BMC Health Services Research最新文献

Background: Hypertension is one of the main risk factors for cardiovascular disease impacting over a billion people worldwide. Work environment factors could adversely affect workers' cardiovascular health, including contributing to hypertension. Healthcare workers who treat patients are also affected. In the Democratic Republic of Congo, limited studies explored the work environment factors associated with hypertension. This study aimed to examine hypertension prevalence and determine the associated risk factors among healthcare workers in Kinshasa.

Methods: A cross-sectional study was conducted in Kinshasa's healthcare facilities from December 2023 to January 2024 among healthcare workers selected by multistage stratified random sampling. Data was collected through a structured questionnaire using a modified WHO STEPwise approach and Karasek questionnaire. Anthropometric parameters, blood pressure, and fasting blood sugar were measured. The prevalence of hypertension was assessed. All sociodemographic, occupational, and lifestyle variables associated with hypertension were included in multivariable logistic regression analysis at the 5% significance level.

Results: The study encompassed 614 participants, comprising 55.2% females and 44.8% males. The mean age of participants was 38.8 ± 10.4 years, ranging from 20 to 78 years. The prevalence of hypertension was 22.6% and over half of those with hypertension (56.1%) were unaware of their condition. Of the known hypertensive participants before the study, 60.7% had uncontrolled blood pressure. In the multivariable analysis, identified risk factors for hypertension were age ≥ 40 years (aOR = 2.75, 95% CI: 1.64-4.61), seniority ≥ 10 years (aOR = 2.65, 95% CI: 1.54-4.58), multiple job holding (aOR = 3.11, 95% CI: 1.81-5.34), job stress (aOR = 1.84, 95% CI: 1.17-2.89), physical inactivity (aOR = 1.67, 95% CI: 1.03-2.68), overweight (aOR = 1.75, 95% CI: 1.06-2.90) and obesity (aOR = 3.75, 95% CI: 2.10-6.70).

Conclusion: Our results underline an important prevalence of hypertension among healthcare workers in Kinshasa, despite their medical knowledge of the causes and the risks. A healthy lifestyle among healthcare workers is fundamental for ensuring the efficiency and productivity of the healthcare system. Regulating multiple job holding and implementing a hypertension prevention intervention encompassing their holistic support is crucial for reducing job stress and promoting well-being.

Background: Many hospitalised patients require rehabilitation during recovery from acute illness. We use routine data from Electronic Health Records (EHR) to report the quantity and intensity of rehabilitation required to achieve hospital discharge, comparing patients with and without COVID-19.

Methods: We performed a retrospective cohort study of consecutive adults in whom COVID-19 testing was undertaken between March 2020 and August 2021 across three acute hospitals in Scotland. We defined rehabilitation contacts (physiotherapy, occupational therapy, dietetics and speech and language therapy) from timestamped EHR data and determined contact time from a linked workforce planning dataset. Our aim was to clarify rehabilitation required to achieve hospital discharge and so we excluded patients who died during their admission, and those who did not require rehabilitation (fewer than two specialist contacts). The primary outcome was total rehabilitation time. Secondary outcomes included the number of contacts, admission to first contact, and rehabilitation minutes per day. A multivariate regression analysis for identifying patient characteristics associated with rehabilitation time included age, sex, comorbidities, and socioeconomic status.

Results: We included 11,591 consecutive unique patient admissions (76 [63,85] years old, 56% female), of which 651 (6%) were with COVID-19, and 10,940 (94%) were admissions with negative testing. There were 128,646 rehabilitation contacts. Patients with COVID-19 received more than double the rehabilitation time compared to those without (365 [165, 772] vs 170 [95, 350] mins, p<0.001), and this was delivered over more specialist contacts (12 [6, 25] vs 6 [3, 11], p<0.001). Admission to first rehabilitation contact was later in patients with COVID-19 (3 [1, 5] vs 2 [1, 4] days from admission). Overall, patients with COVID-19 received fewer minutes of rehabilitation per day of admission (14.1 [9.8, 18.7] vs 15.6 [10.6, 21.3], p<0.001). In our regression analyses, older age and COVID-19 were associated with increased rehabilitation time.

Conclusions: Patients with COVID received more rehabilitation contact time than those without COVID, but this was delivered less intensively and was commenced later in an admission. Rehabilitation data derived from the EHR represents a novel measure of delivered hospital care.

Introduction: Emergency department clinicians, and particularly nurses in triage, frequently perform routine blood tests on patients whose allocated triage category is not time critical (triage categories 3, 4 and 5 of the Australasian Triage Scale). Some observers have questioned the utility of routine blood testing in these acute healthcare settings given the cost and workload implications.

Methods: A quantitative method using retrospective observational design was utilised guided by STROBE checklist. Electronic medical records of patient data collected at a quaternary Australian metropolitan hospital emergency department were reviewed.

Results and discussion: A total of 74,878 adult patients attended the emergency department between 1st January and 31st December 2021 and a sample of 383 were randomly allocated for this study. Of the 383 patients included, 51% were female, age ranges were 18-99 years (mean 51.6). The majority were Australasian Triage scale (ATS) triage category 3 (55%) and 62% had blood tests performed. Blood test performance was found to be associated with advancing age (p < 0.001) but not with department occupancy as determined by the national emergency department overcrowding scale (p = 0.230).

Conclusion: Blood testing in the emergency department in triaged non-time critical patients was found to be frequent thereby affecting nurses' already stretched time resource. Older patients were found to be more likely to have a blood test. There is a positive correlation between blood test performance and length of stay in the emergency department.

Background: Leadership plays a critical role in the delivery of person centered, safe, efficient, and effective healthcare services globally. Poor healthcare leadership contributes to low staff motivation, patient dissatisfaction, and reduced healthcare-seeking behavior. However, there is limited evidence on healthcare leadership practice and associated factors among primary healthcare managers in the study area and at large in Ethiopia. Therefore, the findings of this study will contribute to improved healthcare leadership practices among primary healthcare managers.

Method: Facility-based cross-sectional study supplemented with qualitative inquiry was conducted in the East Gojam zone among 532 primary healthcare managers selected by a two-stage stratified random sampling technique. A pre-tested and structured self-administered questionnaire was used to collect the quantitative data. Data were entered into Epi-Data version 4.6 and exported into Stata version 14.0 for analysis. Multiple linear regression analysis was used to identify factors associated with healthcare leadership practice, and statistical significance was declared at a p-value < 0.05 with a 95% CI. Six key informant interviews were conducted, and thematic analysis was used for the qualitative study.

Result: The magnitude of healthcare leadership practice among primary healthcare managers in the East Gojam zone was 45.7% (95% CI: (41.4, 50.0)). Factors associated with healthcare leadership practice were age [β = 0.44, 95% CI: (0.16, 0.71)], training in healthcare leadership practice [β = 1.19, 95% CI: (0.19, 2.20)], experience sharing [β = 1.68, 95% CI: (0.59, 2.76)], organizational communication [β = 0.19, 95% CI: (0.05, 0.33)], managerial working experience [β = 0.94, 95% CI: (0.18, 1.69)] and emotional intelligence [β = 0.35, 95% CI: (0.31, 0.38)].

Conclusion and recommendation: The magnitude of healthcare leadership practice among primary healthcare managers in the East Gojam zone was low as compared with a previous study in Ethiopia. It was significantly associated with age, training in leadership, experience sharing, organizational communication, managerial working experience, and emotional intelligence. Thus, human resource managers at primary healthcare level should consider older and more experienced candidates during assigning managers, organize training on healthcare leadership and experience sharing with model managers to improve the leadership practice of primary healthcare managers in the East Gojam zone.

Background: Despite several global interventions, tuberculosis (TB) remains a leading cause of death affecting millions of people globally. Many TB patients either have no access to quality care or go undetected by national health systems. Several multilevel factors account for under-detection of persons with TB. This study sought to explore patient-related software, community and health systems software and hardware factors influencing time to notification of TB in Lusaka District, Zambia.

Methods: This was an exploratory qualitative case study that adopted a software and hardware lens of conceptualizing health systems. Data were collected from across three sites - urban and peri-urban areas: Chongwe, Kafue, and Lusaka - within Lusaka Province, Zambia. Sixteen key informants - TB corner nurses, community TB treatment supporters, and TB program managers - were interviewed. Six focus groups were held with TB patients. Data were analyzed using thematic analysis.

Results: The study identified factors influencing timely TB notification, categorized into software and hardware elements. Patient-related software elements, including TB knowledge and awareness, and health-seeking behavior, are crucial for prompt notification among TB patients. In the community health system, software elements like social stigma and undesirable community attitudes towards contact tracing, and hardware elements such as unbalanced schedules, excessive workload and limited capacity of community TB treatment supporters contribute to delayed TB notification. In the formal health system, software elements like negative attitudes of health providers towards TB patients and demotivation of TB staff, and hardware elements such as high diagnostics and transportation costs, outdated diagnostics in primary care facilities, and slow referral mechanisms, can also delay TB notification.

Conclusion: Delays in time to TB notification are influenced by a combination of software (attitudinal and behavioral) and hardware (resource-related) elements across TB patients, community health systems, community TB treatment supporters, health providers, and TB staff. Addressing these factors, particularly social stigma, negative attitudes, and resource constraints, is crucial to improving timely TB detection and treatment.

Background: Previous research indicates that routine inquiry or screening conducted by healthcare providers may significantly increase the identification of interpersonal violence. There is a lack of comprehensive instruments to routinely assess patients about interpersonal violence and violence against children in the household. The purpose of this study was to assess the content validity, face validity and reliability of the Questions on Violence (FOV) tool, an instrument specifically designed for routine inquiries about interpersonal violence in healthcare settings within the Swedish context.

Methods: The content validity, face validity and reliability of the FOV instrument was assessed through (1) a content validity index with six experts in the field of intimate partner violence, (2) cognitive interviews with nine patients recruited from a primary healthcare facility, and (3) an evaluation of the test-retest reliability based on responses from 37(50.0%) university students. The intraclass correlation coefficient, model 2.1, was calculated to assess the degree of correlation and agreement between the two measurements.

Results: Calculations based on the content validity index indicated that five out of seven items had excellent content validity (≥ 0.78). The average content validity index of included items was 0.88, which is slightly below the recommended threshold for excellent content validity. The results based on the cognitive interviews revealed that participants found the seven items to be relevant and easy to understand. Overall, the participants agreed that the concept of 'close relationships' primarily encompassed intimate partners, family members, and close friends. The value of the intraclass correlation coefficient was 0.85 (0.77-0.91; CI 95%), indicating good reliability with an interval of good to excellent test-retest reliability.

Conclusions: The results demonstrate that the seven-item FOV instrument has good content and face validity as well as good to excellent test-retest reliability. The current study provides healthcare professionals with a short yet comprehensive instrument for identifying patients who have experienced or perpetrated different forms of interpersonal violence.

Background: Helicopter Emergency Medical Services (HEMS) in the United Kingdom (UK) deliver enhanced care to high-acuity, critically ill and injured patients. To enable patients to meet the HEMS team who treated them, many services within the UK have developed or are in the process of developing a Patient and Family Aftercare Service (PFAS). This study aims to evaluate whether the introduction of PFAS mitigates anxiety associated with patient aftercare visits.

Methods: A service evaluation of anxiety in HEMS team members before and after patient aftercare visits were conducted. The study was carried out between 1 September 2023, and 31 October 2023, and patient visits were undertaken between March 2022 and July 2023. An electronic survey was distributed to the respondents who provided informed consent for participation. The survey comprised the validated generalised anxiety disorder anxiety scale (GAD-7) and five additional contextualised statements developed through the wider PFAS. Anonymised data were collected using REDCap, a secure electronic database and was analysed in R programming. Free-text comments were reported by content analysis, placed into themes, and discussed with a narrative to complement the quantitative analysis.

Results: Of the 33 recipients, 25 completed the questionnaire. Between the pre- and post-aftercare visits, a statistically significant difference was found between scores for GAD-7 (0.004, p < 0.05) and contextualised statements (0.001, p < 0.05). In addition, six broad themes were identified through content analysis. These include the emotional impact of patient interaction, coping strategies and structural changes in the aftercare system, challenges in patient and family expectations, anxieties relating to operational commitments, memory and recall of the incident, and a positive impact on personal growth.

Conclusion: Anxiety related to patient aftercare visits was reduced when measured before and after the patient visits. Following this service evaluation, we can hypothesise that within pre-hospital care, PFAS plays an important structural role. Future research should focus on affirming the correct tool to measure anxiety in multi-disciplinary teams and prospectively evaluating these methods collaboratively across multiple pre-hospital services.

Introduction: The health of people is negatively impacted by emergencies and catastrophes, and many lives are lost as a result. The guidelines for humanitarian action during times of crisis, whether brought on by armed war or natural disasters, are provided by the humanitarian principles. The purpose of this study was to evaluate how the staff and clients at Tikur Anbessa Specialized Hospital felt about the applicability of the four humanitarian principles when responding to emergency conditions.

Methodology: Facility-based descriptive and explanatory cross-sectional study designs were employed. The study intended to collect data with structured questionnaires from a total of 209 individuals in Tikur Anbessa Specialized Hospital. The participants were selected randomly based on, their willingness. Of the 209 participants, 105 included staff and the rest 104 included clients (patients and caregivers in the emergency room) of Tikur Anbessa Specialized Hospital. The collected data were analyzed using Statistical Package for Social Science version 23.

Results: The descriptive analysis shows that principles of humanity are practiced better with (mean = 3.5) and principles of impartiality are practiced less with (mean = 3.2) as to the perception of the participants. Correlational analysis was used to examine the relationship between the ages, profession, gender, status, work experience, and familiarity with humanitarian principles, and the results indicated a non-significant correlation between variables, r (209) = 0.01 (2 tailored), "p = ns". This suggests that familiarity with humanitarian principles or other independent variables does not affect the applicability of humanitarian principles in healthcare settings.

Conclusion: From the results of this study, it can be concluded that the state of being a staff (health care practitioners and those providing ancillary services) and client of Tikur Anbessa Specialized Teaching Hospital has nothing to do with developing a certain perception towards the practicability of the four humanitarian principles (humanity, impartiality, neutrality, and independence).

Background: Healthcare systems aim to enhance the health status and well-being of the individuals and populations they serve. To achieve this, measuring and evaluating the quality and safety of services provided and the outcomes achieved is essential. Like other countries, Romania faces challenges regarding the quality of care provided in its public hospitals. To address this, the Romanian Ministry of Health initiated reforms in 2022, including implementing a pay-for-performance model based on quality indicators. This paper presents a descriptive analysis of processes, methods, results and lessons learned from developing and piloting a set of Quality of Care indicators for Romanian public hospitals.

Methods: World Health Organization's Athens Office on Quality of Care and Patient Safety assisted Romania in developing and piloting a set of quality-of-care indicators for public hospitals. The development phase included defining indicator domains, identifying potential indicators across these domains, and defining the final indicator set. The piloting phase involved selecting and recruiting piloting hospitals, developing data collection and validation methods and tools, training hospital staff, and collecting and analysing indicator data. Piloting ended with an evaluation workshop. Mixed, quantitative and qualitative methods were used, including literature reviews, stakeholder consultation workshops, survey instruments developed for this study, modified Delphi panels and consensus-building meetings. National stakeholders were actively involved throughout the process.

Results: Four priority domains were defined for quality-of-care indicators for Romanian public hospitals: patient safety, patient experience, healthcare workforce training and safety, and clinical effectiveness. 25 core indicators were selected across these domains. During the pilot, hospitals achieved an average completion rate of 90% for data submission, with all domains rated equally relevant during post-pilot evaluations. Lessons included the need for supportive legislation, improved internal auditing practices and enhanced staff training, refinement of indicator data collection methods and alignment of indicators with hospital-specific contexts.

Conclusions: This work presents a significant stride in improving Romanian public hospitals' quality of care and patient safety. It underscores the importance of high-level commitment, stakeholder engagement, and robust data practices in driving successful quality improvement efforts. Emphasising the role of data-driven and patient-centric approaches in achieving optimal healthcare outcomes, lessons learned offer insights for the continuation of quality improvement work in Romania but also for healthcare systems elsewhere.

Introduction: Assigning qualified interpreters is considered one of the most effective approaches to facilitate communication in language-discordant encounters in mental healthcare. However, particularly in settings with fewer resources, they are not always available and informal practices are often used.

Objective: This study aimed to investigate informal interpreting practices in mental healthcare in South Africa, focusing on security guards (SGs) serving as interpreters.

Methods: Guided interviews were conducted with SGs (n = 12) and mental healthcare providers (MHCPs) (n = 18) at a psychiatric hospital in South Africa. The interviews were audio recorded, transcribed verbatim and analyzed using a thematic analysis approach.

Results: Despite recognizing that SGs serving as interpreters is not an ideal solution to overcome language barriers and could potentially jeopardize the quality of treatment and its outcomes, MHCPs reported relying heavily on them due to the underrepresentation of South Africa's linguistic diversity among them. Given the lack of formal interpreting services, the perceived racial, linguistic and socioeconomic similarities between SGs and some service users, as well as their immediate accessibility, were described as beneficial to providing a minimal level of care (e.g. obtaining information about service users' backgrounds, getting an understanding of their symptoms, psychoeducation, explaining treatment options). Drawbacks reported are SGs being pulled away from their actual duties, experiencing emotional distress, juggling multiple sometimes conflicting roles, and the risk of incorrect interpretation, which could compromise ethical standards of care. Additionally, the complexity of power became apparent: While SGs hold little institutional power within the mental healthcare system, they become powerful figures when serving as interpreters.

Conclusion: It can be assumed that MHCPs will resort to informal interpreting practices as long as effective alternatives are lacking. In doing so, risks such as reduced quality of care are accepted, and the consequences and effects on those serving as interpreters are neglected, which raises concerns from an ethical point of view.