Health Services Insights最新文献

Background: Stroke is a leading cause of long-term disability, significantly impacting health-related quality of life (HRQoL). However, evidence from Nepal remains limited.

Objective: This study aimed to assess HRQoL and identify its associated factors among stroke patients in a tertiary care hospital in Nepal.

Design: Cross-sectional study.

Methods: This study was conducted at the Annapurna Neurological Institute and Allied Sciences (ANIAS) between November 2023 and April 2024 among 120 stroke patients aged ⩾18 years. Baseline data were collected using a semi-structured questionnaire, and HRQoL was assessed using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) scale. Statistical analyses included descriptive statistics, bivariate analyses, and multiple linear regression to identify factors associated with HRQoL. A p-value < .05 was considered statistically significant.

Results: The mean HRQoL score was 21.13 ± 6.62, indicating substantial impairment, particularly in usual activities (Mean ± SD: 4.32 ± 1.32), self-care (4.26 ± 1.34), and mobility (4.22 ± 1.32). Lower HRQoL was significantly associated with older age, unemployment, lower educational attainment, and moderate to severe stroke-related disability (p< .001). Strong positive correlations were observed among all five HRQoL domains.

Conclusion: HRQoL is significantly impacted by stroke, with major impairments in usual activities, self-care, and mobility, influenced by both socio-demographic and clinical factors. Implementing targeted, multidimensional rehabilitation strategies such as structured physiotherapy is essential to enhance recovery and improve the quality of life in this population.

Background: Multiplex polymerase chain reaction (PCR) testing for viral acute respiratory infections (ARI) at the Point of Care (POC) has demonstrated clinical and economic value in secondary care, yet its impact in primary care remains uncertain. United Kingdom (UK) guidelines make conflicting recommendations on the use of testing in primary care settings.

Objectives: This study provides expert consensus on the potential clinical and economic implications of rapid PCR testing at the POC in primary care settings.

Design: A modified Delphi consensus panel approach was employed, with consensus statements developed from existing literature and evaluated through two rounds of questionnaires. Open-ended questions were posed to explore potential barriers to implementation, evidence generation, and suitable settings for testing.

Methods: A multistakeholder panel of 9 experts was purposely recruited, representing stakeholders from seven areas. A narrative literature review was conducted to generate consensus on the potential value of implementing rapid PCR testing at the POC for ARIs in primary care settings. Two Delphi rounds were completed, with participants rating their level of agreement with presented statements on a Likert scale from 1 to 5.

Results: Seventeen statements were generated based on the results of a narrative literature review, with eight achieving consensus and further evidence generation recommendations developed for six statements. Two statements were removed due to non-agreement and two were merged into a single statement, which later achieved consensus. The lack of cost and clinical effectiveness data was ranked as the greatest barrier to implementation. Primary care settings with high and low risk patients, such as general practices and care homes, were considered ideal for implementation.

Conclusion: There is potential value in rapid multiplex viral PCR testing for ARIs in primary care settings and care homes. While existing evidence and expert consensus indicate a likely benefit, further real-world evidence trials are recommended to evaluate the cost-effectiveness of this approach.

Background: Calibration of medical devices is vital for diagnostic reliability, quality healthcare delivery and patient safety. While awareness is critical, the confidence of healthcare professionals (HCPs) in calibration-related knowledge significantly influences adherence to best practices in calibration-related tasks. However, this area is underexplored in sub-Saharan Africa.

Objectives: This study aimed to assess the confidence levels of HCPs in Ghana regarding their calibration-related knowledge and competencies. It examined how these vary by professional role, training status, and years of experience.

Methods: A cross-sectional survey was conducted among 461 HCPs in Ghana, including doctors, nurses, midwives and technicians/clinical engineers, using a structured questionnaire covering five thematic areas: general understanding of calibration knowledge, knowledge of calibration procedures, device-specific knowledge, training and institutional support, and the perceived impact on patient care.

Results: Statistical analyses revealed variations in sentiment scores across profession, experience levels and training status. Technicians/clinical engineers consistently reported higher confidence, while doctors, nurses and midwives scored significantly lower. Additionally, respondents with prior calibration training, regardless of experience level, showed substantially greater confidence than their untrained counterparts.

Conclusion: These findings demonstrate the need for targeted, hands-on calibration training and continuous professional development to improve confidence and competencies in calibration practices. Such initiatives are essential for effective device management and overall healthcare system performance. This study offers evidence to guide policy improvements and capacity-building efforts to strengthen calibration knowledge and practices in Ghana's healthcare sector.

Background: Kenya experienced a 55% increase in maternal mortality between the years 2017 and 2020. While the global targets are yet to be realized, neonatal and infant mortality has improved over the years, but the rate of decline for neonatal mortality has been slow. The persistent high maternal mortality and slow improvements in neonatal and infant mortality warrant regular inquiries into health service provision, its quality and uptake.

Objective: We assessed bottlenecks in accessing reproductive, maternal, newborn and child health (RMNCH) services in Kwale County, Kenya.

Design: We used a cross sectional mixed methods approach.

Methods: We adapted the Tanahashi model to evaluate RMNCH services using 5 key measures that reflect different stages along the service delivery continuum: availability of services; accessibility; initial contact with the health system; continued utilization; and quality coverage. Secondary quantitative data was collected from the Kenya Demographic and Health Survey 2022, Kenya Health Facility Census Report 2023 and other peer reviewed publications. Primary qualitative data was collected from 20 focus group discussions with 176 members including lay community members, community health promoters (CHPs) and traditional birth attendants. Primary data was collected over a 1 month period, between October and November 2022.

Results: The main bottleneck identified from the supply side was the limited number and negative attitude of the healthcare workers. Access to core health workers was at 13/10 000 people, lower than the national average and World Health Organization (WHO) recommendation. From the supply side, low health literacy, gender norms and financial constraints were the major factors fueling the poor health seeking behavior.

Conclusion: Kwale County needs to prioritize investments in human resources for health, advocacy, communication and social mobilization.

Background: Mental illness is a widespread issue that affects millions of people worldwide. Its impact is not only limited to the individuals suffering from it but also extends to their families and communities. Caregivers suffer physically, psychologically, and socially twice than general population related to care giving process.

Methods: An institutional-based cross-sectional study design was employed from January 21 to February 21, 2024, at public hospitals in Harari Regional State and Dire Dawa City Administrative; 437 primary caregivers were selected via a systematic sampling technique. Data were collected using interview-administered questionnaires. Simple and multiple linear regression analysis were used to assess the contributing factors of quality of life domains among the participants, and the ꞵ-coefficient with a 95% confidence interval was used. Statistical significance was accepted at a P-value < .05.

Results: A total of 421 respondents participated, for a response rate of 96.3%. The results found that the mean quality of life scores of caregivers of people living with mental illness for each domain (mean ± SD) were 58.05 ± 18.81, 57.29 ± 16.28, 51.19 ± 23.12, and 53.04 ± 16.13, for physical, psychological, social and environmental factors, respectively. Multiple regression analysis revealed that the caregiver's educational status, depression, perceived stigma, perceived burden and patient's diagnosis were negatively associated with all domains of quality of life, whereas the caregiver's resilience and social support were strongly positively associated with all domains of quality of life.

Conclusion: Caregivers' quality of life found to be low across the four domains of quality of life, with the lowest score in the social domain. Resilience and social support found to plays a positive role in the quality of life of caregivers. Regular evaluation of risky caregivers, and psycho-support are crucial to address these challenges and improve caregivers' well-being.

Background: Malaria remains a public health priority In Zimbabwe, with approximately half the population at risk.

Aim: This study aimed to review the literature to synthesise historical and current evidence regarding the impact of climate change on malaria transmission and management.

Methods: Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for a scoping review framework, a systematic search was conducted across multiple databases and websites, and 22 literature sources were included based on topic relevance and alignment to the inclusion criteria.

Results: Most reviewed studies have consistently demonstrated that climate change is shifting the geographic distribution, trends, timing, and intensity of malaria transmission in Zimbabwe. However, others have emphasised the key role of non-climatic human, ecological, and health system factors and intervention coverage in shaping malaria transmission dynamics. Overstretched health systems and the uncertain effectiveness of existing interventions in a changing climate pose significant challenges to malaria management. This review identified key gaps, including the lack of longitudinal data, limited use of localised predictive modelling, and a limited focus on climate-parasite dynamics.

Conclusion: There is a growing need for climate-informed programming, emphasising the need for improved local funding, multi-sectoral collaboration, community engagement, and building climate-resilient health systems.

Background: The community-based health insurance (CBHI) program was established in Ethiopia to enhance access to healthcare and protect vulnerable populations, including women, from financial risk.

Aim: This study analyzed healthcare utilization and its determinants between community-based health insurance members and nonmembers of women in Sidama's Central Zone, southern Ethiopia.

Methods: From January 19 to February 20, 2024, a community-based comparative cross-sectional study was conducted among 1280 women (640 insured and 640 uninsured). The study participants were selected using a multistage sampling technique, and data were collected through structured face-to-face interviews using the KoBo Toolbox.

Findings: The analysis revealed that CBHI membership was associated with a 77% higher frequency of health facility visits than non-members (APR = 1.77, 95% CI: 1.52-2.06; P < .001). For insured women, some individual and community-level factors were associated with the frequency of health facility visits. Age was positively associated with health facility visits, with each additional year leading to a 1.0% increase (APR = 1.01, 95% CI: 1.01-1.02; P < .001). Healthcare satisfaction also played a role, with a one-unit increase associated with a 4.0% increase in the frequency of healthcare visits (APR = 1.04, 95% CI: 1.03-1.05; P < .001). Geographical accessibility was a barrier, as women living farther from facilities experienced a 41.0% reduction in health facility visits (APR = 0.59, 95% CI: 0.48-0.73; P < .001). Community literacy and poverty levels were also significant determinants, with women from high-literacy communities having more than twice the visits (APR = 2.11, 95% CI: 1.60-2.80; P < .001) and those from low-poverty areas having higher visit rates (APR = 1.58, 95% CI: 1.24-2.01; P < .001). Family size was a determinant among uninsured women, with each additional household member associated with a 9.6% increase in health facility visits (APR = 1.10, 95% CI: 1.02-1.18; P = .015). Healthcare satisfaction had a positive association with the frequency of health facility visits (APR = 1.05, 95% CI: 1.04-1.05; P < .001). Geographical accessibility remained a barrier, with a 42% reduction in visits for those living farther from facilities (APR = 0.58, 95% CI: 0.44-0.77; P < .001). Community literacy was also a significant factor, with women from high-literacy areas having more than twice the frequency of health facility visits (APR = 2.12, 95% CI: 1.60-2.81; P < .001).

Conclusions: This analysis demonstrated that membership in CBHI substantially increased the frequency of health facility visits, resulting in a 77% rise relative to non-members. Among insured women, significant determinants included age, healthcare satisfaction, geographical accessibility, communit

Healthcare students may experience violence from patients and bystanders while undertaking clinical placements. There is ambiguity around responsibility and strategies used to support students before, during and after incidents. A scoping review was conducted of peer reviewed publications (CINAHL, Embase, Medline, Web of Science) and grey literature (Open Grey, WONDER, WorldCat, Trove, Google Scholar). Twenty-nine studies were identified. Studies varied in the way responsibility for risks was shared between students, clinical facilitators, placement providers and universities. Five studies discussed underreporting of incidents as a known issue. Students on clinical placement who experience violence from patients or bystanders face unique challenges in identifying where to report or find support. While universities are generally aware of the risks of violence towards students undertaking placements there is no consensus between education and placement providers on responsibility for reducing violence or supporting students following incidents.

Background: Clinical quality registries (CQRs) systematically monitor the quality of healthcare by routinely collecting and reporting health-related information. The collection of patient reported measures (PRMs) by CQRs provides a personal perspective on the expectations and impacts of treatment. Reporting of CQR-collected PRMs for quality improvement (QI) is highly variable.

Objectives: To develop a best practice guide (BPG) for CQRs, clinicians and health services to support high-quality and transparent reporting of PRM data for QI purposes.

Methods: The project comprised four stages. The first sought to describe how PRMs were reported for QI purposes in Australia and internationally. The second stage included seven focus groups with 20 Australian CQRs to identify existing practices, issues and impacts regarding PRMs reporting. During stage 3, findings from the literature and focus groups were used to draft a preliminary BPG. Finally, expert workshops involving PRMs experts, consumers, clinicians and representatives from CQRs were convened to refine a preliminary BPG.

Results: We identified 61 international and 45 Australian CQRs that reported PRMs for QI purposes. PRMs were used for shared decision-making in clinical encounters, for developing clinical decision aids, to revise treatment guidelines and to monitor complications after hospital discharge. Several themes emerged from the focus groups. These included: purpose and context, funding and resource requirements, consumer involvement, clinician training, instrument selection and administration, outlier identification, visualisation and interpretation of the data. A preliminary BPG was refined during the workshop discussions.

Conclusion: An increasing number of CQRs use PRMs to enhance QI reporting, however there are no published guidelines currently to support this. Through identifying existing practices, methods and techniques that CQRs use to report PRMs, we developed a practical guideline to support CQRs and standardise their PRMs reporting for QI purposes, with the overarching goal of optimising the value of PRM data within CQRs.

Background: Improving cancer screening participation is increasingly important. However, insufficient medical and financial resources have been reported to hinder program implementation; therefore, enhancing program efficiency is crucial. Although demographic factors have been reported to correlate with public health program efficiency, it remains unclear whether this applies to cancer screening.

Objectives: To evaluate the efficiency of cancer screening programs conducted in Japanese municipalities and analyze their relationship with demographic characteristics, including population size and aging rates.

Design: A cross-sectional study using national open-source data from 2019.

Methods: We collected data from all 1741 Japanese municipalities in 2019 using a national open-source database. After applying inclusion criteria, 1593 municipalities were analyzed. Program efficiency was measured using Data Envelopment Analysis (DEA), with inputs including the number of public health nurses, medical institutions, and healthcare expenditure per target population. Outputs were cancer screening participation rates. Logistic regression was used to examine the relationships between efficiency, population size, aging rates, and their interaction.

Results: Of the 1593 municipalities analyzed, 414 (26.0%) were deemed efficient. A statistically significant interaction between aging rates and population size was observed in the model predicting screening efficiency. In municipalities with aging rates above 31.4% (95% confidence interval [CI]: 29.2-37.1), larger target populations were associated with lower efficiency. Conversely, in municipalities with over 1075 screening targets (95% CI: 552-1381), higher aging rates were linked to lower efficiency.

Conclusion: This study suggests that aging rates and population size may be associated with municipal-level differences in the efficiency of cancer screening programs. Understanding the mechanism underlying this relationship could help inform resource allocation and program design. Further research is warranted to explore these relationships more deeply and to support the development of more efficient screening strategies, particularly in the context of ongoing demographic shifts.