BMC Health Services Research最新文献

Background: Posture management is very important in the nursing care of premature infants. This study aimed to investigate the status quo and influencing factors of knowledge, attitude and practice in posture management of premature infants among neonatal nurses.

Methods: This study included the nurses worked in the department of neonates of our hospital as the survey population from May 1 to 25, 2023. The general information questionnaire and the neonatal nurses' knowledge, attitude and practice questionnaire were used to collect data. Multiple linear regression analyses were conducted to evaluate the factors influencing the knowledge, attitude and behavior of posture managements.

Results: One hundred fifty-two neonatal nurses were surveyed in this study. The average knowledge, attitude and behavior score on the posture management were (57.21 ± 6.33), (30.86 ± 5.61) and (52.25 ± 7.18) respectively. There were positive correlations in the nurses' knowledge, attitude and behavior scores on the posture management (all P < 0.05). Years of work experience, marital status and had accepted premature infants posture management training were the independent factors influencing knowledge, attitude and behavior on the posture management of premature infants in neonatal nurses (all P < 0.05).

Conclusions: Neonatal nurses attach great importance to the posture management of premature infants, but their knowledge and skills need to be improved, and there are many related influencing factors. Nursing managers should strengthen the training related to the postural management of premature infants and improve their knowledge and ability of posture management of premature infants.

Postpartum depression (PPD) poses significant risks to both maternal and child health, yet it remains underdiagnosed and undertreated, particularly in developing countries like Bangladesh. Factors such as hormonal changes, lack of communal support and socioeconomic stressors primarily contribute to its prevalence. Despite advancements in research, technological solutions for PPD support are lacking in regions where mental health is deemed negligible. Thus, the objectives of this research are to reveal the underlying factors contributing to PPD among mothers in developing countries and to propose a novel application based on these factors for PPD detection. A Design Science Research (DSR) approach is adopted to achieve these objectives. In this research, firstly 17 factors that could serve as effective indicators for detecting PPD were identified through interviews with 12 key informants, including doctors and patients. Next, for each identified factor, visual and scenario-based questionnaires were designed to facilitate effective screening through user feedback. Then, an Android application, 'PPD Screening App', was developed, which provides users with visual, auditory, and multilingual (in English and Bengali) scenario-based questionnaires for each identified factor, as well as the questionnaires proposed in the Edinburgh Postnatal Depression Scale (EPDS) for PPD detection. Finally, the developed application was evaluated with 45 new mothers in the postpartum period and demonstrated high accuracy (96%) compared to the traditional screening method (84%). The effectiveness of the application was also explored in relation to participants' demographic profiles (age and IT literacy), and participants provided very positive feedback on the usability of the application. This research thus contributes in improving early detection and intervention for PPD, ultimately enhancing maternal and child well-being.

Background: Taiwan introduced PharmaCloud, a system designed to streamline access to comprehensive medication records from various healthcare settings. Despite its potential, the impact of physician-led medication reconciliation (MR) utilizing PharmaCloud on outpatient outcomes remains unclear. This study aims to address this gap by evaluating the effectiveness of PharmaCloud-enabled MR in improving patient outcomes.

Methods: We collected data from outpatients with major polypharmacy (≥ 10 medications) between May 19, 2019, and April 18, 2020, comparing those who received MR with those who did not. Outcomes including total medical expenditures, ED visits, hospitalizations, mortality rate, and number of medications were compared between the two cohorts over a 12-month follow-up period.

Results: The study enrolled 209 patients with MR and 9,053 patients without MR. Patients who received MR were older, had lower body mass index, took more medications, and had a higher prevalence of hypertension, cerebrovascular disease, chronic kidney disease, and mental disorder. After 12 months of follow-up, patients who received MR had a higher proportion of reduced medications (adjusted odds ratio: 1.4; 95% confidence interval: 1.0 - 2.0), but also had more ED visits in the first 12 months compared to those who did not receive MR. The study did not find any significant differences in total medical expenditures, hospitalizations, and mortality rates between the two cohorts.

Conclusions: The model reduced medication use. Further research, including prospective designs, pharmacist involvement, and evaluations of reduced complications from fewer medications, is needed to better clarify patient outcomes.

Introduction: The increasing prevalence of diabetes mellites (DM), especially type 2 diabetes mellitus, presents significant challenges for healthcare systems. Effective blood glucose management is essential for preventing serious complications, and telehealth offers a promising approach to improve patient engagement and adherence. The effectiveness of telehealth on blood glucose management should be investigated. The evaluated metric for diabetes management plans in this study was the change in blood glucose levels, specifically HbA1c, as an indicator of glycemic control. The impact of telehealth interventions on these outcomes was analyzed across various patient groups. This review conducts a comprehensive analysis of the current literature to offer insights that can guide clinical practices and inform policymakers about the advantages of telehealth in managing diabetes.

Methods: In this study, several evidence-based databases and relevant clinical trial registries were searched to evaluate the effects of telehealth on blood glucose management among patients with diabetes. The included studies were randomized controlled trials that compared telehealth with traditional in-person management. Microsoft Excel was used to extract and sort the data before it was exported to STATA/MP 17.0 for analysis. A weighted inverse variance random-effects model with a 95% confidence interval was employed to pool the data. Egger's test and Cochrane I² statistics were used to assess publication bias and heterogeneity, respectively.

Result: This review identified six randomized controlled trials (RCTs) involving a total of 3,995 patients, with 2,022 in the telehealth intervention group and 1,973 in the control group, conducted across the USA, Asia, and Europe. The analysis showed a significant improvement in blood glucose control for patients using telehealth, evidenced by a Standard Mean Difference (SMD) of 0.20 (95% CI: 0.10-0.29; p < 0.001), with USA studies reflecting the highest SMD of 0.24 and diabetic veterans showing an even greater SMD of 0.41.

Conclusion and recommendations: This study demonstrates that telehealth interventions significantly enhance blood glucose management among patients with diabetes. The findings highlight the need for healthcare systems to prioritize telehealth integration into diabetes management protocols while developing tailored interventions to meet the diverse needs of various patient populations.

Background: Implementation research should assess the feasibility of scale up to bridge the evidence-practice gap for integrated care programs in the prevention and management of chronic conditions. Scalability assessment is the first critical step of scale up to determine the potential suitability of a promising health program to be adopted into routine practice and the fit of the program within local contexts. The Community Partnership Program (CPP), an integrated care intervention for older adults with diabetes and multiple chronic conditions, was designed at the outset with scale up in mind, and evaluated in an implementation-effectiveness randomized controlled trial across three Canadian provinces. The final phase of this program of research was to assess scalability and determine the critical factors and next steps for the development of a scale up plan.

Methods: Multiple methods were used to assess the scalability of the CPP including collection and analysis of publicly available documents, synthesis of qualitative and quantitative evidence from studies of the CPP, semi-structured interviews with key informants, feedback and recommendations arising from working group meetings and knowledge exchange workshops to discuss and rate the scalability of the program. Data collection and analysis was informed by the Intervention Scalability Assessment Tool (ISAT); developed to support practitioners and policy makers in conducting systematic assessments of the suitability of health interventions for population scale-up in high-income countries.

Results: Overall, the CPP received high scalability ratings from participants. A phased, horizontal implementation and scale up process was recommended, facilitating local adaptations, on-going program evaluation, and accumulation of evidence. Challenges to scale up were identified, including the need for further evidence of program effectiveness in other diverse settings and populations, and designated funding and adequate health human resources.

Conclusions: Participants agreed the CPP meets the needs of many older adults with diabetes and multiple chronic conditions; however, they suggested further tailoring of the program to support different ethnocultural groups and targeting the CPP to older adults with higher needs. The scalability assessment process was a practical method to generate concrete strategies to facilitate the uptake of the CPP into practice.

Trial registration: Clinical Trials.gov Identifier NCT03664583. Registration date: September 10, 2018.

Background: Fragmentation in maternal healthcare contributes to preventable maternal deaths. Improving continuity and coordination can mitigate this issue by influencing interactions among providers, interdisciplinary teams, and patient-provider relationships. The obstetric near-miss approach has the potential to offer insights into continuity and coordination in maternal health. The aim of this study was to explore the perspectives of near-miss survivors and health care professionals on continuity and coordination of care in a primary health care system in Uasin Ngishu region, Kenya.

Methods: This was a descriptive qualitative single case study. Data was collected through individual interviews, focus group discussions, and observation.

Results: Four deductively identified themes emerged: sequential coordination, continuity, parallel coordination, and access. Sequential coordination was influenced by antagonistic relationships between healthcare providers in primary care facilities and the main referral hospital. Longitudinal and interpersonal continuity were driven by positive interactions between women and healthcare providers, characterized by availability, willingness to listen, and addressing personal issues. Parallel coordination was affected by heavy workloads and ineffective task shifting within primary care facilities. Finally, access-related issues included accommodation strategies such as telephone hotlines for pregnant women, out-of-pocket payments for specialist consultation, and alternative referral pathways different from the formal pathways in the health system.

Conclusion: To promote continuity and coordination in primary health care for pregnant women, there is a need to focus on social competencies and skills among health care professionals providing obstetric care, encourage accommodation strategies in facilities, reduce or eliminate out-of-pocket payments for referred women, address attitude and professional conflicts among midwives at different levels in the referral pathway and address workloads and task shifting in primary care facilities.

Background: Health care organisations have a long history of dividing work and tasks into decentralised functions and units by forming divisions and departments with delegated power. New ways of working, such as process-oriented approaches, have been called for to address challenges such as staffing shortages and resource constraints. There is limited understanding of the interplays that will occur in health care organisations during a shift from a traditional decentralised structure to a process-oriented approach. This study aims to explore the perceptions of health care staff and leaders when introducing a process-oriented routine.

Method: We conducted interviews and focus groups with 29 participants in specialised and primary care in order to explore their experiences of a newly introduced routine regarding on-demand consultation, aimed at enhancing communication and patient coordination in a Swedish health care region. The participants included operating managers, schedulers and physicians. Data were analysed using reflexive thematic analysis in accordance with Braun & Clark's guidance.

Results: The findings encompass three main themes when introducing a process-oriented routine: Creates a readiness to act, The critical role of trust for adopting on-demand consultation in everyday practice and Challenges associated with transformation. The results show that health care staff and leaders are positive about the new way of working, but the readiness to act is challenged by issues of trust, as well as cultural components and structural factors such as experienced resource constraints.

Conclusion: Our results underscore the need to consider not only organisational aspects but also social and individual relational factors when introducing a process-oriented way of work into a decentralised and complex health care system.

Background: The purpose of pharmaceutical distribution is to ensure a consistent supply of quality-assured pharmaceuticals to service delivery points to avoid stock outs and/or overstocks. However, choosing a resource-efficient method is difficult because of the two competing interests of lowering distribution costs and improving service level. This study aimed to assess the public sector pharmaceutical distribution system and its challenges in central Ethiopian Pharmaceuticals Supply Service and selected branches.

Methods: This study was conducted at the Central Ethiopian Pharmaceuticals Supply Service and four regional branches between December 2021 and February 2022, utilizing a concurrent parallel mixed-methods design. The quantitative component involved 104 respondents, with data analyzed using SPSS 23 through descriptive statistics. For the qualitative component, 17 key informants participated, and the data were manually analyzed through thematic analysis using an inductive approach.

Results: Warehouse management was performed relatively well compared to inventory management and delivery practices, with overall mean scores of 3.22, 3.14, and 3.08, respectively. The qualitative study highlighted key challenges, including insufficient stock, off-schedule deliveries, the provision of near-expiry products, and vehicle constraints.

Conclusions: This study demonstrated that improving warehousing, inventory management, and delivery practices, while addressing key challenges, could significantly improve the effectiveness of pharmaceutical distribution.

Background: In India, despite several effective interventions being implemented, pneumonia persists as a major cause of under-five mortality. We explore barriers and facilitators to implementing a childhood pneumonia management program in a North Indian district. The study aims to inform the development of effective implementation strategies for pneumonia management in resource-constrained settings.

Methods: This mixed-method study was conducted during the formative phase of an ongoing pre-post quasi-experimental implementation study. Data collection followed the Consolidated Framework for Implementation Research, encompassing surveys on implementation climate and attitudes toward evidence-based-treatment for childhood pneumonia, as well as in-depth interviews to uncover implementation barriers and facilitators with healthcare staff. Additionally, a baseline cross-sectional facility inventory survey was conducted in 26 government healthcare facilities. We present descriptive statistics from the surveys along with deductive analysis findings from qualitative interviews.

Results: Several barriers were observed, like deficient infrastructure and limited space, privacy concerns, inadequate examination tables, disrupted medicine supply, non-maintenance of under-five children's records, inadequate utilization of the digital portal for pneumonia case registration, lack of specific budget allocation for medicine procurement, absence of functional equipment, staff shortages, lack of training, referral linkage issues, and limited accessibility to guideline materials. The absence of incentives demotivated community healthcare workers (CHWs), while coordination issues, power dynamics, and unclear job responsibilities affected the motivation of other healthcare staff. Community reluctance to seek care from government facilities and diminishing community-level trust in CHWs posed implementation challenges. Facilitators included committed healthcare and community workers, problem-solving skills, community engagement, and untied funds from the district government. Implementation climate scores were mildly positive, yet provider attitudes towards Evidence-Based Practices Adoption were neutral.

Conclusions: We propose a multi-pronged approach including healthcare provider training, task sharing, budget reallocation promoting medication access, performance monitoring, digitalization of the record system, and community engagement to optimize program effectiveness.

Trial registration: This research was prospectively registered in the clinical trial registry CTRI202103031622 [Registered on: 01/03/2021].

Background: Depressive disorders can negatively impact work life sustainability for affected individuals. Little is known about depression care trajectories and their association with sustainable return to work (SRTW) after long-term sick leave. This study aimed to identify depression care trajectories during the first three months of sick leave among long-term sick-listed workers with depression and investigate their associations with SRTW.

Methods: DESIGN: Nationwide cohort study using linked data from Norwegian health and population registries.

Study population: All inhabitants of Norway aged 20-64 from 1 January 2009 to 1 April 2011, who were diagnosed with depression in general practice, and had reached three months consecutive sick leave (n = 13 624, 63.7% women).

Exposure: Depression care trajectories during the first three months of initial sick leave, identified using group-based multi-trajectory modeling. Types of depression care included were general practitioner (GP) consults, GP longer consults and/or talking therapy, antidepressant medication (MED), and specialized mental healthcare.

Outcome: SRTW, measured by accumulated all-cause sickness absence days during two-year follow-up after initial sick leave, with cutoffs at 0, ≤ 30, and ≤ 90 days.

Analysis: Gender stratified generalized linear models, used to investigate the associations between depression care trajectories and SRTW, adjusting for sociodemographic factors and sick leave duration.

Results: Four depression care trajectory groups were identified: "GP 12 weeks" (37.2%), "GP 2 weeks" (18.6%), "GP & MED 12 weeks" (40.0%), and "Specialist, GP & MED 12 weeks" (8.7%). The "GP 12 weeks" group (reference) had the highest proportion attaining SRTW for both genders. Men in the "GP 2 weeks" group had a 12-14% lower likelihood for SRTW compared to the reference. Women in the "Specialist,GP & MED 12 weeks 12 weeks" group had a 19- 23% lower likelihood for SRTW compared to the reference.

Conclusion: The association between depression care trajectories and SRTW varies by gender. However, trajectories involving follow-up by the GP, including both standard and longer consults and/or talking therapy over 12 weeks, showed the highest likelihood of SRTW for both genders. Enhancing GP resources could improve SRTW outcomes by allowing more frequent and longer consultations or talking therapy.