BMC Health Services Research最新文献

Background: Prehospital Assessment Units were recently introduced to emergency medical services in Denmark. These units are designed to assess, triage, and treat patients on-site, and either release, refer to alternative care pathways, or arrange hospital conveyance. The initiative has increased the need for effective collaboration among healthcare professionals in acute care services, including paramedics, nurses, and physicians in emergency medical services, municipalities, emergency departments, and general practice. This study investigates Relational Coordination among healthcare professionals involved in this task for patients triaged by the Prehospital Assessment Units in the Region of Southern Denmark.

Methods: A mixed-methods study, inspired by a convergent parallel design, was conducted based on the framework described in the theory of Relational Coordination. This theory highlights the importance of Communication (Frequent Communication, Timely Communication, Accurate Communication, and Problem-Solving Nature of Communication) and Relationships (Shared Goals, Shared Knowledge, and Mutual Respect). Data were collected between April and August 2024 via online questionnaires and in June 2024 through focus groups.

Results: Questionnaire responses from 138 healthcare professionals were analysed, and 18 participated in the focus groups. Most collaborative ties were classified as moderate and strong. However, weaker ties were identified in Timely Communication and Frequent Communication, and Shared Knowledge, highlighting challenges in both dimensions of Relational Coordination. The qualitative analysis produced four themes: 1) Insufficient communication due to low quality or lack of written communication, 2) Navigating care through phone calls to share information, 3) Multiple objectives with hindered observers, driven by the coexistence of different objectives of the unit and limited insight into the whole care pathway, and 4) Interprofessional tensions in acute care collaboration, based on challenges regarding the competencies, incentives, roles and responsibilities required to achieve the best care pathway for each patient.

Conclusion: The collaboration among healthcare professionals for patients triaged by the Prehospital Assessment Unit was generally classified as moderate to strong. However, critical challenges were identified. Optimising task assignments, enabling municipal correspondence, and addressing discrepancies in objectives, competencies, and roles may improve collaboration. These findings point to broader lessons for strengthening prehospital and inter-organisational coordination internationally, where challenges of information flow, role clarity, and mandate alignment are common.

Background: Research and policy developments in the area of early childhood development and health equity have led to an increase in parent support interventions. An extended home visiting program within Child Health Services in collaboration with social services was developed to improve health equity among children in socioeconomically deprived areas as an early, trust-based, and proportionate universalism intervention. To ensure that evidence-based program models are replicated and implemented successfully, it is essential to monitor fidelity to core components during program delivery. This study aims to investigate the delivery of home visits during the scale-up of an early childhood home visiting model in socio-economically disadvantaged areas in Gothenburg, Sweden, with particular focus on health equity.

Methods: A convergent mixed-methods approach was applied, using data from fidelity monitoring collected through a questionnaire filled out after each visit by the nurses and social workers who provided the home visits. Initial directed content analysis with pre-determined categories was carried out. The qualitative findings informed a subsequent quantitative analysis, which included non-parametric testing to compare program delivery based on variation in home visit characteristics.

Results: The reported content of home visits was very similar to the original program core components. Professionals indicated high levels of satisfaction with their ability to implement the program model, successfully working in professional teams, and establishing an alliance with families. At the same time, communication and parents' participation were noted as challenging aspects. Disparities in program delivery were found between visits with and without an interpreter present, as well as visits with one or both parents present.

Conclusions: The findings suggest successful replication of the program model during scale-up. However, the disparities observed in staff reports on program delivery represent a threat to the principles of proportionate universalism and could potentially increase inequities in the conditions for optimal child development. It is therefore essential to develop strategies to overcome language barriers, to promote fathers' continued engagement, and to ensure equitable program delivery.

Trial registration: The study was retrospectively registered on 19/09/2024 in the ISRCTN registry (ISRCTN19253469).