title: Access to surgical upper extremity care for people with tetraplegia: an international perspective.
abstract: METHODS
  Survey.
  
  
  OBJECTIVE
  To determine whether upper extremity reconstruction in patients with tetraplegia is underutilized internationally and, if so, what are the barriers to care.
  
  
  METHODS
  International-attendees of a meeting in Paris, France.
  
  
  METHODS
  One hundred and seventy attendees at the Tetrahand meeting in Paris in 2010 were sent a 13-question survey to determine the access and utilization of upper limb reconstruction in tetraplegic patients in their practice.
  
  
  RESULTS
  Respondents ranged the globe including North America, South America, Europe, Asia and Australia. Fifty-nine percent of respondents had been practicing for more than 10 years. Sixty-four percent of respondents felt that at least 25% of people with tetraplegia would be candidates for surgery. Yet the majority of respondents found that <15% of potential patients underwent upper extremity reconstruction. Throughout the world direct patient referral was the main avenue of surgeons meeting patients with peer networking a distant second. Designated as the top three barriers to this care were lack of knowledge of surgical options by patients, lack of desire for surgery and poor referral patterns to appropriate upper extremity surgeons.
  
  
  CONCLUSIONS
  The results of this survey, of a worldwide audience, indicate that many of the same barriers to care exist regardless of the patient's address. This was a preliminary opinion survey and thus the results are subjective. However, these results provide a roadmap to improving access to care by improving patient education and interdisciplinary physician communication.
authors: 1] Veterans Affairs Palo Alto Health Care System-Rehabilitation Research and Development, Palo Alto, CA, USA [2] Division of Plastic Surgery, Stanford University, Palo Alto, CA, USA.
authors: P M
authors: PM
authors: Fox
authors: Veterans Affairs Palo Alto Health Care System-Rehabilitation Research and Development, Palo Alto, CA, USA.
authors: P
authors: P
authors: Suarez
authors: 1] Veterans Affairs Palo Alto Health Care System-Rehabilitation Research and Development, Palo Alto, CA, USA [2] Division of Plastic Surgery, Stanford University, Palo Alto, CA, USA.
authors: V R
authors: VR
authors: Hentz
authors: 1] Veterans Affairs Palo Alto Health Care System-Rehabilitation Research and Development, Palo Alto, CA, USA [2] Division of Plastic Surgery, Stanford University, Palo Alto, CA, USA.
authors: C M
authors: CM
authors: Curtin
mesh_terms: D001291:Attitude of Health Personnel; D003226:Congresses as Topic; D006297:Health Services Accessibility; D006801:Humans; D038622:Internationality; D011782:Quadriplegia / Q000601:surgery*; D019651:Plastic Surgery Procedures; D012017:Referral and Consultation; D034941:Upper Extremity / Q000601:surgery*