Access to Reconstructive Hand Surgery in the United States - Investigating the Obstacles: A Scoping Review
Jack Mangan1, Joshua Kohan1, Ashit Patel3
1University of Vermont Larner College of Medicine, Burlington VT; 3Department of Plastic Surgery, Albany College of Medicine, Albany, NY
Background: Among individuals in the United States, current research has documented a multitude of barriers impacting surgical care for hand disorders.Objective: This scoping review aims to investigate the available literature describing mechanisms that influence access to reconstructive hand surgery and follow-up care in the United States, how such literature is organized, and directions for future investigation.
Methods: This review was guided by the PRISMA-ScR guidelines for scoping reviews in association with the framework presented by Arksey and O’Malley (2005). Search terms related to the concepts of hand, reconstructive surgery, and access were used to formulate a search strategy. A total of 471 articles were identified by searching the databases MEDLINE and EMBASE. Abstract screening followed by full-text review was completed by two authors, with a third author acting as a ‘tie-breaker’ in the setting of disagreements. Articles were excluded from our analysis if they were written in a language other than English, published outside of the United States, published before 2000, or published in a non-peer reviewed journal or book. A total of 49 articles were included in our final review. Data was extracted from the articles by two authors using a predefined data charting form. A narrative summary of the characteristics and key findings of each article will be used to present the data to facilitate the integration of diverse evidence.
Results: The majority of extracted publications were reported with cohort studies (33%) with cross-sectional studies comprising 27% of the data. Most studies (27%) reported patients with non-commercial or no insurance are less likely to get an appointment with a hand specialist or to receive treatment. Emergency department overuse (16%) accounted for the second most reported reason for diminished access to reconstructive hand care. Better financial compensation for non-elective hand care (16%). poor emergency department coverage (14%), geographic location (12%), race (10%) and policy (10%) were also notably reported across the literature.
Conclusions: There appear to be significant barriers regarding access to reconstructive hand surgery involving both patient and healthcare system mechanisms. Objective measures that attempt to describe these difficulties seem to be multifaceted and complex. Additionally, possible solutions and policy changes that may help improve access have been described. While the quality of studies is generally high, future research in this field would benefit from an analysis of the magnitude of factors and mechanisms that hinder access, as well as potential solutions to improve access for all patients.
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