Challenges in Effective Referral of Cardiovascular Diseases in Nepal: A Qualitative Study from Health Workers' and Patients' Perspective

被引:0
|
作者
Shrestha, Soniya [1 ,2 ]
Maharjan, Rashmi [2 ,3 ,4 ]
Bajracharya, Swornim [2 ]
Jha, Niharika [2 ]
Mali, Sushmita [2 ]
Thapa, Bobby [3 ,5 ]
Suwal, Punya Shori [3 ,6 ]
Prajapati, Dipanker [3 ,7 ,8 ]
Karmacharya, Biraj Man [2 ,9 ]
Shrestha, Archana [9 ,10 ,11 ]
机构
[1] Patan Acad Hlth Sci, Sch Publ Hlth, Lagankhel, Lalitpur, Nepal
[2] Kathmandu Univ Hosp, Dhulikhel Hosp, Res & Dev Div, Kavrepalanchowk, Dhulikhel, Nepal
[3] Kathmandu Univ, CVD Translat Res Program, Sch Med Sci, Kavre, Dhulikhel, Nepal
[4] Kathmandu Univ, Dept Nursing & Midwifery, Sch Med Sci, Kavre, Dhulikhel, Nepal
[5] Tribhuvan Univ, Dept Nursing, Nepalgunj Nursing Campus, Nepalganj, Nepal
[6] Nepal Inst Hlth Sci, Jorpati, Kathmandu, Nepal
[7] Shahid Gangalal Natl Heart Ctr, Kathmandu, Nepal
[8] Natl Acad Med Sci, Kathmandu, Nepal
[9] Kathmandu Univ, Dept Publ Hlth, Sch Med Sci, Dhulikhel, Nepal
[10] Yale Sch Publ Hlth, Ctr Methods Implementat & Prevent Sci, New Haven, CT USA
[11] Inst Implementat Sci & Hlth, Kathmandu, Nepal
基金
美国国家卫生研究院;
关键词
CARDIAC REHABILITATION; RISK; CARE;
D O I
10.1155/2024/5583709
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Nepal, currently facing a high burden of noncommunicable diseases (NCDs), including cardiovascular diseases (CVDs), which poses the highest mortality rate in the country, does not seem to have a proper referral strategy. This study explored the wide range of factors and challenges that affect the referral system of CVD cases in Nepal. Methods. In this qualitative study, we conducted face-to-face and telephone interviews with purposely selected 57 key participants which included 35 healthcare professionals from tertiary, secondary, and primary levels from Bagmati Province and 22 CVD patients (myocardial infarction and stroke) from Bagmati and Madhesh Provinces. We interviewed them using an interview guide with open-ended questions for in-depth information in a local language and in a private space. The interviews were audio-recorded, transcribed verbatim, coded, and analyzed using the thematic approach. Results. The findings indicated that the referral system for CVD cases from primary- to secondary- to tertiary-level care is inadequate and malfunctioning. The major factors affecting referral of CVD cases are centralization of CVD-specific services in few urban areas, inadequate systematic communication between the centers, self-referential, lack of human resources for CVD care, and obstacles to patient transfer due to geographical and financial reasons. Conclusion. A referral system for CVD patients is absent in the context of Nepal. Understanding and addressing key factors that affect the referral system of CVD patients may help to improve cardiac outcomes and ultimately save lives.
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页数:7
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