Currently, there is no consensus on the indications and clinical performance of implant-supported overdentures (IODs) involving computer-aided design and manufacturing (CAD-CAM) bars.

This study aims to determine the waiting time and the forms of access to specialized health services in public hospitals in Ecuador. A representative sample of 32 hospitals under the Ministry of Public Health was considered, with 26 selected by accessibility convenience. Data will be collected using a structured questionnaire. Patients will be asked about the number of days they waited for their medical appointments and the method used to schedule their appointments. The study distinguishes between standardized access, based on Ecuador’s formal referral and counter-referral system, and non-standardized access methods, such as personal connections or hospital staff involvement. The data of this protocol are registered and publicly accessible at: https://dx.doi.org/10.17504/protocols.io.261ge5z7wg47/v1. We expect to identify a correlation between waiting times and the type of access to specialized medical services, with non-standardized access potentially leading to shorter waiting times. This research may highlight disparities in the system and suggest areas for improvement in equity and efficiency within the healthcare referral process. To do so, a structured survey will be used. Since a construct is not needed to determine the waiting time or the forms of access, it was not necessary to validate the instrument. However, we did validate the understanding of the questions and the response options in several places in the country. According to the results of the validation of the instrument, pollsters will be instructed to inform users about the meaning of the question on ethnic identification, which was difficult to understand in the country’s coastal areas.

Background: Waiting time is a key dimension of effective access to health- care. We assessed whether waiting time to outpatient specialist appointments differs between standard (system-based) and non-standard (non-system-based) referral pathways in Ecuador and whether differences vary by specialty referral requirement. We further stratified analyses by referral requirement among different specialties. Methods: We analysed hospital-based survey data from Ecuadorian public hospitals restricted to respondents attending for a specialist appointment (n=4436). Waiting time (days) was compared by access type using the Mann–Whitney U test. Sociodemographic correlates of non-standard access were examined using adjusted logistic regression. Adjusted differences in waiting time were estimated using median (quantile) regression (τ=0·50). Analyses were stratified into direct-access specialties (Dentistry, General Medicine, Psychology) versus referral-required specialties (all other specialties). Findings: Non-standard access was associated with shorter waiting time than standard access. In adjusted median regression, non-standard access remained associated with a 3·2-day shorter median waiting time (adjusted median difference −3·2 days, 95% CI −4·6 to −1·8). The waiting-time gap was larger for direct-access specialties (standard: 30 days [IQR 15–30], n=130; non-standard: 15 [5–30], n=281; median difference −15·0 days, 95% CI −15·0 to −6·0) than for referral-required specialties (standard: 30 [15–45], n=1301; non-standard: 25 [15–45], n=2724; median difference −5·0 days, 95% CI −5·0 to 0·0). Interpretation: In Ecuadorian public hospitals, non-standard access to specialist appointments was associated with shorter waiting times than standard access, particularly in specialties that do not require referral in practice. Strengthening equitable timeliness may require improved transparency and governance of appointment allocation and referral coordination.

This study aims to determine the waiting time and the forms of access to specialized health services in public hospitals in Ecuador. A representative sample of 32 hospitals under the Ministry of Public Health was considered, with 26 selected by accessibility convenience. Data will be collected using a structured questionnaire. Patients will be asked about the number of days they waited for their medical appointments and the method used to schedule their appointments. The study distinguishes between standardized access, based on Ecuador’s formal referral and counter-referral system, and non-standardized access methods, such as personal connections or hospital staff involvement. The data of this protocol are registered and publicly accessible at: https://dx.doi.org/10.17504/protocols.io.261ge5z7wg47/v1 We expect to identify a correlation between waiting times and the type of access to specialized medical services, with non-standardized access potentially leading to shorter waiting times. This research may highlight disparities in the system and suggest areas for improvement in equity and efficiency within the healthcare referral process. To do so, a structured survey will be used. Since a construct is not needed to determine the waiting time or the forms of access, it was not necessary to validate the instrument. However, we did validate the understanding of the questions and the response options in several places in the country. According to the results According to the results of the validation of the instrument, pollsters will be instructed to inform users about the meaning of the question on ethnic identification, which was difficult to understand in the country’s coastal areas.