Barriers to accessing primary healthcare for minor surgical procedures and their impact on tertiary care utilisation: prospective, cross-sectional study

Abstract

Introduction: Minor surgical procedures are commonly performed in surgical emergency rooms within tertiary care hospitals, yet many of these cases could be managed in primary healthcare settings. Over-reliance on tertiary facilities for minor surgical care contributes to emergency department overcrowding and increased workload for surgical teams. This study aims to assess the barriers preventing patients from accessing minor surgical care at local healthcare centres and to identify the factors leading to their preference for tertiary-level care.

Methods: This prospective, observational, cross-sectional study was conducted in the surgical emergency room of Hayatabad Medical Complex, a tertiary care hospital in Peshawar, Pakistan, from 1 March 2023 to 30 March 2023. A total of 200 patients presenting with minor surgical conditions were recruited using a non-probability consecutive sampling technique. Data were collected through structured questionnaires and analysed using Statistical Package for Social Sciences (SPSS) version 22.0.

Results: Nearly all patients (99.5%) reported having access to a nearby healthcare facility, with Basic Health Units (46.0%) and District Headquarters Hospitals (31.5%) being the most common. However, patients sought care at the tertiary hospital due to the lack of minor operating theatres (20.0%), shortage of qualified doctors (18.0%), and resource limitations (17.5%). Difficulties in accessing tertiary care were reported by 75.0% of patients, with financial constraints (43.3%), domestic responsibilities (30.7%), and transportation issues (24.7%) being the most common barriers.

Conclusion: This study highlights significant gaps in the provision of minor surgical care at the primary healthcare level, leading to increased patient reliance on tertiary hospitals. Strengthening local healthcare infrastructure and improving access to minor surgical services at community levels could reduce the burden on emergency departments and ensure more efficient resource utilisation within tertiary care facilities.