Multilevel Model of Care and Access to Surgery

For this discussion I have chosen to focus on access to surgical care using the social ecological model. This model identifies five levels of influence which include: individual, interpersonal, community, organizational, and policy. I have found 2 examples that I will use to as a starting point. The first diagram is from the Centers for Disease Control, Colorectal Cancer Control Program (CCRP) and is very descriptive as to what is included in each level.

(image from CDC Colorectal Cancer Control Program)

The second example is from https://www.unicef.org/cbsc/files/MNCH_Guide_Module_1.docx and presents this model in a simpler form, which can make it easier to understand and adapt. Using this model I will explain how access to safe surgical care crosses theses levels and I will be including a regional, provincial and global perspective.

(Image from www.unicef.org)

Individual and interpersonal topics can include factors such as one's attitude toward the appropriateness or effectiveness of surgery. For example if someone if fearful of having and anesthetic or perceives the risk of surgery to be greater than the risk of living with their condition this would influence their desire to seek out care. On a regional level the Winnipeg Regional Health Authority (WRHA) addresses some of these factors by offering support through programs such as Indigenous Health. Through this program a spiritual and cultural care provider helps to patients and their families through the facilitation of cultural ceremonies such as smudges, and may also help advocate for traditional healing practices. (WRHA Indigenous Health, n.d.). This may alleviate the patient’s fear and concern of the surgical journey. This can also is linked to the community and interpersonal level of the social ecological model as ones cultural beliefs are shaped by relationships and connections to their community.

Provincially, the vision of Shared Health is to improve access to care for all Manitobans regardless of where they live (Shared Health Mission, Vision, and Values, n.d.). The future state of this organization is still largely unknown but the general belief is that they will achieve this by setting provincial policies and standards of care. These issues fall into the organizational and policy levels of the social ecological model.

In recent years there has been a global initiative to increase access to safe surgical care. According to the Lancet Commission "5 billion people do not have access to safe, affordable surgical and anaesthesia care when needed." (Meara et.al., 2015). In this report three reasons for delay in surgical care are identified. First is the delay in seeking care, which can be due to multiple factors including financial, geographical, or cultural. The second delay is in reaching care, which can be due to distance from the nearest care centre and the lack of transportation. Once one reaches a care centre there may also be a third delay, a delay in receiving care. Hospitals may not be equipped to provide adequate emergent operative care. Organizations such as the G4 Alliance are working towards increasing access to safe surgical care by advocating for the neglected surgical patient and making safe surgical care a global political priority which is part of the policy and organizational level of the social ecological model

References

About the Global Alliance for Surgical, Obstetric, Trauma & Anaesthesia Care. Retrieved June 18, 2018 from http://www.theg4alliance.org/about-the-g4-alliance/

Centers for Disease Control, Colorectal Cancer Control Program (CCRP). Retrieved June 15, 2018 from https://www.cdc.gov/cancer/crccp/sem.htm

Meara, J. G., Leather, A. J. M., Hagander, B. C. A, Nivaldo, A., Ameh, E. A., Bickler, S. W,..., Yip, W. (2015). Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet Commissions, 386, 569–624. Retrieved from http://docs.wixstatic.com/ugd/346076_ee70c0ea4fe54f3ca2b02dcc73c19afe.pdf.

Module 1: What are the Social Ecological Model (SEM), Communication for Development (C4D)? (n.d.). Retrieved June 15, 2018 from https://www.unicef.org/cbsc/files/MNCH_Guide_Module_1.docx

Winnipeg Regional Health Authority Indigenous Health (n.d.). Retrieved June 18, 2018 form http://www.wrha.mb.ca/aboriginalhealth/services/spiritual.php.