Barriers to feasibility were noted including low education levels of participants, unavailability of caregivers, and logistical issues such as difficulty in follow up of participants.
Firstly, the number of participants was small and the tuberculin skin tests were not performed in most of patients due to difficulty in follow up schedule for interpretation of TST results.
In addition to the difficulties for follow up introduced by hospitalization or relapse of participants, difficulties with tracing participants may be particularly relevant in LMIC with high levels of mobility amongst communities.
Other Canadians who have already gone abroad for treatment have faced complications and difficulties obtaining follow up care for their MS from their regular health care providers [ 25].
Despite the practical difficulties with follow up over summer, the response among the patients was high and all intervention GPs who were contactable agreed to be interviewed.
In addition, some of the independent variables were assessed with single questions, for example treatment adherence and difficulties of follow up adherence to their clinic appointments that may lead some patients to respond improperly.
Given the dangers associated with some of these interventions, questions about their efficacy, and difficulties accessing follow up care, it is easy to treat those paying out of pocket for these interventions as vulnerable and even gullible individuals that should be protected from themselves.
Medical tourism, however, carries with it additional risks, including communication gaps between the physician and patient, taking lengthy flights post-operatively, exposure to medical malpractice abroad, difficulties obtaining follow up care, and the danger of infectious disease transmission, among others [ 1].
Additional problems faced by the health workers are poor compliance by patients with prescribed medication, and difficulty giving sustained follow up to clients.
Other issues that were mentioned included difficulty getting adequate follow up in settings without an established clinician-patient relationship, parental resistance to randomization, and group imbalances due to small sample size.
