Opportunities to Improve Primary-Level Otolaryngology Care: A Survey of Rwandan General Practitioners.

OBJECTIVE

In Rwanda, 30 OHNS clinicians serve the country's population of 14 million. With low subspecialist density, primary care providers (PCPs) become the first line of otolaryngologic triage and care. However, it is unclear if Rwandan PCPs are equipped to bridge OHNS care gaps.

STUDY

DESIGN

Cross-sectional qualitative survey-based study.

SETTING

Rwandan PCPs were surveyed, and responses were collected between November 2024 and May.

METHODS

Surveys were co-developed with Rwandan OHNS clinicians and evaluated the diagnostic and management confidence of common head and neck conditions. Responses were analyzed with descriptive statistics.

RESULTS

Forty-four PCPs completed the survey. PCPs most frequently encountered sinonasal, pediatric, and ear/hearing diseases (mean of 10.5, 9.7, and 6.7 presentations/week, respectively). However, confidence in sinonasal skills was low (mean confidence score of 2.9 out of 5). Diagnostic and management confidence scores were stable across disease categories. Eighty-eight percent of PCPs identified limited training/knowledge as barriers to patient care. Ninety-seven percent of PCPs agreed that further emphasis on otolaryngology training is needed during medical school.

CONCLUSIONS

This study highlights training gaps and systemic barriers affecting the Rwandan primary care workforce. Targeted hands-on training is needed to improve PCPs' skills. Furthermore, evaluation of PCP recognition and management confidence did not reveal specific areas of deficit, indicating that training topics should be comprehensive and diverse. Finally, limited training/knowledge/skills was a common barrier to care, highlighting the importance of PCP-focused continuing medical education. This survey framework could be utilized in other LMIC settings to identify areas of reduced confidence in otolaryngology provision.