Frontiers in health services最新文献

Background: Health services research (HSR) in Austria has expanded rapidly over the past two decades, reflecting the evolving need for a healthcare system that effectively addresses the broader challenges of an increasingly strained healthcare environment. Mapping the progression and focus areas of this research is essential for guiding policy-making and future studies.

Objectives: This bibliometric study aims to chart the evolution of Austrian HSR between 2000 and 2024. By examining publication trends, thematic priorities, collaboration networks, and research impacts, the analysis provides evidence-based insights that inform healthcare strategies and highlight research gaps.

Methods: A systematic literature search was conducted in PubMed, which targeted peer-reviewed articles published from 2000-July 31, 2024. In total, 81 articles met the inclusion criteria. Bibliometric methods, including coauthorship mapping, keyword co-occurrence analysis, and citation tracking, were used to identify core research themes, key authors, and institutional collaborations.

Results: Annual publication outputs increased notably from 2019 to 2020, corresponding to the heightened focus on healthcare during the COVID-19 pandemic. The major themes included mental health, patient care, public health, and disease management, with a growing interest in telemedicine and digital solutions. The Medical University of Vienna led publication activity, and strong international ties were evident, particularly with institutions in the UK and Germany. Citation analyses revealed varied research impacts, with some highly cited studies influencing policy debates and clinical practices.

Conclusions: Austrian HSR has a dynamic trajectory, reflecting evolving national priorities and global healthcare challenges. Continued efforts are needed to address gaps involving underserved populations, integrate digital health technologies, and enhance economic evaluations of primary care reforms. Furthermore, better standardization in the reporting of funding sources and conflicts of interest is recommended to strengthen methodological rigor and public trust. By fostering collaboration, transparency, and comprehensive evaluations, HSR can more effectively shape equitable healthcare policies in Austria.

Introduction: The health-related consequences of work stress are as broadly studied in the health care sector as they are elsewhere. However, behaviors such as underperforming at work, being less engaged at work, being habitually absent from work without good reason, intending to take unpaid leave, changing jobs or leaving the profession as consequences or correlates of stress and reward frustration at work are largely underresearched, particularly in Switzerland and in health care and across different health professions.

Methods: Cross-sectional survey data collected from the workforces of six public hospitals and rehabilitation clinics in German-speaking Switzerland were used for this observational study. A total of 1,441 health care workers from various professions participated in the survey. The study focused on effort-reward imbalance (ERI) as a work stress measure and on six different withdrawal behaviors. Relative frequencies stratified by health professions for all study variables (exposure, confounders, and outcomes) and multiple-adjusted odds ratios as measures of association were calculated.

Results: The findings revealed frequent work stress or rather widespread ERI among health professionals (49%). The results further revealed strong to very strong dose-response relationships between work stress levels and the chance or risk of withdrawal from work. Compared with the least stressed individuals, the most stressed individuals were at significantly increased risk for reduced job performance (aOR = 5.2), low work engagement (aOR = 4.4), increased work absenteeism (aOR = 2.2), and intentions to take unpaid leave (aOR = 3.1), to change the job (aOR = 35.0) or to leave the profession (aOR = 12.3).

Conclusion: Highly prevalent reward frustration in Swiss health care needs to be reduced to overcome inner resignation and resistance and to prevent health professionals from withdrawing from work, and health care from high follow-up costs above and beyond mere absences from work or high turnover.

Background: Patients with chronic illnesses need to take care of themselves and seek ongoing medical attention. By using technology, telemonitoring can minimize hospitalization and care costs, while increasing professional productivity, providing constant medical attention and enhancing patient self-care management. Despite all these advantages, nothing is known regarding the intentions of Ethiopian professionals and nurses to adopt telemonitoring technologies. Therefore, the purpose of this study is to evaluate the telemonitoring intention of Ethiopian professionals and nurses, as well as the factors related to it.

Methods: A total of 781 randomly chosen nurses and physicians who worked at public hospitals in Bahir Dar City, northwest Ethiopia, participated in a cross-sectional survey. To give everyone an opportunity, the sample size was distributed equitably among the hospitals and the profession according to staffing numbers. The sample was obtained using a simple random sampling technique. Data were gathered by skilled data collectors utilizing a self-administered questionnaire. For additional cleaning and descriptive statistical analysis, the data were imported into EpiData version 4.6 and exported to Statistical Package for Social Science version 25. Analysis of Moment Structure version 23 structural equation modeling was used to ascertain the degree of the association between the variables.

Result: The response rate was 732/781 (93.7%), with 55.7% (408/732) of the participants being men and two-thirds (67.6%, 495/732) being nurses. About 55.9% [95% confidence interval (CI): 52.3-59.6] of respondents intended to use telemonitoring. The desire to employ telemonitoring is positively impacted by performance expectancy (β = 0.375, 95% CI: 0.258-0.494), effort expectancy (β = 0.158, 95% CI: 0.058-0.252), facilitating condition (β = 0.255, 95% CI: 0.144-0.368), and habit (β = 0.147, 95% CI: 0.059-0.233). Age and gender positively affected the link between effort expectancy and intention to employ telemonitoring. It was discovered that being young and male has a beneficial relationship impact. Age positively moderated the association between the intention to use telemonitoring and the facilitating conditions, and adults were strongly linked with the relationship.

Conclusion: In Bahir Dar City public hospitals, over half of the doctors and nurses have the intention to use telemonitoring. Predictive indicators of intention to utilize telemonitoring that were statistically significant were performance expectancy, effort expectancy, facilitating condition, and habit.

Communication and Resolution Programs' (CRP) favorable impact on professional liability claims continues to draw attention, but because they are deliberately aligned to advance the health system's mission rather than amelioration of litigation exposure, CRPs stand a better chance of delivering durable healthcare improvements than traditional responses to patient harm. CRP adherents employ focused investigations overseen by their own patient safety leader in order to engage patients with a principled response following unintended clinical outcomes. Focused on safety and unencumbered by litigation delays, CRP investigations are more apt than traditional responses to lay bare patient safety risks including professionalism challenges. Leaders, however, must be prepared to embrace and address hard-to-hear truths about dysfunctional systems or disruptive humans that threaten outcomes of care or clinical staff wellbeing.

Introduction: Emergency department (ED) encounters offer strategic opportunities for sexually transmitted infection (STI) screening, prevention, and treatment for adolescents at risk for STIs who may not otherwise have access to routine screening. This study determined optimal ED implementation of the Teen Health Screen (THS), a validated, tablet-based, patient-reported, sexual risk assessment, and evaluated its implementation feasibility under variable workflows and high-stress tasks.

Methods: Workflow analysis included semi-structured interviews with patients, caregivers, and clinical staff members and clinical observations to understand patient and clinical workflow. The study was conducted in two urban pediatric EDs over six weeks. Participants included patients, parents/caregivers, registration staff, nurses, social workers, child life specialists, providers, and health IT experts.

Results: The primary study outcome was development of a general model of ED workflow and patient-clinician engagement, focusing on patient flow, clinical tasks, people, and technologies involved. Workflow analyses identified key opportunities for THS deployment during the nurse assessment process, which aligns with other existing screening activities and offers privacy. This approach addresses potential barriers to integration such as privacy concerns, language and literacy barriers, the sensitivity of discussing sexual history, comfort with technology, tablet accessibility and security, and internet availability.

Discussion: Workflow analysis provided valuable insights to the perceptions, thoughts, and practicality of implementing the THS in the ED. Interviews revealed general acceptance of the new process but highlighted logistical challenges, particularly with staffing and patient surge. Implementing the THS in ED settings appears feasible, with important opportunities identified for integration to improve patient safety, including staffing and workflow optimization.

Introduction: Restorative systems are human centred and distinguished by an emphasis on relational principles and practices. Emerging evidence indicates that a restorative approach holds promise to mitigate and respond to harm in the complex health environment. Advocates are collaborating with clinicians and institutions to develop restorative responses to adverse events.

Method: This paper shares the insights of an international network who have been collaborating to nurture the development of restorative policy and practice in five countries since 2019 (Aotearoa New Zealand, Australia [New South Wales & Queensland]; Canada [British Columbia], England and the United States [California]). Our work is at varying stages of maturity and incorporates co-designing, implementing, and evaluating restorative responses to adverse events.

Results & discussion: The viewpoint provides an overview of the core principles, emerging evidence, and shares our collective reflections about the constraining and enabling factors to development. We recognise that we cannot speak to the breadth of work underway worldwide. Our hope is that by drawing on our experiences, we can offer some thoughts about what a restorative lens offers the future of patient and family involvement in patient safety, whilst providing the opportunity for transparent critique of work to date.

Background: Patients' knowledge of dispensed drugs is essential to prevent preventable patient mortality and facilitating their recovery from illnesses. Several studies have been conducted in Ethiopia, but the overall level of patients' exit knowledge about the dispensed drugs and associated factors has not been estimated. The objective of this review is to assess overall level patients' exit knowledge of dispensed drugs and associated factors in Ethiopia.

Methods and materials: Only articles published in English were included in this review. PubMed, EMBASE and CINAHL, Web of Science, Google Scholar, Scopus, Ethiopian University Repository Online, and the Cochrane Library are the main databases. The review included cross-sectional studies written in English that met the inclusion criteria. Using a random effects model, the overall level patients' exit knowledge of dispensed drugs was estimated. Additionally, funnel plots and Eggers' test were used to assess publication bias. STATA version 14 was used to perform all statistical analyzes.

Results: This review included 10 studies involving 3,431 patients in Ethiopia. In Ethiopia, the overall patients' knowledge towards dispensed drugs was 50.73% [95% CI (31.81; 69.66); I2 = 99.4%, P < 0.001]. The patients' exit knowledge of dispensed drugs was statistically associated with the education level of the patients and the availability of adequate drug information.

Conclusions: One in two patients has good knowledge of dispended drugs in Ethiopia. Therefore, patients need special attention when dispensing drugs and leaving a health facility. Furthermore, the Ethiopian government, pharmacists, and other stakeholders must take immediate action to improve patients' knowledge about dispensed drugs in Ethiopia and identified factors.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024544256, identifier: CRD42024544256.

Hundreds of patients each year transfer from child to adult medical care when they become adults. The transfer in health care comes with a risk of interrupted treatment or a failure to follow treatment properly, which can have serious consequences for the physical and mental health and well-being of the young person, and for their future ability to engage in education, work or social life. The Child to Adult Transition project (CAT) is a cross-country and inter-disciplinary innovation and research project that aims to address this pertinent topic. CAT focuses on young people in rheumatology and mental health care in Denmark and Germany and develops transition programmes to support young persons and their parents in the transfer from child to adult medical care, while exploring how young people experience and reflect on this transition and their experiences of the CAT programs. The CAT study has a longitudinal, mixed-methods study design, surveying young patients (age 15-25 years), their parents/guardians, and health-care professionals via interviews (individual or group), field observations, and/or online surveys. At baseline, interviews will be conducted with 24-68 adolescents and young adults, 24-68 parents/guardians, and 24-68 health-care professionals in both countries and across disciplines. 13-14 observations will be made in three settings and, at baseline, 400 adolescents and young adults will receive the survey. Interviews and surveys will be repeated after six and 12 months. The study will focus on topics such as everyday life as a young patient, transition experiences, somatic, and mental health, and quality of life. The CAT project period runs from January 2023 to December 2025. Recruitment to the CAT study is ongoing and all ethical approval have been obtained from the different departmental sites and ethical committees. The project combines different medical disciplines (child, adolescent and adult rheumatology and mental health), academic disciplines (medicine, anthropology and psychology) as well as countries (Germany, Denmark). It also combines person-groups (young persons, parents, professionals) and methods (interviews, observations, surveys). This approach provides new perspectives on the medical, psychological and anthropological aspects of the complex nature of the medical transfer. The findings will feed into the guidelines on transitional care, can also be used in other medical disciplines, and can be prepared as popular publications and other media enabling a broader audience to be reached. The study protocol is registered on the Open Science Framework: https://osf.io/vdy9p.

Objective: This study aims to provide a deeper understanding of what persons with lived experience and professionals with experience of patient safety, suicide research, and investigations consider to be most important in investigations of healthcare before suicide to learn and improve the care of suicidal patients.

Method: This is a qualitative study based on 15 semistructured interviews with persons with lived experience of suicidality and professionals. Thematic analysis was used.

Results: The persons with lived experience and the professionals agreed that a holistic approach to the investigations is crucial. They should embrace a longer period of time, involve family and significant others, integrate the perspective and expectations of the patient, and analyze factors of significance for suicidality, suicide prevention, and safety. There is a need to improve the investigations through the involvement of all stakeholders and actors, securing competence in the investigation team and prioritizing cases to investigate.

Conclusions: Substantial changes in the approach and performance of investigations of suicide in healthcare are needed to make these investigations valuable for increasing the safety of the care of suicidal patients. A holistic perspective during the analysis is crucial for understanding the suicidal process, the interacting factors, and the care process preceding suicide. Competencies in suicidality, suicide prevention, and patient safety must be included in the analysis team to ensure high quality and relevance. To improve the value of these investigations, we suggest establishing a template based on current knowledge to ensure attention to variables of significance for a safe care of suicidal patients.