BMC Health Services Research最新文献

Background: Health and social care professional regulators are organisations that ensure their registrants have the correct qualifications and experience to practise in their profession. There are 13 statutory regulators in the United Kingdom (UK) and 29 voluntary accredited registers. Referrals of serious concerns about registrants' Fitness to Practise (FtP) are investigated by regulators, and can lead to a public hearing. Employers may refer their employee to the regulator, and provide evidence about the concerns about their practice. Communication between the regulator and employer is central to ensure fitness to practise procedures are timely and effective, contributing to patient safety and to the improvement of health and social care professional and organisational practices.

Methods: In this mixed-methods research, semi-structured interviews were conducted with 25 participants who held senior management roles in health and social care organisations in the UK and were responsible for communicating with professional regulators. Descriptive statistics were produced relating to participants' roles and organisations, and qualitative data was analysed using Template Analysis methodology.

Results: Four themes relating to communication between employers and regulators were identified: Process of regulatory investigation, Point of contact with employers, Local level/informal resolutions, and Organisational learning. Employers frequently described the processes as protracted and stressful for all concerned, and communication with regulators as sporadic and unidirectional during investigations. This style of communication hampered organisational learning from Fitness to Practise cases. Regulators' employer liaison officers, where they existed, improved communications.

Conclusions: Fitness to Practise processes create the opportunities for not only the determination of whether an individual professional is fit to practise and the supportive measures that might need to be taken if they continue to practice, but also for health and social care organisations to prevent occurrence and re-occurrence of misconduct, thereby improving their services. Regulators' communication patterns resulted in these employers' organisational opportunities being missed. It may also lead to over-referral thereby leading to burden on employers, registrants and regulators. Improvements in communication by regulators such as via dedicated employer liaison functions could help organisations access these opportunities as well as promote the objectives of regulators to uphold trust in regulation.

Background: This study examined the serial mediating roles of perceived quality and customer satisfaction in the relationship between trust and repurchase intentions among private health insurance owners.

Methods: This cross-sectional study included 525 private health insurance owners. The data were collected between 15.12.2023 and 15.03.2024, and SPSS AMOS was used to analyze the direct and indirect estimates. The study utilized structural equation modeling (SEM) to examine the relationships among the constructs. The proposed model was tested using maximum likelihood estimation. Model fit indices and statistical significance levels were reported to ensure the robustness of the findings. Using an online survey, the participants completed self-reported measures of perceived quality, customer satisfaction, trust, and repurchase intention.

Results: Trust significantly affected perceived quality, customer satisfaction and repurchase intention. Furthermore, perceived quality acted as a mediator in the relationship between trust and customer satisfaction. Additionally, customer satisfaction played a partial mediating role in the relationship between trust and repurchase intention. Both perceived quality and customer satisfaction play a serial mediating role in the relationship between trust and repurchase intention.

Conclusions: This study highlighted the significance of perceived quality and customer satisfaction in the relationship between trust and repurchase intention. Private health insurance agencies both alleviate the burden on public health services and operate as profit-driven entities. Considering their indirect benefits to healthcare services, maintaining existing customer portfolios and acquiring new customers are important for both the health system and the profitability of insurance businesses.

Introduction: Mobile applications, as innovative tools for promoting bystander cardiopulmonary resuscitation (CPR), have demonstrated potential to improve outcomes for patients experiencing out-of-hospital cardiac arrest (OHCA). This meta-analysis sought to systematically review the technical features of existing mobile applications and evaluate their impact on OHCA patient outcomes under various emergency response strategies. The findings aimed to guide the development and optimization of prehospital public emergency response systems.

Methods: A systematic search was conducted in databases including China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Scientific Journals Database (VIP), SinoMed, PubMed, Embase, Web of Science, and the Cochrane Library, from inception to August 2023. The included studies involved notifying citizens via text messages or smartphone applications to act as first responders or volunteers in OHCA cases. Using a random effects model and subgroup analysis, we synthesized the results to identify sources of heterogeneity and assess outcomes.

Results: Thirteen mobile applications were included, with an average activation rate of 35.3% among patients and a volunteer arrival rate of 53.3%. Compared to traditional emergency medical services, mobile applications significantly improved survival to discharge or 30-day survival rates (RR = 1.34, 95% CI: 1.24-1.44; P < 0.05), return of spontaneous circulation (ROSC) rates upon hospital admission (RR = 1.23, 95% CI: 1.09-1.40; P < 0.05), bystander CPR rates (RR = 1.25, 95% CI: 1.13-1.37; P < 0.05), and bystander defibrillation rates (RR = 1.23, 95% CI: 1.00-1.51; P = 0.05). Subgroup analyses revealed consistent results for bystander CPR rates and survival outcomes, while variations in defibrillation rates and ROSC at admission were observed, indicating potential influences of application design and operational parameters.

Conclusions: This study highlighted the significant potential of mobile applications in enhancing bystander interventions and improving patient outcomes. Addressing challenges such as improving access to automated external defibrillators and raising public awareness remained essential to maximizing their overall effectiveness. PROSPERO REGISTRATION NUMBER: CRD42023477676.

Background: This research aims to understand job incentives of health professionals who work in rural and remote areas, which could lead to the further development of policy proposals.

Methods: The study design has been applied discrete choice experiment (DCE) to determine attribute preferences of: 1) doctors, dentists, and pharmacists, and 2) nurses and interdisciplinary teams. Four areas in northern Thailand were purposively selected. To determine the attributes and levels, a qualitative method was employed. An orthogonal array was adopted to produce 16 options for categorizing the employment preferences of each person. Conditional and mixed logit regressions were used to examine the major incentives influencing health workforce decision-making. In addition, willingness to pay (WTP) analysis according to beta coefficients from the regression models was performed.

Results: The total number of participants in the first group was 34, and the latter group included 160 participants. Financial incentives, suitable accommodation, workload and job post in hometown were all significant criteria for both groups. Surprisingly, opportunity to continue study was not a significant consideration for doctors, dentists, or pharmacists to work in remote areas. When getting a 40% higher income than counterparts working in public hospitals in urban regions, the decision-making level among doctors, dentists and pharmacists influenced decisions by 4.2 times, while nurses and interdisciplinary teams were influenced twice as much. Regarding the WTP analysis, doctors, pharmacists, and dentists were willing to receive 8,126 (95% CI: 3,477; 15,442) Baht per month, and nurses and interdisciplinary teams were willing to receive 7,733 (95% CI: 4,926; 11,502) Baht per month to work more than 48 h per week. The results of mixed and conditional logit models were found consistently.

Conclusion: Financial subsidies for all types of healthcare workers in rural and remote areas remain effective policies and need to be maintained. It is not merely a matter of national policy; hospital-level policies can change and contribute to resolving the problem of health personnel shortages. The short-term plan for retaining health staff would be to provide suitable, safe, and satisfying accommodations.

Introduction: The primary health care system is the first of the three hierarchical levels of care, and it is the first point of contact of the population with the health system. In Luanda, Angola, the primary care network presents challenges in its management, as well as in the perception of its purposes, which constitutes a serious problem for the demand for health services, being the reason for this study. The present research aimed to evaluate the level of adherence and satisfaction related to the health care system and their influence on usage of the public primary health care facilities in Luanda, from the perspective of health professionals and users.

Methods: A cross-sectional and descriptive study was carried out on 120 health professionals and 423 users.

Results: We found a statistically significant association between the level of education and the professionals' disbelief in health services (P = 0.001), as well as the users' family income (P = 0.0002).

Discussion: The users' perception is that there is a switch in test results (P = 0.01). Furthermore, they also believe that when attending health units, the user leaves sicker than he entered (P = 0.01).

Conclusion: Thus, it was found that the level of user adherence to the services of the primary health care units in Luanda ranged between "good" and "acceptable". We identified elements capable of compromising the quality of services and, consequently, interfering with adherence to them, which suggests the need for the development of management strategies for health facilities, in order to overcome the challenges presented in the study.

Background: In Tanzania, residential treatment centers for alcohol and other drugs, locally known as "sober houses," play a critical role in the treatment of people living with a substance use disorder (SUD), but little is known about the services they offer and service users' and providers' perceptions of those services. We aimed to address these gaps in knowledge and to better understand where evidence-based interventions may be able to address gaps in service provision.

Materials and methods: This study used a mixed-methods approach across four sober houses in Dar es Salaam, Tanzania. We conducted 48 semi-structured interviews with a sub-sample of sober house service users (n = 38) and service providers (n = 10). Eighty-six (86) service users also completed a written survey to capture demographic information and assess knowledge of HIV and willingness to use HIV preventive care. All interviews were audio-recorded, translated into English, and then coded according to constructs developed with the Recovery Capital Framework. Following coding, a thematic analysis was conducted for the qualitative data using the framework developed by Braun and Clarke.

Results: Service users were generally positive about the treatment they were receiving but identified gaps in health service provision related to HIV, as well as a lack of preparation to address the employment-related challenges they face in the community after completing treatment. Service providers largely agreed with users' perceptions of needs and identified a lack of clinical personnel in sober houses and funding challenges as barriers to meeting these needs.

Conclusion: Sober houses provide treatment services to Tanzanians with SUD that service users largely view as positive. This evaluation identified employment challenges after treatment completion and gaps related to HIV care in the sober house. Further research is needed to investigate how interventions can be adapted to the sober house setting to meet these needs.

Background: The digitization of healthcare, through electronic medical records (EMRs), is recognized globally as a transformative initiative. Indonesia mandated all healthcare facilities to adopt EMRs by December 31, 2023. However, this transition is complicated by diverse technological, cultural, and infrastructural challenges, with little research addressing the recordkeeping culture's impact on EMR adoption. This study investigates the electronic recordkeeping culture in Indonesian hospitals following a government mandate to adopt Electronic Medical Records (EMRs). It aims to understand the readiness and challenges in implementing EMRs across hospitals on Java and Sulawesi islands, focusing on infrastructure, staff digital skills, and varied adoption approaches.

Methods: A qualitative case study approach was utilized, involving focus groups and semi-structured interviews with 150 staff from 12 hospitals. Conducted between November 2023 and June 2024, the study applied thematic analysis based on Oliver and Foscarini's (2020) recordkeeping culture framework to explore organizational readiness, technological infrastructure, and healthcare professionals' skills in managing electronic records.

Results: The findings reveal significant differences in EMR adoption between the islands. Hospitals on Java exhibited proactive engagement, supported by better technological infrastructure and staff training programs, while Sulawesi hospitals adopted EMRs primarily to meet regulatory requirements. Challenges included inconsistent internet connectivity, low digital literacy among staff, and ongoing reliance on paper records during the transition. Some Java hospitals have begun fostering a culture conducive to electronic recordkeeping by focusing on developing staff skills in EMR management.

Conclusions: The effectiveness of EMR adoption in Indonesia relies on addressing technological infrastructure issues and enhancing staff digital literacy. While progress has been made, particularly in more developed regions, a cohesive national strategy emphasizing technological support and targeted training is essential to fully realize the benefits of EMRs in improving healthcare and recordkeeping standards across Indonesia.

Background: Rheumatic heart disease (RHD) is highly prevalent and under-detected in remote First Nations Australian communities. Rural communities face severe health workforce shortages that impact negatively on health outcomes. Task-sharing using local healthcare workers, trained to screen for active RHD cases (using handheld ultrasound with remote support from experts), has been proposed as a means of improving early detection whilst also strengthening referral pathways. Implementing new models of care within remote communities, however, requires local knowledge, cultural and operational adaptation, whilst ensuring consistency and quality assurance across multiple sites. This study aimed to co-design local implementation strategies for an RHD active case finding program with five remote communities and explain how and why the task-sharing program might lead to improved health outcomes.

Methods: A qualitative study using a Theory of Change approach and 'yarning' methods, was conducted with five remote First Nations Australian communities. We used a combination of participant observation, extensive field notes over sequential visits to each site, supplemented with document analysis to inform co-design of Theories of Change for each community. Data were curated using NVivo software and analysed using Powell's refined compilation of implementation strategies framework.

Results: Through the co-design process, a total of 24 locally tailored implementation strategies were identified. All sites identified the need for a positive implementation environment, including recognition of local healthcare workers through positive messaging and celebratory events for achieving key training milestones. Other key themes included the importance of opportunistic RHD screening, and the integration of local languages during both training and screening. Five locally adapted versions of the Theory of Change were co-designed to include planned outcomes, assumptions, causal mechanisms, and indicators for the program at each community.

Conclusions: Our study identified implementation strategies and Theories of Change for the training and screening aspects of a new model of care for RHD screening in five remote First Nation Australian communities. These findings will be used to support future program evaluation and exploration the mechanisms by which the RHD screening program achieves its outcomes.

Objective: Transportation barriers can lead to delays in care and suboptimal treatment. Our objective was to assess the utilization of a novel transportation pilot intervention in gynecologic oncology.

Methods: Since May 2022, we have provided donor-funded transportation to patients receiving gynecologic cancer treatment at 5 University of Pennsylvania practices. Patients are screened for transportation barriers at first visit and re-screened during care. Patients who screen positive are referred to the intervention, a HIPAA-compliant ride-sharing service. There are no income or insurance restrictions; distance was limited to 25 miles. We report descriptive statistics on ride completion, distance traveled, and cost.

Results: In the 15-month pilot, 133 of 4,376 patients (3%) screened positive, and 48 (1%) patients received rides. Of 85 patients who screened positive, but did not receive ride-sharing, 43 (51%) had transportation assistance through their insurance, 12 (14%) lived more than 25 miles away, and the remainder (30; 35%) identified alternative transportation. Patients who received transportation assistance were more likely to be older, self-identify as a race other than white, have Medicare or Medicaid insurance, and have a higher ECOG score than the overall patient population. Eight patients received a single ride, and the rest (n = 40) received multiple rides (range 2-30) for total of 417 rides. The mean time via ride-sharing was 19.5 min shorter than public transportation, and mean cost of a one-way trip was $25.75 (range $13.83-129.91).

Conclusion: A rideshare service served a socially-vulnerable population and reduced commute times to oncology visits, which may contribute to more equitable access to cancer care. Further research on clinical outcomes is needed to understand the impact of transportation assistance on equitable cancer care delivery.

Background: The National Healthcare Service (NHS) radiology service delivery in London is representative of the current pressures and challenges faced in England of Musculoskeletal (MSK) X-ray reporting workforce shortages, and national turnaround time (TATs) targets. The implementation project evaluated facilitation as a strategy to achieve the NHS England 50% target for all MSK X-rays to be reported by radiographers.

Methods: The project was an eight-month multi-centre (n = 5 London NHS Trusts) study applying the Promoting Action on Research Implementation in Health Services (PARIHS) framework with embedded mixed-methods evaluation. Initial observational data using the Context Assessment Index (CAI) tool and the Workplace Culture Critical Analysis Tool (WCCAT) set the implementation interventions which comprised external facilitation, to support internal facilitators action learning activities. Evaluation data comprised monthly reporting performance, systems mapping, interviews.

Results: System mapping allowed a perspective beyond the characteristics of the NHS Trusts involved (small single site hospitals to large multi-sites hospitals) of mixed clinical duties, scope of practice, reporting session allocation, and equipment used. CAI scores for workplace culture demonstrated $\overline{x}$ = 73.7% (SD 6.8; 95%CI 8.49), leadership scored $\overline{x}$ = 69.3% (SD 7.3; 95% CI 9.17), and evaluation scored $\overline{x}$ = 75.5% (SD 6.9; 95% CI 98.63). WCCAT observations provided themes for facilitation focusing on remote reporting, insourcing backlogs, prioritising worklists to reduce breaching TATs, reporting metrics, and reducing auto reporting. The combined reporting of MSK X-rays by London radiographers during this study achieved $\overline{x}$ = 53.7%.

Conclusion: This study had an innovative approach using an implementation facilitation framework to improve service delivery. The clinical workplace context in which MSK X-ray reporting by radiographers occurs was key to implementing change. The complexities of sustaining and upscaling MSK X-ray reporting by radiographers to meet the NHS England target of 50% are varied and require local champions to facilitate and drive change at organisational levels. It is recommended that there are dedicated 'resources' to sustain implementations with a community of practice for support. Workplace leadership and stakeholder networks are needed to sustain improved working practices and embrace regular evaluation and monitoring of service delivery performance.