BMC Health Services Research最新文献

Background: Stroke rehabilitation guidelines recommend using outcome measures like the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) to assess post-stroke upper extremity function. However, integrating such outcome measures into routine clinical practice remains challenging, highlighting the need to understand factors affecting their implementation in evolving healthcare models.

Objective: Our study aimed to identify the barriers and facilitators to sustain the routine use of the FMA-UE among hospital-based occupational therapists (OTs) using a theory-driven approach.

Methods: Employing a mixed-method sequential exploratory study design rooted in Normalisation Process Theory (NPT), we gathered quantitative data through a validated survey followed by qualitative insights analysed with directed content analysis from focus group discussions involving occupational therapists from four hospitals.

Results: Survey findings (n = 34) revealed barriers primarily associated with NPT constructs of collective action and coherence. Facilitators were linked to the cognitive participation construct. Key barriers identified in focus groups included insufficient coaching, competing priorities, and perceived limited value of the FMA-UE. Facilitators included legitimation of therapists' role in outcome measurements and an open learning culture.

Conclusions: Through a theory-based approach, we identified barriers and facilitators to sustain the routine of the FMA-UE. Our findings offer insights for designing implementation strategies to embed the FMA-UE into routine practice, supporting its sustained use in stroke rehabilitation.

Background: While studies might have found misinformation to affect health decision-making, it is not solely responsible; it also plays a role. The rapid spread of misinformation undermines public trust in health systems and interventions, negatively affecting health decisions and exacerbating health crises. Nigeria Health Watch established a Health Misinformation Fellowship programme in this study to combat health misinformation through community-based approaches in Nigeria.

Methods: The fellowship was conducted between August 2023 and January 2024 in Niger State, Nigeria, and combines both in-person and virtual training sessions to equip participants with the skills and knowledge needed to identify, address, and manage health misinformation. The participants were from diverse backgrounds, including media practitioners, civil society organisations, traditional and religious leaders, community leaders, and people with disabilities. The programme included practical community engagement activities and strategic collaborations with state authorities. The evaluation was conducted through pre-and post-test assessments of participants' knowledge levels.

Results: Participants (25) were selected from 45 applicants; 56% were males, and the largest groups of participants were from religious organisations (28%). The pre-test assessment revealed a 31-40% score for respondents, indicating a low level of knowledge, whereas the post-test indicated an improvement, with the highest score ranging from 81 to 100%. Several rumours were identified through community listening and social media monitoring, including misconceptions about vaccines and herbal medications. TV and Radio had the highest media engagement (10,000). The proactive engagement of fellows led to effective interventions and increased awareness within the community.

Conclusions: Community-based approaches were found to be effective at combating health misinformation. The programme developed a sustainable health communication model by resolving issues related to logistics, cultural considerations, and coordination efforts. Lessons learned and strategies established provided a robust framework for future initiatives. Continued efforts to expand the programme and build strong partnerships with learning networks and government agencies are essential for sustainable impact and achieving long-term public health goals.

Background: Many people who contract the SAR-CoV-2 virus present with multiple persistent and debilitating physical, cognitive and mental health symptoms that endure beyond the acute infection period. This new syndrome - generally referred to as long COVID - negatively affects patients' emotional wellbeing and quality of life, and presents a major challenge for treatment providers. Considering the lack of evidence-based treatment and supports, this qualitative descriptive study explores the experiences of Canadian health and social service providers working with individuals with long COVID, as well as their suggestions for intervention development.

Methods: Twenty health and social service providers between the ages of 29 and 57 across Canada completed virtual individual interviews to discuss their care experiences and service recommendations for long COVID. Participants were from a range of service sectors, including primary care, rehabilitation, mental health, and community support. Interviews were recorded, transcribed, and analyzed using codebook thematic analysis.

Results: Four themes illustrated providers' the experiences of (1) selecting personalized treatments based on patient presentation and similar conditions amidst uncertainty; and their recommendations for long COVID services, including (2) building an integrated and evidence-based model of care; (3) providing holistic support for patients and families through psychoeducation and daily living resources; and (4) caring for mental health in long COVID.

Conclusions: Canadian health and social service providers are adopting personalized treatment approaches to address the symptom persistence of long COVID in the face of a considerable knowledge gap. A comprehensive, integrated care pathway is needed to support patients' physical and psychosocial wellbeing while increasing provider preparedness to treat this complex condition.

Background: Diabetes mellitus, like many other chronic diseases, is costly to manage and poses a substantial economic burden on individuals directly and indirectly. In this paper, we studied the associations between cost of diabetes and socio-demographic characteristics.

Methods: This was a cross-sectional cost-of-illness study that employed systematic random sampling. We collected data from 385 respondents at the Tamale Teaching Hospital of Ghana between June and August of 2023. Prevalence-based costing and the human capital approach were employed to arrive at total cost of illness. Regression analysis was used to find associations between sociodemographic characteristics of the respondents and the total cost of illness.

Results: The mean total cost of diabetes mellitus per year is $290.44. Mean direct annual cost of illness per year is $159.70 representing 54.99% of the total cost while the mean indirect annual cost per patient is $130.72. Being male (B = 0.42, 95% CI 0.02-0.82; p = 0.039), living in an urban area (B = - 1.05 95% CI - 1.58 - - 0.53; p = 0.000), having a longer duration of illness (B = 0.04, 95% CI 0.003-0.07; p = 0.032), and having the complications of diabetic retinopathy (B = 0.42, 95% CI 0.02-0.82; p = 0.041) and stroke (B = 1.26, 95% CI 0.52-2.00; p = 0.001) were statistically significant in association with total cost of illness.

Conclusions: Various demographics with diabetes carry different dynamics in terms of cost burden. We recommend a tailored approach to care for individuals with diabetes mellitus and their families as a protection against catastrophic health care expenditure that could result from a high cost of illness.

Background: Reducing above-guideline opioid prescribing is one approach to reducing the availability of unused opioids. We describe contextual factors affecting the implementation and outcomes of a successful email 'nudge' aimed at reducing post-operative opioid prescribing, with the goal of informing future implementation and dissemination efforts.

Methods: Between October 2021-September 2022, we sent email nudges to general, orthopedic, and obstetrics/gynecology surgeons at 19 hospitals in a large integrated healthcare system in California whose patients had post-operative opioid prescriptions that exceeded guideline-recommended quantities. We then interviewed 36 surgeons between September 2022-January 2023 and coded and themed transcripts and implementation process documents from the study. We used the Consolidated Framework for Implementation Research (CFIR) to understand the contextual factors impacting nudge design, implementation, and effectiveness.

Results: Factors across all five CFIR domains were found to be important in understanding the acceptability, feasibility, and sustainability of the intervention. In the Innovation Domain, key factors included the method of nudge delivery, the validity of comparators, and the design and layout of the nudge itself. The interaction between the nudges and existing state regulations (Outer Setting Domain) caused confusion, while the size, structure, and centralization of hospitals (Inner Setting Domain) influenced communication and leadership engagement, underscoring the need for local champions (Individuals Domain). In the Implementation Process Domain, workflow considerations emerged, e.g., the fact that the surgeon performing the procedure was at times not the discharge prescriber, the need for pre-intervention education, and the importance of ensuring surgeons have a clear process to access additional information when questions arise about nudge content.

Conclusions: Contextual factors related to how the nudges were implemented influenced their acceptability among surgeons. Future dissemination efforts of similar interventions to curb opioid overprescribing should take these design considerations into account, including how to account for variations in prescribing workflows, the amount of information provided in the nudge, how information is construed, and how the rest of the hospital system can adjust to encourage guideline-supported opioid prescribing at the point of post-surgical discharge. These types of considerations may also apply to other clinician-directed, nudge-based interventions beyond the subject of opioid prescribing.

Trial registration: Clinicaltrials.gov, Identifier: NCT05070338, Registration Date: October 19, 2021.

Background: Previous research showed the potential of quality improvement programs in nursing home care. However, studies that quantitatively evaluate the effectiveness of quality of care improvement programs are scarce. In this study, we examine the results of a Dutch nation-wide programme that was established to support the implementation of the Quality Framework for Nursing Home care.

Methods: The Dignity & Pride at every Facility (D&PF) program was accessible to all Dutch nursing home facilities. Problem analysis per facility was conducted by means of a quantitative Quality Scan targeting all eight themes of the quality framework. Based on the baseline measurements nursing home facilities received tailored support from an external expert coach. The Quality Scan was repeated at the end of the support trajectories, 9 to 24 months later depending on the type of support provided. Scan data of 331 nursing home facilities was used to quantify the effectiveness of the D&PF program, the contribution of tailored support and the influence of organizational factors on care outcomes.

Results: The entire pool of participating facilities scored better on the final scan (M = 3.21, SD = 0.74) than on the baseline scan (M = 2.64, SD = 0.87, p < 0.001). Greater improvements on theme level were seen when (partial) support was provided by an external expert coach. The probability of achieving high scores on care outcomes (person-centred care, resident safety and well-being) was significantly increased with high scores on organizational conditions. A multilevel model demonstrated that the themes Learning and improvement, Responsive workforce and Use of resources were statistically significant associated with positive care outcomes.

Conclusion: This study demonstrates significant improvements across all themes of the quality framework and provides supporting evidence for the positive contribution of tailored on-site support of external expert coaches. This study also indicates that a supportive organizational environment and a learning-oriented culture are of significant importance for good care outcomes in terms of safety, person-centred care and resident well-being.

Objective: Based on the "Three-Dimensional Quality Structure" theory, a sensitive index system of nursing quality during the perioperative period of liver transplantation patients was constructed.

Methods: Through a comprehensive literature review and rigorous application of the Delphi method, a panel of 27 experts completed three rounds of effective letter consultation to obtain expert consensus opinions. The contents of indicators were determined based on this process, and the analytic hierarchy process was employed to confirm the weightage assigned to each indicator. Consequently, we established a sensitive index system of nursing quality during the perioperative period of liver transplantation patients.

Results: The effective recovery rates of the questionnaires in the three rounds of expert consultation reached 96.6%, 100% and 96.4%, respectively, and the proportions of experts who gave opinions were 55%, 25% and 12%,respectively, indicating a high degree of expert authority. The expert authority coefficients were calculated to be 0.899, 0.895 and 0.909,respectively, indicating a high degree of expert authority. In the third round, Kendall's coordination coefficients for primary, secondary, and tertiary indicators were determined to be 0.340, 0.379, and 0.402 (P < 0.001), indicating that expert opinions tended to be consistent. Finally, We established a comprehensive sensitivity quality index system comprising 3 first-level indexes,11 s-level indexes, and 60 third-level indexes specifically designed for liver transplantation patients during the perioperative period.

Conclusion: The sensitive index system of perioperative nursing quality for liver transplantation patients can provide a theoretical basis for nursing staff to construct precise individualized nursing models.

Background: There is limited research on burnout among healthcare providers in sub-Saharan Africa. One prior study of Rwanda anesthesia providers found a moderate level of burnout, and several qualitative studies have highlighted significant stressors. This study aims to evaluate the prevalence of professional fulfillment, burnout, and fatigue among healthcare providers at King Faisal Hospital Rwanda (KFH), a tertiary-level teaching hospital in Kigali, Rwanda.

Methods: A cross-sectional, quantitative study was conducted from August to November 2023 at KFH. Participants included all staff employed at KFH at the time of survey distribution, including both non-clinical and clinical staff. Burnout, fatigue, and professional fulfillment were assessed using validated tools (Professional Fulfillment Index, Burnout Scale, and Fatigue Assessment Scale).

Findings: Two hundred ninety-four respondents completed the survey. 47.1% reported professional fulfillment, while over half (57.0%) experienced burnout, and the majority experienced fatigue (71.0%). Years of experience and profession were found to be risk factors for burnout and low fulfillment. Age and profession were risk factors for fatigue. The highest levels of burnout were among doctors, nurses, and midwives.

Discussion: Burnout rates and fatigue were high among healthcare providers. They were highest among those professions with direct patient contact. There are several evidence-based institutional interventions for burnout, but most evidence comes from settings outside of sub-Saharan Africa. Future research should assess the effectiveness of interventions specific to this setting.

Background: Moral injury - the betrayal of one's moral and professional values - is a negative factor affecting physicians' wellbeing. However, few studies have examined moral injury and its predictors in healthcare professionals. Therefore, this study aimed to explore the prevalence, associated factors, and predictors of moral injury in Chinese physicians.

Methods: This study was a cross-sectional survey conducted from September 14 to October 27, 2023, in mainland China. A total of 549 physicians completed the online self-administered questionnaire through the WeChat app. The 10-item Moral Injury Symptom Scale-Health Professional (MISS-HP) was used to assess the severity of moral injury symptoms, and the Moral Injury Events Scale (MIES) was used to measure exposure to potentially morally injurious events (PMIEs).

Results: The results of the study showed a mean score of 42.07 (SD = 13.67) for the MISS - HP, and the prevalence of moral injury among the physicians was 31.6%. The multiple linear regression identified five main predictors of moral injury: exposure to PMIEs, job satisfaction, lack of organizational support, witnessing patient suffering or death, and mental health needs.

Conclusions: Chinese physicians reported experiencing different types of PMIEs and suffering from moral injury-related symptoms in their clinical practice. It helped to understand modifiable risk factors for moral injury, highlighting the need for systemic interventions. Healthcare institutions can mitigate moral injury and safeguard the wellbeing of healthcare workers by building peer-support networks, improving communication to address workload issues, and implementing recognition systems for ethics.

Background: Irrational prescription of medication is a common issue in clinical practice, particularly for eye disorders that can affect vision. This study aimed to assess the prescribing practices, drug utilization, and post-dispensing knowledge of ophthalmic medications at the University of Gondar Comprehensive and Specialized Hospital in Northwest Ethiopia.

Methods: An explanatory sequential mixed-methods study was conducted at the ophthalmology department of the University of Gondar Comprehensive Specialized Hospital from March 2024 to June 2024. Quantitative data were collected using an interviewer-administered structured questionnaire, and chart review was then entered into EpiData version 4.6 and analyzed using SPSS version 25. Descriptive statistics were computed and Binary logistic regression analyses identified factors influencing post-dispensing knowledge, with a significance level of p < 0.05 and results presented with 95% confidence intervals. Qualitative data were collected through in-depth interviews and analyzed thematically using OpenCode software version 4.2.

Results: Most respondents were elderly and male, with a higher prevalence of ocular diseases. Ophthalmic medications were predominantly solutions (53.2%), with antibacterial drugs (41.2%), especially Tetracycline, being the most common. Fixed-dose combination drugs were primarily steroid-antibiotic combinations. The average number of drugs per prescription was 1.43, with 90.37% of prescriptions being generic and 66.8% from the National Essential Drug List. Strength, dose, frequency, and duration were recorded in 68.3%, 31.5%, 92.4%, and 31.5% of the prescriptions, respectively. Post-dispensing knowledge was good in 38% of the patients, and 11.5% used medication in both eyes despite infection in only one. Patients with a diploma or higher education (AOR = 2.46, 95% CI 1.35, 4.46) were more likely to have better medication knowledge than those unable to read or write.

Conclusion: Most prescribing indicators were below the e World Health Organization's recommended standards, except for the number of drugs per prescription and the dispensing time. In addition, most ophthalmic prescriptions lacked adequate and complete prescribing information, and most patients had insufficient post-dispensing knowledge. These findings highlight the urgent need to improve prescribing practices, enhance counseling, and implement targeted educational programs to ensure safer and more effective ophthalmic care.