Access to quality trauma care after injury in Pakistan: a systematic review and narrative synthesis

Objectives To conduct a systematic review and narrative synthesis to identify barriers, facilitators and pre-existing interventions and describe the current status of initiatives/interventions aimed at improving access to quality trauma healthcare after injury in Pakistan. Design Systematic review and narrative synthesis Data sources MEDLINE (Ovid), Embase (Ovid), Web of Science (Clarivate Analytics), Cochrane (Wiley), Scopus and ProQuest, as well as grey literature. Eligibility criteria Full-text peer-reviewed publications, including cross-sectional studies, cohort studies, case-control studies, randomised controlled trials and qualitative studies published in English from January 2013 to December 2023. Data extraction and synthesis Two independent reviewers used a standardised tool to extract data variables to Excel. The quality of the included studies was evaluated using the CASP checklist. The barriers, facilitators and pre-existing interventions were mapped using the four delays framework, the Institute of Medicine (IOM) quality domains and the WHO health systems building blocks. The data were synthesised narratively to improve access to quality trauma care in Pakistan. This review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Results The review included 20 studies. 19 studies reported 58 barriers to access to quality care. Six studies reported 20 facilitators, and eight studies described initiatives or interventions aimed at improving access to quality trauma healthcare after injury. According to the four delays framework, the receiving care stage of access to care was primarily studied in 16 studies, which identified 37 barriers and 13 facilitators across 5 studies. Regarding the quality of care according to IOM domains, the effectiveness of quality trauma care after an injury was studied in 15 studies, which identified 19 barriers and 10 facilitators across four studies. According to the WHO health system building blocks, most studies (n=15) described challenges in healthcare service delivery, with these 15 studies identifying 23 barriers and 3 studies identifying 4 facilitators. Conclusion Our findings highlighted the scarcity of available literature, identified barriers and facilitators and pre-existing interventions, which informed the need to develop feasible, sustainable and contextually relevant interventions to improve access to quality trauma care after injury in Pakistan.