BMC Health Services Research最新文献

Background: International collaborations have been pivotal in global health delivery, particularly in addressing challenges like tuberculosis. Recently, there has been a shift towards more focused alliances designed for targeted collaboration. This study examines health alliances as a distinct model of international partnership in global health, exploring their operational approaches, key activities, encountered challenges, and potential contributions.

Methods: A qualitative approach was utilised, in which ten semi-structured interviews were conducted with individuals involved in various health alliances. These were transcribed, anonymised, and analysed to identify common themes.

Results: Four main themes were generated, revealing that health alliances operate through collaborative efforts pooled from diverse stakeholders, including governments, and academic institutions. Serving as platforms for open communication, these alliances facilitate the exchange of expertise, resources, and best practices. The study highlights key activities undertaken by health alliances, including research, capacity building, policy engagement, and resource mobilisation. These activities strengthen health systems, generate new knowledge, and mobilise financial and technical resources.

Conclusion: This research demonstrates the potential of health alliances as effective models for future collaborations in global health. By addressing the challenges of fragmentation, lack of coordination, and limited focus on capacity building and evaluation, health alliances enhance the impact of global health initiatives. The findings contribute to a better understanding of health alliances and could inform the development of future alliances.

Background: Despite increased awareness of the significant health and healthcare inequalities experienced by minoritised groups, limited research considers the interaction of multiple domains of social disadvantage. This review therefore sought to explore how LGBTQ + adults' experiences of homelessness, substance use, and criminal justice involvement impact upon their access to and use of health and social care services in the UK and Ireland.

Methods: A qualitative scoping review was conducted in accordance with the PRISMA-ScR framework. Electronic database and web searches identified 26 eligible peer-reviewed and grey literature documents published between 2010-2024. The data were charted, coded, and knowledge gaps identified.

Results: Data were coded thematically, clustered around the concept of normativity. Descriptive qualitative techniques were applied to explore how this was enacted and experienced. Synthesis across the literature identified experiences of discrimination and anticipated stigma that acted as barriers to accessing and engaging with services.

Conclusions: Structural normativity and the privilege afforded to hegemonic population groups impacted upon this population's access to and use of services. The review adds depth and context to questions around the lack of visibility or engagement in services by LGBTQ + people with experience of disadvantage, and contributes to the wider literature on improving service access for marginalised, underserved, or disadvantaged communities.

Background: The IN-PATSAT32 and QLQ-INFO25 are questionnaires which can be applied to assess and improve communication with cancer patients, as well as for research and clinical trials aimed at assessing patients' satisfaction and perception of the information received from nurses and other healthcare providers. Given the recently passed "Polish oncological network" act of law, the issue of patient satisfaction and its regular assessment is finally acknowledged in the socioeconomic and cultural context of Poland. The aim of this study was to validate the EORTC quality of information, QLQ-INFO25, and satisfaction with care, IN-PATSAT32 modules.

Methods: This prospective cross-sectional study included patients from a cancer reference center in Krakow, Poland. The translated and pilot-tested module QLQ-INFO25 was used together with the core questionnaire QLQ-C30 and the satisfaction module IN-PATSAT32. Adult patients with histological confirmation of any malignancy and the ability to answer the questionnaire were included in the study.

Results: A total of 187 patients, including 111 women and 76 men (mean age ± SD; 59.32 ± 10.4), were enrolled. The Cronbach's alpha coefficients, ranged from 0.83-0.85 for the QLQ-INFO25 and 0.82-0.94 for the IN-PATSAT32, indicating positive internal consistency. Acceptable convergent and discriminant validity in multi-trait scaling analyses was observed for both modules, with r < 0.3 for all calculations. Interclass correlations proved satisfactory test-retest reliability.

Conclusions: The Polish versions of the IN-PATSAT32 and QLQ-INFO25 are reliable and valid instruments providing domains not covered by the core EORTC module. These tools are suitable for use in daily clinical practice, in research as well as in clinical trials to obtain data regarding patients' perception of and satisfaction with received information within the socioeconomic and cultural context of Poland.

Background: The extension of PrEP coverage for vulnerable populations depends on demand creation strategies that aim to inform, encourage usage, and facilitate access to health services. However, there are no cost estimates for Brazil or Latin America regarding demand creation strategies focused on populations with higher vulnerability and risk of HIV infection. This analysis aims to assess the costs and health outcomes of different strategies used to create demand for PrEP for individuals aged 15 to 19 who identify as men who have sex with men (MSM), transgender women (TGW), or non-binary people assigned male at birth.

Methods: Cost-consequence analysis of six demand creation strategies used in the "PrEP1519 Study" (chatbot strategy; dating apps strategy; social media strategy; socialization places strategy; NGOs strategy; direct referrals strategy). The analysis was conducted using data from January 2019 to December 2021. The evaluated outcome was the "PrEP initiation ratio" (PrEPIR), which represents the percentage of approached individuals who started PrEP. The cost analysis included direct costs related to personnel, promotional materials, testing, equipment, and services.

Results: The strategy with the highest PrEPIR was the social media strategy (2.97% [95% CI 2.29-3.84]), followed by the socialization places strategy (2.05% [1.45-2.89]). The direct referrals strategy, which served as the baseline, had one of the lowest PrEPIR (0.36% [0.30-0.43]). The average cost per participant included ranged from $100.74 for the direct referrals strategy to $5,572.00 for the chatbot strategy. The strategy with the highest total cost was the chatbot strategy ($55,719.98), whereas the strategy with the lowest total cost was the NGOs strategy ($10,809.80).

Conclusion: Despite incurring higher costs, the implementation of more successful demand creation strategies (such as socialization places, social media, and dating apps) has the potential to increase PrEP usage and, consequently, reduce HIV infection in populations facing greater vulnerability. These findings can contribute to more effective planning and organization of prevention programs by healthcare services to reach these populations.

Trial registration: This analysis is part of the "PrEP1519 Study" (protocol number 89993018.9.0000.0065).

Background: An increasing number of patients in the palliative phase of their disease are cared for at home by palliative home care services. A sense of security, normality of everyday life and symptom control are found to be active factors of quality of care in Specialized Palliative Home Care. Whether this also applies to General Palliative Home Care has not yet been systematically investigated. The aim of this study was to identify distinctions between General and Specialized Palliative Home Care from a healthcare professional's perspective concerning those factors.

Methods: With a qualitative approach, we conducted 11 semi-structured interviews with healthcare professionals from different professional backgrounds in General and/or Specialized Palliative Home Care.

Results: In both General and Specialized Palliative Home Care, healthcare-professionals (HCP) found a sense of security (through availability) to be most relevant for the patients. The majority saw aspects of normality of everyday life as a key component for high-quality palliative home care, especially having time for the patient and the family caregiver(s). However, statements about symptom control are mainly related to Specialized Palliative Home Care. The subcodes availability, having time and competence, symptom burden and financial resources were the main distinguishing factors between General and Specialized Palliative Home Care in sense of security, normality of everyday life and symptom control, respectively.

Conclusions: Our results provide the basis for a clearer definition of GPHC and SPHC and contribute to identifying factors for a transferal between the two services to provide best care for the patient. Distinguishing (sub)factors revealed challenges and short-term solutions. Providing (financial) incentives to guarantee time and availability in General Palliative Home Care would lead to more effective care.

Background: Despite rolling out publicly-funded hepatitis C virus (HCV) treatment across the province of British Columbia (BC), Canada, 35% of people returning positive HCV RNA results in 2020 did not initiate treatment. The HCV epidemic in Canada continues to disproportionately impact people who use drugs and yet, this population has the lowest proportional uptake of HCV treatment. Evidence suggests linkages to healthcare after diagnosis is one of the key factors that impacts uptake of HCV treatment among this priority population. The Hep C Connect pilot project was implemented to characterize HCV testing outcomes and linkage-to-care rates within a low-barrier supervised consumption site (SCS) in Vancouver, BC.

Methods: All clients (aged ≥ 19 years) attending the Hope to Health SCS in Vancouver, Canada were invited to participate in the pilot study between November 2021 and December 2022. Interviewer-led surveys were conducted and participants were offered same-day HCV point-of-care (POC) antibody (Ab) testing. Participants received a cash honorarium for sharing their time and experiences. Descriptive statistics are shared in order to describe the reach and impact of this pilot project.

Results: The study enrolled 186 participants including 123(66.1%) men and 59(31.7%) women, with a median age of 42 (Q1,Q3- 34,49). Forty-seven (25.3%) participants stated that they use an SCS regularly and 123(66.1%) stated that they get new rigs every day. Notably, 64(34.4%) participants reported not having a primary care provider yet more than three-quarters of the participants (144, 77.4%) reported having been ever tested for HCV. All 186 participants agreed to HCV POC Ab testing with 59.7% returning a positive HCV POC Ab result. Despite good HCV POC Ab uptake and high rates of HCV knowledge, 49(44.1%) of the HCV Ab positive participants chose not to engage in confirmatory ribonucleic acid (RNA) testing.

Conclusions: The Hep C Connect pilot explored the gaps evident in the HCV cascade-of-care as it pertains to people who use drugs. Findings suggest that, despite high levels of HCV knowledge, the employment of blood draw RNA testing deterred people from engaging in confirmatory testing. Improving the HCV cascade-of-care will require alternative strategies that are more acceptable to this population.

Background: Community Health Centers (CHCs) are a vital part of the health safety net, providing high quality care to underserved communities with complex health and social needs. Yet, despite their crucial role, CHCs operate on slim financial margins, relying in part on grant funding streams. Little is known about the role that grant requirements have in directing the functioning of CHCs.

Methods: We conducted qualitative thematic analysis, based on 56 semi-structured interviews of CHC leadership and staff in New York City.

Results: Three overarching themes described ways that CHCs are hampered by the designs and requirements of grant funding: 1) narrowness of available funding, 2) lack of access to operational funding, and 3) inability to utilize available funding to address workforce needs.

Conclusions: Our analysis illuminates the tension between the weighty charge placed on CHCs as key pillars of the health safety net and the inflexible grant funding mechanisms available to sustain them. Restrictive funding limits CHCs' capacity to deliver comprehensive care and meet community needs.

Background: Open disclosure, or 'error disclosure,' is a policy requiring healthcare professionals to promptly offer an honest apology after an adverse event. While the fundamental principles of open disclosure have evolved into an important right for patients who experience adverse events, the process also plays an integral role in ensuring continuous improvements in the delivery of patient care. Healthcare providers often encounter challenges in fully adopting open disclosure processes, limiting their use in practice. This systematic review aims to explore patient experiences following open disclosure, focusing on how these experiences are being measured and evaluated. By examining patient experiences, this review seeks to enhance our understanding of the effectiveness of open disclosure and inform improvements in healthcare communication practices.

Methods: A detailed search strategy was developed to identify relevant literature published between 2008 and 2023. The review focused on original research in English, emphasising qualitative or quantitative studies that evaluate and measure patient experiences of disclosure. Four major databases (PubMed, CINAHL, PsycINFO, and EMBASE) were searched for studies reporting details of patients/clients/service users and their families/relevant others who have experienced the OD process/duty of candour. The Mixed Methods Appraisal Tool (MMAT) was used to appraise included studies. The review adopted a narrative approach to synthesise the findings.

Results: From the initial 8,940 studies identified, 26 met the inclusion criteria, comprising 17 qualitative studies, two quantitative studies, three mixed-methods studies, and four case studies. The study explored patients' and service users' perspectives on their experiences with OD following patient safety incidents. The synthesis highlights five key themes across the included studies: timeliness of disclosure, quality of communication, addressing patient and family support needs, organisational arrangements for the OD process, and viewing OD as a forward-looking conversation.

Conclusions: While explicit open disclosure policies are common in healthcare, routine assessments of patient and family experiences remain infrequent. Patients and families, as service users, perceive safety incidents differently from healthcare providers and hold specific expectations. They emphasise the importance of transparent, ongoing communication, emotional support, and active involvement in post-incident evaluations, considering OD vital for building trust and achieving resolution after adverse events.

Background: Developing countries' public health systems struggle with digital health implementation, and reports of low digital health readiness exist within the workforce. This study investigates the perceived digital health readiness of healthcare leaders in operational management to implement digital health tools.

Methods: A cross-sectional survey using the E-Ready 2.0 scale was used to measure digital health readiness (n = 329) in 11 hospitals in the Western Cape, South Africa (September 2023 - March 2024). Descriptive statistics summarised respondent characteristics and the E-Ready 2.0 subscales: conditions for change at the workplace and among individuals, support and engagement from management, colleagues' readiness, consequences for the status quo and workplace attitudes. Statements scoring 60% or more were considered to have higher readiness. Chi-square and Mann-Whitney U tests were used to examine associations between demographic variables and subscale statements.

Results: A total of 143 healthcare leaders responded (56.1% response rate) (n = 114 nurses [79.7%], n = 29 medical doctors [20.3%]). The average age was 46.4 ± 10.0 years. Overall, higher levels of readiness (above 70%) were observed with statements related to workplace attitudes, whereas conditions for change at the workplace and among individuals showed lower readiness (below 50%).

Conclusion: Despite significant investment in digital health tools, there remains limited digital health readiness among those responsible for leading these implementations.

Background: Work organization significantly impacts occupational incidents and fatigue in hospital settings, particularly among nurses. This study aimed to evaluate the psychometric properties of instruments measuring work organization and fatigue and to examine their relationship with occupational accidents.

Methods: A cross-sectional study was conducted in 2019 with 200 nurses working in hospitals in Qom, Iran using the stratified sampling method. Data were collected using three standardized tools: the Work Organization Questionnaire, the Fatigue Checklist, and a demographic information questionnaire. Structural equation modeling was employed to analyze the data, while instrument validity and reliability were assessed through Cronbach's alpha, composite reliability, and average variance extracted (AVE). Analysis was performed using Smart PLS and SPSS V20.

Results: The analysis revealed a significant relationship between work organization and occupational accidents (t = 3.22, p < 0.05). However, the relationships between work organization and fatigue (t = 0.03) and between fatigue and occupational accidents (t = 1.49) were not statistically significant. The Work Organization Questionnaire (WOAQ) demonstrated robust validity and reliability, making it suitable for assessing occupational risks in hospital environments. In contrast, the Fatigue Questionnaire (CIS) exhibited acceptable validity but insufficient reliability (Cronbach's alpha < 0.7), highlighting the need for further refinement.

Conclusion: This study revealed that the Work Organization Questionnaire has acceptable validity and reliability, making it suitable for hospital settings, while the Fatigue Questionnaire requires further revision. It is recommended that hospital administrators optimize work schedules and provide fatigue management training, and policymakers utilize validated tools to reduce occupational risks and enhance workplace safety.