BMC Health Services Research最新文献

Background: The burden of opportunistic infections (OIs) remains high among people living with HIV (PLWH) in Mexico, despite improvements in mortality worldwide.

Objective: Reporting the current access to diagnostics of OIs in Mexican Health Care Centers offering health-care services to PLWH.

Methods: An online questionnaire was sent to public health care facilities providing HIV care in Mexico. We evaluated capacities to 1) identify individuals with advanced-HIV, and 2) local and/or on-site access to: point-of-care assays, imaging studies, histological analysis, and microbiology tests useful to diagnose a wide variety of OIs.

Results: In 2022, 46 centers answered the questionnaire, from 23/32 (71.8%) states of the country; 29 (63%) were primary care facilities, 5 (11%) general hospitals and 12 (26%) tertiary care hospitals, providing health services to 67,000 PLWH. These centers received 1,135 new patients/month, 48% with advance disease. Less than 50% could determine CD4 + T cell count (39%, N = 18), toxoplasma serology (41%, N = 19) and HIV viral load (41%, N = 19). Twenty-five centers could diagnose cryptococcosis and tuberculosis (54%). Meanwhile, 11 centers (24%) had access to aspergillosis or Histoplasma tests. Seven centers (11%) had access to coccidioidomycosis tests, five centers to any Pneumocystis diagnosis. In primary care centers, Mycobacterium tuberculosis complex GeneXPert was accessible in 41%, cryptococcal antigen by latex agglutination was available in one facility (3%), Indian ink in 9 centers (31%). No primary health center had access to lateral flow test for Cryptococcus or Histoplasma antigens.

Conclusions: In Mexico, most public HIV-dedicated health care centers lack on-site capacity to diagnose opportunistic infections, specifically fungal infections. Rapid tests and point-of-care tests are frequently unavailable, which is more pronounced in primary care centres. Considering that IFDs still contribute significantly to mortality among PLWH, better access to diagnostic tools in all levels of HIV-care is urgent.

Background: Well-functioning primary health care (PHC) systems are needed to meet the challenges of aging populations and increasing care needs. However, "medical deserts", areas with poor accessibility and availability of PHC services, remain a significant issue throughout Europe, contributing to regional inequalities. Identifying the location of these areas is crucial for effective policymaking and for improving health outcomes. Our aim was to locate underserved areas in Finland by developing a medical desert index. In addition, we examined the impact of telehealth, care needs, and multiple funding sources on the index and analyzed its association with key quality indicators.

Methods: The index was calculated using routinely collected municipality-level PHC consultation data from 2022 adjusted for population care needs (availability) and the average travel time to the nearest PHC center (accessibility). Telehealth and occupational healthcare consultations were included separately. Standardized index values were mapped and categorized using descriptive analysis, and compared with indicators of healthcare utilization, care accessibility and availability, care satisfaction, and continuity of care using correlation analysis.

Results: The index displayed clear patterns of medical deserts, primarily in the rural areas of northern and eastern Finland. Approximately 13% of the Finnish population resided in medical deserts, defined as a standard score of -0.5 or lower. The inclusion of telehealth consultations appeared to improve the index values especially in some rural areas. Better accessibility and availability of PHC services, as indicated through the index, was significantly correlated with lower proportion of acute care consultations, fewer hospital care days, and lower continuity of care among clients aged 65 years and older.

Conclusions: We were able to identify medical deserts in Finland utilizing novel methodology distinct from previous indicators, and thus providing important considerations for future research on regional inequalities in accessibility and availability of PHC services. Our findings demonstrated the potential of telehealth services in mitigating medical deserts, though its appropriateness for some population groups and care needs remains unclear. We call for health policy addressing PHC service provision especially in rural areas.

Background: Digital health technologies (DHT) have become an integral component of modern healthcare systems, offering the potential to improve healthcare delivery and outcomes. Guided by the Technology-Organization-Environment (TOE) framework, this study examines the impact of DHT adoption on healthcare workers' performance and workload in public and private hospitals in Mogadishu, Somalia.

Method: A stratified random sampling approach was used to collect data from 286 healthcare workers in public and private hospitals. Data were analyzed using Structural Equation Modeling (SEM) to test hypotheses and assess direct and mediating relationships among variables.

Results: The analysis revealed that DHT significantly improves healthcare workers' performance and workload respectively (β = 0.452, C.R. = 10.150, p < 0.001) and (β = 0.594, C.R. = 9.972, p < 0.001), organizational and environmental factors are positively impacting on healthcare workers' performance (β = 0.327, C.R. = 8.709, p < 0.001) and (β = 0.102, C.R. = 2.872, p = 0.004). Healthcare workers' performance significantly reduces workload (β = 0.594, C.R. = 9.972, p < 0.001) and the mediating role of healthcare workers' performance between DHT and workload were also confirmed (β = 0.281, C.R. = 5.9787, p < 0.001).

Conclusion: The findings underscore the critical role of DHT in enhancing healthcare workers' performance and reducing workload, with the TOE framework and performance acting as significant mediators. These results provide actionable insights for healthcare administrators and policymakers to optimize DHT implementation, support workforce efficiency, and address workload challenges through strategic organizational and environmental adaptations.

Background: The development of effective eHealth strategies is critical to enhancing healthcare systems' efficiency and outcomes. However, there is limited comparative analysis of eHealth strategies across health systems, particularly in terms of their vision, objectives, implementation methods, and follow-up processes. This study compares the eHealth strategies of nine health systems, focusing on three key dimensions: vision and objectives, means to achieve objectives, and structures for follow-up.

Methods: A comparative qualitative analysis was conducted using publicly available eHealth strategy documents from nine health systems: Australia, Denmark, Estonia, Finland, Norway, Sweden, the UK (NHS England), Catalonia (Spain), and the USA (Veterans Affairs). The analysis mapped these systems' visions, objectives, implementation methods, and follow-up structures.

Results: Findings show that most systems articulate clear visions and strategic goals. However, there is considerable variability in the level of detail regarding the means of achieving objectives and structures for follow-up. Australia and Estonia present the most comprehensive strategies, with clear tasks, responsibilities, timelines, and follow-up mechanisms. In contrast, countries like Sweden and Catalonia provide less detailed strategic plans, particularly in terms of follow-up processes.

Conclusions: While most studied health systems include clear visions and strategic goals, there is variability in the detail and comprehensiveness of their implementation and evaluation frameworks. Strategies with detailed implementation plans and follow-up processes, such as those from Australia and Estonia, offer valuable models. Further research is recommended to explore the practical impact of these strategies on healthcare delivery, patient outcomes, and system efficiency. Additionally, the role of stakeholder involvement in shaping these strategies warrants further investigation.

Background: The COVID-19 pandemic accelerated the adoption of telemedicine, integrating it into mainstream healthcare, especially in underserved and rural areas. This study examines the implementation and perceptions of telehealth in a rural Midwestern community in the post-pandemic period. Rural populations often face unique healthcare challenges. Telehealth has the potential to mitigate these issues by improving healthcare accessibility and patient satisfaction, thus being a vital topic for research.

Methods: A survey was created and conducted from September to October 2023 to evaluate Internet access, telehealth usage, and perceptions among residents of a rural Midwestern county. The county received fiberoptic Internet in November 2021, offering a valuable glimpse at the impact of advanced internet. The survey, distributed both online and in person, garnered 253 valid responses. Statistical analyses, including chi-square tests, were performed using IBM SPSS to explore the relationships between survey responses.

Results: Among the 253 participants, the majority were female (81.4%) with a median age of 50 years. Internet access varied, with 22% of paper survey respondents lacking home Internet compared to 1.3% of online respondents. Telehealth usage for participants increased from 5% pre-pandemic to 42.1% during the pandemic, with 21.8% continuing to use telehealth post-pandemic. Primary care visits were the most common telehealth appointments. Key concerns included a preference for in-person care and perceived lower quality of telehealth services. Despite these concerns, 59.7% of respondents were willing to use telehealth, rising to 67.5% if recommended by a healthcare provider. Comfort with telehealth was significantly linked to perceptions of Internet speed and stability.

Conclusions: While broadband and fiberoptic Internet are associated with better telehealth experiences, other types of Internet also facilitated telehealth usage in our study, indicating that factors beyond access influence patient comfort and willingness to use telehealth. Our findings also reveal significant interest in telehealth for primary care, suggesting rural patients prefer familiar providers for telehealth interactions. Despite increased telehealth interest and usage during the pandemic, a decline post-pandemic indicates potential barriers exist, such as limited availability of healthcare providers. Exploring and addressing these barriers remains crucial for sustaining telehealth adoption and improving healthcare access in rural communities.

Background: The calculation of aggregated composite measures is a widely used approach to reduce the amount of quality-related data on hospital report cards (HRCs). This study aims to elicit patient preferences for hospital choice concerning publicly available hospital quality information for total hip replacement surgery. The results may assist in the development of weighted composite measures for elective hip replacement, which facilitates a conscious selection of the hospital.

Methods: We collect primary survey data on a sample of 364 randomly selected users of the German HRC "Weisse Liste" (WL) (4/5 2023). The key attributes for hospital choice are based on the information provided in WL. We run various model specifications to identify patient preferences, allowing the analysis of unobserved preference heterogeneity.

Results: Our sample consists of 177 respondents (mean age 56.46; 43.5% female). All attributes used are statistically significant for hospital choice ( $p<0.01$ ). Patients consider the "Quality of treatment" (26.95%; level range 1.734) and "Number of cases treated" (24.78%; level range 1.594) to be the most important. In contrast, "EndoCert Certificate" (17.50%; level range 1.126), "Equipment and qualification" (15.83%; level range 1.018), and "Recommendation from other patients" (14.94%; level range 0.960) remain less important. We find no evidence for unobserved heterogeneity regarding the preferences for hospital choice.

Conclusion: Based on our findings, HRC users value publicly available hospital quality information for elective hip replacement differently. These differences should be taken into account when calculating aggregated composite measures. Our results may allow the calculation of a weighted aggregate composite measure from the perspective of HRC users.

Background: In times of crisis, decision-making can become a highly complex process that is shaped differently than in ordinary contexts. The literature presents different decision-making models that have not yet been thoroughly tested in practice. This paper aims to enhance our understanding of the distinctive characteristics of healthcare organizations' decision-making models in crisis contexts, building upon and expanding the framework proposed by Arendt et al. (2005).

Methods: Based on a qualitative research design, data were collected through semi-structured interviews with 49 CEOs of Italian healthcare organizations, including both local health authorities and independent hospitals.

Results: CEOs' decision-making processes demonstrated several commonalities: a shift from strategic issues to operational issues; a narrowed CEO focus on only a few areas of operations, and a significant concentration of the DMP in time and space. These shared elements provide insights into the nature of the centralization process adopted by CEOs in such situations. Additionally, we identified various decision-making models to manage the same crisis, with each model presenting a different level of involvement of other actors in the decision-making process, reflecting the CEO's unique vision and background.

Conclusions: This research makes a significant contribution to the growing literature on crisis management in three key ways. First, it emphasizes the importance of analyzing the decision-making process through the combined lens of different dimensions and phases. Second, it enhances the Arendt et al. (2015) model to include multiple critical dimensions of the decision-making process beyond the initial focus on decentralization, and demonstrates how, in a crisis context, the actors involved by the CEOs diverge from the original framework. Third, it offers new insights into the variables affecting the roles of the CEOs and other key actors in crisis-related decision-making, transcending the boundaries of role theory. In terms of managerial implications, reflecting on and interpreting the core of the organization's decision-making processes, can support top management teams in navigating change, providing them a more robust and rational base for guiding the transition to a post-crisis "new normal".

Background: Nurses have a crucial role in recognizing potential dangers to patient safety during direct patient care. However, there are occasions when they opt to stay quiet instead of voicing their concerns, ultimately endangering patients. The underlying reasons for this silence pose a significant challenge in the nursing industry. While it's known that workplace conditions contribute to this silence, the specific ways in which this occurs need to be clarified. This research aimed to investigate the factors that lead nurses to remain silent about patient safety, specifically focusing on environmental influences in Ardabil City.

Methods: This descriptive and analytical study examined 630 nurses, including head nurses, from five medical training centers in Ardabil, northwest Iran. The primary instruments used in the research included the Employee Silence about Patient Safety Questionnaire, the Practice Environment Scale of the Nursing Work Index (PES-NWI), measures of psychological safety, leader-member exchange (LMX) assessments, and evaluations of professional discrimination. Data analysis was performed using SPSS version 16.0, applying descriptive statistics, t-tests, ANOVA, Pearson's correlation coefficient, and hierarchical regression analysis.

Results: The average score for employee silence regarding patient safety was 2.62, with a standard deviation of 0.98. Several factors were found to be significant predictors of employees' silence about patient safety, including nurse participation in hospital affairs (ß = 0.196, p = 0.002), nurse's role in the quality of care (ß = -0.352, p < 0.001), staff and facility adequacy (ß = 0.156, p = 0.001), communication with the physician (ß = -0.105, p = 0.015), LMX (ß = -0.284, p < 0.001), and job position (ß = -0.093, p = 0.018).

Conclusion: This study has identified several critical factors influencing employee silence regarding patient safety, including nurse involvement in hospital decision-making, the quality of care, communication with physicians, and job positions. To address these challenges, healthcare organizations must implement standardized protocols, improved communication channels, regular safety training, and the integration of advanced technologies. Increasing nurse participation in decision-making processes and strengthening communication between nursing staff and physicians can foster a culture of openness that encourages employees to voice their safety concerns. By creating an environment where staff feel supported and empowered to speak up, healthcare facilities can enhance patient safety and improve overall care quality, ultimately leading to a safer working environment for healthcare professionals.

Objective: To compare the cost-effectiveness of tandem mass spectrometry (MS/MS) screening for neonatal inherited metabolic diseases (IMDs) with fluorescence analysis (FA) screening for neonatal inherited metabolic diseases (IMDs) and provide evidence for promoting MS/MS in China.

Methods: An Excel-based decision tree model was constructed to evaluate the cost-effectiveness of MS/MS versus FA screening from a societal perspective. The model simulated the screening pathway, prevention, and treatment of IMDs, adjusted to 2023 price levels. Health outcomes were measured in quality-adjusted life years (QALYs), with a 3% annual discount rate applied. The willingness-to-pay (WTP) threshold was set at one times the per-capita GDP of China in 2023.

Results: MS/MS screening was more costly (CNY 1,121,637; USD 158,423 vs. CNY 380,276; USD 53,711) but more effective (16.47 QALYs vs. 5.93 QALYs) than FA screening. The incremental cost-effectiveness ratio (ICER) was CNY 70,286 (USD 9,927) per QALY, below the WTP threshold. The benefit-cost ratio (BCR) was 1:3.94.

Conclusion: While MS/MS screening incurs higher costs, it achieves significantly greater QALY gains and demonstrates favorable cost-effectiveness and economic benefits. MS/MS screening should be actively promoted for neonatal IMDs in China.