BMC Health Services Research最新文献

Background: Broad-scale, rapid health care change is critically needed to improve value-based, effective health care. Health care providers and systems need to address common barriers and facilitators across the evidence to implementation pathway, across diverse specialties. However, most evidence translation / implementation research evaluates single topic areas, and may be of limited value for informing comprehensive efforts. This project's objective was to identify, characterize, and illustrate common trans-topic facilitators and barriers of translating new health care evidence results to clinical implementation across multiple medical specialties.

Methods: This study was an evaluation of all evidence-based innovation projects completed during 2019-2021. Each project was created with medical group clinical leaders and was intended to inform clinical care. The evaluation took place in a large community-based integrated health care system, and an embedded delivery science and applied research program. Clinical investigators, scientific investigators, and clinical operational leaders received structured questionnaires regarding barriers and facilitators for the operational implementation of new research findings for each project. Responses were mapped to the Consolidated Framework for Implementation Research to identify perceived implementation barriers and facilitators.

Results: All 48 projects completed between 2019 and 2021 were evaluated; responses were received for 45 (94%) and 34 had comments mappable to framework domains. Potential barriers and facilitators to clinical implementation of new research results were identified across all five framework domains and, within these, the 38 constructs or sub-constructs. Among 245 total comments, the most commonly cited facilitators were how the new research evidence generated, compelled change (n = 29), specialty communication networks for disseminating results and initiating change (n = 20), leadership engagement in the project (n = 19), and the innovation's relative advantage over existing practices (n = 11). The most commonly cited barriers were inadequate resource commitment for next-step implementation (n = 15), insufficient learning/implementation culture (n = 5), and insufficient individual-level willingness/ability for change (n = 5).

Conclusions: A novel large-scale evaluation of barriers and facilitators across the evidence to implementation pathway identified common factors across multiple topic areas and specialties. These common potentially replicable facilitators and modifiable barriers can focus health systems and leaders pursuing large-volume evidence-to-implementation initiatives on those areas with the likely greatest benefit-for-effort, for accelerating health care change.

Background: Health is a fundamental right intricately linked to geographical factors, as evidenced in the health geography literature. The application of geographical information systems (GISs) plays a pivotal role in mapping diseases and evaluating healthcare accessibility and is acknowledged by the World Health Organisation as a solution for enhancing health system resilience and achieving universal health coverage. This study focuses on the geographical perspectives to provide insights into the evolving role of GIS in addressing challenges and shaping healthcare strategies in health research within India. The primary objective was to analyse the utilisation of GISs in health studies specifically on three thematic areas: disease surveillance, health risk assessment, and healthcare access.

Methods: The databases were searched using sixteen keywords for peer-reviewed articles published during 2000-2022. A systematic literature survey was conducted, drawing from peer-reviewed literature available in the PubMed, Web of Science and Scopus databases. Out of 162 search results, 58 articles were selected for review after three rounds of eliminations based on the predefined specific criteria. A systematic literature review was conducted following PRISMA guidelines addressing two research questions.

Results: This review reveals the extensive use of GIS in health studies since its inception, with particular prominence as a decision-making tool in the aftermath of the COVID-19 outbreak. The analysis of scientific articles focused on disease surveillance, risk assessment, and healthcare access in the Indian context demonstrates the effectiveness of GIS in managing and planning healthcare resources and services. GIS has proven to be an indispensable instrument for understanding spatial patterns in disease and optimising health interventions.

Conclusion: This systematic review underscores the critical role of GIS in health research, particularly in the Indian context. The versatile applications of GIS in disease surveillance, risk assessment, and healthcare access highlight its effectiveness as a tool for managing and planning healthcare strategies, contributing to a more resilient and accessible healthcare system in India and beyond.

Background: Violence against health professionals is a growing problem that affects the quality of care provided and the well-being of workers. In the Alentejo region (Southern Portugal), the Regional Health Administration has been developing strategies to prevent and combat this phenomenon, namely, through the implementation of the Action Plan for the Prevention of Violence in the Health Sector. Violence in the health sector includes all situations in which a worker in the Ministry of Health's health institutions is exposed to any type of violence related to their work, putting their safety, well-being or health at risk, or that of others. The aim of this study was to analyze the perceptions and practices of local focal points (e.g.,departments, services, offices or functional units) on violence against health professionals in the Alentejo region.

Methods: Semi-structured interviews were carried out local focal points in the Alentejo region. The sampling was selected for convenience from different health units. The interviews were recorded, transcribed and analyzed according to the analysis protocol of the IRaMuTeQ software (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires) version 0.7 alpha 2.

Results: In total, 43 interviews were conducted between February and April 2024. Interviews revealed that local focal points face various challenges in combating violence against health workers. The lack of specific training, the scarcity of security resources and the culture of underreporting were some of the obstacles identified. However, participants also stressed the importance of teamwork, effective communication and institutional support in dealing with this problem.

Conclusions: Violence against health professionals is a worrying reality that requires effective measures to prevent and combat it, requiring a coordinated and multifaceted response. Local focal points play a key role in this process, but they need adequate training, resources and institutional support. Comprehensive and regular training programs on violence, interpersonal communication and conflict management, and investment in security resources, including physical and technological measures, should be implemented in health facilities. Clear protocols should be created for dealing with situations of violence and a culture of reporting situations of violence to health professionals should be promoted, as well as the monitoring of victims by the authorities involved in cases of violence. Ongoing training and the simulation of real-life scenarios are crucial for preparing professionals to effectively manage situations of violence.

Background: In the UK, over 7,000 people are on the waiting list for an organ transplant and there are inequalities in need, access and waiting time for organs, with notable differences between minority ethnic groups. In May 2020, England changed the law and introduced a 'soft' opt-out system of consent to organ donation with a view to increase consent rates. We aimed to learn more about the impact of the law change on attitudes and views likely to be relevant to consent to deceased organ donation between different population subgroups.

Methods: Mixed-methods design involving latent class analysis of data from twelve repeated cross-sectional surveys undertaken from 2015 to 2021 (n = 19,011); analysis of the law change survey dataset collected quarterly from 2018 to 2022 (n = 45,439); and interviews with purposively selected members of the public (n = 30) with a focus on minority perspectives.

Results: Support for the principle of deceased organ donation remained high and stable in the general population (80%) but was 20% lower among ethnic minorities. From 2018 to 2022, an average of 58% of the general population was aware of the law change; this was lower among minority ethnic groups (31%). We identified four population subgroups (supportive donors (24% of the population); unengaged donors (22%); uncommitted donors (46%); and unsupportive donors (9%)). Interview themes included the challenges of discussing organ donation decisions, balancing autonomy with respecting family relationships, targeted misinformation, frustrations at the lack of consensus between community leaders, limited understanding of what happens during the end-of-life care leading to organ donation, and how this aligns with cultural values and preferences.

Conclusion: Implementation of the law change has not been associated to date with any change in public attitudes and preferences likely to influence consent overall or in minority ethnic groups in England. Uncommitted donors may benefit from encouragement to express their organ donation decision, and unengaged donors from attempts to address mis/information, confusion, and uncertainty. Interventions to raise the consent rate need to take account of the significant role of the family as well as wider community influences on attitudes, preferences and decision-making, particularly among certain minority (ethnic) groups.

Background: To analyze the equity and efficiency of health resource allocation in Sichuan Province and to provide a scientific basis for promoting health resource development.

Methods: Theil index, coefficient of variation, equalization index and health resource agglomeration degree (HRAD) were used to analyze the equity of health resource allocation, and data envelopment analysis (DEA) was used to analyze the efficiency of health resource allocation in Sichuan Province from 2017 to 2021.

Results: The Theil index and coefficient of variation of health technicians, licensed (assistant) physicians and registered nurses are larger than those of the number of beds, indicating that the equalization of the number of beds is relatively good. The equalization index of health resources in Sichuan Province ranges from 3.228 2 to 3.404 4 between 2017 and 2021, showing a gradually decreasing trend. The equalization index of Northwest Sichuan Economic Zone is the largest, indicating that the equity is relatively good. The equalization index of Chengdu Plain Economic Zone is the lowest, indicating that the equity is relatively poor. The HRAD of the number of beds, health technicians, licensed (assistant) physicians and registered nurses in Chengdu Plain Economic Zone, South Sichuan Economic Zone and Northeast Sichuan Economic Zone are all greater than 1, indicating that the health resources in these regions are better allocated by geography. The HRAD/ population agglomeration degree (PAD) of health technicians, licensed (assistant) physicians and registered nurses in South Sichuan Economic Zone, Northeast Sichuan Economic Zone and Panxi Economic Zone is less than 1, indicating that the health resources in these regions are insufficient relative to the agglomerated population. The comprehensive efficiency of health resource allocation in Sichuan Province and the five economic zones in 2020 is not 1, and the DEA is relatively ineffective. The Panxi Economic Zone, Northeast Sichuan Economic Zone and Northwest Sichuan Economic Zone all have relatively ineffective DEA.

Conclusions: From 2017 to 2021, health resources in Sichuan Province continue to grow, but equity has gotten worse. The degree of variation in the health resource allocation among the five major economic zones in Sichuan Province is large, with the Chengdu Plain Economic Zone having better equity in the health resource allocation by population and geography, and the Panxi Economic Zone and the Northwest Sichuan Economic Zone having insufficient equity in the health resource allocation by population and geography. The efficiency of health resource allocation in the Panxi Economic Zone, Northeast Sichuan Economic Zone and Northwest Sichuan Economic Zone needs to be improved.

Background: Telehealth has become increasingly essential in healthcare provision, also in the Prehospital Emergency Medical Services (EMS), where live video is implemented as a supplemental tool to assess and triage medical emergency calls. So far, using video for emergency calls seems beneficial for patient assessment and dispatcher-assisted first aid. However, the EMS dispatchers' experiences with and perceptions of using video during emergency calls are largely unexplored.

Methods: In 2023, a nationwide survey study was conducted in Denmark, which is covered by five Emergency Medical Dispatch Centers. All Danish EMS dispatchers were invited to participate in the study. The survey explored the dispatchers' experience with using video during emergency calls, the perception of their own video use, and the process of implementing video as a new tool in their working procedure. Main questions were answered on a scale from 1 to 7, where higher scores indicate more agreement.

Results: Of the 183 EMS dispatchers employed during the study period, 78% completed the survey. They found video easy to use (median = 7) and found video supportive in guidance and dispatch when the patient's problem was unclear (median = 7), but did not find video suitable for all emergency calls and expressed that complications with the technology was a barrier for using video. The EMS dispatchers were least likely to agree that they choose not to use video due to the risk of being emotionally affected by what they might see (median = 1). When dividing the sample based on EMS dispatcher's gender, age, seniority, and educational background, generally few differences between groups were found.

Conclusions: Live video during emergency calls is generally experienced as a useful supplemental tool by EMS dispatchers in Denmark, and the greatest self-perceived barriers for using video were not finding video suitable for all situations and the technology.

Background: Few studies have evaluated direct medical or societal costs of haemophilia in the United Kingdom (UK), and how patient characteristics impact future costs is uncertain. Cost predictors were identified and examined using cross-sectional data from the CHESS I and II studies.

Methods: Patient- and physician-reported outcomes were analysed for UK adult males aged ≤ 65, with haemophilia A or B and no recent clinical trial participation. Demographics, haemophilia type and severity, inhibitors, annual bleed rate (ABR), problem joints (PJs), treatment type, and comorbidities, were utilised in regression analyses. Health-related quality of life was assessed using EQ-5D. Generalised linear models estimated expected non-drug haemophilia-related direct medical costs (DMC) and societal costs (non-drug DMC, direct non-medical and indirect costs). Average marginal effects (AMEs) determined predictors of cost.

Results: Costs for 378 patients were analysed. Mean age was 33 years and 79% (299) had haemophilia A. Mean annual per-patient DMC were £165,001 (including factor treatment costs) and £4,091 when excluding factor replacement treatment costs (non-drug DMC). Mean annual per-patient non-treatment societal costs were £11,550 (standard deviation £20,171) among those with data available (n = 51). Number of PJs, ABR, and treatment regimen were significant determinants of haemophilia-related non-drug DMC (all P < 0.001). Non-drug DMC increased as ABR increased (AMEs were £2,018 for ABR 1-5, £3,101 for ABR 6-10 and £5,785 for ABR ≥ 11, vs. ABR 0) and by £1,869 per additional PJ. No significant predictors of non-drug haemophilia-related societal costs were identified. Mean EQ-5D score was 0.66, with lower scores observed for people with haemophilia B (0.48) compared with haemophilia A (0.71) and with increasing haemophilia severity.

Conclusions: UK direct medical and societal costs of haemophilia are substantial. Non-drug DMC were particularly associated with ABR and number of PJs. These findings may be useful for real-world evaluations of the economic burden of haemophilia in the UK.

Background: Although coordination of care and integrated care models aim to enhance patient satisfaction and perceived care quality, evidence regarding their practical implementation remains scarce. Understanding the nuances of collaboration across care providers to achieve effective coordination of care is imperative for seamless care integration. The aim of this study was to construct a grounded theory of how inter-organizational collaboration is performed to support coordination of care for patients with complex care needs.

Methods: A qualitative design with a constructivist grounded theory approach was applied. In total, 86 participants with diverse backgrounds were recruited across multiple care settings, including hospitals, ambulance services, primary care centers, municipal home healthcare and home care services. The grounded theory was developed iteratively, based on a combination of observations and interviews, and using constant comparative analysis.

Results: Coordination of care, a complex process that occurs across interconnected healthcare organizations, is manifested as "Negotiating care in organizational borderlands." Care coordination evolves through a spectrum of inter-organizational collaboration, ranging from "Dividing care by disease-specific expertise" to "Establishing paths for collaboration" and ultimately "Co-constructing a comprehensive whole." These categories highlight the challenges of coordinating care across both professional and organizational boundaries. In the multifaceted healthcare landscape, effective care coordination occurs when healthcare professionals actively bridge the divides, leveraging their collective expertise. Importantly, organizational boundaries may serve a purpose and should not be dissolved to facilitate effective care coordination.

Conclusions: The key to effective care coordination lies in robust inter-organizational collaboration. Even when patients receive integrated care, healthcare professionals may have fragmented roles. This research emphasizes the importance of clearly defined lines of accountability, reinforcing mutual responsibility and facilitating bridging of professional and organizational boundaries. Healthcare professionals and policymakers can use these insights to effectively utilize inter-organizational collaboration in supporting care coordination for patients with complex care needs.

Background: Since the 1990s, healthcare systems in many Western countries, including Italy, have undergone significant reforms, transforming organizational models and structures to meet the growing demand for healthcare services efficiently. This transformation has introduced new managerial roles for doctors-managers, particularly at the midlevel, creating "doctor-manager" positions that involve both clinical and managerial responsibilities. However, doctor-managers often struggle to balance these dual roles due to a lack of formal managerial training and the inherent conflict between clinical and economic objectives. This study aims to define new evaluation dimensions that can enhance the existing scale and develop a new tool to assess the necessary components of the managerial attitude dimension required by doctor-managers in the current Italian healthcare system.

Methods: This study updated Cicchetti's 2005 scale to reflect the changes that have occurred in healthcare organizations over the past 20 years, focusing on the evolving roles and challenges of middle healthcare managers. A scoping review was conducted to explore the existing literature, resulting in the identification and analysis of 24 key articles. Thematic analysis, facilitated by NVivo software, identified 171 items related to managerial attitude. These items were further refined, resulting in a 61-item Health Middle Manager Competencies Scale. The scale was evaluated by a Delphi panel through an e-survey, and Cronbach's alpha was used to assess reliability.

Results: The final Competencies Scale for Middle Managers of Health consists of 61 items, validated by the Delphi panel of experts. The panel reached consensus on the relevance and significance of each item, confirming the scale's reliability with an acceptable Cronbach alpha. The new scale captures various dimensions of the competencies essential for middle managers in healthcare settings.

Conclusion: The study provides insights into the dimensions of doctor managerial attitude and contributes to the update of Cicchetti's Scale to develop a new tool that assesses all the necessary components now required within the managerial attitude dimension.

Background: Primary healthcare centres are burdened by the management of patients with skin conditions, while general practitioners might lack the expertise to assess skin changes accurately. The traditional care chain for skin findings is a multistage process that can cause delayed diagnosis and treatment, distressing the patient. This study aimed to determine whether adding a dermatologist to the primary care team would streamline the care pathway of patients with skin conditions, while examining levels of satisfaction among patients and healthcare professionals.

Methods: A quasi-experimental multicentre study was conducted in three primary health centres in Finland. A dermatologist was integrated into two of the centres (intervention) but not the third (control). Data on timing of diagnosis and treatment and number of contacts were collected from records and analysed per care path. The Patient Enablement Instrument (PEI) and Net Promoter Score (NPS) were used to measure the patient's experience of the appointment. NPS and professional satisfaction queries were used to measure professional satisfaction.

Results: In total 186 intervention and 176 control patients were included, with 38 primary care professionals. Compared with the control group, the intervention group showed a significantly shorter time to confirmed diagnosis and to treatment start (25 vs. 49 days, p < 0.001), with a higher proportion (49% vs. 27%, p < 0.001) receiving immediate treatment in the primary care setting. Patients in the intervention group required fewer visits. Patient experience by PEI and NPS scores were higher in the intervention group (p ≤ 0.022 for each). Satisfaction levels among professionals in both groups were higher after the intervention than before, although the NPS score did not improve significantly in the control group. Almost all professionals advocated for the continuation of the integrated care pathway.

Conclusions: The integration of dermatologists into the primary care streamlined the management of skin conditions from diagnosis to treatment, while improving the experiences of both patients and healthcare professionals. This integrated care path is beneficial for the management of patients with skin findings in primary care.