BMC Health Services Research最新文献

Background: Allocating healthcare resources to local areas in proportion to need is an important element of many universal health care systems, aiming to provide equal access for equal need. The UK National Health Service allocates resources to relatively large areas in proportion to need, using needs-weighted capitation formulae. However, within those planning areas, local providers and commissioners also require robust methods for allocating resources to neighbourhoods in proportion to need to ensure equitable access. We therefore developed a local resource allocation formula for NHS district nursing services for a City in the North West of England, demonstrating a novel application of the national formulae principles for equitable resource allocation to small areas.

Methods: Using linked data from community health services, primary care, secondary care and social care, we used a zero-inflated Poisson regression to model the number of district nursing services contacts for each individual based on predictors of need, while including the supply of district nurses per head to account for historical supply induced patterns. Individual need was estimated based on the predictions from this model, keeping supply fixed at the average. We then compared the distribution of district nurses between neighbourhoods, based on our formula, to the current service staffing distribution.

Results: Key predictors of need for district nursing services were age, deprivation, chronic diseases such as, cardiovascular disease, chronic liver disease, neurological disease, mental ill health, learning disability living in a nursing home, living alone, and receiving palliative care. Need for district nursing services was highly weighted towards older and more deprived populations. The current distribution of staff was, however, more correlated with age than deprivation. Moving to a needs-based staffing distribution would shift staff from less deprived areas to more deprived areas potentially reducing inequalities.

Conclusion: A neighbourhood-level model for needs for district nursing is a useful tool that can potentially improve the allocation of resources, addressing unmet need and inequalities.

Introduction: Healthcare professionals' perspectives are often overlooked in the evaluation of digital weight loss interventions. Thus, we examined how healthcare professionals perceive patient success in a one-year web-based weight management program, the Healthy Weight Coaching, aiming to identify key success factors and common challenges within the coaching process.

Methods: Thematic analysis was conducted on ten semi-structured interviews with healthcare professionals from the Healthy Weight Coaching. Interviewees included individuals of both sexes, with an average age of 41 years, ranging from 10 months to 5 years of coaching experience, and treating 90 to 500 patients.

Results: Three main themes emerged from the analysis: (1) Positive progress during the Healthy Weight Coaching, (2) Factors facilitating success, and (3) Barriers hindering progress. The coaches noted significant positive changes among patients, including increased self-compassion, reduced weight-related stress, and a shift toward holistic well-being. Improvements in eating habits, physical activity, and vegetable consumption were observed, along with reductions in binge eating behaviors. Personal factors such as internal motivation and engagement with the program were crucial for success. Additionally, aspects of the Healthy Weight Coaching program, such as its individualized and supportive environment, flexible coaching approach, and the pivotal role of coaches, were seen as facilitators of success. Patients valued being treated equally and acceptingly and fostering trust and collaboration. However, challenges such as burdensome life situations, limited resources, and inadequate support posed significant barriers to progress. Unrealistic goals and societal pressures were also observed to hinder successful weight management efforts.

Conclusion: A comprehensive, individualized approach addressing resource limitations and societal norms can enhance long-term success in weight management programs like the Healthy Weight Coaching, ultimately promoting overall well-being.

Background: Existing research on the psychosocial wellbeing of sheltered women is primarily from Western contexts, with limited studies from collectivistic cultures like Pakistan. This study aims to compare the psychosocial health and illness of sheltered women in Pakistan with those of women living with their families.

Methods: A total of 184 sheltered women and 207 women from the general population from four Pakistani cities participated in this study. Data were collected using two validated instruments: the Psychosocial Health Evaluator and the Sukoon Psychosocial Illness Scale. The study employed independent sample t-tests, simple linear regression and Pearson correlation.

Results: The study revealed significant differences between women residing in shelters and those in the general population. Sheltered women exhibited lower levels of psychosocial health and higher levels of psychosocial illness. Emotional, sexual, spiritual, and social health were notably lower among sheltered women. Sheltered women also reported elevated levels of psychosocial problems, including emotional, social, and professional difficulties. Additionally, the length of stay in shelters was negatively correlated with psychosocial health and positively correlated with psychosocial illness, while education showed a positive correlation with psychosocial health.

Conclusion: The current research highlights the psychosocial vulnerability of women residing in shelter homes. Government, non-governmental organizations, and mental health professionals are advised to work together to uplift the psychosocial health of women residing in Pakistani shelter homes. Appointments of psychological counselors in shelter homes are highly recommended in this regard.

Background: There is growing evidence that spending time with or in nature can be beneficial for health and wellbeing. Emerging evidence suggests potential benefits for staff and service users in healthcare settings, yet little is known about how to put Nature-based approaches (NBAs) into practice within the Child and Adolescent Mental Health Services (CAMHS) setting. The CAMHS Goes Wild project in Southwest England aimed to explore the implementation of NBAs within CAMHS, examining staff attitudes and understanding to identify potential benefits and challenges through a mixed methods study.

Methods: The study involved three phases of data collection: an online survey with two waves, the first wave prior to the training, and the second four months post-training, and semi-structured interviews. Data collection was designed to fit around NatureWell training, attended by sixty-four CAMHS staff, which took place alongside the study. All participants were sampled from one NHS Trust and the study was open to both those who had attended the NatureWell training and those who had not. Data were synthesised to produce an understanding of staff attitudes towards NBAs and perceived barriers and facilitators to the implementation of this approach.

Results: Ninety-seven staff responded to the wave 1 survey and 57 responded to the wave 2 survey. Fourteen staff members were interviewed. Data synthesis generated three themes: Tension between the culture of CAMHS and NBAs (Theme 1) and the need for buy-in and governance support (Theme 2). Theme three described the potential benefits of NBAs for staff and service users in CAMHS and is presented in a separate paper. The first two themes are presented in this paper.

Conclusions: The implementation of NBAs in mental health service settings for CYP presents both significant challenges and opportunities. Our findings suggest multiple barriers to implementation, often in the form of organisational or cultural factors, such as the risk averse nature of the service. Our work also elucidates several potential facilitators which may address or mitigate some of these barriers. These potential enablers, such as harnessing the role of firsthand experience, warrant further exploration in the implementation of NBAs in CAMHS.

Background: Having a home is the foundation of most people's lives. People with co-occurring substance use and mental health problems may experience challenges in acquiring and keeping housing. Many also have major health challenges. Supported housing is the subject of increasing interest, but there seems to be a lack of studies exploring supported housing's potential for facilitating recovery and health promotion. Therefore, a scoping review was performed to answer our review question: What is known in the literature about the experiences of persons with co-occurring substance use and mental health problems with supported housing, including experiences of recovery and health promotion?

Methods: Systematic searches were conducted in the Ovid MEDLINE, Embase, PsycInfo, CINAHL, Social Services Abstracts, Web of Science, Scopus, and Oria, and Idunn.no databases. The search terms were derived from the population, concepts, and context. The search for grey literature was conducted in various Norwegian sources.

Results: Forty studies were included: 7 with quantitative design, 28 with qualitative design and 5 with mixed methods design. The studies were from Canada, Ireland, Norway, Scotland, and the USA. The review identified four themes related to tenants' experiences with supported housing: 1)The importance of a permanent and safe home; 2) Housing's importance for physical health; 3) A shoulder to lean on - the importance of relationships and support; 4) the value of choice and independence. Factors that may influence physical health were poorly represented.

Conclusions: Long-term housing and safety are prerequisites for recovery for people with co-occurring problems. Programmes such as Housing First and Assertive Community Teams, especially, were experienced to support recovery. Autonomy was valued, including access to individual and respectful support from service providers when needed. Supported housing may be a health-promoting arena, especially in relation to mental health. More attention should be given to how service providers can support tenants to protect their physical health, especially related to nutrition, meals and communal cooking. Further research is needed to tailor optimal services and support for people with co-occurring problems, including balancing support and autonomy with the aim of promoting health and recovery. Peer specialists' contributions to supported housing are scarce and need further development.

Background: To address the societal burden of low back pain (LBP), several health systems have adopted Models of Care (MoCs). These evidence-informed models aim for consistent care and outcomes. However, real-world applications vary, with each setting presenting unique challenges and nuances in the primary healthcare landscape. This scoping review aims to synthesize the available evidence regarding the use of implementation theories, models or frameworks, context-specific factors, implementation strategies and outcomes reported in MoCs targeting LBP in primary healthcare.

Methods: MEDLINE(Pubmed), EMBASE, Cochrane Central Register of Controlled Trials, PEDro, Scopus, Web of Science and grey literature databases were searched. Eligible records included MoCs for adults with LBP in primary healthcare. Two reviewers independently extracted data concerning patient-related, system-related and implementation-related outcomes. The implementation processes, including guiding theories, models or frameworks, barriers and facilitators to implementation and implementation strategies were also extracted. The data were analysed through a descriptive qualitative content analysis and synthesized via both quantitative and qualitative approaches.

Results: Eleven MoCs (n = 29 studies) were included. Implementation outcomes were assessed in 6 MoCs through quantitative, qualitative, and mixed methods approaches. Acceptability and appropriateness were the most reported outcomes. Only 5 MoCs reported underlying theories, models, or frameworks. Context-specific factors influencing implementation were identified in 3 MoCs. Common strategies included training providers, developing educational materials, and changing record systems. Notably, only one MoC included a structured multifaceted implementation strategy aligned with the evaluation of patient, organizational and implementation outcomes.

Conclusions: The implementation processes and outcomes of the MoCs were not adequately reported and lacked sufficient theoretical support. As a result, conclusions about the success of implementation cannot be drawn, as the strategies employed were not aligned with the outcomes. This study highlights the need for theoretical guidance in the development and implementation of MoCs for the management of LBP in primary healthcare.

Registration: Open Science Framework Registries ( https://osf.io/rsd8x ).

Background: Integrating behavioral health services in primary care is challenging; a toolkit approach to practice implementation can help. A recent comparative effectiveness randomized clinical trial examined the impact of a toolkit for improving integration on outcomes for patients with multiple chronic conditions. Some aspects of behavioral health integration improved; patient-reported outcomes did not. This report evaluates the implementation strategy (Toolkit) using Proctor's (2011) implementation outcomes model.

Methods: Using data from the 20 practices randomized to the active (toolkit strategy) arm (education, redesign workbooks, online learning community, remote coaching), we identified 23 measures from practice member surveys, coach interviews, reports, and field logs to assess Toolkit acceptability, appropriateness, feasibility, and fidelity. A practice survey score was high (met expectations) if its average was ≥ 4 on a scale 1-5; all other data were coded dichotomously, with high = 1.

Results: Regarding acceptability, 74% (14) of practices had high scores for willingness of providers and staff to use the Toolkit and 68% (13) for quality improvement teams liking the Toolkit. For appropriateness, 95% (19) of practices had high scores for the structured process being a good match and 63% (12) for the Toolkit being a good match. Feasibility, measured by Toolkit prerequisites, was scored lower by site members at project end (e.g., provider leader available as champion: 53% of practices) compared to remote coaches observing practice teams (74%). For "do-ability," coaches rated feasibility lower for practices (e.g., completion of workbook activities: 32%) than the practice teams (68%). Fidelity was low as assessed across seven measures, with 50% to 78% of practices having high scores across the seven measures.

Conclusions: Existing data from large trials can be used to describe implementation outcomes. The Toolkit was not implemented with fidelity in at least one quarter of the sites, despite being acceptable and appropriate, possibly due to low feasibility in the form of unmet prerequisites and Toolkit complexity. Variability in fidelity reflects the importance of implementation strategies that fit each organization, suggesting that further study on contextual factors and use of the Toolkit, as well as the relationship of Toolkit use and study outcomes, is needed.

Trial registration: ClinicalTrials.gov NCT02868983; date of registration: 08/15/2016.

Background: Co-creation and participation among different user groups have been highlighted as pivotal for improving residential care facilities for older persons. However, more knowledge is needed on methods aiming to overcome challenges in constructing inclusive co-creation and participation processes. In particular, there is a need for knowledge concerning how art and design workshops could contribute to co-creation and participation of social care professionals designing the physical environment in residential care facilities. Therefore, this study aimed to examine how art and design workshops can contribute to co-creation and participation in designing the physical environment with residential care facility professionals.

Methods: A qualitative method was used to investigate social care professionals' experiences. Data were collected through semi-structured group interviews and analysed with inspiration from Corbin and Strauss's analysis method.

Results: This study concludes that art and design workshops could serve as deliberating and developing practices. First, the art and design workshop as a deliberating practice involves conditions that create a communication arena and space supporting professionals in sharing experiences and voicing different perspectives. Second, the art and design workshop, as a developing practice, supports shared agency through dialogue focusing on designing the physical environment in residential care facilities, using photographs, materials, and fabrics.

Conclusions: This research contributes to the understanding of the relevance of art and design workshops and co-creation between artists and social care professionals in designing the physical environment in residential care facilities. The study can be valuable in identifying important mechanisms that facilitate co-creation and participation among social care professionals, as well as the development of art and design as a tool for improving environments in residential care facilities. The research focuses on how art and design workshops could influence co-creation and participation through art and design from the perspective of social care professionals.

Background: National audit programmes are a recognised means of assessing quality of healthcare by collecting and reporting data in relation to evidence-based standards. The Sentinel Stroke National Audit Programme is a prospective audit of processes and outcomes for all stroke patients in England, Wales and Northern Ireland which has historically focused on hospital-based care. Evidence suggests it has been successful in driving quality improvement. What has yet to be explored is the influence of such a national audit programme on community-based healthcare. The aims of this study were to understand how community stakeholders perceive and participate in the audit.

Methods: The study used a realist approach, being theory driven and informed by collaborators including stroke clinicians and experts in realist and audit methodology. Contextual determinants and mechanisms were identified from the literature as having the potential to influence quality improvement. These were operationalised into 18 survey items, using a combination of 5-point scales and yes / no responses. Free text options offered the opportunity to expand upon responses. The online survey was distributed using social media, clinical networks and professional bodies. Representation was sought from community stroke stakeholders across England and from roles throughout the audit process including administrative, clinical, management and commissioning.

Results: The survey achieved a national sample from a broad range of stakeholders (n=206). Participants reported being engaged in the audit, committing significant resources to participation. National audit feedback was described as being used to support a range of improvement activities, including funding for additional staff and service reorganisation. A number of factors influenced the ability of teams to participate in audit and utilise feedback for quality improvement. These included the online platform, the accuracy of data submitted and leadership support.

Conclusions: Findings highlight the work needed in terms of the data captured, organisational audit support and engagement with feedback if the potential of the audit as a tool for quality improvement in community rehabilitation (as highlighted in acute stroke care) is to be realised.