Abstract
Objective
To assess rehabilitation infrastructure in Peru in terms of the World Health Organization
(WHO) health systems building blocks.
Design
Anonymous quantitative survey; questions were based on the WHO's Guidelines for Essential Trauma Care and rehabilitation professionals' input.
Setting
Large public hospitals and referral centers and an online survey platform.
Participants
Convenience sample of hospital personnel working in rehabilitation and neurology (N=239),
recruited through existing contacts and professional societies.
Interventions
Not applicable.
Main Outcome Measures
Outcome measures were for 4 WHO domains: health workforce, health service delivery,
essential medical products and technologies, and health information systems.
Results
Regarding the domain of health workforce, 47% of physical therapists, 50% of occupational
therapists, and 22% of physiatrists never see inpatients. Few reported rehabilitative
nurses (15%) or prosthetist/orthotists (14%) at their hospitals. Even at the largest
hospitals, most reported ≤3 occupational therapists (54%) and speech-language pathologists
(70%). At hospitals without speech-language pathologists, physical therapists (49%)
or nobody (34%) perform speech-language pathology roles. At hospitals without occupational
therapists, physical therapists most commonly (59%) perform occupational therapy tasks.
Alternate prosthetist/orthotist task performers are occupational therapists (26%),
physical therapists (19%), and physicians (16%). Forty-four percent reported interdisciplinary
collaboration. Regarding the domain of health services, the most frequent inpatient
and outpatient rehabilitation barriers were referral delays (50%) and distance/transportation
(39%), respectively. Regarding the domain of health information systems, 28% reported
rehabilitation service data collection. Regarding the domain of essential medical
products and technologies, electrophysical agents (88%), gyms (81%), and electromyography
(76%) were most common; thickened liquids (19%), swallow studies (24%), and cognitive
training tools (28%) were least frequent.
Conclusions
Rehabilitation emphasis is on outpatient services, and there are comparatively adequate
numbers of physical therapists and physiatrists relative to rehabilitation personnel.
Financial barriers seem low for accessing existing services. There appear to be shortages
of inpatient rehabilitation, specialized services, and interdisciplinary collaboration.
These may be addressed by redistributing personnel and investing in education and
equipment for specialized services. Further examination of task sharing's role in
Peru's rehabilitation services is necessary to evaluate its potential to address deficiencies.
Keywords
List of abbreviations:
LMIC (low- and middle-income country), PWD (person with disability), WHO (World Health Organization)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: November 20, 2017
Footnotes
Supported by a National Institutes of Health research training grant (grant no. R25 TW009345), funded by the Fogarty International Center; the National Institutes of Health, Office of the Director, Office of AIDS Research; the National Institutes of Health, Office of the Director, Office of Research on Women's Health; the National Heart, Lung, and Blood Institute; the National Institute of Mental Health; and the National Institute of General Medical Sciences.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
