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Background: The TeleTriageTeam (TTT) is a novel system for remote eyecare delivery.

Objectives: Explores the impact of TTT on costs by depicting program theory of care prioritization. Moreover, a quantification of longer-term effects of delay (and inversely earlier treatment) on costs is performed.

Design: Mixed-methods health economic evaluation.

Methods: First, we depicted the program theory of prioritization into a LOGIC-model using existing TTT-data and expert interviews outlining the causal pathways how and why a program is expected to work. Second, we identified the most relevant key diagnoses to be appraised based on incidence, severity, and presumed triage impact. Third, we estimated the impact of delay (or inversely earlier treatment) on societal costs and quality of life (QoL) based on literature searches. Cost data were updated to 2023. Results were reported per delayed patient per 6 months (the average TTT delay).

Results: Five key diagnoses were selected: cataract, diabetic retinopathy (DRP), age-related macular disease (AMD), glaucoma, and dry-eye-syndrome (DES). The LOGIC-model showed how the TTT actions could influence costs and QoL. Semi-structured interviews revealed delay results in adverse events, at the expense of shorter waiting times in prioritized patients, and overall decreases personnel burden. Reduced waiting times were also believed to decrease burden and costs in prioritized patients. Literature showed that a delay in glaucoma treatment results in savings (-€409), while the other diagnoses suggested higher societal costs (cataract €3298, DES €2156, AMD €1455, DRP €117). QoL reduction and increased costs due to delay were more apparent when delay results in longer duration of curable symptoms compared to delay in stable disease (up to 0.09 vs 0.003 QALYs and €3298 vs €1455, respectively).

Conclusions: Eye care delay results reduced QoL and increased societal costs, yet this is compounded by gains attributable to justified prioritization of more urgent and more severe patients.

Background: Healthcare-seeking behaviour, and its associated factors, for obstetric complications are an important determinant of maternal deaths and adverse foetal outcomes. However, there is limited evidence on healthcare-seeking behaviours from health facilities in response to obstetric complications among Ethiopian women.

Objective: To investigate women's healthcare-seeking behaviour in response to obstetric complications, and its associated factors, in Ethiopia.

Methods: Data were sourced from the Performance Monitoring for Action (PMA-E) longitudinal survey national database. Andersen's health service use model was utilised to group individual and contextual factors. A multilevel mixed-effect logistic regression model was employed, with adjusted Odds Ratio (aOR) and 95% confidence intervals reported.

Results: Data were derived from a weighted sample of 1750 women who experienced obstetric complications during pregnancy, childbirth, and immediately postpartum. Overall healthcare-seeking at health facilities for obstetric complication symptoms during the maternity continuum was 62% (95%CI: 59.6-64.3), with 47.8% (95%CI: 45.0-50.5), 64.5% (95%CI: 61.3-67.5), and 52% (95%CI: 48.3-55.6) seeking healthcare from health facilities during pregnancy, childbirth, and the immediate post-partum period, respectively. Antenatal care attendance (aOR = 3.43, 95%CI: 2.4-5.0), nulliparity (aOR = 2.1; 95%CI: 1.0-4.4), household access to media (aOR = 1.5, 95%CI: 1.0-2.1), no intimate partner violence (IPV) during pregnancy (aOR = 1.8, 95%CI: 1.1-3.1), high community wealth status (aOR = 1.2, 95%CI: 1.1-2.4), community encouragement of facility childbirth (aOR = 2.2, 95%CI: 1.1-4.3), community non-acceptance of the traditional birth attendant (TBA; aOR = 2.4, 95%CI: 1.6-3.7), and high community participation in health developmental army (HDA; aOR = 2.1, 95%CI: 1.1-3.9) were significantly associated with healthcare seeking behaviour.

Conclusions: The healthcare-seeking behaviour of women from health facilities in response to obstetric complication symptoms was low and varied across the different stages of the maternity continuum. Key programme priority interventions should focus on reducing community reliance on TBA care, enhancing community encouragement of facility childbirth, and strengthening the HDA.

This study aims to identify factors influencing the continuity of follow-up care after hospital discharge from the perspectives of physicians and key healthcare stakeholders and map their interactions to facilitate understanding of dynamic relationships. We conducted audio-recorded semi-structured interviews with 17 participants (10 medical doctors, 3 state key informants, and 4 federal key informants) in Khartoum State, Sudan. Data analysis included thematic analysis to identify the factors and purposive text analysis to develop a causal loop diagram. We identified 39 factors affecting the continuity of follow-up care from hospital to home, categorized into 5 challenges: follow-up care adherence, quality of pre-discharge patient education, efficiency of the referral system, primary healthcare center accessibility, and quality improvement efforts. The study identified 2 balancing loops and 5 reinforcement feedback loops affecting follow-up care post-hospital discharge. The low adherence to follow-up care proposes quality improvement efforts as a solution, however, the high workload, resource depletion, referral system inefficiency, and quality improvement stagnation reinforcing loops impede progress in this direction. We recommend enhancing pre-discharge patient education and using multisectoral approaches to improve primary healthcare, optimize referrals with digital tools, and address staff turnover, to strengthen follow-up care.

Background: Cultural malpractices are socially shared perspectives and traditionally accepted behaviors experienced in a certain society that harm maternal health. In Ethiopia, about 18% of infant deaths occur due to cultural malpractice. However, evidence of cultural malpractice during the postnatal period is not well understood in Ethiopia, particularly in West Hararghe. Moreover, there is no study conducted on cultural practice during the postnatal period in this study area. Therefore, this aimed to assess the magnitude and factors associated with cultural malpractice among mothers attending postnatal care within 6 weeks after delivery at Gelemso General Hospital, Eastern Ethiopia.

Methods: Institutional-based cross-sectional study design was conducted among 407 mothers attending postnatal care with their babies at Gelemso General Hospital. The study participants were selected by systematic random sampling technique. Data were collected using a pretested and structured interviewer-administered questionnaire. The collected data were entered into EpiData version 4.6 and exported to Statistical Package of Social Sciences version 27 for analysis. Descriptive statistics were computed to describe the characteristics of the participants. Bivariable and multivariable logistic regression analyses were fitted to identify factors associated with the outcome variable. Adjusted odds ratios along a 95% confidence interval were used to report the result and show the strength of the association. A P-value < .05 was used to declare a significant association. The results were presented using figures, tables, graphs, and text.

Results: The study revealed that the magnitude of cultural malpractice during the postnatal period was 70.0% (95% CI: 65%, 74%). Lack of ANC visit (AOR = 3.3; 95% CI: 1.03, 10.27), partner's being a farmer (AOR = 7.4; 95% CI: 2.11, 26.48), distance to health facility (AOR = 3.6; 95% CI: 1.68, 7.65), having greater than 5 alive children (AOR = 3.5; 95% CI: 1.25, 9.84) were factors significantly associated with cultural malpractice during the postnatal period.

Conclusions: This study noted that more than two-thirds of participants committed cultural malpractice during the postnatal period. Therefore, emphasizing the importance of ANC follow-up, and encouraging home visits of postnatal mothers by professionals especially for those rural residents and remoter to health facilities may contribute to reducing the cultural malpractice.

Background: Domestic sex trafficking is a prevalent health and human rights issue in Ontario, Canada. Although providers working in healthcare settings are uniquely positioned to identify and care for individuals who are sex trafficked, they may be hampered by a limited understanding of who is vulnerable to being sex trafficked and, thereby, fail to recognize those in need of support.

Objectives: This qualitative study, part of a larger program of research, sought to apply critical social theory, and intersectionality to explore providers' perceptions of who is vulnerable to domestic sex trafficking.

Methods: Thirty-one healthcare providers of diverse identities and professional backgrounds were interviewed, using open-ended semi-structured questions, between November 2022 and February 2023. The interviews were analyzed using Braun and Clarke's reflexive thematic analysis framework and organized by a modified Taxonomy of Vulnerability.

Results: Three themes were generated: Traumatic history, social identities and relationships, and structural determinants. Providers consistently identified being female as a vulnerability to domestic sex trafficking. Few providers referenced the intersections of being female with other sociodemographic characteristics or acknowledged the complex ways in which larger systems have perpetuated the marginalization and inequitable status of some persons.

Conclusion: The findings emphasize the urgent need to understand vulnerability as more than just an individual condition. Further, provider training must cultivate critical consciousness to recognize the contextual roots of vulnerability and how the role and socialization processes of larger systems in perpetuating vulnerabilities differently across individuals' lives.

Background: In Switzerland, recently introduced legislation requires the implementation of a framework for mandatory quality improvement at the level of individual general practitioners (GPs) and includes the introduction of quality indicators (QIs) amongst other components. The GP-sided acceptance of potential components of such a framework is important to its success.

Objectives: To identify components of a potential framework for mandatory quality improvement that are most likely to be accepted by Swiss GPs.

Design: Cross-sectional web-based survey conducted among employed and self-employed Swiss GPs in 2024.

Methods: The survey was distributed to 1103 Swiss GPs via their physician networks. The survey inquired the acceptability of 62 possible components of a mandatory framework for quality improvement. Components were categorized as "acceptable" if they were rated as "acceptable" or "very acceptable" by more than 50% of participants, in contrast to those rated as "neutral" or "not acceptable."

Results: A total of 244 GPs participated (participation rate 22.1%, 53.0% male, 51.2% <50 years old, 50.8% employed). The majority of participants rated 31 of the proposed 62 components as acceptable. Among these were QIs pertaining to structures and processes of care (rated as acceptable by 58.3%-83.4%) and sharing QI achievement data with peers from different group practices and physician networks (53.9%-92.2%). A majority of participants accepted physician networks, medical associations, and academic institutions as entities that could establish QIs and manage QI data (acceptance 62.1%-88.8%).

Conclusions: Swiss GPs appear to accept QIs that reflect structures and processes of care established by physician networks, medical associations or academic institutions, exclusively shared among their peers.

Background: Direct oral anticoagulants (DOACs) have been increasingly prescribed instead of vitamin-K-antagonists (VKA) although VKAs cost considerably less than DOACs. In 2014, a new system for drug expenditures, the Wirkstoffvereinbarung (WSV, Active substance agreement), was implemented in Bavaria, Germany to control pharmaceutical expenditures transparently. Achieving the targets for the VKAs set by the WSV was difficult for general practitioners (GPs). We explored the determinants of prescribing VKAs (specifically phenprocoumon) versus DOACs.

Methods: Qualitative interviews (n = 18) and two small group discussions (n = 10) were conducted with GPs. For the qualitative content analysis, we formed a system of categories based on the domains of the Theoretical Domains Framework (TDF).

Results: Participants actively weighed various factors when deciding between prescribing phenprocoumon or DOACs. Costs played a subordinate role although all participants were aware that DOACs come at a higher cost than phenprocoumon. Trend reports served as a tool for GPs to assess their prescribing practices, however did not lead to a change in prescribing behaviour. The interviewees had a very heterogeneous view of safety, effect, and evidence of phenprocoumon or DOACs. The cooperation of the patients is crucial. Time is a significant challenge for participants when initiating patients on or switching them to phenprocoumon, which is especially problematic as all of the patients discharged from the hospital are put on DOACs.

Conclusions: GPs are caught between economic requirements, patients' wishes, and good collegial cooperation when deciding for or against phenprocoumon. As oral anticoagulant therapy (OAC) is mostly initiated in the hospital, and as physicians almost exclusively prescribe DOACs there, participating GPs feel overchallenged in reaching the targets set by the WSV.

Trial registration number: Main ID: DRKS00019820 (German Register of Clinical Studies and World Health Organization).

Healthcare workers frequently experience emotional distress from repeated exposure to patient death, yet professional grief remains poorly recognized and inadequately supported. The COVID-19 pandemic further magnified these challenges, bringing professional grief into sharper focus. The purpose of this scoping review was to comprehensively examine professional grief among healthcare workers (HCWs) across different professions and specialties, map existing literature, identify research gaps, and provide educational, clinical, and policy recommendations. This scoping review followed Arksey and O'Malley's methodological framework and PRISMA-ScR guidelines. Databases searched included PubMed, CINAHL, and PsycINFO for literature from 2004 to 2024. Studies were screened based on inclusion criteria focusing on professional grief experiences of HCWs dealing with patient deaths. Qualitative, quantitative, and mixed-method studies were included. Eighty-one publications were reviewed, with most studies published since 2020, highlighting increased attention post-COVID-19. Key findings identified significant individual (eg, early career vulnerability, lack of formal education), interpersonal (eg, patient demographics, relationship quality), and systemic factors (eg, emotional suppression culture, workload constraints) influencing professional grief. Existing interventions were predominantly peer-based and lacked demonstrated efficacy in reducing grief intensity. Measurement inconsistencies revealed discrepancies between qualitative and quantitative assessments of grief intensity, indicating a need for specialized measurement tools tailored to professional contexts. Professional grief among HCWs is multifaceted and deeply influenced by cultural, educational, and systemic barriers. Comprehensive strategies addressing these barriers must include structured educational curricula, ongoing clinical support programs, validated grief measurement tools, and institutional policies promoting open emotional expression. These approaches are essential to fostering resilience, enhancing professional well-being, and improving patient care outcomes.

Background: The complexity of treatment pathways and the chronic nature of diseases in vascular surgery necessitate a patient-centred approach to improve care quality and health outcomes.

Objectives: To explore vascular patients' experiences, identifying key factors influencing their satisfaction and adherence to treatment.

Study design: Qualitative design using thematic analysis.

Methods: Seventeen semi-structured interviews were conducted with vascular patients (10 males and 7 females) from 3 vascular units in Wales. Proportional random sampling was used for participant selection based on recent vascular care, age, sex, and clinical backgrounds. Interviews were conducted in person, recorded, and transcribed verbatim. Thematic analysis was employed to identify key themes. NVivo 10 software facilitated data management.

Results: Six themes were identified: (i) communication and information delivery, (ii) patient involvement in decision-making, (iii) pain management, (iv) psychological and emotional support, (v) healthcare environment and systemic processes and (vi) continuity of care and post-discharge experience. While patients generally appreciated the professionalism of the healthcare staff, notable disparities emerged in communication, particularly for patients with lower health literacy or during waiting periods. Inconsistencies in discharge planning and follow-up care highlighted systemic inequities. Across all units, patients reported a lack of formal psychological support. Involvement in decision-making varied, with some patients feeling adequately included, while others experienced exclusion and anxiety.

Conclusion: These findings reveal key areas for improvement, with communication serving as a foundational element that enhances patient involvement in decision-making, psychological support, and continuity of care. Addressing these interconnected areas, with a focus on effective communication and health equity, may help close care gaps and improve outcomes for all vascular patients.