BMC Health Services Research最新文献

Introduction: Despite the Alma-Ata Declaration's emphasis on primary health care (PHC) to achieve universal health coverage (UHC), oral diseases remain prevalent and costly. In Iran, health reforms have expanded PHC, yet oral health services lag. This study explored barriers and facilitators of primary oral health service delivery in Tehran.

Methods: This qualitative study employed semi-structured, face-to-face interviews with dentists, heads of comprehensive health centers (CHCs), healthcare providers and visitors to the health centers in Tehran from November 2021 to January 2022. Data were analyzed using inductive content analysis with MAXQDA2020 and interpreted through the WHO Health Systems Framework, complemented by patient access dimensions, guiding understanding of system-level and user-level barriers and facilitators in oral health service delivery.

Results: Thirty participants (10 healthcare providers, eight dentists, six CHC heads, and six visitors; aged 24-60) identified inadequate education, staffing shortages, equipment problems, financial difficulties, and poor attitudes toward oral health as major barriers. Facilitators included broad community coverage, dentist availability, and free patient education.

Conclusion: This study highlights barriers and facilitators in oral health services within Tehran's health networks. Policymakers and practitioners should use these insights to improve education, infrastructure, and financial support, and foster a culture prioritizing oral health.

Background: Availability of mental health services is often limited, with many patients suffering from depression or anxiety either unidentified or unable to access care. Community pharmacists may be well-positioned to serve as behavioral healthcare extenders by offering timely screening, referrals, education, and medication management. However, evidence supporting feasibility and effectiveness of behavioral health (BH) care interventions in community pharmacy settings remains anecdotal. The purpose of this article is to summarize the findings from a feasibility evaluation of a BH intervention in 7 U.S. community pharmacies.

Methods: The BH intervention, delivered over 6-11 months, consisted of a screening and referral program and a 6-session education and medication management program. Participating pharmacies benefited from a multi-faceted implementation strategy (e.g., coaching, toolkits). An effectiveness-implementation hybrid Type II design was used to assess effectiveness of the intervention, while evaluating its implementation. Implementation outcomes involved program adoption rates, levels of program acceptability, appropriateness, and feasibility, intent to sustain, and fidelity rates. Intervention outcomes included: patient referral rates, perceived benefits, and changes in patient knowledge, clinical symptoms, and medication adherence. The data were collected using multiple methods (e.g., surveys, interviews, administrative data) and analyzed accordingly.

Results: Results indicated a 100% adoption rate by the pharmacies with intent to continue past the project period; significant increases in program acceptability, appropriateness, and feasibility; and high levels of program fidelity. All 206 patients were appropriately referred as needed, with patients enrolled in the 6-session program reporting statistically significant changes in knowledge, clinical symptoms, and a nonadherence to medications.

Conclusions: These findings lend support to the role that community pharmacists can play in bridging the mental health care gap and improving population health.