Worldwide assessment of healthcare personnel dealing with lymphoedema

Henrike Schulze, Marisa Nacke, Christoph Gutenbrunner and Catarina Hadamitzky. Health Economics Review (2018) 8:10

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Worldwide assessment of healthcare personnel dealing with lymphoedema

Henrike Schulze, Marisa Nacke, Christoph Gutenbrunner and Catarina Hadamitzky. Health Economics Review (2018) 8:10

Background: Lymphoedema is a pandemic with about 250 million people suffering from this condition worldwide. Lymphatic diseases have considerable public health significance, but yet few professionals are specialised in their management causing a substantial burden on health resources.

Aims and objectives: This study aims to give an overview of the approximate number of medical professionals, professional societies, institutions and companies dealing with lymphoedema in various countries. Concepts of improvement for current human resources are considered.

Methods: An online database analysis (Google search engine and PubMed) was carried out for each country of the world. Additionally, relevant congress participant lists as well as member lists of significant medical societies and reports of the World Health Organisation were analysed.

Results: Overall distribution of tertiary level professionals specialised in this field is heterogenous. A decrescent gradient of professionals can be seen between developed and developing countries and between urban and rural areas. Countries in general do not seem to have yet met the current demand for specialists at tertiary level in this field.

Conclusions: This study intends to draw attention to the current medical coverage gaps due to a low number of lymphoedema specialists at tertiary level. It wishes to start a discussion about structured reimbursement and certification of knowledge and skills that are essential incentives for experts to act as multiplicators and change the lack of care in the mid-term. Current fail prescriptions and evitable disability and sick certificates represent a high financial burden that could be reinvested in a correct management. Policy makers must focus in the two above mentioned essential measures. Medical training and the consequent development of the industry will then naturally take place, as it was the case for other professional groups in the past.

Main findings

  • The conducted research included 208 countries on six continents. Of the entirety of countries in the world, 123 countries provided online information on at least one of the researched topics (59% of the total sample).
  • Activities could be mapped in twelve out of 23 countries in North and Central America; 13 out of 17 in South America; 27 out of 49 countries in Europe; 14 out of 20 countries in Oceania; 25 out of 48 Asian countries and 32 out of 51 countries in Africa.
  • Tertiary level professionals were divided into clinical activity and research. Professionals with both foci were included in both statistics. When considering only clinically active physicians per million inhabitants, e.g. Europe had high ratios (0.89 ppm), whereas Africa, with a total of 26 clinically active physicians, has according to our research criteria practically inexistent medical coverage in this field. Similar coverage exists for researchers in most continents excluding Oceania. Oceania has a high ratio of researchers per million inhabitants (3.5 ppm).
  • The uneven distribution of tertiary level physicians was not only present at a global level, but also within single countries.
  • Data regarding the specialty of physicians showed that most are focused on the conservative management of the disease (n=641), most of them being located in Europe (n=535). Concerning the operative therapy of lymphoedema, the online search was able to identify the highest number of surgeons in Europe (n=295), followed by Asia (n=139). Surprisingly, very few physicians are specialised in imaging procedures of lymphatic vessels (n=64) despite the overlap with imaging methods used in cancer management.
  • Lymphology should be taught in undergraduate medical school in order to close the knowledge gap