Frontiers in health services最新文献

Introduction: Alongside the logic of care, many Western welfare states have introduced market elements or a logic of choice in their healthcare systems, which has led to consumerist behavior in patients. For the medical field, it is well documented how consumerism creates complex ethical dilemmas and undermines ways of thinking and acting crucial to healthcare. Little is known about these dynamics in mental healthcare.

Methods: This study used a qualitative mixed methods design, combining 180 online patient narratives (blogs) with 25 interviews with therapists in a grounded theory approach.

Results: Findings show that articulate behavior can be divided into two categories: assertive and adamant. While assertive behavior is understood as an integral, reciprocal part of therapy and is stimulated by therapists, adamant or consumerist behavior is experienced as damaging the relationship-the "commodity" the patient is seeking to obtain, as the single most important predictor of treatment success. Findings also show that articulate behavior in both varieties takes a different shape over time during the course of treatment.

Discussion: Adamant behavior clashes with the internal logic of care, which is especially problematic in mental healthcare where the relationship with one's therapist is key to successful treatment. Therefore, patients should be taught and helped to display assertive behavior without resorting to adamancy. Individual therapists cannot achieve this alone; this endeavour should be supported by their organizations, societal beliefs about therapy and policy choices.

Introduction: Implementation science frameworks with a focus on health equity have emerged to help guide the introduction of new interventions into healthcare and community settings while limiting health disparities. The purpose of this research was to explore the applicability of such frameworks to guide the equitable implementation of population genetic screening programs.

Methods: We searched PubMed and reference lists for relevant frameworks and examples of their use in health settings. We then assessed if and how selected frameworks provide guidance for different stages of population genetic screening: recruitment, sample collection, result return, follow-up care and long-term management, and cascade screening. Findings were synthesized into a list of health equity considerations specific to each stage.

Results: We identified 5 implementation frameworks that focus on health equity. Guidance varied by framework type: determinant (explaining what affects implementation outcomes), process (translating research into practice), or evaluation (assessing implementation). Common characteristics included focusing implementation efforts on populations who have historically experienced health inequities and adapting interventions to fit local contexts. Process models also highlighted the importance of community partnerships.

Discussion: Overall, frameworks offered broad recommendations applicable to population genetic screening program implementation. However, gaps still exist in guidance provided for later stages of population genetic screening. To improve the equitable implementation of genetic screening, future programs may benefit from utilizing one or more of these frameworks or by incorporating the health equity considerations and outcomes compiled in this analysis.

High maternal mortality and morbidity rates continue to significantly impact the United States, with Black birthing individuals being two to three times more likely to die from pregnancy related causes compared to other races. Ongoing discussions are crucial to improving care delivery and amplifying the experiences and needs of marginalized survivors of pregnancy-related psychological harm. Thus, this commentary leverages current literature and vignettes to deliver recommendations on authentically engaging patients in the cross-sectoral process of dismantling harmful clinical and research practices, thus building a safe, equitable future for maternal health.

Background: Quality laboratory services are key in the healthcare system for successful diagnosis and patient care. Uninterrupted laboratory services are needed to meet the needs of all patients and clinical personnel, but studies in developing nations revealed that most clinicians were dissatisfied due to the lack of quality laboratory services and frequent interruptions.

Objective: This study aimed to assess the level of health laboratory service quality, service interruptions, and its predictors in public Hospitals in Harar town, eastern Ethiopia.

Method: A facility-based cross-sectional study was conducted at Hiwot Fana Specialized University Hospital and Jugel General Hospital between January and April 2024. Data collection utilized Standardized Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) checklists and questionnaires based on the Ethiopian Hospital Standard Transformation Guidelines. Data were entered and analyzed by Statistical Package for the Social Sciences, version 26. Descriptive statistics such as frequencies, proportions, and means, were calculated. Binary and multivariable logistic regression models were applied to identify predictors with adjusted odds ratio (AOR) and a cut-off p-values <0.05 with 95% confidence interval (CI).

Results: Two public hospital laboratories and their 54 laboratory professionals were involved in our study. According to our study, the mean score of the two public hospitals was 168.5 (61%), while Hiwot Fana specialized university hospital scored 212 (77%) and Jugel General Hospital scored 127 (46.1%). The study also revealed that out of 72 tests, 31 (43.05%) were interrupted, with clinical chemistry tests being the most interrupted (16, 51.6%) followed by Serology (7, 22.6%) and Hematology (4, 12.9%) tests. Lack of timely management response (AOR = 7.78, 95% CI = 1.48-40.83) and shortage of supplies (AOR = 60.8, 95% CI = 1.07-32.83) were significantly associated predictors of laboratory service interruptions.

Conclusion: Neither of the hospital's laboratories met the required score of the SLIPTA standard for quality clinical laboratory services. Moreover, laboratory service interruptions were very common in the two public hospitals in which clinical chemistry, serology and hematology tests were the most frequently interrupted. Shortage of reagents and supplies and inefficient laboratory management are the major causes of service interruptions. So, policymakers and other stakeholders should support continuous quality improvement for a better patient clinical outcome.

Introduction: The experiences of patients receiving health care constitute an important aspect of health-care quality assessments. One of the purposes of the national program of patient-experience surveys in Norway is to support institutional and departmental improvements to the quality of local health-care services. This program includes national surveys of patients receiving interdisciplinary treatment for substance dependence performed four times between 2013 and 2017. The aims of this study were twofold: (i) to determine the attitudes of employees towards these surveys and their use of the survey results, and (ii) to identify changes in patient experiences at the national level from 2013 to 2017.

Material and methods: Employees were surveyed one week prior to conducting cross-sectional patient experience surveys. One-way ANOVA and chi-square tests were used to assess differences between years, and content analysis was applied to the open-ended comments.

Results: Around 400 employees were recruited in each of the four survey years, and the response rate varied from 61% to 79%. The employees generally reported a positive attitude towards patient-experience surveys, and 40%-50% of them had implemented quality initiatives based on the results of the patient surveys. The mean score for the question on usefulness was higher than 3 (on a Likert scale from 1 to 5 points) for all four surveys. Many employees provided details about the changes that had been made in open-ended comments. The results from the patient-experience surveys demonstrated positive changes over time.

Discussion: The employees had positive viewpoints towards patient-experience surveys, and around half of them had implemented quality initiatives. This implies that employees find such surveys important, and that patient-experience surveys are regarded as useful and actionable. The surveys of patients showed positive changes in their experiences over time. The most-common target areas reported by employees showed clear improvements in patient experiences at the national level.

Introduction: Anticipating and addressing implementation challenges is critical to ensuring success of mobile healthcare programs. Mobile Prosthetic and Orthotic (O&P) Care (MoPOC) is a new U.S. Department of Veterans Affairs (VA) program that aims to improve access to VA-based O&P services through a national network of traveling O&P clinicians who deliver care in rural communities. We conducted an iterative evaluation guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to identify challenges and associated strategies for successful implementation of this mobile O&P program.

Methods: MoPOC is delivered by an O&P clinician anchored at a VA medical center (VAMC). Clinicians travel to remote VA clinics and Veteran's homes with a custom vehicle which provides storage and a workshop to modify O&P devices. Each clinician is supported by a program support assistant. MoPOC was implemented in three phases. The qualitative evaluation of MoPOC implementation was conducted as part of a larger evaluation of MoPOC program outcomes. We conducted semi-structured interviews and regular check-ins with MoPOC clinicians, site managers, and stakeholders both prior to implementation and throughout the implementation process. Interviews were recorded and transcribed verbatim. Data was analyzed across sites and comparatively by phase using a rapid matrix analysis to identify themes related to adoption and implementation challenges and key strategies developed to address those challenges.

Results: We identified four key themes related to successful program implementation, each with associated challenges and improvement strategies: (1) "Finding the right sites for MoPOC" through intentional recruitment and site selection; (2) Identifying the "sweet spot": Balancing program capacity, sustainability, and MoPOC clinician satisfaction; (3) Shifting from testing to standardizing; and (4) "Being strategic with hiring" to improve program adoption.

Discussion: Implementation challenges were related to recruiting and selecting successful sites, ensuring timely program adoption, balancing site level adaptation and program standardization, and scaling programs to enhance efficiency, reach, and satisfaction. An iterative approach guided by the RE-AIM framework resulted in program improvement and more rapid implementation in each successive phase. The challenges described in MoPOC implementation may be common issues in implementing new mobile programs in rural areas.

Introduction: The translational gap from the discovery of evidence-based solutions to their implementation in healthcare delivery organizations derives from an incorrect assumption that the need for change among executive, administrative, or clinical personnel is the same as the demand for change. For sickle cell disease (SCD), implementation of evidence-based guidelines is often delayed or obstructed due to lack of demand. This challenge allows for the persistence of resource limitations and care delivery models that do not meet the community's unique needs. Agile Storytelling is a process built on the scientific foundations of behavioral economics, complexity science, and network science to create local demand for the implementation of evidence-based solutions.

Methods: Agile Storytelling includes a design phase and a testing phase. The design phase converts the evidence-based solution into a minimally viable story of a hero, a villain, struggle, drama, and a resolution. The testing phase evaluates the effectiveness of the story via a series of storytelling sprints in the target local healthcare delivery organization. The efficacy of Agile Storytelling was tested in an iterative n-of-1 case study design.

Results: Agile Storytelling was used in a large, urban, healthcare system within the United States to facilitate implementation of national SCD best-practice guidelines. After repeated failures attempting to use national and local data regarding the high societal need to hire a SCD-specific social worker, an Agile change conductor using Agile Storytelling was able to create demand for the new position within a week. This decision has ultimately improved patient outcomes and led to the adoption of a specialized collaborative care team for SCD within the health network.

Discussion: Agile Storytelling can lead to structured, effective, and informed storytelling to create local demand within healthcare delivery organizations.

Background: Care partners are individuals chosen by a person with an illness to support their care during hospitalization. Patients with persistent critical illness have longer than average critical care admission and often other conditions including dysphagia, communication vulnerability, severe physical deconditioning, the need for an artificial airway, and difficulty weaning from invasive mechanical ventilation. Family presence has been identified as important for patients experiencing persistent critical illness in specialized weaning centers. Despite this, the role of care partners in clinical settings for patients with persistent critical illness has not been fully characterized, particularly from the perspectives of patients, care partners, and health care providers. The aim of this study was to gain insights into the roles of care partners during persistent critical illness from the perspectives of patients, care partners, and health care providers.

Methods: We used qualitative descriptive methodology including semi-structured interviews and content analysis. Interviews were audio recorded and transcribed verbatim. Included participants (n = 30) were patient survivors (n = 7), care partners of patient survivors (n = 9), and professionally diverse health care providers (n = 14) of adult patients with persistent critical illness from two specialized units in one community academic hospital in Toronto, Canada.

Results: Participants across all groups described care partner roles that included physical, mental health, cognitive, social, and spiritual support of the patient, including the perceived role of safeguarding the multiple dimensions of care for the patient who is experiencing persistent critical care in specialized care settings.

Discussion: The results of this study are being used to co-design, implement, and evaluate a sustainable care partner program that is acceptable, appropriate, and feasible to implement in clinical settings where the care of patients with persistent critical illness occurs.

Reporting method: Consolidated criteria for reporting qualitative studies (COREQ).