BMC Health Services Research最新文献

Background: The burden of chronic non-communicable diseases (NCDs) is a growing public health concern. The availability of cost-of-illness data, particularly public healthcare costs for NCDs, is limited in Sub-Saharan Africa (SSA), yet such data evidence is needed for policy action.

Objective: The objective of this study was to estimate the economic burden of type 2 diabetes (T2D) on Kenya's public healthcare system in 2021 and project costs for 2045.

Methods: This was a cost-of-illness study using the prevalence-based bottom-up costing approach to estimate the economic burden of T2D in the year 2021. We further conducted projections on the estimated costs for the year 2045. The costs were estimated corresponding to the care, treatment, and management of diabetes and some diabetes complications based on the primary data collected from six healthcare facilities in Nairobi and secondary costing data from previous costing studies in low and middle-income countries (LMICs). The data capture and costing analysis were done in Microsoft Excel 16, and sensitivity analysis was conducted on all the parameters to estimate the cost changes.

Results: The total cost of managing T2D for the healthcare system in Kenya was estimated to be US$ 635 million (KES 74,521 million) in 2021. This was an increase of US$ 2 million (KES 197 million) considering the screening costs of undiagnosed T2D in the country. The major cost driver representing 59% of the overall costs was attributed to T2D complications, with nephropathy having the highest estimated costs of care and management (US$ 332 million (KES 36, 457 million). The total cost for T2D was projected to rise to US$ 1.6 billion (KES 177 billion) in 2045.

Conclusion: This study shows that T2D imposes a huge burden on Kenya's healthcare system. There is a need for government and societal action to develop and implement policies that prevent T2D, and appropriately plan care for those diagnosed with T2D.

Background: Organizational health literacy (OHL) describes conditions and measures in healthcare institutions to enable patients to make good health-related decisions. By providing easy access to and appropriate communication of understandable information to use and navigate the facility, healthcare organizations can contribute to strengthening patients' health literacy and self-management. The extent of OHL implementation in German hospitals remains largely unknown. This study aims to fill this gap in our knowledge by investigating OHL-related activities reported by hospital managers.

Methods: Between November and December 2022, we conducted a national online survey among medical, nursing and administrative hospital managers with hospitals that operate more than 50 beds. The data were collected via the health literate health care organization ten item questionnaire (HLHO-10) and supplemented by sociodemographic questions and an open-ended question. We applied variance and correlation analyses to investigate the data.

Results: Of 3,301 invited hospital managers, 371 participated in the survey (response rate 11%). The overall mean score for HLHO-10 was 4.6 (SD = 1.1) on a 7-point Likert scale, indicating a moderate level of OHL implementation. Hospital managers stated that hospitals concentrate on helping patients find their way around and communicating the costs of treatment transparently and clearly; conversely, that active patient participation in the design and evaluation of health information is rare in care settings, and that health information is seldom provided to patients through a range of media. For the practical implementation of the OHL, most hospital managers mentioned activities regarding communication standards, such as providing information materials.

Conclusions: Given their unique position as hubs of human interaction, hospitals provide an ideal opportunity to promote the adoption of OHL. By actively involving patients, hospitals can better tailor their approaches to meet patient needs and preferences. Compared to studies from oncology centres in Germany and 20 Italian hospitals, the average HLHO-10 score of this study is lower. While some aspects of OHL are already embedded in inpatient care, it is imperative that OHL is thoroughly embedded in the hospitals' organizational culture and plays a fundamental role in the daily operations of the institution. This could be done, for instance, by more explicitly addressing the topic of health literacy in staff communication training.

Background: Evidence-based and evidence-informed interventions designed to address gaps in the HIV care continuum have the potential to improve HIV care and treatment. However, inadequate organizational readiness can derail intervention uptake, prevent the integration of interventions, and contribute to suboptimal HIV treatment outcomes. This study sought to understand organizational readiness to implement bundled interventions for Black women with HIV and inform facilitators and barriers to implementation.

Methods: We conducted a mixed methods readiness assessment across 12 sites participating in the Black Women First (BWF) initiative to gauge preparedness to implement bundled interventions. Readiness was assessed using the organizational readiness for implementing change (ORIC) scale, and two open-ended questions examined facilitators and barriers. Associations between participant and organizational level factors were evaluated using linear models with clustering by site at baseline, 6- and 12-months. Pre-implementation interviews were conducted with staff virtually and transcripts were managed in NVivo. Directed content analysis was used to explore implementation barriers and facilitators.

Findings: Sites demonstrated high levels of organizational readiness at baseline; overall organizational readiness for implementing change (ORIC) (mean 56.4, median 59, interquartile range [IQR] 5) and subscales of the ORIC change efficacy (mean 32.4, median 35, IQR 4), change commitment (mean 24, median 25, IQR 1), which is consistent with willingness and capability to implement bundled interventions for Black women with HIV. Organizational readiness remained high at 6- and 12-month follow-up periods. Staff role was significantly associated with organizational readiness (p = 0.007), change efficacy (p = 0.006), and change commitment (p = 0.020) at 6 months. Qualitative analysis indicated strategic planning and assessment (e.g., team coordination and the development of workflows to support implementation); organizational change through network weaving across silos within the organization, and communications systems that engage external partners, as well as resources available for hiring and training, supported readiness. Collaborative leadership and organizational buy-in, staff motivation, and partnerships facilitated implementation processes.

Conclusions: Organizations in the BWF initiative have high levels of organizational readiness reflecting willingness and capability to implement bundled interventions for Black women with HIV. Future research should examine the relationship between readiness and clinical outcomes.

Background: The delivery of high-quality services in chronically underfunded social or long-term care systems is a major challenge internationally. National guidelines, developed by the National Institute for Health and Care Excellence, set out how local authorities in England and Wales should fund and provide care based on best available evidence. Theoretical and participatory approaches can usefully inform the design and evaluation of implementation strategies for guidelines. The aim of the study is to develop a Theory-of-Change for how the implementation of these guidelines is expected to lead to impacts from a local authority perspective.

Methods: As part of a comparative case study (The 'Valuing Care Guidelines' study; February 2022 to April 2024) with three local authority sites in England and Wales, we involved altogether 17 participants in two Theory-of-Change online workshops per site, each of 2 hours. Additional data gathered from the same participants as part of the overall study were used to conceptualise and enrich information from the workshops.

Results: Participants described the Theory-of-Change map as follows: A wide range of activities (categorised in stages of 'pre-implementation', 'implementation', 'sustainment and scaling') and skills were required to implement guidelines, and achieve long-term organisational sustainability and service delivery outcomes, leading to final impacts for service users and carers. Participants described a co-creation implementation model, led by 'Implementation Support Practitioners', who utilised relational skills to achieve motivation, trust, and confidence at different organisational levels, addressing contextual barriers such as inadequate staffing, lack of resources and of organisational support systems. Consistent use of guidelines by frontline staff could only be achieved if the value of guideline implementation was promoted widely, and if consideration was given to the roles of stakeholders, such as the inspection body, local health care providers, users and carers.

Conclusions: Our study is the first to investigate the implementation of national social care guidelines by local authorities in England and Wales. It generates insights that can guide implementation practice as well as inform the evaluation of future implementation strategies.

Colombia is among the countries with the most robust financial protection against personal health spending in the world, with out-of-pocket spending ranking lowest across OECD countries. We investigate the evolution, distribution, and persistence of health spending by age group, sex, health care setting, health condition and geographic region for over 19 million users of Colombia's health system between 2013 and 2021 (contributory scheme). We use average patient-level expenditure data from the Health-Promoting Entities of the Ministry of Health and Social Protection. We applied multivariate statistical techniques such as multiple correspondence analysis, factor maps and correlations. For both sexes, average health expenditure increases gradually with age until 60 years, accelerating thereafter abruptly. Health conditions with the highest percentage of expenditure were those related to neoplasms, blood diseases, circulatory system, pregnancy, puerperium and perinatal period. We found that home-based care in Amazonía-Orinoquía is almost non-existent, and that outpatient care represents a high proportion in all age groups (over 65%) compared to the other regions. There is a strong persistence of expenditure from one year to the next (i.e. they can provide relevant information for prediction), especially in areas with a larger supply of health services such as Bogotá-Cundinamarca. To the authors' knowledge, this is the most comprehensive and detailed micro-analysis of health spending that has been developed for a Latin American country to date.

Background: Despite the positive impact of adhering to the new antenatal care model on pregnancy outcomes and maternal health service uptake, women in resource-limited settings exhibit low levels of compliance with this recommendation. Previous studies on women's adherence to the new antenatal care recommendation have been limited to individual countries, with no evidence available at Sub-Saharan Africa (SSA) level. Therefore, this study sought to investigate compliance with the 2016 WHO's recommendation of at least eight antenatal care contacts among women in SSA countries and identify its determinants.

Methods: The study utilized a weighted sample of 101,983 women who had received antenatal care during their index pregnancy, drawn from recent DHS data of sixteen SSA countries. A multilevel mixed-effect analysis was conducted to identify factors that influence compliance with new antenatal care recommendations. Model comparison was performed using deviance and log-likelihood values, and statistical significance was determined at a P-value of less than 0.05.

Results: The level of compliance with the recommended antenatal care contacts among women in SSA was 9.9% (95% CI: 9.7-10.1%), with the highest rate in Sierra Leone (26.1%) and lowest in Rwanda (< 1%). A multivariable logistic regression analysis showed that age, education, employment status, household wealth, healthcare decisions, the timing of antenatal contacts, consumption of nutritional supplements, residence, community-level women illiteracy, and media exposure were the significant determinants of compliance.

Conclusion: Only one in ten pregnant women in SSA countries had attended the recommended number of antenatal contacts, with Sierra Leone having the highest compliance rate and Rwanda and Senegal having the lowest. Therefore, policymakers should focus on improving access to education, especially for women and their partners, and providing exempted services for pregnant women from low-income households. Interventions that target communities with low levels of literacy and media exposure could also be effective in improving the uptake of the services.

Introduction: Burkina Faso faces many challenges in the health domain, with no real opportunity for an increase in public health expenditures. In Burkina Faso, as in all low-income countries, health spending efficiency is crucial. The objective of this paper is to assess the efficiency of Advanced Medical Centers (AMCs)-which correspond to district hospitals-in Burkina Faso over the 2017-2020 period and identify the factors that promote-or, on the contrary, limit-the efficiency of these health structures.

Method: We first assessed the efficiency level of the 45 AMCs running in the country between 2017 and 2020 using a bootstrap Data Envelopment Analysis (DEA) methodology. Inputs include the number of doctors, nurses, other medical staff, non-medical staff, and beds, while output variables correspond to the number of inpatients, surgeries, outpatients, and inpatient days. In a second step, determinants of AMC's efficiency levels were explored using a double-bootstrap procedure. The roles of AMCs' internal and environmental factors were both considered.

Results: We found a mean efficiency score of 0.51 over the study period, indicating that AMCs could have almost doubled their healthcare production without needing additional resources. The size, education level, and health status of the covered population and the density of the healthcare supply in the district appeared to be the driving factors of AMCs' efficiency.

Conclusion: Our results indicate that improving the efficiency of AMCs should be a high-level priority for the Burkinabe health policy. Resources could be reallocated across AMCs to increase the overall efficiency of the health system.

Background: Pharmacists face unique occupational challenges that can impact their health and well-being. This study examines the relationships between work-life balance factors, physical activity, sleep quality, and general health among pharmacists in Shiraz, Iran.

Methods: A cross-sectional survey was conducted from 7 August 2021 to 21 November 2021 among 136 pharmacists working in community and hospital pharmacies in Shiraz. Participants were selected using stratified random sampling. The Persian versions of the International Physical Activity Questionnaire (P-IPAQ), Pittsburgh Sleep Quality Index (P-PSQI), and General Health Questionnaire (P-GHQ-28) were used to assess physical activity, sleep quality, and general health status, respectively. Data were analyzed using descriptive statistics, Chi-square, Fisher's exact, Mann-Whitney U, and Kruskal-Wallis tests. Statistical significance was set at p < 0.05.

Results: Low physical activity was reported by 35.3% of pharmacists, with longer work hours significantly associated with lower physical activity (p = 0.009). Poor sleep quality was prevalent in 57.4% of participants, with no significant associations with demographic variables. General health was categorized as unhealthy for 50.7% of pharmacists, with female pharmacists more likely to be in this category (χ2 = 4.383, p = 0.036). Older pharmacists reported better general health status (Mann-Whitney U = 1792.500, p = 0.024).

Conclusions: Pharmacists face significant challenges in maintaining work-life balance, evidenced by low physical activity, poor sleep quality, and compromised general health. Targeted interventions, including workplace exercise programs, optimized schedules, and comprehensive wellness initiatives, are needed to support pharmacists' well-being and enhance patient care quality.

Background: Accessing sexual and reproductive health (SRH) services in rural Australia presents complex challenges that negatively impact women's health and exacerbate health inequities across the life course. This systematic review synthesises evidence on the barriers and facilitators to women's access to SRH services in rural Australia, considering both supply and demand dimensions.

Methods: We systematically searched peer-reviewed literature published between 2013 and 2023. Search terms were derived from three major topics: (1) women living in rural Australia; (2) spatial or aspatial access to SRH services; and (3) barriers or facilitators. We adopted the "best fit" approach to framework synthesis using the patient-centred access to healthcare model.

Results: Database searches retrieved 1,024 unique records, with 50 studies meeting the inclusion criteria. Most studies analysed access to primary care services (n = 29; 58%), followed by hospital services (n = 14; 28%), health promotion and prevention (n = 5; 10%), and specialist care (n = 2; 4%). The type of care accessed was mostly maternity care (n = 21; 42%), followed by abortion services (n = 11; 22%), screening and testing (n = 8; 16%), other women's health services (n = 6; 12%), and family planning (n = 4; 8%). There were numerous barriers and facilitators in access from supply and demand dimensions. Supply barriers included fragmented healthcare pathways, negative provider attitudes, limited availability of services and providers, and high costs. Demand barriers encompassed limited awareness, travel challenges, and financial burdens. Supply facilitators included health system improvements, inclusive practices, enhanced local services, and patient-centred care. Demand facilitators involved knowledge and awareness, care preferences, and telehealth accessibility.

Conclusion: This review highlights the urgent need for targeted interventions to address SRH service access disparities in rural Australia. Understanding the barriers and facilitators women face in accessing SRH services within the rural context is necessary to develop comprehensive healthcare policies and interventions informed by a nuanced understanding of rural women's diverse needs.

Background: The ageing population has increased the demand for healthcare services. In Norway, community-based long-term care are prioritised, leading to fewer nursing home places. As a result, nursing home residents are now older and have more complex needs. Nearly 92% of nursing home residents are affected by cognitive impairments accompanied by neuropsychiatric symptoms (NPS) that affect their daily activity, physical function, cognition, and behaviour. Traditionally, pharmacological therapy has been the prevailing treatment for NPS. However, emerging evidence suggests that physical activity can serve as an alternative treatment approach. Physical activity has the potential to maintain physical independence and enhance the quality of life (QoL) for the residents. Despite these benefits, institutionalisation in a nursing home often restricts activity levels of residents. This study explores facilitators and barriers to physical activity in nursing homes through the experiences of healthcare professionals and family caregivers. The goal is to enhance our understanding of how to promote and support physical activity for nursing home residents by identifying essential factors for successfully implementing daily physical activity initiatives.

Methods: Seven focus groups were conducted with a total of 31 participants. Participants included healthcare professionals (physiotherapists, nurses, unit- and department managers, assistant occupational therapists, and assistant nurses) and family caregivers of residents at nursing homes. Data were analysed using Braun and Clarke's reflexive thematic analysis, underpinned by hermeneutic phenomenology.

Results: Three main themes related to facilitators and barriers to physical activity in nursing homes were identified: inconsistency in task prioritisation; need for improved interprofessional collaboration; and need for improved utilisation of external resources. The participants experienced task prioritisation and lack of interdisciplinary collaboration as barriers to physical activity. The involvement of external societal resources was considered as both a facilitator and a necessity for obtaining physical activity in nursing homes.

Conclusions: This study highlights the need for a consensus in task prioritisation, enhanced competence among healthcare professionals, and better interdisciplinary collaboration to facilitate physical activity in nursing homes. Involving external societal resources could be a strategic approach to address barriers and support physical activity initiatives. Future research should focus on developing effective strategies for interdisciplinary collaboration that prioritises and promotes physical activity in nursing homes.