This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Web of Science (2) Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Kapiriri, L. Articles by Martin, D. K. Search for Related Content PubMed PubMed Citation Articles by Kapiriri, L. Articles by Martin, D. K. Social Bookmarking                         What's this?

Bedside Rationing by Health Practitioners: A Case Study in a Ugandan Hospital

Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada

Douglas K. Martin, PhD

Joint Centre for Bioethics, Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada, lydia.kapiriri{at}utoronto.ca

Purpose. The purpose of this study was to describe bedside rationing by health practitioners in a teaching hospital in Uganda.

Methods. This was a case study involving in-depth interviews. A modified thematic approach was used in data analysis. Types of decisions, the decision-making process, key players, and hospital-, medical-, and patient-related considerations in the process were identified. Klein’s 6 forms of rationing were used to identify the forms of rationing used. The setting was a tertiary hospital in Uganda. Theoretical sampling was used to identify 40 doctors and 16 nurses from the Departments of Medicine, Surgery, Paediatrics, and Obstetric and Gynaecology.

Results. Four types of bedside rationing decisions were identified: 1) which patients are seen first, 2) which treatment the patients receive, 3) which patients are admitted, and 4) which patients are taken to the operating theatre first. Hospital-related considerations regarding bedside rationing included the hospital budget and number of beds; medical-related considerations included the patient’s diagnosis and effectiveness of treatment; and patient-related considerations included poverty, social status, and age. All forms of rationing (denial, dilution, deflection, deterrence, delay, and termination) were practiced.

Conclusion. Although bedside rationing decisions in the study hospital seem somewhat similar to that in developed countries, the rationing of 1st-line drugs by health practitioners in Uganda is complex, difficult, and different from what has been described in industrialized countries. The complexity and severity of the consequences of the bedside decisions necessitate the development of resource-sensitive clinical guidelines and transparent decision-making processes to foster patients’ understanding of the reasons and the procedures and to ensure fair decision-making processes.

Key Words: bedside rationing • considerations • developing countries • health care

Medical Decision Making, Vol. 27, No. 1, 44-52 (2007)
DOI: 10.1177/0272989X06297397


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?