ArticleFrontiers in health services2026
Gastrointestinal bleeding care across hospital and EMS settings in the Almaty region: a cross-sectional survey of organization, practice, and service capacity.
Article in Frontiers in health services, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Gastrointestinal bleeding (GIB), particularly upper gastrointestinal bleeding (UGIB), requires rapid coordination between emergency medical services (EMS) and hospital teams, yet evidence on how service organization affects timeliness and practice is limited in Kazakhstan. Aim: To evaluate the organization of GIB care in Almaty region, with emphasis on clinician knowledge and practice, EMS performance, and organizational features of hospital care. Methods: We conducted a cross-sectional survey between March and October 2024 involving two broad respondent groups and three distinct samples: a hospital-based group comprising 99 inpatient clinicians and 99 hospital representatives, and an EMS group comprising 120 personnel. The three samples completed different questionnaires and were analyzed separately. Descriptive analyses, chi-square or Fisher's exact tests, and exploratory Spearman correlations were used. Results: Inpatient clinicians showed near-universal agreement with guideline-based UGIB management principles, but self-reported adherence was inconsistent. Only 1.0% reported always using validated risk scores, and 99.0% reported only sometimes protecting the airway before endoscopy in patients with active hematemesis and altered mental status. In unadjusted respondent-level analyses, clinicians with ≥5 years of experience more frequently reported adequate training and perceived risk scores as useful (both Conclusions: UGIB care in the Almaty region showed consistently described structural endoscopy availability but incomplete protocol content, together with selected inpatient-practice and prehospital differences. The EMS findings were exploratory and require confirmation using operational and patient-level data.
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