementia, senility, etc.) that affected the perception of the event and did not allow the respondent to answer the questionnaires.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3814912&req=5

f1: Flowchart of study participation.* Victims admitted to emergency services of health care facilities (HCFs) included in the study. This includes all patients cared for in the emergency department and discharged with or without previous hospitalization. ** Altered states of consciousness and speech directly attributable to the road traffic incident (RTI; for example, encephalocranial traumas) or not (for example, alcohol intoxication, Alzheimer’s, dementia, senility, etc.) that affected the perception of the event and did not allow the respondent to answer the questionnaires.
Mentions: Six public HCFs, one in Ayacucho, two in Pucallpa and three in Lima; and two private HCFs, both in Lima, participated in the study. A total of 1064 RTI victims sought care in the eight emergency departments during the study period (Figure 1). Of them, 644 participated in the study: response rate 82%, 46% female, mean participant age 37.3 (SD 15.7 years), age range 18–88 years.

Bottom Line: After adjustment for various factors, there was strong evidence of higher global dissatisfaction levels among those receiving care at public HCFs compared to private ones (odds ratio (OR) 5.05, 95% confidence interval (CI) 1.88-13.54).This difference was not observed when provincial sites were compared to Lima (OR 1.41, 95% CI 0.42-4.70).Overall, dissatisfaction was high, mainly at public institutions indicating much need for improvements in service provision.

View Article: PubMed Central - PubMed

Affiliation: Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; School of Medicine, Universisdad Peruana Cayetano Heredia, Lima, Peru ; CRONICAS, Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru ; EDHUCASALUD, Asociación Civil para la Educación en Derechos Humanos con Aplicación en Salud, Lima, Peru.

ABSTRACT

Background: Road injuries are the second-leading cause of disease and injury in the Andean region of South America. Adequate management of road traffic crash victims is important to prevent and reduce deaths and serious long-term injuries.

Objective: To evaluate the promptness of health care services provided to those injured in road traffic incidents (RTIs) and the satisfaction with those services during the pre-hospital and hospital periods.

Methods: We conducted a cross-sectional study with active surveillance to recruit participants in emergency departments at eight health care facilities in three Peruvian cities: a large metropolitan city (Lima) and two provincial cities (an urban center in the southern Andes and an urban center in the rainforest region), between August and September 2009. The main outcomes of interest were promptness of care, measured by time between injury and each service offered, as well as patient satisfaction measured by the Service Quality (SERVQUAL) survey. We explored the association between outcomes and city, type of health care facility (HCF), and type of provider.

Results: We recruited 644 adults seeking care for RTIs. This active surveillance strategy yielded 34% more events than anticipated, suggesting under-reporting in traditional registries. Median response time between a RTI and any care at a HCF was 33 minutes overall and only 62% of participants received professional care during the initial "golden" hour after the RTI. After adjustment for various factors, there was strong evidence of higher global dissatisfaction levels among those receiving care at public HCFs compared to private ones (odds ratio (OR) 5.05, 95% confidence interval (CI) 1.88-13.54). This difference was not observed when provincial sites were compared to Lima (OR 1.41, 95% CI 0.42-4.70).

Conclusions: Response time to RTIs was adequate overall, though a large proportion of RTI victims could have received more prompt care. Overall, dissatisfaction was high, mainly at public institutions indicating much need for improvements in service provision.

No MeSH data available.


Related in: MedlinePlus