Strategies for High-Quality Spine Surgery in Resource-Limited Settings: The Five-P Framework for Equitable Surgical Delivery.
review · Level V
Where this comes from
- Record sourced from PubMed, PMID 42755687.
- Also identified by DOI 10.1177/21925682261491746.
- No licence information is recorded for this record.
- Because redistribution is not established, this page shows the abstract only. Follow the links below for the full text.
Abstract
Study DesignNarrative review with a Conceptual Framework.ObjectivesLow- and middle-income countries (LMICs), home to approximately 80-85% of the global population, face a disproportionate burden of spinal disorders and limited access to timely, safe, and affordable surgical care. This review proposes a practical framework for delivering high-value spine care in LMICs by integrating evidence on health systems, value-based healthcare, and spine surgery into five strategic domains: Policy & Governance, Patient Selection, Perioperative Efficiency, Products & Technology, and Protection (the Five-P Framework).MethodsA narrative review with a structured literature search was conducted using PubMed and gray literature. Studies on spinal care delivery, health systems, cost-effectiveness, and surgical strategies in LMICs or comparable settings were qualitatively synthesized into thematic domains.ResultsFive domains were identified: (1) <b>P</b>olicy & Governance, including centralization of care, regulation of financial incentives, anti-corruption measures, and complication reduction; (2) <b>P</b>atient Selection, emphasizing evidence-based indications; (3) <b>P</b>erioperative Efficiency, including enhanced recovery pathways, ambulatory surgery, and standardized protocols; (4) <b>P</b>roducts & Technology, focusing on resource optimization and context-appropriate technologies, including locally manufactured implants; and (5) <b>P</b>rotection, promoting balanced medicolegal frameworks. Together, these domains aim to maximize value, improve access, and reduce unnecessary procedures and inefficient resource utilization.ConclusionThe Five-P Framework is a theoretical model that provides a system-level strategy to improve access to high-value spine care in LMICs through appropriate patient selection, efficient perioperative care, and optimal use of limited resources. Future studies to validate this proposal are necessary.