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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.

Background: Addressing social determinants of health in patient care helps hospitals better understand the non-medical factors influencing patients' health outcomes.

Objectives: The objective of this study was to evaluate the correlation between hospital characteristics, county determinants, and the systematic recording of health-related social needs among general and surgical acute care hospitals in the United States. It focused on the hospital's routine collection of data on patients' health-related social needs, such as transportation, housing, and food insecurity.

Design: A cross-sectional retrospective study design was utilized.

Methods: All hospitals that completed the American Hospital Association Annual survey (n = 2254) were included in the study. A series of multinomial logistic analyses were conducted.

Results: The relative risk of hospitals routinely collecting health-related social needs data is 67% lower in for-profit hospitals and 90% higher in not-for-profit hospitals compared to government hospitals. Hospitals that are part of a system are 1.5 times more likely to routinely collect data on social needs. In addition, counties with higher household income have a statistically significant higher relative risk of hospitals collecting data on social needs, though the magnitude of the difference is small. The relative risk of hospitals collecting social needs data, but not routinely, is 2 times higher in teaching hospitals and 3 times higher among system hospitals.

Conclusion: Our research strongly indicates that understanding and addressing these inherent hospital-related factors are essential for effectively integrating social determinants of health into routine healthcare data collection practices. Establishing more robust guidelines and standardization in these practices may enhance hospitals' ability to document and utilize health-related social needs information, ultimately driving improved patient outcomes and supporting more equitable care.

Objectives: The primary purpose of this study was to assess the knowledge and prevalence of cervical cancer screening (CCS) among women attending prenatal care clinics in the Okaikwei North Municipal Assembly (ONMA) in the Greater Accra region, Ghana. The study also aimed to examine whether there were differences in CCS knowledge between the women attending the prenatal care clinics.

Design: This study utilized a cross-sectional, quantitative approach and a two-stage cluster sampling method.

Setting: The study involved 393 women receiving prenatal care at three health facilities in the district, namely NK Salem Medical Centre Hospital (NMCH), Achimota Hospital (AH), and Lapaz Community Hospital (LCH).

Primary outcome: Level of Knowledge and Prevalence of CCS.

Results: The sampled participants from the three hospitals were Achimota (36.6%), Lapaz Community (32.1%), and NK Salem (31.3%). The mean age (SD) was 29.7 (±3.8) years. The age group 21 to 30 years formed the majority (57.8%). The prevalence of CCS among women receiving prenatal care was 7.4%; although most of them had heard about CCS, a proportion (46.5%) of them did not know CCS was, and only 33.9% knew Pap Smear as the test for detecting cervical cancer. A very small proportion (19.8%) of the women receiving prenatal care had CCS knowledge. There was a statistically significant difference in mean knowledge by 1.47 between women receiving prenatal care at AH and LCH, as well as by 1.82 between NMCH and LCH.

Conclusion: There was a very low knowledge and prevalence of CCS in the district. Knowledge of CCS differed significantly between the health facilities in the district.

First responders (police, firefighters, and paramedics) are routinely exposed to potentially psychologically traumatic events (PPTE). While the prevalence of mental disorders is difficult to estimate, research has demonstrated that first responders report higher rates of mental health disorders than the general population. They also report significant barriers to accessing mental healthcare, including concerns about the confidentiality of mental health services and stigma by co-workers and organizational leadership. One way to address these barriers to seeking care is through the establishment of a first responder specific mental health clinic. The objective of this qualitative study was to assess how to best implement such a service for first responders in Ottawa, Canada. We conducted 14 in-depth semi-structured qualitative interviews with key interest holders from first responder services, unions/associations, and the Workplace Safety and Insurance Board (WSIB) which explored elements of service delivery and organizational barriers and facilitators to implementing the clinic. Interviews were analyzed and coded using thematic analysis by two independent coders. Four main themes were identified: implementation context (perceived need, workplace culture), design of the clinic (service delivery, confidentiality, cost, and communication about the clinic), the implementation process (barriers and facilitators to implementation), and the broader impact of the implementation of the clinic. Findings show that it is the right time to implement first responder specific clinical services as services begin to prioritize the mental health needs of their members. To increase uptake by first responders, confidentiality and cultural competency of care providers is paramount.

Introduction: Clinical pathways (CPWs) are evidence-based, standardised, clinical management plans that are designed to deliver a sequence of clinical interventions to improve the efficiency and effectiveness of healthcare. The aim of this study was to identify and summarise the current available evidence on the use of CPWs in emergency departments (EDs).

Study design: A literature search was conducted in Scopus, Embase, Emcare, and PubMed academic databases. The search strategy was guided by Arksey and O'Malley's framework and results reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews Checklist. Studies were included if they reported empirical data either qualitatively or quantitatively, studied the use of CPW practices, and reported on the use of at least one CPW activity.

Results: Sixty-four articles were eligible for the scoping review. Variation and quality of treatment, resource utilisation and time to treatment were identified as the three main patient and organisational outcomes from the use of CPWs. Three main categories of barriers to use were identified: Organisational environment factors, Healthcare professional-related factors, and CPW operational issues.

Conclusions: CPW implementation has wide positive patient and organisational outcomes in the ED. Whilst no single strategy would result in implementing CPWs in the ED settings successfully, broad engagement with clinicians of all disciplines who use the pathways and involvement of multidisciplinary teams in implementation is vital to increase visibility of the CPW.

Background: Integrated primary care teams remain a debatable policy in family medicine that could be a convenient response to French shortages in medical density.

Objectives: To analyse how general practitioners (GPs) respond to insufficient GP supply in their practice area in terms of quantity and quality of care, and how this response is mediated by enrolment in integrated primary care teams - multi-professional group practices (MGPs).

Methods: We used structural equation modelling on 3 representative cross-sectional surveys (2019-2020) of 1209 French GPs. Quantity and quality of care were approximated by latent variables comprising respectively GPs' demand absorption capacity and frequencies of vaccine recommendations.

Results: In the absence of potential mediators, low GP density was negatively associated with quantity (-0.221, unstandardized direct effects), but not with the quality of care. In the presence of mediators, low GP density was associated with higher work-related stress (0.120), which was consecutively associated with deteriorated demand absorption capacity (-0.202). Higher use of e-health tools was associated with greater involvement in vaccine recommendations (0.357). GPs in MGPs tended to use more e-health tools than those practicing outside MGPs (0.032), with a favourable effect on vaccine recommendations.

Conclusion: Lower level of work-related stress is the key mediator in handling patients' requests. When correcting for self-selection into MGPs, we found no significant mediation effect of enrolment in MGPs on the quantity of care but rather an effect on the quality of care. Our results pinpoint an added value of an enrolment in an MGPs to care quality that advocates for its further development.

Jel classification: I14, I18.