BMC Health Services Research最新文献

Background: Intraoperative C-arm fluoroscopy is vital for orthopedic precision, yet its availability in resource-constrained settings like Nigeria remains under-researched. This study assessed the availability, utilization patterns, and barriers to C-arm use among Nigerian orthopedic surgeons.

Methods: A cross-sectional online survey was conducted using convenience and voluntary sampling. The questionnaire evaluated demographics, practice settings, C-arm availability, and barriers. Data were analyzed using SPSS (v.23) with descriptive statistics and Fisher's exact test.

Results: Seventy-seven surgeons from 46 hospitals across 25 states participated. While 88.3% (n = 68) reported C-arm availability at their primary workplace, only 44.1% of those with access used it consistently when indicated. Significant disparities in C-arm presence were found across practice settings (p < 0.001) and city types (p = 0.032), with higher reported presence in federal academic and specialist hospitals. Primary barriers to utilization included machine faults and technical staff shortages, compounded by unreliable electricity. Notably, 77.9% (60 out of 77) of respondents reported altering surgical plans due to physical or functional C-arm non-availability.

Conclusions: While C-arm availability is relatively high in federal Nigerian institutions, consistent utilization remains low due to technical failure and personnel shortages. The high rate of altered surgical plans (77.9%) underscores a critical functional gap that compromises orthopedic standards. Policy interventions must prioritize equipment maintenance frameworks and specialized staff training over mere procurement to bridge the disparity between availability and effective intraoperative use.

Background: Primary health care (PHC) is central to universal health coverage, yet delivery performance varies across settings. This study examines Turkey's Healthy Life Centers (HLCs)-a nationwide PHC-strengthening initiative-by including all 11 HLCs in Konya to identify service delivery strengths, operational challenges, and improvement priorities with lessons relevant to other upper-middle-income contexts.

Methods: A mixed-methods design was applied. The quantitative element utilized a cross-sectional design involving 208 participants, while the qualitative element followed a phenomenological approach with 44 participants. The participants were physicians in charge of HLCs and staff delivering services to applicants. Data were collected using two separate forms. Quantitative data were analyzed using chi-square tests (p < 0.05). Qualitative transcripts were coded to identify themes.

Results: Quantitative results showed that 77.9% of participants found the range of services satisfactory and 92.8% considered them beneficial. More than half of health professionals rated HLC conditions positively. Significant differences were identified by location and building status, largely reflecting physical conditions. Qualitative findings highlighted service gaps, perceptions of service delivery, physical conditions, community awareness, patients/applicants' needs, referrals from other institutions, appointment system, and safety needs.

Conclusion: This is one of the few studies examining HLCs in Turkey from the provider perspective. A mixed-methods design enabled a more comprehensive evaluation. Findings can guide targeted improvements in infrastructure, service delivery models, and referral mechanisms within HLCs and provide actionable insights for policymakers and managers to strengthen primary health care, with relevance to other upper-middle-income settings.