Frontiers in health services最新文献

Objective: Centering birthing parents is critical for improving reproductive health policies and practices. This study investigates patient perspectives on measuring the quality of perinatal care.

Methods: A cross-sectional qualitative research study was conducted at an academic medical center in the Southeastern United States. Individuals who had recently given birth participated in audio-recorded interviews between May 2020 and September 2020. This analysis addresses the research question, "If we were providing quality healthcare for families, how would we know?" Transcribed and translated responses were inductively coded to develop categories and identify themes.

Results: Forty birthing parents participated in the study. Metrics, timing, and process were identified as important components of meaningfully measuring the quality of perinatal care. Recommended metrics included asking patients whether their health priorities were addressed. Additional metrics of importance were whether coping strategies were provided, the clarity of information provided, patient comprehension of health information, the extent to which care planning was collaborative among patients and their healthcare team members, whether clinicians alleviated patient doubts, patient feelings of being taken care of, healthcare team mannerisms, clinician demonstrations of respect for patient autonomy, and postpartum visit attendance. With regard to timing, patients desired that their healthcare team members "check-in" with them as part of an ongoing, direct dialog. Birthing parents also wanted opportunities to provide feedback soon after encounters. As part of a robust measurement process, they wanted to share their insights with someone who was not a part of their healthcare team, for maintaining confidentiality. The patients desired a "serious platform" with accessible methods for all birthing parents to be able to convey nuanced accounts of their care. They also wanted to hear from the healthcare institutions about their feedback. Birthing parents sought assurances for their perinatal care feedback to be de-identified to protect them from potential retaliation. The participants recognized that they might need to utilize healthcare services from the same institution and individuals in the future.

Conclusion: Birthing parents expressed desire for their perinatal healthcare experiences to be understood. Meaningful quality measurement may be promoted through transparent and multimethod opportunities for patients to securely share insights. In addition to healthcare systems communicating assurances of patient confidentiality, institutional feedback in response to patient-reported experiences is recommended.

Background: Professionals who provide implementation support in human service systems describe relationships as being critical to support evidence use; however, developing trusting relationships are not strongly featured in implementation science literature. The aims of this study were to (a) assess the feasibility and acceptability of a theory-driven training and coaching approach for building trusting relationships among members of an implementation team who were supporting the implementation of an evidence-informed program in a public child welfare system in the United States and (b) gauge the initial efficacy of the approach in terms of the development of trusting relationships and subsequent implementation outcomes.

Methods: Consistent with a convergent mixed-methods approach, we collected both quantitative and qualitative data to address our research questions. Quantitative methods included an adapted version of the Trusting Relationship Questionnaire, a seven-item measure of psychological safety, and items designed to measure acceptability of the training. Qualitative data were collected through semi-structured interviews with participants.

Results: Sixteen individuals participated in the program, consisting of a kick-off training event, five monthly training modules, and five monthly coaching sessions with implementation team leads. Session attendance rates and self-reported satisfaction highlight the general feasibility and acceptability of the training and coaching approach. On average, participants also reported significant increases over time in their perceptions that they were trusted by their team. Results from in-depth interviews further indicated the efficacy of the program in terms of cultivating trust among team members and promoting several elements that were theorized to link trusting relationships to implementation outcomes.

Discussion: Findings suggest the training and coaching approach for trust building was acceptable and feasible. Additionally, results indicate the value of the approach in building trust among implementation partners to increase commitment to implementation efforts, promote a culture of learning and psychological safety, and increase participants' sense of capability and motivation for supporting implementation.

This perspective article shares the viewpoints of two long-standing patient safety advocates who have participated first-hand in the evolution of patient engagement in healthcare quality and safety. Their involvement is motivated by a rejection of the common cruelty of institutional betrayal that compounds harm when patient safety fails. The advocates have sought to understand how it can be that fractured trust spreads so predictably after harm, just when it most needs strengthening. Instead, the abandonment of trust upends healthcare values and effectiveness at interpersonal, systemic and structural levels. They argue that authentic care (healthcare that is truly caring) transcends mere service delivery, thus embodying an inviolable commitment to mutual well-being, compassion and generosity. The advocates identify the influence of social determinants, such as culture, identity, and socioeconomic status, as critical to trust formation, where pathogenic vulnerability exacerbates existing inequalities and further impedes trust. The advocates call for a shift from transactional to relational, trust-based interactions that explore the potential for mobilizing restorative justice principles to repair harm and rebuild trust, enabling dialogue, mutual understanding and systemic improvement. Trust, they assert, is born in relationships, not transactions. The bureaucratic, legal and resource constraints that often impair meaningful interactions, also cause moral distress to healthcare providers and poor care quality for patients. They argue that central to the current healthcare crisis is the fundamental need for genuine connection and trust, framing this as both a practical necessity and a confirmation of humanity as intrinsic to healthcare. The advocates envision a future where patient engagement is integral to patient safety to prioritize epistemic justice, mutual respect and compassionate care, to restore healthcare as a cohesive, supportive and deeply human endeavor. They query what contributions a restorative approach could make to centre trust as necessary for cultivating the conditions for care in our healthcare system.

Worldwide 56·8 million people need palliative care (PC), and Africa shows the highest demand. This study updates the 2017 review of African PC development, using a scoping review methodology based on Arksey and O'Malley's framework and the PRISMA-ScR checklist. The review was conducted across PUBMED, CINAHL, Embase, government websites, and the African PC Association Atlas, from 2017 to 2023, charting its progress using the new WHO framework for PC Development, which, in addition to Services, Education, Medicines, and Policies, two new dimensions were incorporated: Research and Empowerment of people and Communities. Of the 4.420 records, 118 met the inclusion criteria. Findings showed increased adult specialised services (n = 675), and 15 of 54 countries have paediatric services. Nonetheless, the ratio of services per population mostly remains under 0,10 per 100.000 inhabitants. PC education was included in undergraduate curricula in 29 countries; despite the rise in morphine availability (28 countries), median consumption remains under 3 mg/per capita/year, and 14 countries presented stand-alone policies. Publications on PC development increased, and 26 countries have National PC Associations. Notwithstanding progress since 2017, significant hurdles remain, highlighting the need for ongoing research and policy development to ensure equitable access to palliative care in Africa.

Background: Women's empowerment is one of the fundamental issues for attaining sustainable development goals crossing multiple dimensions. In Ethiopia, Women's Development Network (WDN), a network of women, was established in 2010 with development aims. Ensuring women's empowerment critically needs collective efforts of platforms such as WDN. However, there was a paucity of information about the patterns of WDN functionalities, its contribution, and factors affecting its functionality in rural areas of Southern Ethiopia. Hence, this study aimed to explore WDN status and factors affecting their functionality in Southern Ethiopia.

Methodology: The study employed an exploratory qualitative design. Data were collected from purposively selected zones using focus group discussions and key informant interviews. Audio-taped materials were transcribed verbatim and analyzed using a thematic approach. Initially, data were coded (open coding) and after several reviews, themes were developed and interpreted in line with the study objectives.

Result: WDN has passed several steps from its establishment up to now. It was seen skeptically at its early inception, very good level of acceptance in the middle, and staggering currently. However, WDN has contributed to improvements in household welfare resulting from increased ability to afford food, clothing, health, and education. Specific to health, WDN has contributed to general awareness creation, maternal and child health utilization, and environmental sanitation. On the other hand, the volunteer nature of the job put pressure on WDN and revealed socioeconomic stresses. Moreover, inconsistent support from stakeholders especially health extension workers, inadequate men's engagement, and sidelining of WDN by some educated women remain challenges for the sustainable functionality.

Conclusion: WDN has contributed to multidimensional development goals, especially health services uptake and environmental sanitation. However, over time, it became flaccid and lost adequate emphasis from most of its stakeholders and supportive structures. Therefore, considering such vital inputs from community participation in resource-limited settings, stakeholders should offer adequate attention to WDN in terms of selection, training, orientation, follow-up, and acquainting with the community they serve. Moreover, efforts are needed to retain women voluntarily serving and build positive images across all stakeholders and fellow women receiving the services.

Introduction: Aging rural veterans have limited access to geriatric mental health services. The establishment of Veterans Health Administration (VHA) regional telehealth hubs, or Clinical Resource Hubs (CRHs), has the potential to improve access to specialist care via telehealth delivered across healthcare systems within each VHA region. We used the Consolidated Framework for Implementation Research (CFIR 1.0) to examine variations in the tele-geriatric mental health (tele-GMH) care models being used in four CRHs.

Methods: We interviewed 11 CRH geriatric mental health providers and 12 leaders to (1) characterize the models of care, (2) identify factors in their region that support tele-GMH, (3) identify factors underlying model adaptations, and (4) learn about barriers and facilitators during implementation. The interviews were analyzed using a combination of CFIR-based coding and rapid qualitative analysis.

Results: The services used multiple telehealth modalities; their care delivery approach ranged from consultative to continuity services. Aspects of the inner setting, specifically structural characteristics, implementation climate, and implementation readiness, influenced the model that each CRH implemented. Barriers were largely related to inner setting structural characteristics. Facilitators highlighted the importance of planning, iteration, and engaging stakeholders during implementation.

Conclusion: Tele-GMH models varied in approach, tailoring their services to fit inner setting characteristics. Barriers and facilitators remained consistent across regions. Attending to inner setting characteristics, ongoing process improvement, and nurturing relationships with stakeholders is critical throughout the implementation of a tele-GMH program. Future research should examine the impact of the varied care delivery models on quantitative outcomes, including metrics related to access and healthcare utilization.

Introduction: Despite the prevalence and devastating consequences of diagnostic breakdowns, there have been minimal efforts to systematically collect patient insight into diagnostic problems and mistakes. Collaborating with patient advocates to guide how patient-derived insights are interpreted and used is a critical, yet often overlooked, approach to identifying actionable solutions that speak to patients' priorities.

Objective: We collaborated with patient advocate co-authors to guide our understanding of findings from a mixed methods survey on diagnostic problems and mistakes, and report implications for patient engagement at three levels of action: (1) individual level before, during, after encounters (micro); (2) within health service delivery systems (meso); and (3) policy advocacy (macro).

Methods: Our research team applied narrative elicitation methods to conduct a novel survey about Americans' diagnostic experiences in a national, population-based survey. We shared early results with patient co-authors who highlighted the importance of further exploring how health systems and clinicians address the aftermath of diagnostic mishaps. Based on their input, we summarized the quantitative and qualitative survey results about the aftermath and worked with our patient co-authors to explore how findings might inform actionable next steps, including efforts to catalyze patient action, quality improvement efforts, and policy reform.

Results: Of the 3,684 survey respondents, about a third (33.0%, 1,216/3,684) of screened households reported diagnostic problems and mistakes in the past four years involving either themselves (18.9%, 697/3,684) or someone close to them (14.1%, 519/3,684). In the aftermath of a diagnostic mishap, over a third reported that someone in the healthcare setting where the mistake occurred acknowledged the mistake (35.9%, 432/1,204). In qualitative findings, reports that the health system "did nothing" surfacing as the most common response. Patient co-authors confirmed the results resonated with their experiences and emphasized the need for health systems to take accountability when a mishap occurs and to take follow-up actions to prevent future mishaps.

Discussion: Patients and care partners not only want and deserve acknowledgement of diagnostic problems or mistakes in their own care, they also want assurance that steps are being taken to prevent similar events from happening to others. Across micro-, meso-, and macro-levels of action, working with patients to understand and act on contributors to diagnostic breakdowns is aligned with high-reliability organizing principles.

Background: Administrative staff in primary care undertake numerous tasks to support patient care delivery. Although their roles are often overlooked, administrative staff are essential to the coordination and operations of primary care clinics. The COVID-19 pandemic introduced additional clinical and administrative tasks, including transitioning to virtual appointments and triaging patients for urgency, changing typical workflows. In Canada, existing pandemic plans for primary care did not account for these administrative tasks, nor the support that family physicians would require to continue to provide patient access to primary care. This research seeks to describe and understand the perceptions and experiences of family physicians of their administrative staff roles in primary care during the COVID-19 pandemic, to help inform future pandemic planning.

Methods: We present findings from a qualitative case study across four regions in Canada: Vancouver Coastal health region in British Columbia, Ontario Health West region, the province of Nova Scotia, and the Eastern Health region of Newfoundland and Labrador. We conducted semi-structured qualitative interviews with family physicians (n = 68) across the four regions and thematically analysed the data.

Results: We identified five salient themes in the data, including (1) applying public health guidelines, (2) educating patients on COVID-19 and COVID-19 services, (3) re-organizing patient visits, (4) maintaining adequate staffing, and (5) recognizing administrative staff contributions. During the COVID-19 pandemic, family physicians took on numerous additional roles to reduce the risk of transmission of the virus with the support of their administrative staff. Family physicians emphasized the challenges of maintaining adequate staffing, and the importance of administrative staff in enabling the provision of primary care.

Conclusions: Existing pandemic plans do not account for increased administrative roles taken on by primary care administrative staff. Pandemic plans must include guidance for the roles taken on by primary care administrative staff, such as clinical tasks, as they will continue to play an important role in pandemic recovery. Supporting administrative staff would enhance primary care providers' ability to manage care during pandemics, facilitate resilience, and decrease provider and administrative burnout.

Background: Visual impairment (VI) is common among older adults aged 70 years and older, and its prevalence increases with advancing age. The optometry profession may play an important role in a patient-centred health system that incorporates medical and psychosocial aspects by working closely with low vision counselling services (LVCS). This paper investigates the current level of cooperation between optometry and LVCS by analysing the referral practice of optometrists to LVCS for the older population with VI, based on the PROVIAGE study.

Methods: A national, telephone-based survey of individuals aged ≥70 years and an online survey of professionals in ophthalmology, optometry and LVCS was conducted in 2022 across Switzerland.

Results: The responses of 154 individuals with VI and 272 professionals (123 ophthalmologists, 126 optometrists and 23 staff of low vision rehabilitation consulting centres) were analysed. Among the respondents with age-related VI, 33.1% stated that they were aware of LVCS. Of these, however, only 11.7% reported that they had visited such centres during the last five years. Sixty-eight percent of respondents attended the ophthalmologist, but only 1.3% went to the optometrist for vision-related problems. Among ophthalmologists, 95.9% indicated that they had referred patients to LVCS, whereas only 58.8% of optometrists had done so.

Conclusions: The results of this study highlighted the relationship between the different clinician referrals, patient needs, and potential barriers preventing referrals towards older adults in Switzerland. A stronger cooperation between professions in the care network will enhance vision care for the ageing population without the need for additional infrastructure.