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- Title
Referral patterns, delays, and equity in access to advanced paediatric emergency care in Vietnam.
- Authors
Treleaven, Emily; Toan Ngoc Pham; Duy Ngoc Le; Brooks, Trevor N.; Hai Thanh Le; Partridge, J. Colin
- Abstract
Background: Quality emergency care is a critical component of a well-functioning health system. However, severely ill children often face barriers to timely, appropriate care in less-developed health systems. Such barriers disproportionately affect poorer children, and may be particularly acute when children seek advanced emergency care. We examine predictors of increased acuity and patient outcomes at a tertiary paediatric emergency department to identify barriers to advanced emergency care among children. Methods: We analysed a sample of 557 children admitted to a paediatric referral hospital in Hanoi, Vietnam. We examined associations between socio-demographic and facility characteristics, referrals and transfers, and patient outcomes. We used generalized ordered logistic regression to examine predictors of increased acuity on arrival. Results: Most children accessing advanced emergency care were under two years of age (68.4%). Pneumonia was the most prevalent diagnosis (23.7%). Children referred from lower-level facilities experienced higher acuity on arrival (p = .000), were more likely to be admitted to an ICU (p = .000), and were more likely to die during hospitalization (p = .009). The poorest children [OR = 4.98, (1.82--13.61)], and children entering care at provincial hospitals [OR = 3.66, (2.39--5.63)] and other lower-level facilities [OR = 3.24, (1.78--5.88)] had significantly higher odds of increased acuity on arrival. Conclusions: The poorest children, who were more likely to enter care at lower-level facilities, were especially disadvantaged. While delays in entry to care were not predictive of acuity, children referred to tertiary care from lower-level facilities experienced worse outcomes. Improvements in triage, stabilization, and referral linkages at all levels should reduce within-system delays, increasing timely access to advanced emergency care for all children.
- Subjects
VIETNAM; EMERGENCY medical services; PEDIATRICS; HEALTH facilities; CONFIDENCE intervals; DIAGNOSIS; HEALTH services accessibility; EVALUATION of medical care; MEDICAL quality control; MEDICAL errors; MEDICAL referrals; LOGISTIC regression analysis; SOCIOECONOMIC factors; MEDICALLY underserved persons; TREATMENT delay (Medicine); TERTIARY care; ODDS ratio; PSYCHOLOGY; STANDARDS
- Publication
International Journal for Equity in Health, 2017, Vol 16, p1
- ISSN
1475-9276
- Publication type
Article
- DOI
10.1186/s12939-017-0703-y