Journal of Health Services Research & Policy最新文献

Objectives: The lack of Indigenous health care data in Canada makes it challenging to plan health care services and inform Indigenous leadership on the health care needs of their respective Nations and communities. Several Canadian health care organizations have implemented a voluntary Indigenous identifier of patients within their electronic medical records. This study examines facilitators and barriers to implementing such a voluntary self-reported Indigenous identifier, from the perspective of key stakeholders who work at four Canadian health providers where an Indigenous identifier has been implemented.

Methods: The four Canadian sites comprise three hospitals and one health authority. At each site, key stakeholders participated in semi-structured qualitative interviews. Interviews were transcribed and coded. Relevant documents that were publicly available or provided by each site were reviewed.

Results: There were four primary findings. First, for the introduction of an Indigenous identifier to be successful there must be pre-existing strong and trusting relationships between Indigenous communities and health care organizations. Second, health care organizations must provide training for those who ask clientele to self-identify as Indigenous, to overcome issues such as any patient backlash. Third, for the relationship between Indigenous people and health organizations to flourish, data governance must be Indigenous-led. Finally, the collection of Indigenous identifier data can enhance Indigenous health care services and health care service planning and delivery.

Conclusions: Due to the ongoing distrust of government and health care services among Indigenous peoples and communities, special considerations are required prior to the implementation of an Indigenous identifier. Of primary importance is how health care organizations can contribute to Indigenous data governance and minimize potential harms associated with the collection of such data. The findings of this study can be used to guide other health care sites and Indigenous leaders aspiring for more robust health data by implementing voluntary Indigenous identity data collection.

Objectives: Collaborative and integrated (C + I) working between general practice and community pharmacies has the potential to increase accessibility to services, improve service efficiency and quality of care, and reduce health care expenditures. Many existing studies report challenges and complexities inherent in establishing effective C + I ways of working. The aim of our review is to understand how, when and why working arrangements between General Practitioners (GP) and Community Pharmacists (CP) can provide the conditions necessary for effective communication, decision-making, and C + I working.

Methods: We conducted a realist review to explore the key contextual factors and mechanisms through which GP-CP C + I working may be achieved. MEDLINE, Embase, CINAHL, PsycINFO, HMIC, Web of Science, IBSS, ASSIA, Sociological Abstracts, Sociology Database and the King's Fund Library Database were searched for articles and grey literature published between January 2000 and April 2022.

Results: A total of 136 documents were included in the final synthesis. Our findings highlight the importance of mutually beneficial remuneration models to support effective integration of services; supportive organisational cultures and values; flexible and agile IT systems/technologies; adequate physical infrastructure and space design to support multidisciplinary teamworking; the importance of establishing patient's trust in collaborative processes between GP-CP; and the need to acknowledge, support and utilise effective triadic relationships.

Conclusions: Our research generates new insights regarding how, why and in which contexts C + I working can be achieved between GPs and CPs. The findings of our review can be used to inform future policy, research and clinical practice guidelines for designing and delivering C + I care.

Objectives: The purpose of this study is to investigate how organizational factors influence the ethical and economic problems of overtreatment of cancer patients.

Methods: The study applies a sequential mixed-method approach. First, our logistic regression model assesses how patient characteristics and hospital department variables influence the use of late cancer treatment (LCT), primarily chemotherapy, in stage IV non-small cell lung cancer cases using Danish registry data. Department-specific variations in LCT use across hospitals are identified, while controlling for population differences. Then, using qualitative data, we explore organizational factors that may influence hospitals' decisions regarding LCT for lung cancer patients.

Results: Between 13% and 33.3% of the studied lung cancer population receive LCT within their last 30 days of life. Variation in LCT can in part be explained by organizational factors specific to the hospital departments and their organization of their treatment decision-making process.

Conclusions: This article is among the first to show how organizational solutions can contribute to curbing overtreatment. Hospital managers can seek to reduce overtreatment by (a) adjusting the format and frequency of patient consultations, (b) improving the cross-disciplinary collaboration structures, and (c) utilizing team conferences for discussions of treatment cessation.

Objective: In England, most long-term care for older people with complex health care needs is provided by private care homes. They rely on primary care to provide medical care and access to specialist health care services. This study explored the working relationships between care homes and primary care in one region in England to inform a theory of change for achieving improved relationships.

Methods: We carried out a multi-method qualitative study using appreciative inquiry. We thematically analysed data from 33 survey responses, 15 interviews, and eight workshops with care home and primary care staff, family carers, and other community specialists to populate the theory of change. A patient and public involvement representative supported data collection, analysis, and write-up.

Results: Study participants described activities that encouraged role understanding, communication, and learning together benefitting staff, relationships, and quality of services. The lessons and experiences from the COVID-19 pandemic had shaped participants' understanding of what is required to sustain cross-sector collaboration. Key inputs included time, staff, and funding to facilitate learning how to work together effectively, as well as the capacity to adapt to diverse care settings and address the complex, individual needs of care home residents. Participants noted the few opportunities they had to share their learning and discuss best practice.

Conclusion: The theory of change identified different dimensions of good practice, providing insight into areas for action to inform service design and practice. Ongoing organisational changes should consider what is already working well and build on these achievements to enable positive care home and primary care working relationships and so foster high quality care and equitable access to services.

Objectives: This study sought to describe feelings and perceptions of burnout and moral distress experienced by health care providers in the Canadian province of Saskatchewan during the COVID-19 pandemic.

Methods: This study was part of a larger mixed methods project, and we here report on the qualitative results relating to burnout and moral distress experienced by medical doctors, registered nurses and respiratory therapists. We used an exploratory, qualitative descriptive design involving one-one-one interviews with 24 health care providers. Interview data were analysed using a reflexive thematic analysis approach.

Results: We identified three overarching themes each for health care provider burnout and moral distress. Interviews revealed that providers experienced burnout through (i) increased expectations and (ii) unfavourable work environments, which led most of them to recognise (iii) a need to step back. Regarding moral distress, key themes were: (i) a sense of compromised care, (ii) feelings of bumping heads with authorities and patient families, and (iii) seeing patients make difficult decisions.

Conclusion: Our study found that medical doctors, registered nurses and respiratory therapists working during the COVID-19 pandemic experienced and continue to experience significant burnout and moral distress. This was often driven by both institution- and system-level factors. There is a need for sustained investment to build and support a motivated health care workforce to prepare for future pandemics and health emergencies.

Objective: This study examined whether being scheduled in a screening clinic versus scheduled directly with a long-term provider to conduct a mental health intake (MHI) is associated with engagement in child psychiatry services in New England, USA.

Method: We used electronic medical record data from one safety-net hospital serving a predominantly low-income and minoritised population. The study sample included 815 youths aged 0 to 25 years, referred or scheduled for a MHI between 1 January 2016 and 31 December 2016. We used chi-square and t-tests to examine the association between referral pathways and engagement, logistic regression to understand the relationship between youth's socio-demographic characteristics and referral pathways, and logistic and Poisson regressions to assess potential moderating effects of socio-demographic characteristics on engagement.

Results: The mean age of the study population was 12 years; 46% were female, and the majority had public health insurance (84%) and lived in high social vulnerability areas (65%). Less than half of the youth attended the first scheduled MHI visit. Those scheduled with the screening clinic were less likely than those scheduled with the provider to ever attend a MHI appointment. Spanish-speakers were more likely to be directly scheduled with a provider (Odds Ratio, OR 0.48; 95% CI: 0.32, 0.73), while those with public health insurance were more likely to be scheduled with the screening clinic (OR 0.56; 95% CI: 0.43, 0.96). Spanish-speaking status and areas social vulnerability scores moderated the relationship between the referral pathway and engagement in psychiatric appointments.

Conclusions: The study highlights the need for psychiatric services to evaluate how MHI referral procedures may mitigate barriers to care and facilitate engagement for youth at high risk of not attending psychiatric service appointments.

Objectives: The recruitment and retention of health care staff to remote and rural communities is a major challenge. This study explored the experiences of remote and rural communities in trying to attract and retain health care staff and their families in the UK.

Methods: Qualitative case studies in five remote and rural communities, two in England and three in Scotland. We conducted interviews with 22 participants across the five sites, including community members actively involved in recruitment and retention, health care professionals, and their family members. Fieldwork combined remote and in-person data collection. We used thematic analysis across cases drawing on asset-based community development as our theoretical framework.

Results: Communities undertook various activities such as making promotional videos, social media campaigns, getting involved on interview panels, and informal social integration efforts. They drew on a range of local assets to encourage health care staff to come to the area, including showcasing local landscapes, outdoor activities, a safe, welcoming community for children and families, and good quality of life. They also drew on the skills of local people with backgrounds in marketing, design, communications and photography or film-making. The absence of some key assets posed challenges, particularly lack of housing, schooling provision, employment opportunities for other family members, and cultural activities. Community-led initiatives were often prompted by local dissatisfaction with health organisations' efforts to recruit health care staff, and a wish to exercise some control over recruitment initiatives. Activities were commonly driven by a small number of individuals. While this worked well in some communities, the burden of responsibility could be substantial. This also sometimes led to tension within communities. Retention efforts commonly relied on informal networks of key individuals who intentionally forged social links for incoming families.

Conclusions: There is a key role for communities to play in recruitment and retention in remote and rural regions. There is an opportunity to actively engage community members in collaboratively crafting a campaign that highlights the area's key attractions while being mindful of limitations on reliance on an asset-based approach. Retention is a neglected topic, relying on key individuals going out of their way to help newcomers integrate. The formation of a community stakeholder group could help formalise this and reduce reliance on the goodwill and energy of individuals.

Objectives: General practice plays an important role in delivering and supporting mental health care within communities, particularly for those living in rural areas where access to specialised support is limited. This study sought to understand the barriers and facilitators to providing mental health care in rural Australian general practices. Methods: A descriptive qualitative study was undertaken involving online interviews with 14 staff at three rural Australian general practices between June and September 2023. Participants included nurses (n = 4), GPs, (n = 4), reception staff (n = 3) and practice managers (n = 3). Data were analysed using inductive thematic analysis. Results: Our analysis identified three themes: (i) systemic challenges and supportive infrastructure; (ii) health care personnel factors; and (iii) patient characteristics and preferences. Systemic challenges included limited access to services and specialist support, and challenges with information transmission, while the clinic location and set-up were seen as beneficial. Health care personnel factors included interpersonal needs and challenges, time constraints and how to balance care needs, and the difficulties of attracting and retaining a local workforce. Patient characteristics and preferences included societal stigma and individual hesitancy, lack of awareness, understanding and education around mental health and willingness and affordability of travel and using technology. Conclusions: Rural general practice in Australia faces a range of barriers and enablers that shape the provision of mental health care. To address these challenges, collaboration across various sectors will be required. Improving infrastructure, better resource allocation, addressing workforce shortages, reducing stigma, enhancing mental health literacy, and ensuring the accessibility of mental health care services are all crucial steps. It will be important to align policy goals across sectors to improve the delivery of mental health care in rural general practice in Australia.