title: The Ponseti method in Latin America: initial impact and barriers to its diffusion and implementation.
abstract: The Ponseti method for correcting clubfoot is a safe, effective, and minimally invasive treatment that has recently been implemented in Latin America. This study evaluates the initial impact and unique barriers to the diffusion of the Ponseti method throughout this region. Structured interviews were conducted with 30 physicians practicing the Ponseti method in three socioeconomically diverse countries: Chile, Peru and Guatemala. Since learning the Ponseti method, these physicians have treated approximately 1,740 clubfoot patients, with an estimated 1,705 (98%) patients treated using the Ponseti method, and 35 (2%) patients treated using surgical techniques. The barriers were classified into the following themes: physician education, health care system of the country, culture and beliefs of patients, physical distance and transport, financial barriers for patients, and parental compliance with the method. The results yielded several common barriers throughout Latin America including lack of physician education, physical distance to the treatment centers, and financial barriers for patients. Information from this study can be used to inform, and to implement and evaluate specific strategies to improve the diffusion of the Ponseti method for treating clubfoot throughout Latin America.
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Carver College of Medicine, The University of Iowa, Iowa City, IA 52242, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Boardman
authors.forename: Asitha
authors.initials: A
authors.lastname: Jayawardena
authors.forename: Florin
authors.initials: F
authors.lastname: Oprescu
authors.forename: Thomas
authors.initials: T
authors.lastname: Cook
authors.forename: Jose A
authors.initials: JA
authors.lastname: Morcuende
mesh_terms: D001291:Attitude of Health Personnel; D002370:Casts, Surgical / Q000191:economics / Q000706:statistics & numerical data*; D002648:Child; D002677:Chile / Q000453:epidemiology; D003025:Clubfoot / Q000191:economics / Q000208:ethnology* / Q000628:therapy*; D003466:Cultural Characteristics; D003906:Developing Countries; D006166:Guatemala / Q000453:epidemiology; D017048:Health Care Costs; D006801:Humans; D033181:Information Dissemination; D007407:Interviews as Topic; D026201:Musculoskeletal Manipulations / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000208:ethnology / Q000706:statistics & numerical data; D010568:Peru / Q000453:epidemiology; D010820:Physicians / Q000523:psychology; D036301:Qualitative Research
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