Frontiers in health services最新文献

Introduction: Timely access to positive, culturally competent healthcare experiences may be critical for transgender and gender diverse (TGD) individuals. However, gaps remain in our understanding of TGD individuals' access to these experiences. Our aim was to determine whether TGD individuals' likelihood of reporting delays in care and positive healthcare provider interactions differs from that of cisgender people.

Methods: We analyzed survey data from 89,133 participants who enrolled in the National Institutes of Health's All of Us Research Program from 5/6/2018 to 4/1/2021. Unadjusted and adjusted logistic regressions were performed to assess the association of gender with delays in care in the past 12 months and provider interactions.

Results: After adjustment, TGD individuals were more likely than cisgender men to report eight of nine reasons for care delays and more likely than cisgender women to report two of nine reasons. TGD individuals were more likely than cisgender men (OR: 2.20, 95% CI: 1.88-2.58, p < .001) or women (OR: 1.45, 95% CI: 1.24-1.70) to report delaying care for any reason enquired about on the survey. TGD individuals were less likely than cisgender men to report all three types of positive healthcare provider interactions and were less likely than cisgender women to report two of three types of positive interactions.

Conclusion: Our findings indicate that TGD individuals may be more likely than cisgender people to experience delays in care and less likely to experience positive healthcare provider interactions. This suggests a critical need to increase TGD individuals' access to supportive, culturally competent healthcare providers.

Background: Decentralization in health systems enhances responsiveness and equity but is often accompanied by uneven implementation and resource disparities. Greece' health system has undergone successive phases of decentralization, culminating in a transformation in 2015 when regional health authorities (RHAs) assumed operational responsibility for public primary healthcare (PHC). This study presents the first comprehensive assessment of this transition, examining funding adequacy and resource allocation across RHAs.

Methods: Financial and operational analyses were performed to assess disparities among RHAs and between RHAs and hospitals. Data were drawn from publicly available sources, including financial statements, reports from the Ministry of Health, and national statistics. The analysis examined patient visits, staffing levels, infrastructure, funding, labor productivity, and efficiency across health regions.

Results: Between 2018 and 2023, patient visits declined at most RHAs. Staffing composition shifted toward nursing personnel, while medical staff numbers declined. Substantial intraregional and interregional disparities were observed in service utilization, staffing, infrastructure, funding, labor productivity, and efficiency. Hospitals continued to absorb a large share of PHC demand and funding, whereas RHA units held markedly fewer assets and received lower financial support. Funding imbalances among RHAs were evident, and the overall negative return on assets indicated systemic underfunding of public PHC.

Conclusion: The ongoing decentralization of Greece's health system faces structural challenges, including overlapping territorial jurisdictions and uneven, occasionally insufficient, resource allocation. These challenges hinder progress toward health equity. Policy interventions should prioritize evidence-based resource allocation, standardized financing frameworks, and strengthened PHC integration to promote equitable and sustainable healthcare delivery under decentralized governance.

Introduction: The World Health Organization (WHO) and UNICEF recommend at least two postnatal home visits by a health provider within the first two weeks of life to improve newborn survival. Kenya's Universal Health Coverage (UHC) initiative includes a home-visit strategy to advance Sustainable Development Goal (SDG) 3.2, which targets reducing neonatal mortality to below 12 per 1,000 live births. We estimated the costs of starting a postnatal home-visit program in a level three health facility in Kenya, based on recommendations from Kenya's Ministry of Health policymakers.

Methods: An ingredients-based costing method was used to determine the actual costs of home visits incurred during a research project conducted in 2019, and to estimate program costs from the government's perspective as the payer. Per-visit costs were calculated for three staffing approaches: Community Health Promoter (CHP), Registered Nurse (RN), and a Combined model where two providers (RN + CHP) visited each home together.

Results: Staff salaries and transportation costs were the main drivers of recurrent program expenses. The CHP approach had the lowest total cost at $27,302 ($24.46 per visit), followed by the RN-only approach at $36.45 per visit, while the Combined model (RN+CHP) was the most expensive at $52.10 per visit. Discussions with policymakers noted that the RN+CHP approach was least feasible and scalable. They proposed an alternative "Hybrid" model in line with current programs being scaled up: weekly RN visits during the first month of life (neonatal period), and quarterly CHP visits thereafter.

Discussion: This study presents a costing tool and generalizable formula that policymakers can use to estimate program costs based on different facility characteristics and staffing needs. The findings can support Kenya's efforts to scale up postnatal home-visit programs to improve maternal and newborn health outcomes within the UHC framework.

Introduction: Knowledge translation in healthcare has been of keen interest to researchers, practitioners, policymakers and administrators as it seeks to confront complex health issues within communities by closing the gap between knowledge generation through research and knowledge application. A paucity of information exists regarding nature of the relationship between Nigerian implementation science researchers and policymakers in the sphere of knowledge translation. This study aimed to identify and discuss barriers to successful engagement between implementation researchers and policymakers as well as to identify strategies for successful engagement between both parties in Nigeria.

Methods: A modified Nominal Group Technique was conducted with 259 diverse health research stakeholders attending the 7th Nigeria Implementation Science Alliance conference in Abuja, Nigeria, to identify barriers to knowledge translation in Nigerian healthcare settings.

Results: Lack of interest in non-aligned priorities of implementation researchers and policymakers, knowledge and capacity gap in stakeholder engagement, and non-existence of engagement framework were ranked as the top three barriers. Developing and sustaining an effective engagement framework, aligning researcher-policymaker interests through collaborative research projects, and joint capacity-building were ranked the topmost facilitators of researcher-policymaker engagement.

Conclusion: This study highlights key barriers to research-to-policy engagement in Nigeria, namely the need for structured engagement frameworks, alignment of priorities, and targeted capacity development, and proposes actionable strategies to address them. Sustainable impact will depend on dedicated financing, governance reforms, and institutional changes, supported by long-term partnerships and robust evaluation systems to advance knowledge translation and improve health outcomes.

Introduction: Developmental and Epileptic Encephalopathies (DEEs) are rare and complex conditions characterized by drug-resistant seizures and severe neurocognitive impairments. Management models for these disorders are often inconsistent, and the transition of care from pediatric to adult services represents a critical phase. This transition is frequently managed in an unstructured manner, leading to significant consequences for care continuity and the quality of life of both patients and their families.

Methods: A cross-sectional observational survey was conducted among specialists (neurologists and pediatric neuropsychiatrists) and caregivers of patients with DEEs, particularly those diagnosed with Lennox-Gastaut Syndrome (LGS). The aim was to analyze organizational models, transition pathways, and patient and caregiver experiences, identifying existing gaps in care and comparing these models with those used for another DEE, Dravet Syndrome (DS).

Results: The survey involved 47 physicians and 30 caregivers. Findings revealed substantial fragmentation in management models and the absence of standardized transition pathways in 54% of respondents. The transition of LGS patients to adult care centers is often left to individual families, with a dropout rate of 40% for LGS-similar to that observed in DS patients (38%). Caregivers reported stress, organizational difficulties, and a perceived decline in the quality of adult care. Furthermore, 53% of caregivers stated they received no support services following diagnosis.

Discussion: The lack of standardization in transition pathways represents a critical barrier to ensuring continuity of care for DEE and LGS patients. Developing structured, best-practice-based transition models, enhancing caregiver support, and fostering a multidisciplinary approach are essential to improve quality of life and ensure effective disease management into adulthood.

Background: In the delivery of environmental health services (EHS), the data that gets collected provides an opportunity to depict the extent of environmental threats to human health in communities and inform required interventions. In this study, the perspectives and role of environmental health managers in improving data management in the delivery of EHS in municipalities in the KwaZulu-Natal province of South Africa were assessed.

Methods: A qualitative phenomenological approach was followed. Data were collected from ten managers via a semi-structured interview guide from February 2024 to April 2024. The transcripts derived from the interviews were analysed via ATLAS.ti version 24.0.0.29576, following which deductive and inductive thematic analysis methods were used.

Results: The results revealed various roles and responsibilities that environmental health managers play to improve data management and enable insight-driven decision-making. Furthermore, it was shown that through data-driven insights, EHS delivery can be strengthened to be impactful and enable better health outcomes in communities amid existing institutional and technical challenges. This indicated a need for a holistic approach to review and modernise environmental health data management in South Africa to maximise available opportunities.

Conclusion: In this juncture, managers have a duty to drive transformation, apply change management and instil a culture of data use in their institutions for impactful service delivery.