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Background: Maternal and neonatal health outcomes are heavily influenced by equitable access to specialized healthcare providers. Globally, unequal distribution of obstetricians and gynecologists (OB/GYN) has been linked to higher maternal mortality rates and worse neonatal outcomes. In Saudi Arabia, ongoing regional disparities in healthcare infrastructure and workforce distribution continue to affect maternal and neonatal health despite reforms.

Objective: This study aims to evaluate the regional distribution of obstetricians and gynecologists (OB/GYN) across Saudi Arabia and its impact on maternal and neonatal health outcomes.

Methods: We conducted a cross-sectional secondary data analysis using the 2022 Saudi Ministry of Health Statistical Yearbook, covering all 20 health regions. We calculated the number of OB/GYN specialists per 100 000 females by region. Pearson's correlation examined associations between specialist density, population size, infrastructure, and health outcomes. Multiple regression identified predictors of specialist distribution.

Results: Specialist distribution varied widely. Rural regions, such as Qurayyat, had the highest specialist-to-female ratio (92 per 100 000), while urban regions, like Riyadh, had the lowest (53 per 100 000). A strong negative correlation existed between population size and specialist density (r = -.748, P < .001). OB/GYN bed availability was the strongest predictor of specialist distribution (β = .908, P < .001).

Conclusions: This nationwide analysis highlights significant disparities in the distribution of OB/GYN specialists across Saudi Arabia. Urban regions are underserved relative to their population size, while rural regions often lack adequate infrastructure to support existing specialists. Addressing these imbalances through equitable workforce planning and infrastructure investment is crucial for enhancing maternal and neonatal outcomes in alignment with Vision 2030 goals.

Background: Cyber-victimisation is a growing public health challenge, particularly for people with long-term conditions and disabilities. These individuals face complex challenges in managing health, compounded by experiences of discrimination and insufficient access to appropriate support.

Aim: This study examines healthcare professionals' encounters with patients who have long-term conditions or disabilities and reported cyber-victimisation. It focuses on the scope of these experiences in healthcare, impact on patients, healthcare professionals' awareness, and perceived training needs.

Method: A mixed-methods survey was conducted with UK-based healthcare professionals, recruited through the Modality Super GP partnership, social media, and contacting relevant organisations.

Results: The participant sample comprised 118 healthcare professionals, with a mean of 20.72 years of professional experience (SD = 13.72). Among them, 33.90% encountered patients affected by cyber-victimisation, and of these, 82.50% indicated that such experiences had a detrimental impact on their patients' health. Reported impacts were on mental health, social relationships, lifestyle, physical complications, missing routine appointments, changes to medications, and lab tests. Qualitative themes included mental health consequences, worsening of chronic conditions, increased vulnerability due to certain conditions, trust and stigma, and varied professional awareness. Among those asked about training (n = 77), 58.44% supported research-informed programmes, with preferred formats being interactive media, workshops, and printed materials.

Conclusion: Findings confirm that cyber-victimisation of this group is prevalent in healthcare, yet support and awareness remain limited. Training is needed to equip professionals to assist affected patients. Future research should explore interdisciplinary strategies to strengthen healthcare responses and embed cyber-victimisation awareness into public health policy.

Introduction: Workplace wellbeing programmes are increasingly recognised as essential in managing occupational distress, burnout, and improving staff wellbeing in healthcare. This study examines the implementation of the SEED Champion Initiative, designed to embed sustainable wellbeing practices across diverse hospital and community settings. The study aimed to determine the key components of implementing a workplace wellbeing initiative in an Australian public health service.

Methods: This study utilised triangulated qualitative methods, including observations of the implementation process and semi-structured interviews with participants trained as SEED champions. Reflexive thematic analysis examined data from participant observations, SEED team reflections, and champion feedback. The analysis focussed on champions' experiences participating in the initiative and the systemic factors that influenced their capacity to engage.

Results: The study identified 3 key components for implementing workplace wellbeing initiatives in healthcare: (1) Laying the Groundwork for Wellbeing; (2) Becoming a Wellbeing Champion; and (3) Sustaining the Wellbeing Momentum. Leadership commitment and staff preparation were essential in fostering engagement. Creative, strengths-based approaches, including arts-based activities and in-person interactions enhanced peer support. Regular follow-ups and leadership-driven resource allocation ensured long-term engagement.

Conclusion: This study demonstrates that champion-led workplace wellbeing initiatives are a feasible approach to enhancing staff wellbeing in healthcare settings. While the strengths-based peer support approach was successful, long-term sustainability requires ongoing leadership commitment and structural integration into organisational practices. Future research should investigate the long-term sustainability and impact of staff-led wellbeing initiatives on absenteeism, presenteeism, and organisational change to inform policy and practice.

[This corrects the article DOI: 10.1177/11786329251316668.].

Background: Patients performing self-triage for chest pain need to pick an algorithm which includes questions pertinent to chest pain to triage accurately.

Objective: Our study reviews patient self-triage choices and outcomes for patients who completed an online self-triage encounter before being triaged by a nurse for chest pain.

Methods: Patients who underwent telephone nurse triage for chest pain, and also had an online self-triage encounter within the prior 24 hours were reviewed for the frequency with which they chose "chest pain" as their symptom to triage for during self-triage, whether they reported chest pain during the self-triage encounter (if asked as part of the algorithm for their chosen self-triage symptom) and whether the patient had any follow up evaluation within 1 week.

Results: There were 70 self-triage and nurse triage dyads during the study period where triage nurses chose "chest pain" as the primary symptom to be triaged for during the telephone triage encounter. Of these, only 5 (7.1%) patients chose the "chest pain" self-triage option during online self-triage. During the self-triage encounter, 50 (71%) reported chest pain, 10 (14%) denied chest pain and 10 chose to self-triage their symptoms with an algorithm that did not include a question on whether chest pain was present. Of the 70 total dyads 59 (84%) had a follow up emergency department (40 patients) or office visit (19 patients) documented.

Conclusion: Most patients chosen to be triaged for chest pain by triage nurses did not choose the online self-triage algorithm for chest pain even though the majority did report chest pain during their self-triage encounter (when asked). This is concerning from a safety perspective as a non-chest pain self-triage option chosen by the patient may not always ask about the presence or absence of chest pain and thus could increase the risk of being triaged inaccurately. Implications for improvement of self-triage could include diagrams for patients to choose the symptom area.

Background: Many health systems fail to fully link evidence to decisions and suffer from inadequate ability to respond to priority health needs. Routine data use capacity-building efforts are poorly implemented, lacking integration, quality training, and adequate support.

Objective: This study was aimed to evaluate the effect of Augmented Capacity Development Interventions (ACDI) strategies on information utilization for decision-making in the Routine Health Information System (RHIS).

Methods: A two-arm parallel-group cluster randomized controlled trial was conducted across clusters of public health institutions. Baseline data were collected in April 2023, an eight-month intervention was implemented from July 2023 to February 2024, and end-line data were collected in April 2024. Training, supportive supervision, mentorship, recognition, and monitoring and evaluation were the ACDI strategies implemented in this study. The study involved 72 health institutions and 304 health workers. A general linear mixed model analysis was used to assess the effect of the intervention on information utilization.

Results: The proportion of participants with good information utilization increased significantly from 55.2% at baseline to 82.3% at the end-line among the intervention groups. The ACDI intervention has a significant effect on information utilization (β = 0.19, 95% CI: 0.05, 0.33, P = .006). Moreover, availability of internet service (β = 0.21, 95% CI: 0.04, 0.38; P = .017), culture of information utilization (β = 0.12; 95% CI: 0.02, 0.22; P = .018), ease or skill of data management (β = 0.31, 95% CI: 0.23, 0.39; P < .001) and timeliness of reports (β = 0.27; 95% CI: 0.13, 0.40; P < .001) were predictors that increased information utilization in intervention health institutions as compared to control institutions.

Conclusion: This study demonstrated that the implementation of ACDI led to a significant improvement in information utilization. These results suggest that the intervention effectively improved information use in the RHIS and support adopting this approach in similar settings.

Trial registration id: PACTR202212472091194, registered on 14 December 2022.

Health systems in Canada and elsewhere are reeling from ongoing syndemic shocks and mounting political-economic concerns that are having significant negative impacts on health equity, and on staff recruitment, wellbeing, and retention. Pressures to privatize delivery of publicly funded healthcare services in Canada are mounting, posing an additional risk to equity in access and outcomes, especially for those least well-served by current systems. This paper examines existing approaches to health system improvement and their alignment with the quintuple aim of enhancing patient experiences and outcomes, service and system efficiency, provider well-being, and health equity. Quality improvement efforts derived from private sector models such as Lean and Six Sigma have been shown, in the Canadian context and elsewhere, to add costs and negatively impact key aims such as provider well-being and patient experiences of care, though they can improve process-specific aspects of care, especially when an integrated team approach is applied in properly resourced contexts. Models that treat equity as an add-on to Lean/Six Sigma-based approaches have not been well-tested. Equity-oriented health care (EOHC) provides a promising alternative for health system improvement aligned with the quintuple aim, and is positioned as an emerging, innovative way to mitigate mounting system pressures, enhance health service effectiveness, and improve population health.

Background: The Ontario government launched the High Priority Communities Strategy (HPCS) in December 2020, funding community agencies operating in neighborhoods disproportionately affected by COVID-19 in Durham, Peel, Toronto, York, and Ottawa. Community-led task forces and networks also formed with the aim to increase vaccine confidence and uptake among minoritized communities.

Objectives: To explore how community-led task forces, networks and agencies mobilized and engaged faith-based and ethno-racial communities in Peel Region and Toronto to improve vaccine confidence and uptake, including perceived facilitators and barriers.

Design: Multi-method qualitative study.

Methods: Between June 2023 and March 2024, we conducted ten online focus groups with three task forces and six HPCS-funded community agencies, as well as four key-informant interviews with representatives from two task forces and one network. We used thematic analysis to explore respondents' perceptions and experiences.

Results: Three key themes emerged. First, community-led task forces, the network and agencies used community mobilization strategies, such as tailored outreach, mitigating vaccine access barriers and leveraging trusted community voices, to improve vaccine confidence and uptake. Second, fostering a sense of community was central to their work, enabled through member engagement and power (knowledge and resource) sharing for collective impact. Third, sustaining community-led efforts was a challenge. The volunteer-driven task forces and network lacked the capacity to formally evaluate their activities or long-term infrastructure, and most disbanded post-pandemic. However, community agencies pivoted to preventative and primary care initiatives under HPCS.

Conclusion: Community-led structures contributed to promoting vaccine uptake among ethno-racial and faith-based communities in hotspot areas. Facilitators included the use of trusted messengers and power sharing, while barriers included short-term funding and challenges sustaining efforts over time. Long-term sustainability of these efforts requires continued investment, sustained infrastructure, and strong community partnerships. Lessons from these findings can help strengthen community-led responses to future public health emergencies.

Background: The work of addressing veteran homelessness has largely been focused on veterans who are already homeless.

Objectives: This study aimed to identify factors that can be targeted upstream before military personnel leave the military to prevent veteran homelessness during the critical transition from active duty to civilian life.

Design: Data were analyzed from a 2001 to 2014 longitudinal cohort study of 418 624 post-9/11 veterans who entered Veterans Affairs (VA) healthcare after leaving the military.

Methods: Department of Defense (DoD) data on clinical diagnoses, demographics, and military history were linked to VA data on homelessness and neighborhood of residence.

Results: Homelessness in the 2 years after military discharge was associated with residing in a socioeconomically disadvantaged neighborhood after discharge as well as with younger age; Black race; and diagnoses of substance use disorder (SUD), serious mental illness (SMI), and personality disorder. Veterans with co-occurring SUD, SMI, and personality disorder had 5 times higher incidence of homelessness than veterans with none of these diagnoses, with rates most elevated among veterans residing in disadvantaged neighborhoods.

Limitations and conclusion: Several limitations include potential for missed cases of homelessness due to the use of medical records and lack of generalizability as note all veterans utilize VA services. Nevertheless, this large-sample, longitudinal sampling frame revealed critical environment-level and individual-level risk factors predicting homelessness after military separation that can be addressed proactively by policy and programs aimed at improving community reintegration of veterans transitioning to civilian life.