Exploring barriers to, and enablers of, evidence-informed hip fracture care in five low- middle-income countries: China, India, Thailand, the Philippines and Vietnam
Issued Date
2022-10-01
Resource Type
ISSN
02681080
eISSN
14602237
Scopus ID
2-s2.0-85138447304
Pubmed ID
35678318
Journal Title
Health Policy and Planning
Volume
37
Issue
8
Start Page
1000
End Page
1011
Rights Holder(s)
SCOPUS
Bibliographic Citation
Health Policy and Planning Vol.37 No.8 (2022) , 1000-1011
Suggested Citation
Armstrong E., Yin X., Razee H., Pham C.V., Sa-Ngasoongsong P., Tabu I., Jagnoor J., Cameron I.D., Yang M., Sharma V., Zhang J., Close J.C.T., Harris I.A., 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 and Planning Vol.37 No.8 (2022) , 1000-1011. 1011. doi:10.1093/heapol/czac043 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/87230
Title
Exploring barriers to, and enablers of, evidence-informed hip fracture care in five low- middle-income countries: China, India, Thailand, the Philippines and Vietnam
Author's Affiliation
The University of Sydney, John Walsh Centre for Rehabilitation Research
Ingham Institute for Applied Medical Research
George Institute for Global Health
Beijing Ji Shui Tan Hospital
University of the Philippines Manila
Hanoi School of Public Health
UNSW Sydney
Neuroscience Research Australia
Harbin Medical University
Faculty of Medicine Ramathibodi Hospital, Mahidol University
UNSW Medicine
All India Institute of Medical Sciences, New Delhi
Ingham Institute for Applied Medical Research
George Institute for Global Health
Beijing Ji Shui Tan Hospital
University of the Philippines Manila
Hanoi School of Public Health
UNSW Sydney
Neuroscience Research Australia
Harbin Medical University
Faculty of Medicine Ramathibodi Hospital, Mahidol University
UNSW Medicine
All India Institute of Medical Sciences, New Delhi
Other Contributor(s)
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 utilized 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 11 hospitals in 5 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 utilization 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.