BMC Health Services Research最新文献

Background: The success of an electronic health records (EHR) system is dependent on the effectiveness, satisfaction, and efficient use of these systems by health professionals. This paper explores the interdependency among effectiveness, satisfaction, and efficient use of Lightwave Health Information Management Systems (LHIMS) which is an EHR by health professionals.

Methods: A non-interventional descriptive cross-sectional study design was employed for this research. The study used stratified random sampling for the selection of participants. The population for the study was all the health professionals in the Central Region of Ghana. The number of health professionals who responded to the questions was 1126.

Results: The findings suggest that understanding the interdependency of efficiency, effectiveness and satisfaction is crucial for the successful implementation and adoption of LHIMS in healthcare organisations. The study investigated the interdependence among effectiveness, satisfaction, and efficient use of the LHIMS by health professionals, and found a positive but weak significant relationship between these factors.

Conclusion: In conclusion, this study aimed to assess the interdependency among effectiveness, satisfaction, and efficient use of LHIMS by health professionals. The. results support a positive but weak significant relationship between satisfaction, effectiveness, and efficient use of the LHIMS. These findings have implications for policymakers and hospital management in their efforts to improve the use of LHIMS. Policymakers can focus on any one of the three usability areas to enhance LHIMS use, with visible effects across the other two domains.

Background: Clinical guidelines are widely used to support clinical decision making, so they could also provide economic information about medical interventions to promote cost-conscious health care. We developed a new way to integrate economic information into the Finnish Current Care Guidelines.

Methods: Our development team consisted of clinical guideline specialists and health economists. We first looked at integration of economic information in clinical guidelines of other countries. Our key principle was that economic information should be integrated only to mutually exclusive medical interventions where the extensive choice of one the options will yield a significant cost differences on the national level. For the comparative effectiveness information of the interventions, we primarily looked for network meta-analyses. We then combined the effectiveness information presented as number needed to treat with prices or costs for the interventions and present the result as a cost per responder, which reflects both effectiveness and price or costs.

Results: We introduce a process to integrate and present the economic information of the selected interventions in tables in the Current Care Guidelines.

Conclusions: Our novel way to integrate economic information into the Current Care Guidelines is an effort to support cost-conscious clinical decision making to promote cost-effective health care in Finland. This process is general and could be used in clinical guidelines in other countries as well.

Background: In the wake of the coronavirus disease-19 (COVID-19) pandemic, research on the difficulties faced by epidemiologists conducting epidemiological investigations has been progressing steadily. However, few studies have developed applications (apps) that can directly support epidemiological investigations via information and communication (ICT) technology, and conducted usability evaluations on them via user responses. This has caused difficulties when developing such technologies. We introduced and evaluated two mobile apps that support epidemiological investigations. This study attempted to identify the predictors affecting the acceptance of infectious disease self-management apps.

Methods: We developed two infectious disease self-management smartphone apps for epidemiological investigations: KODARI (the Korean version) and MEDARI (in English version). We collected data from 248 users of KODARI by surveying Korean citizens. This study was conducted from November 15 to December 14, 2022. We used multiple regression analysis to identify the variables that affected continuous intention to use the KODARI app. We conducted two independent-samples t-tests to determine whether there were any differences in the perception of each variable in relation to demographic and COVID-19-related user characteristics.

Results: The factors that affected continuous intention to use the KODARI app, in order of relative importance, were: price value, satisfaction, performance expectancy, and facilitating conditions. Overall, male participants were more satisfied with the KODARI app than female ones, and more willing to continue using it. The male participants also evaluated facilitating conditions more positively than the female ones did. Married participants rated the app higher than single ones in terms of price value, performance expectancy, and continued intention to use.

Conclusions: The study suggests factors that increase the use of health apps and suggests that use of these apps may increase further in the event of a future pandemics. These results are expected to help researchers study other infectious disease apps in the context of public health surveillance.

Background: There are several strategies used to assess involvement in their healthcare across service providers. However, there is no consensus on the most appropriate measurement tool to use when evaluating patient involvement initiatives. This qualitative study aimed to explore the perspectives of stakeholders from micro, meso, and macro levels within the Danish healthcare system on measuring patient involvement in their healthcare.

Methods: This descriptive, explorative study employed semi-structured interviews with open-ended questions to elicit participants' views and experiences of patient involvement and measurement tools. A purposeful sample of participants was identified, to include decision makers, researchers, and health professionals (n = 20) with experiences of measuring patient involvement in healthcare at micro, meso, and macro levels across Danish organizations. Data underwent reflexive thematic analysis.

Results: Three main themes were identified: 1) Determining the purpose of patient involvement practices and measurement alignment; 2) Reflecting on the qualities, fit, and usefulness of measures; 3) Recognizing conflicting stakeholder paradigms. Despite the interest in and positive attitudes toward patient involvement innovations, views on the meaning and value of evaluating involvement varied; in part, this was attributable to challenges in selecting criteria, methods, and measures for evaluation.

Conclusion: The findings indicate the need to integrate the perspectives of all key stakeholders in designing the evaluation of patient involvement initiatives. The application of a multiple stakeholder approach and co-production of a multidimensional evaluation may provide some common ground for selecting evaluation criteria and measurement tools in the healthcare setting.

Trial registration: Danish Data Protection Agency (1-16-02-400-21) 15 October 2021.

Background: Musculoskeletal pain and disability are leading causes of reduced health and significant economic costs worldwide. Individualised, and evidence-based treatment approaches for specific musculoskeletal conditions aimed at improving patient outcomes and costs have not been successful. Recently authors have suggested that the 'process' of how care is implemented within a health system needs to be considered as an influencer on patient outcomes. With the rising prevalence of musculoskeletal conditions and the burgeoning costs associated with their treatment, it seems timely that new research focusing on process variables and their influence on patients with musculoskeletal conditions is explored. Before such studies can take place, a modern definition of a process variable within a musculoskeletal care pathway is needed to anchor future research endeavours. Therefore, the aim of this study was to establish a consensus-based definition of a process variable within a musculoskeletal care pathway, based on a New Zealand setting.

Methods: This study used a virtual nominal group technique and took place in July 2023 using a Microsoft Teams platform. A nominal group technique employs a structured approach to generate information and solutions to problems that can then be prioritised through group discussion and consensus. It is unique because it allows expert participants to explore using in-depth inquiry, areas previously unidentified or not yet investigated. There was an inclusion criterion and the participants completed pre-work before the two-hour five stage virtual meeting. The Auckland University of Technology Ethics Committee (AUTEC) approved this study (AUTEC 23/94).

Results: The study included eight participants (five male, three female) who had extensive experience with the New Zealand ACC insurance scheme and the design, implementation, and administration of musculoskeletal care pathways. The consensus definition was 'A health process variable is any modifiable factor in a health process or pathway that can be quantified and measured and that if varied may achieve a different operational or patient outcome'.

Conclusions: This study of New Zealand-based experts has formed a consensus-based agreement for a definition of a process variable in a musculoskeletal care pathway. This is an important first step in developing our understanding of process variables, and further research is needed to establish the link between process variables and their influence on the outcomes of patients with musculoskeletal conditions.

Background: To ensure workforce stability in China's healthcare system and maintain high-quality care, it is essential to comprehensively understand the interplay of factors contributing to turnover intention of healthcare workers. This study aims to examine the associations between potential factors and turnover intention in healthcare workers and explore the mediating effect of job satisfaction and work engagement in the association between them.

Methods: In this cross-sectional study, a random sample of 1060 healthcare workers working in 98 public medical institutions were recruited to rate their turnover intention in 2018 in Shenzhen, China. Information on socio-demographic characteristics, job-related factors, turnover intention, job satisfaction, work engagement, work stress and doctor-patient relationship of participants were collected. Pearson's chi-squared tests and binary logistic regression analyses were performed to explore the association between these factor and turnover intention. Mediation analysis was used to explore the roles of potential mediators and moderators.

Results: The results showed that age (OR: 0.35, 95%CI: 0.16 to 0.72), tenure (OR: 0.98, 95%CI: 0.96 to 0.99), administrative positions (OR: 0.33, 95%CI: 0.16 to 0.63), and night shift frequency (OR: 1.84, 95%CI: 1.26 to 2.67) were significantly associated with turnover intention. We identified the mediating effect of job satisfaction and work engagement in the relationship between administrative positions and turnover intention, while the suppressing effect in the relationship between professional titles and turnover intention. Additionally, we found that monthly income plays a moderating role in the relationship between work engagement and turnover intention, and in the association between professional titles and turnover intention.

Conclusions: Greater job satisfaction and engagement, along with reasonable remuneration, were found to be associated with lower turnover intention among healthcare workers. Employers should proactively monitor the dynamic interactions among these factors and then develop more tailored interventions in order to alleviate the ongoing loss of healthcare workers.

Background: Sexual abuse among street children is a problem that renders a burden of sexually transmitted diseases, HIV infection, and early pregnancy. Literature shows that globally 95 million children experience sexual abuse with 1 in 5 girls and 1 in 7 boys exposed to sexual abuse before 18 years of age in Malawi. Malawi adopted the World Health Organization guidelines for providing emergency health services for victims of sexual abuse, which include HIV Post Exposure Prophylaxis (PEP) and Emergency Contraceptive Pills (ECP) within 72 h of exposure, Sexually Transmitted Infections (STI) treatment, and psychosocial services. However, there are challenges associated with the services that limit access and utilization among street children. This study explored the factors associated with access and utilization of sexual abuse emergency healthcare services among street children in Zomba.

Methodology: This was a cross-sectional phenomenological qualitative study conducted in Zomba City from 2022 to 2023 using in-depth and key informant interviews. We purposively selected street children between 10 to 17 years who have been exposed to sexual abuse on the streets and social actors working with street children. The study employed a thematic analysis approach.

Results: The study found that street children did not utilize sexual abuse emergency health services. The major factors associated with utilization included the knowledge of sexual abuse, its associated health risks and sexual abuse emergency health services, and perceptions of utilizing sexual abuse emergency health services. The barriers to utilization of sexual abuse emergency health services included perceived shame, fear, discrimination, prolonged treatment process, and attitude of the health service providers.

Conclusion: Sexual abuse and its health risks continue to be a challenge among street children. The absence of adequate connections and secure environments for street children to report sexual abuse and seek help without facing judgment has created significant obstacles for them in accessing sexual abuse emergency health services. To curb this challenge it is crucial for successful interventions to specifically address the health needs of street children and involve them in the decision-making processes related to their interventions.

Background: This study aimed to contribute to a better understanding of the context, mechanisms and outcomes in the implementation process of an eHealth video consultation program in primary care. The study focused on how the program is normalized in the primary care setting. The primary research question for this study is "in what ways is the implementation of video consultation normalized in primary care?".

Methods: The qualitative design and content analysis of primary data from the transcripts were based on in-depth interviews, complemented with free-text answers to open-ended survey questions and various documents. The study focuses on the large-scale implementation of the public eHealth program Närhälsan Online, which represents more than 100 health centers in Sweden's largest region of Västra Götaland. Multiagent perspectives on how the program is normalized were drawn from expressed perceptions by professions directly linked to both strategic and functional implementation, as well as administration and clinical operation.

Results: This study both confirms and enhances the field with a theoretical contribution in six ways to the reviewed previous research, as well as showing practical implications. It also provides multi-agent perspectives on the rapid normalization of the implementation program studied.

Conclusions: In relation to the rapid progression of different initiatives in eHealth, this study contributes to perspectives on specific challenges as expressed by professions directly linked to both strategic and functional implementation as well as administration and clinical operation.

Background: Investing in allied health, dentistry, medical, and nursing undergraduate and postgraduate qualifying education is critical to meet a growing demand on global health care systems. Clinical placements are an integral component of qualifying training and are conventionally unpaid. Widespread economic challenges, attributed to a post-COVID-19 pandemic recovery era and global unrest, have led to growing economic hardship for populations, even in high-income countries like Australia. Allied health, dentistry, medical, and nursing undergraduate and postgraduate students undertaking unpaid clinical placements are not immune from these stressors, which has implications for education providers, ageing populations, the future health care system, and policy-makers. The purpose of this review was to better understand these stressors by scoping the financial implications of unpaid clinical placements for allied health, dentistry, medical, and nursing students in Australian research.

Methods: The Joanna Briggs Institute's scoping review methodology was used. This involved a search of academic databases and an extensive search of grey literature sources. Literature published from 1 January 2014 was included. Citations were independently screened by two reviewers.

Results: Thirty-three research studies were included. Most studies focused on allied health students (n = 12), followed by nursing (n = 11), and medical students (n = 5), with an additional five studies focused on multiple disciplines, including dentistry. One study had an interventional component. Findings were grouped around four concepts: reliance on self-reported measures of financial implications, costs of unpaid clinical placements for students, implications of costs for students, and an urgent need for targeted strategies to redress.

Conclusions: The financial implications of unpaid clinical placements for allied health, dentistry, medical, and nursing students in Australia are well-established in research. Impacts are significant for the future of Australia's health workforce and health system. Research findings have been consistent over the past decade in advocating for greater financial support for students undertaking unpaid clinical placements and flexibility of placement models to mitigate the indirect costs of placements. Collaboration between state and federal government, universities, peak professional bodies, and placement host organisations is imperative to implement a suite of strategies to redress the financial burden experienced by students and secure the future of Australia's health workforce.

Background: Digitalization in the healthcare sector offers several organizational advantages, ranging from enhanced service quality to cost savings. However, its adoption often progresses slowly and faces challenges, especially in critical settings like emergency departments, requiring prompt, clear, and efficient communication. As such, this study aims to comprehensively assess the factors influencing the preference for digitalized tools over traditional methods from the perspectives of both service providers and users.

Methods: We employ two ad hoc stated preference surveys in which we ask respondents to reveal their preference in simulated triage scenarios. Three main alternatives are proposed: traditional procedures, a fully digitalized solution with no direct patient-professional interaction, and a hybrid option that combines traditional and digital aspects. Scenarios and alternatives vary according to predetermined attributes, selected among the features acknowledged to impact the triage efficiency and efficacy: the possibility to communicate in a known language, the completeness of information retrieved from the patient, the time dedicated to triage activity, and the level of privacy. Responses are analyzed by means of discrete choice models.

Results: Our findings reveal a preference for the hybrid approach, wherein patients use digital tools to input relevant information, followed by an interview with healthcare professionals. Nevertheless, distinct alternative- and case-specific features can favor the preference toward other kinds of triage. Respondents prefer shorter triage times and the opportunity to interact in a known language, while the level of privacy does not significantly impact their choices. Interestingly, the presence of an algorithm assigning urgency code diminishes the probability that healthcare professionals select the fully digitalized option.

Conclusions: This study provides important insight into the utilization of digital tools in emergency departments. The results can be used by hospital managers and policy makers to develop digital tools that meet the needs of both users and healthcare professionals. This, in turn, may result in cost savings and improved quality of service.