Frontiers in health services最新文献

Many patients experience unexpected harm while receiving healthcare, with a lasting impact on patients, families, and caregivers. Communication and Resolution Programs are being adopted with increased frequency, as a more systematic, transparent, and equitable approach to these unexpected outcomes. The aim of this study was to identify whether demographic factors played a role in identifying patients with unexpected death, as managed in our CRP. This nested case-controlled compared 236 patients who experienced an unanticipated death with 2,360 controls who died expectedly over a 10-year period. Patients with unexpected death were more likely to be Black (AOR 2.18 95% CI 1.01-4.68), higher comorbidity burden (AOR 1.07 per additional co-morbidity, 95% OR 1.01-1.14), and a lower Relative Expected Mortality (AOR: 5.39; 95% CI: 1.76-16.55). Awareness of these demographic risk factors for unexpected mortality may lead to changes in how these patients are evaluated and treated. Communication and Resolution Programs can be used to identify the patients at the highest risk for unexpected outcomes.

A significant gap in perioperative safety persists due to the absence of internationally recognized guidelines for managing surgeon fatigue. While other high-risk fields utilize robust fatigue management systems, surgical institutions frequently rely on fragmented coping strategies and inconsistent local policies. This oversight is concerning, as evidence confirms that sleep deprivation compromises surgical performance, with simulator studies reporting technical skill reductions of up to 32%. Current countermeasures, such as work-hour limits or caffeine use, are insufficient substitutes for restorative sleep and have an inconclusive impact on patient care. This paper proposes a systemic solution, urging global, national, and hospital-level collaboration to establish a standardized framework for fatigue risk management. Key recommendations include the use of fatigue-monitoring tools, mandating rest periods that allow for at least six hours of sleep before elective procedures, creating backup on-call rosters, and making fatigue management a part of surgical training. Adopting these evidence-based protocols is an essential step toward protecting patients and fostering a sustainable, safer surgical culture.

Background: Various intravenous iron formulations show great promise in the treatment of iron deficiency anemia (IDA), and economic evaluation results are becoming increasingly important as criteria for allocating healthcare resources. This study aimed to systematically evaluate the economics of six main intravenous iron formulations in the treatment of IDA.

Methods: Computerized search of relevant studies in PubMed, Embase, Web of Science, and The Cochrane Library to collect economic evaluation of six intravenous iron formulations for the treatment of patients with IDA; the time limit for searching was from the establishment of the database to 30 July 2025. Two reviewers independently screened literature, extracted data, evaluated the quality of included studies using the Consolidated Health Economic Evaluations Reporting Standards 2022, and performed descriptive analyses.

Results: Of the 2,288 articles retrieved, 17 studies were included, including five drugs, conducted in 10 different countries. Six studies compared ferric carboxymaltose (FCM) with iron sucrose (IS); two studies compared FCM, ferric derisomaltose (FDI), and IS; one study compared FCM, iron dextran (ID), and IS; one study compared FCM, IS, ID, and FDI at three dose levels; one study obtained an economic ranking for FCM, ID, IS, and ferrous gluconate (FG); five studies compared FDI and FCM; and one study compared FDI with IS. The overall quality of the included studies was high. A total of 13 studies conducted sensitivity analyses to check the robustness of their results.

Conclusion: This review systematically evaluates the economic characteristics of the six main intravenous iron formulations for treating IDA. Current evidence suggests that the efficacy of FDI is better than IS, and the economic ranking of the four intravenous iron formulations can be summarized as FCM, ID, IS, and FG. Further research is needed to justify the economic comparison between FCM and FDI.

Introduction: The COVID-19 pandemic highlighted pre-existing weaknesses, revealing deep-rooted issues in infrastructure, access, and resource allocation that have long impeded African countries' ability to effectively meet population health needs. It also became evident during the pandemic that there were discrepancies in how vaccines were distributed, delivered and accessed in these countries. We aimed to identify vaccine distribution, service delivery processes and related barriers in Botswana to contextually explore practices that either enhance or hinder access and equity in vaccine distribution and delivery.

Methods: We conducted in-depth interviews, using a semi-structured interview guide, with a purposive sample of 18 key informants, including public health sector officials, non-state actors, policy makers, regulatory bodies and other stakeholders. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted following a deductive approach according to the six-step analysis framework by Braun and Clarke: (i) familiarization with the data; (ii) generation of initial codes; (iii) searching for themes; (iv) reviewing themes; (v) refining and naming themes; and finally, (vi) producing the report. Steps i-iii were conducted by two researchers. Attention was given to aspects of credibility, dependability, and transferability of the findings through key strategies, including team data review, coding, consensus on themes and review of both secondary and grey literature on vaccine roll-out in the country.

Results: Seven primary themes emerged from the findings. COVID-19 vaccine distribution and delivery in Botswana followed the existing primary health care system structures for routine vaccine delivery. Traditional mechanisms such as static public health facilities, private facilities, outreach campaigns, and mobile stops, were augmented through different roles played by stakeholders in the private sector, civil society organizations and non-governmental organizations. Religious and cultural norms were reported to affect vaccine uptake centered around smaller population groups that are historically known to be anti-vaccines. There is no deliberate gender and the disabled population programming for vaccine distribution and delivery in Botswana. The private sector improved access to vaccines by supporting supply chain logistics with transportation, especially to hard-to-reach areas.

Discussions: Achieving equitable vaccine access involves not only logistical and infrastructural considerations, but also coordination and collaboration across several sectors, enhancing gender diversity and inclusivity in planning, coordination, and decision making and implementation of strategies tailored to the needs of a wide range of vulnerable population groups.

Objective: This review will examine existing research to compare the differences in healthcare access for people with disabilities in rural vs. urban areas. The goal is to identify common obstacles and helpful factors that affect their ability to get healthcare, which can inform the creation of specific programs to close these gaps.

Methods: This systematic review was pre-registered with PROSPERO (Registration No. CRD42025648258). A comprehensive search was conducted across databases including PubMed, Scopus, Web of Science, and the Cochrane Library, for peer-reviewed articles published between January 1, 2010, and December 31, 2024. Studies were included if they addressed healthcare access for disabled individuals and made comparisons between rural and urban settings. Data extraction was performed using standardized forms, and quality assessment was conducted using the Mixed Methods Appraisal Tool (MMAT). Data synthesis involved a narrative synthesis and thematic analysis to identify key barriers and facilitators to healthcare access in rural and urban areas. The reporting of this review follows the PRISMA guidelines.

Results: Eight studies from Peru, China, the United States, Mozambique, and South Africa were included in the final review. A clear distinction emerged between the barriers to healthcare access in rural and urban areas. Rural settings were defined by infrastructure-related challenges, such as transportation difficulties, a lower number of healthcare facilities, and limited provider availability. Meanwhile, urban areas presented different barriers, including overcrowded facilities and extended wait times. Both settings struggled with socioeconomic disparities, but the specific barriers and facilitators varied. In rural areas, telemedicine and mobile clinics were identified as key facilitators, while in urban areas, specialized healthcare services and better public transportation were the most helpful in bridging access gaps.

Conclusion: This systematic review confirms that disabled individuals face significant, yet distinct, healthcare access disparities depending on their location. In rural areas, the primary barriers are transportation and a lack of facilities, which necessitates the development of community-specific solutions such as mobile clinics and expanded telemedicine. In urban settings, access is hindered by system overcrowding and socioeconomic divides, calling for interventions that improve public transportation access and address systemic inequalities. Ultimately, addressing these disparities requires a dual approach: empowering rural communities with technological and logistical support while simultaneously optimizing urban healthcare systems to be more accessible and equitable.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025648258, PROSPERO CRD42025648258.

Background: Simulation is a well-established tool for clinical education and has been used to uncover latent safety threats (LSTs) in healthcare settings. However, the extent to which systems theory underpins efforts to detect and mitigate LSTs remains unclear.

Objective: This scoping review explores how healthcare simulations have been used to identify and address LSTs, with particular attention to the visibility and application of systems theory in study design, implementation, and analysis.

Methods: Using PRISMA-ScR, we systematically reviewed studies from 2014 to 2024 across MEDLINE, EMBASE, and grey literature sources. Studies were included if simulation was used with the primary aim of identifying LSTs. Data extraction focused on definitions of LSTs, approaches used to identify and analyse LSTs, response strategies, and the visibility of systems theory.

Results: Sixty-six studies met inclusion criteria. Most (74.2%) used the term "latent safety threat," though definitions varied. Many studies lacked explicit detail on how LSTs were identified (33.3%) or analysed (41.8%). Systems theory was applied with varying visibility: 36.4% showed unclear or no visibility, 43.9% showed partial visibility, and 19.7% showed full visibility. While 80.3% described actions to address LSTs, approaches ranged from one-off fixes to structured quality improvement strategies. Case studies illustrate best practices and opportunities for improvement in theoretical transparency.

Conclusions: Simulation is a valuable method for identifying LSTs, but inconsistent application of systems theory and variable methodological transparency limit learning and generalisability. Future research should make theoretical underpinnings explicit, define terminology clearly, and align simulation design with both educational and organisational improvement goals.

Background: Diabetes education is key to achieving metabolic control and promoting healthy behaviors in people with type 2 diabetes. Mobile health (mHealth) tools have been shown to be an important tool for monitoring, disease care and lifestyle improvement in people with type 2 diabetes (T2D). In less developed countries, the effect of educational intervention through mHealth is still inconclusive. The objective of this study is to evaluate the effect of an intervention on metabolic control in people with T2D with mHealth intervention and educational website called "I understand my diabetes".

Methods: The study is designed as a 12-month randomized controlled trial with three parallel arms: (1) Web-based education, (2) Web-based education + mobile app (diet and exercise plan), (3) Usual care. The total study duration is 12 months with data collection at baseline, 3, 6, 9 and 12 months. We will enroll 408 Mexican adults with T2D, randomized equally across arms. Measurements at baseline, 3, 6, 9, and 12 months include A1c (primary outcome), lipid profile, anthropometry, body composition, quality of life, lifestyle, and physical activity.

Discussion: The trial will evaluate whether reinforcing diabetes education with an app and educational website improves metabolic outcomes in people with type 2 diabetes. Findings may be relevant for implementation in public institutions with high demand of people with type 2 diabetes who have not presented severe complications of the disease. Integration of mHealth into routine care could enhance self-management and disease control in people with type 2 diabetes.Clinical Trial Registration: Trial registration number: Clinical Trials.gov. Registry (NCT0627857I). The protocol number: Effect of Education with Mobile App on metabolic control in Patients With type 2 Diabetes. The registration number R-2018-785-100. Instituto Mexicano del Seguro Social. Mexico. Registration date: February 22, 2024.