Frontiers in health services最新文献

Introduction: Several barriers, such as lack of time, knowledge and support, hinder clinicians from providing an individually tailored physical activity (PA) prescription and referral to their patients. As a result, "exercise is medicine" (E = M) is not systematically implemented in clinical care today. Many studies have identified facilitators and barriers to implementation, yet linking these factors to tailored implementation strategies is still an under-researched area. Therefore, this study aimed to apply Implementation Mapping to develop an implementation protocol to support the individually tailored PA prescription in hospital care.

Methods: We used strong stakeholder participation and, we applied the five tasks of the systematic Implementation Mapping approach to match implementation strategies to implementation barriers and facilitators identified through interviews with clinicians working at two university hospitals in the Netherlands.

Results: We identified clinicians as primary actors. Secondary actors were managers of the departments and stakeholders in the broader context. For each actor group, performance objectives were defined. We matched previously identified facilitators and barriers to theory and evidence-informed implementation strategies from the Effective Practice and Organisation of Care taxonomy using the CFIR Strategy Matching Tool. Next, we translated these implementation strategies (e.g., active learning, audit, and feedback, technical assistance, peer education) into practical activities to support the implementation of the E = M tool, such as training for clinicians, creating overviews of possible local exercise referral options, and appointing role models for clinicians. Lastly, these activities were bundled into an implementation protocol. The implementation protocol consisted of a set of implementation activities to support and guide clinicians during the adoption, implementation, and sustainability process of the prescription of E = M. All activities were supported by implementation tools, practical applications, and materials while allowing tailoring to the specific clinical context.

Discussion/conclusion: This study illustrates the application of Implementation Mapping to design an implementation protocol to support and guide the prescription of E = M by clinicians in the hospital environment, using strong stakeholder participation in the development process. The stepwise development of the implementation protocol can serve as an example for researchers or practitioners preparing for E = M implementation.

Background: Psychiatric patients admitted through emergency pathways often presented with severe comorbid physical illnesses, which posed challenges for timely diagnosis and effective management in psychiatric specialty hospitals. To address this gap, our hospital established an integrated model that linked the Psychiatric Emergency Department (PED) with the Psychiatric Intensive Care Unit (PICU), aiming to create a continuous and coordinated emergency-critical care system.

Description of the model: The PED-PICU integrated model was developed through progressive institutional innovations, including the establishment of a dedicated PICU, functional integration of the PED, and the creation of specialized rapid-response centers. This model enabled early identification of critical conditions, seamless transfer between emergency and intensive care, and continuity of treatment until recovery.

Experience and outcomes: In practice, the model improved coordination between emergency and critical care teams, facilitated timely interventions, and ensured that patients with severe psychiatric and medical comorbidities received comprehensive management within a single institutional framework. The integration also strengthened multidisciplinary collaboration and highlighted the unique role of psychiatric specialty hospitals in managing complex emergencies.

Conclusions: The PED-PICU integrated model represented a pioneering and unique practice in psychiatric specialty hospitals. By closing the gaps between emergency stabilization and intensive care, it established a closed-loop system that might serve as a valuable reference for developing similar subspecialties and improving emergency-critical care pathways in mental health services.

Background: A growing workforce is being employed internationally to assist patients in navigating between health and social care providers. These roles operate under various care models including patient navigation, social prescribing, and care coordination; tasks and responsibilities of care navigators are highly variable and often lack clarity. Understanding the similarities and differences amongst care navigator roles could improve the embedding of roles into health and social care systems and legitimise professional identity. This umbrella review synthesises evidence on care navigator roles, role titles, tasks, and functions, across diverse models that integrate care at the health and social care interface.

Methods: MEDLINE, Embase, CINAHL, Scopus, and PsycINFO were searched from 1 Jan 2019-31 May 2024. Reviews that used systematic, scoping, or other rigorous methodology were included if they discussed the role or function of workers who coordinated services involving health and social care. Data were synthesised using an inductive thematic approach.

Results: Twenty-six review articles were included, which synthesised 824 unique primary sources. Seventy-eight unique role titles were used to describe care navigators, which aggregated under seven role categories: Patient Navigator, Link Worker, Care Coordinator, Case Manager, Social Prescriber, Intermediary, Health Mediator. The most common were Patient Navigator and Link Worker. Tasks related to navigation, building service users' capacity for self-management, and providing person-centred care overlapped across all role categories, indicating the core functions of the navigation workforce. Patient Navigators' scope of practice included the provision of education, appointment coordination, and assistance with logistic issues, while the roles of Link Workers typically only provided referral-based navigation and developed the capacity of service users for self-management.

Conclusions: The range in the titles and role scope of care navigators highlights increasing demand for system integration, however, the high variability of interchangeable terms and overlapping tasks create complexity for service users, providers, and researchers. An international Delphi study could create a consensus on the nomenclature and taxonomy for navigator roles that interface between health and social care systems. Developing professional identities, training, and strategies to seamlessly embed such roles into existing health and social care structures is also needed.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, PROSPERO #CRD42024572605.

Introduction: Short breaks are essential to enable unpaid carers to have a life alongside caregiving. However, there is limited understanding of how carers' break needs evolve over time. This scoping review aimed to identify models of dementia caregiving to explore how short break needs may change across the caregiving career.

Methods: The review followed the best practice guidelines by and Arksey and O'Malley and Levac et al. A search was conducted across four databases in 2023 and rerun in 2025: Applied Social Sciences Index and Abstracts, CINAHL, MEDLINE, and APA PsycINFO.

Results: Eleven models were identified, outlining various stages of caregiving. These models focused specifically on spousal carers or predominantly included spouses. They demonstrate that caregiving is a dynamic process, marked by increasing demands on carers' time and shifting relational dynamics. The models suggest that short break needs may change in response to certain circumstances, with a shift in emphasis from relational well-being in the early stages to rest and recuperation in later stages.

Discussion: The findings highlight the importance of regular practitioner engagement to monitor and discuss changing break needs, and the need for accessible community and social opportunities that support a mutual respite experience for both the carer and the person with dementia. Key knowledge gaps are identified, including the potential role of short breaks in supporting the person with dementia during the transition to residential care, and in helping carers adjust to this new phase of caregiving. Future research could also examine the best ways to capture and monitor short break needs over time, including during Carers' Assessments and other short break conversations.

Introduction: Male involvement is crucial in optimizing maternal reproductive health outcomes, offering the potential to bolster reproductive health outcomes for mothers. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework can describe the implementation of interventions focused on promoting male involvement in maternal reproductive health. This study aims to (1) examine the implementation of male involvement interventions that influence maternal reproductive health outcomes and (2) report the implementation outcomes as conceptualized in the RE-AIM framework.

Methods: This protocol followed the preferred reporting items for systematic review and meta-analysis. We searched PubMed, CINAHL, PsycINFO, and Web of Science utilizing a systematic review with narrative synthesis methodology to identify studies describing interventions that promote male involvement in maternal reproductive health outcomes in Africa from 2000 to 2024 Furthermore, we evaluated the public health impact of male involvement interventions from selected studies using the RE-AIM framework. Two reviewers independently screened articles, selected eligible studies, and extracted data. The quality of included studies was assessed using the NIH Assessment Tool for Observational Cohort and Cross-Sectional Studies.

Results: This review included six studies that met the inclusion criteria. Overall, the studies reported increased maternal reproductive health indicators (e.g., antenatal care uptake, antiretroviral medication adherence, and postnatal care uptake) after implementing the male involvement-focused interventions. The most commonly reported RE-AIM dimensions were Reach (83.4%) and Efficacy/Effectiveness (70%). Adoption (40.5%), Implementation (38.9%), and Maintenance (13.3%) were less often reported. All studies reported on measures of primary outcomes, intervention duration and frequency, sample size, and participants' characteristics. However, few reported on implementation fidelity, quality of life, methods used to identify staff, staff inclusion/exclusion criteria, implementation cost, and maintenance indicators.

Conclusions: The review underscores the potential of male-involvement interventions in advancing maternal reproductive health outcomes. However, the limited reporting of external validity indicators such as intervention fidelity, intervention cost, and maintenance indicators limits such interventions' scalability and long-term sustainability. This calls for more focus on reporting external validity indicators to inform the scalability and transferability of such interventions in real-world settings.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251031192, PROSPERO CRD420251031192.

Community-based clinics are a crucial site for the detection and response to Hypertensive Disorders of Pregnancy (HDP), yet many sites lack a standard protocol to address hypertensive emergencies. Moreover, interventions to address this disparity lack a patient centered lens that inform implementation in a community setting. To address these gaps, the Advancing Community and Clinical Care for Childbirth-related Hypertension: Implementation, Engagement and Valuing Equity (ACHIEVE) study is engaging patients with lived experience of HDP. The study integrates community engagement and implementation science to inform adaptation of a hypertension bundle in outpatient clinics. We have created two Patient Action Groups (PAGs) involving members from populations impacted by HDP to guide our community-academic-clinic-coalition team's iterative processes for bundle implementation and resource development. One PAG is comprised of Black and the other Latina/e birthing people, all of whom have lived experience with HDP. Both PAGs meet monthly, led by a racially/ethnically, culturally, or linguistically congruent facilitator. Agendas are co-created, and activities structured to build relationships, trust, and capacity. PAGs review ACHIEVE strategies and materials to spur recommendations and improve respectful care. To facilitate reciprocal exchange, PAG facilitators meet with the ACHIEVE community engagement team and share updates at monthly partner coalition meetings. We recommend PAGs as a power-shifting strategy to ensure those most affected by inequitable perinatal outcomes can engage in research in a way they feel safe, respected and heard. Researchers can also increase trustworthiness by listening and translating patient-generated ideas into strategies that improve clinical care.

Introduction: Spinal muscular atrophy (SMA) is a rare disease characterized by challenges in its management both for patients and parents/caregivers. In Greece, these challenges are exacerbated by the lack of an integrated SMA patient pathway. This survey mapped the experiences of parents of SMA pediatric patients with the Greek healthcare system, highlighting the actual pathway, its impact on quality of life, and associated financial burden.

Methods: Parents of children living with SMA, who were members of MDA Hellas, a non-profit organization for people with neuromuscular diseases in Greece, were invited to complete a novel online questionnaire, prepared in collaboration with the Health Policy Institute, a non-profit research organization specializing in health policy evaluation and design. The survey ran from May to September 2023. The results were analyzed using SPSS V26.0.

Results: Forty-four parents participated in the survey, with a mean age of 43.2 years. In the absence of universal prenatal or newborn screening, parents were the first to recognize any symptoms in the majority (73.5%) of cases. A total of 38.6% of parents had to travel from their place of residence to receive a diagnosis for their child. More than half had to pay out-of-pocket for diagnosis-related services. Parents shouldered additional treatment services and assistive aids' costs in excess of 300 euros a month. The majority reported feelings of agony and fear (90.9%) and guilt (25%) upon receiving the diagnosis. The average PedsQol score was 67 (SD = 15.8), whereas Zarit scores confirmed a higher burden for caregivers of children with graver SMA types.

Conclusion: This survey details the concerns and needs and quantifies SMA burden on parents/caregivers of children with SMA in Greece to inform health policy advocacy. Such advocacy should be translated into a national action plan with a focus on integrating care organization and delivery options.

This policy brief presents a structured, phased framework to establish Health Technology Assessment (HTA) within Emirates Health Services (EHS), promoting evidence-based decision-making and optimizing healthcare delivery. The model emphasizes capacity building, stakeholder engagement, and transparency to enhance patient outcomes and ensure financial sustainability. It follows four phases: Phase 0 (strategy alignment, stakeholder mapping), Phase 1 (budget impact and disease burden analysis), Phase 2 (managed entry agreements, multi-criteria decision analysis), and Phase 3 (full HTA adoption with performance metrics). Key methodologies include budget impact modeling, cost-effectiveness, and cost-utility analysis. Evidence is drawn from registries, clinical databases, and pharmacoeconomic studies. The framework offers a scalable and sustainable roadmap for HTA in the UAE, supporting efficient technology integration, optimal resource allocation, and alignment with national priorities. However, the framework's successful implementation will depend on the availability of high-quality local data, sustained stakeholder engagement, and supportive regulatory mechanisms. Potential challenges such as resource constraints, fragmented governance, and variability in HTA maturity across the region highlight the need for flexibility and adaptive strategies.