Examining Access to Vascular Surgery Care for Indigenous Populations in North West Ontario
There is a growing body of evidence suggesting that Indigenous patients across North West Ontario face a higher rate of peripheral arterial disease (PAD) and its associated risk factors compared to non-Indigenous Ontarians. This puts these patients at greater risk for complications of their vascular disease, leading to a disproportionately higher rate of major amputation than the general population. Early consultation with vascular surgery has been shown to improve limb preservation, however, there is a lack of timely referral to vascular surgery for Indigenous patients in this region.
Background
Objectives:
This study aimed to identify systemic barriers impeding access to vascular surgery care by delineating patients’ pathway to vascular consultation, and propose areas for intervention to overcome these barriers, improve vascular care and ultimately limb salvage for Indigenous patients in North West Ontario.
Methods:
Process mapping was conducted to engage key stakeholders to model the flow of the system, and subsequently identify areas where gaps in accessing vascular care exist, requiring intervention. Semi-structured interviews were then conducted with health care workers identified through a snowball sampling strategy to further explore the barriers to accessing vascular care and possible change ideas.
Results:
A high-level process map was developed and analyzed to highlight barriers to care and gaps in knowledge. Ten individuals across six specialties who work within North West Ontario participated in the semi-structured interviews. Key themes that were identified include health systems capacity, physical barriers to accessing care, cultural and societal impact on the patient population, and a lack of sustained provider awareness.
Conclusion:
The barriers to accessing vascular surgery care faced by Indigenous patients with tissue loss are complex and multi-faceted. A systemic and coordinated approach, including suggested interventions like standardization of processes, implementation of photo-sharing systems, education for primary care providers, combining services, and increased research efforts should be employed to address the multitude of interacting factors along the patient care pathway to incite change. Future work will include the development and implementation of systemic changes to improve limb preservation outcomes in conjunction with Indigenous patient representatives.
Project team
- Asha Behdinan
TRP supervisors
Project advisory committee
- Ben Chan
- Mary MacDonald
- Ahmed Kayssi
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