Presentation (CTI)

OBJECTIVES: This study aims to assess the prevalence of access barriers and care pathway delays in public hospitals in Pakistan and examine their association with healthcare utilization, treatment continuity, and patient-reported outcomes.
METHODS: A cross-sectional survey was conducted among 988 adult patients attending outpatient and inpatient departments of public hospitals across urban and semi-urban districts of Pakistan in 2024. The survey captured sociodemographic characteristics, healthcare-seeking behavior, access barriers including travel time, waiting time, affordability, administrative complexity, and referral processes, and delays at key stages of care including registration, diagnostics, consultation, referral, and treatment initiation. Primary outcomes included missed follow-up appointments, delayed treatment initiation, treatment discontinuation, and patient satisfaction. Multivariable logistic regression models assessed associations between access barriers, care pathway delays, and outcomes, adjusting for age, gender, income, education, employment status, chronic illness, and self-reported health status.
RESULTS: Overall, 68% of respondents reported experiencing at least one major access barrier, and 52% reported delays at two or more stages of the care pathway. Long waiting times were the most commonly reported barrier (58%), followed by referral-related delays (41%), high indirect costs such as travel and lost wages (39%), and administrative complexity (34%). Patients experiencing care pathway delays were significantly more likely to miss scheduled follow-up visits (OR=1.47, p<0.01), delay treatment initiation (OR=1.36, p<0.01), and discontinue treatment prematurely (OR=1.28, p<0.05). Delays were disproportionately higher among low-income patients and women, particularly at diagnostic and referral stages. Greater delays were also associated with lower patient satisfaction and poorer self-reported health status.
CONCLUSIONS: Access barriers and care pathway delays are widespread in Pakistan’s public hospitals and are strongly associated with disrupted care, lower continuity, and poorer patient experiences. Policy efforts to streamline administrative procedures, reduce waiting times, and strengthen referral systems—particularly for vulnerable populations—may improve service delivery and equity.