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Hackett AM, Adereti CO, Walker AP, Ozobu I, Petit J, Waldron KR, Rolle M. The impact of limited access to electronic medical records on neurosurgical care within the CARICOM countries: A survey and scoping review. BRAIN & SPINE 2023; 3:101747. [PMID: 37383430 PMCID: PMC10293305 DOI: 10.1016/j.bas.2023.101747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/15/2023] [Accepted: 04/21/2023] [Indexed: 06/30/2023]
Abstract
Introduction Global access to electronic medical records (EMRs) continues to grow, however many countries including those within the Caribbean Community (CARICOM) lack access to this system. Minimal research investigating EMR use in this region exists. Research question How does limited EMR access impact neurosurgical care within the CARICOM? Materials and methods The Cochrane Library, EMBASE, Scopus, PubMed/MEDLINE databases, and grey literature were queried for studies addressing this issue within the CARICOM and low- and/or middle-income countries (LMICs). A comprehensive search for hospitals within the CARICOM was performed and responses to a survey inquiring about neurosurgery availability and EMR access within each facility were recorded. Results 26 out of 87 surveys were returned leading to a response rate of 29.0%. Among the survey respondents, 57.7% stated neurosurgery was provided at their facility; however, only 38.4% admitted to using an EMR system. Paper charting was the primary means of record keeping for the majority of the facilities (61.5%). The most frequently reported barriers stalling EMR implementation were financial limitations (73.6%) and poor internet access (26.3%). A total of 14 articles were included in the scoping review. Results from these studies suggest that limited EMR access contributes to suboptimal neurosurgical outcomes within the CARICOM and LMICs. Discussion and conclusion This paper is the first to address the impact that limited EMR has on neurosurgical outcomes in the CARICOM. The lack of research addressing this issue also highlights the need for ongoing efforts to increase research output focused on EMR accessibility and neurosurgical outcomes in these countries.
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Affiliation(s)
- Ashia M. Hackett
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | | | | | | | - Johnnie Petit
- Ross University School of Medicine, Miramar, FL, USA
| | | | - Myron Rolle
- Department of Neurosurgery, Massachusetts General Hospital, Harvard University, Boston, MA, USA
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Thango N, Baticulon RE, Lippa L. The Role of Registries in Neurotrauma Research: Translating Data Into Health Policy That Enhances Patient Care Comment on "Neurotrauma Surveillance in National Registries of Low- and Middle-Income Countries: A Scoping Review and Comparative Analysis of Data Dictionaries". Int J Health Policy Manag 2023; 12:7521. [PMID: 37579434 PMCID: PMC10125055 DOI: 10.34172/ijhpm.2023.7521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 01/18/2023] [Indexed: 08/16/2023] Open
Abstract
The paucity of robust neurotrauma data is felt most in regions that experience a higher burden of traumatic brain injury (TBI). The scoping review done by Barthélemy et al provides insight into the current state of national registries in low- and middle-income countries (LMICs) while also exploring the tools required to standardize data collection. In this commentary, we reflect on the barriers to data collection (ie, creation and maintenance of a TBI registry) and explore how registries can aid both scientific output and preventative public awareness campaigns that may pave the way to improved health policy and social change that avert mortality and morbidity from TBI.
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Affiliation(s)
- Nqobile Thango
- Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Ronnie E. Baticulon
- Division of Neurosurgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Laura Lippa
- Department of Neurosurgery, ASST Ospedale Maggiore Niguarda, Milano, Italy
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Armstrong E, Yin X, Razee H, Pham CV, Sa-Ngasoongsong P, Tabu I, Jagnoor J, Cameron ID, Yang M, Sharma V, Zhang J, Close JCT, Harris IA, Tian M, Ivers R. Exploring Barriers to, and Enablers of, Evidence-Informed Hip Fracture Care in Five Low- Middle-Income Countries: China, India, Thailand, the Philippines and Vietnam. Health Policy Plan 2022; 37:1000-1011. [PMID: 35678318 DOI: 10.1093/heapol/czac043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 05/02/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Globally, populations are ageing and the estimated number of hip fractures will increase from 1.7 million in 1990 to more than 6 million in 2050. The greatest increase in hip fractures is predicted in Low- and Middle‑Income Countries (LMICs), largely in the Asia-Pacific region where direct costs are expected to exceed $US15 billion by 2050. The aims of this qualitative study are to identify barriers to, and enablers of, evidence informed hip fracture care in LMICs, and to determine if the Blue Book standards, developed by the British Orthopaedic Association and British Geriatrics Society to facilitate evidence informed care of patients with fragility fractures, are applicable to these settings. This study utilised semi-structured interviews with clinical and administrative hospital staff to explore current hip fracture care in LMICs. Transcribed interviews were imported into NVivo 12 and analysed thematically. Interviews were conducted with 35 participants from eleven hospitals in five countries. We identified five themes-costs of care and the capacity of patients to pay, timely hospital presentation, competing demands on limited resources, delegation and defined responsibility, and utilisation of available data-and within each theme, barriers and enablers were distinguished. We found a mismatch between patient needs and provision of recommended hip fracture care, which in LMICs must commence at the time of injury. This study describes clinician and administrator perspectives of the barriers to, and enablers of, high quality hip fracture care in LMICs; results indicate that initiatives to overcome barriers (in particular, delays to definitive treatment) are required. While the Blue Book offers a starting point for clinicians and administrators looking to provide high quality hip fracture care to older people in LMICs, locally developed interventions are likely to provide the most successful solutions to improving hip fracture care.
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Affiliation(s)
| | - Xuejun Yin
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Australia
| | - Husna Razee
- School of Population Health, UNSW Sydney, Australia
| | - Cuong Viet Pham
- Centre for Injury Policy and Prevention Research, Hanoi University of Public Health, Hanoi, Vietnam
| | - Paphon Sa-Ngasoongsong
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Irewin Tabu
- Orthopedic Trauma Division and Arthroplasty Service, University of the Philippines Manila -Philippine General Hospital, The Philippines
| | - Jagnoor Jagnoor
- Injury Division, The George Institute for Global Health, New Delhi, India.,UNSW Sydney, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, University of Sydney, St Leonards, Australia
| | - Minghui Yang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Beijing, China
| | - Vijay Sharma
- Department of Orthopaedics, JPN Apex Trauma Centre, AIIMS, New Delhi, India
| | - Jing Zhang
- School of Population Health, UNSW Sydney, Australia
| | - Jacqueline C T Close
- Falls Balance Injury Research Centre, Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, UNSW Sydney, Australia
| | - Ian A Harris
- South Western Sydney Clinical School, UNSW Sydney, Liverpool, Australia; Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Maoyi Tian
- The George Institute for Global Health, Faculty of Medicine and Healt, UNSW Sydneyh, Australia.,School of Public Health, Harbin Medical University, Harbin, China
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