BMC Health Services Research最新文献

Background: Inadequate medication knowledge may contribute to inappropriate medication use and treatment harms. We aimed to map and synthesise the existing evidence on patients' knowledge of the indications for their medications.

Method: We searched MEDLINE, Embase, CINAHL, PsychInfo and the Cochrane Library for studies that assessed patients' knowledge of the indications for their medications from inception to June 16, 2022. A pair of reviewers independently screened and extracted data on study characteristics, aims, and methods used to assess and report patients' knowledge of the indications for their medications.

Results: We included 99 studies conducted in 33 countries, published between 1979 and 2021, with 42,377 participants in total (median 126 participants [Interquartile range: 63-338]). Studies were observational (n = 77), experimental (n = 18), or qualitative interviews (n = 4). The exact question used to assess knowledge of the indications was reported in 27 studies and was phrased in 25 different ways. Knowledge of the indications was reported as a proportion of either 1) all participants (n = 65) or 2) the total number of medications used by all patients (n = 13). Sixteen studies used both reporting methods, while five only reported a proportion without specifying the denominator. Fourteen studies in various populations reported the number of participants with correct knowledge of all their medications, ranging from 19% (long-term psychiatric in-patients) to 87% (general practice patients).

Conclusion: We did not identify any established scientific standard for assessing patients' knowledge of the indications for their medications. The wide range of study methodologies and reporting styles observed call for a methodological consensus in this research field. Estimates of correct knowledge varied widely between studies, but whether this was due to differences in study populations or study methodology could not be determined. Furthermore, we did not identify any study investigating whether participants' knowledge of the indications for their medications was associated with the quality, e.g. appropriateness, of their treatment.

Objectives: The main objective of the study was to explore the perspectives of healthcare professionals (HCPs) regarding artificial intelligence (AI) and to identify challenges in its incorporation in the healthcare sector of Pakistan.

Methods: A qualitative exploratory study design was adopted. The study was conducted from January 15th to February 29th, 2024, and HCPs (doctors, pharmacists and nurses) from two tertiary care teaching hospitals in southern Punjab, Pakistan were taken as the study population. The interviews were conducted with the help of a semi structured interview schema. A thematic approach was adopted to analyse the data.

Results: Out of 40 HCPs approached, 25 participated in the study with a response rate of 62%. The participants included in the study were doctors (14), pharmacists (6) and nurses (5). The participants had limited knowledge regarding AI and its basics. However, they showed positive perceptions about its incorporation. They believed that many of the problems faced by the healthcare sector of Pakistan can be minimized by AI incorporation. They believed that AI can boost up the efficiency of healthcare providers, reduce their workload, save time and minimize medical errors. Four main themes with multiple subthemes were identified: (1) Cognizance of AI, (2) Acceptability of AI among HCPs and training requirements for effective incorporation, (3) Merits and Demerits of AI, and (4) Challenges in incorporation of AI with proposed solutions.

Conclusion: HCPs showed a willingness to embrace AI incorporation and believed that it may bring numerous benefits to the health system. Policymakers should take necessary steps to ensure AI incorporation in our healthcare sector.

Background: QbTest is a commercially available, computerised test of attention, impulsivity, and activity designed to assist with the diagnosis of attention deficit hyperactivity disorder (ADHD). Health Innovation East Midlands (formerly East Midlands AHSN), led the implementation of the QbTest on behalf of the 15 Health Innovation Networks across Child and Adolescent Mental Health services (CAMHS) and Paediatric sites in England between April 2020 and March 2023. We evaluate the impact of this programme on diagnostic assessment at participating sites.

Methods: A mixed-methods approach was used including: case-note data collected on 10-30 cases per site pre and post QbTest implementation; interviews with healthcare staff working with QbTest; and surveys to explore perspectives of healthcare staff and patients/carers. Case-note data was descriptively analysed to compare time to diagnosis (number of appointments and days) pre/post QbTest implementation. Survey data was analysed descriptively. Qualitative interview data was explored using thematic analysis.

Results: Case-note data was provided by 20 sites across England. Comparison of mean values pre- and post-QbTest implementation identified a decrease of 0.37 (11.5%) in number of appointments to reach a diagnostic decision, a 55-day (12.5%) increase in days from initial referral to diagnosis, and a 12-day (10.3%) increase in days to reach a diagnostic decision. Exploratory analyses indicated greater benefit for Paediatric services over CAMHS, in terms of a decrease in days from referral to diagnosis and number of appointments to diagnosis. Interviews with healthcare staff (n=21) revealed that the QbTest was perceived to support a faster, more efficient diagnostic process. Survey data (n=65 healthcare staff, n=22 patients/carers) identified that the QbTest helped patients understand their symptoms and the diagnostic decision.  Although some logistical issues (e.g., room requirements) and patient issues (e.g., sensory sensitivity) were identified, healthcare staff considered that QbTest was easily incorporated into the ADHD assessment pathway.

Conclusion: The national implementation of QbTest in ADHD clinics resulted in a small reduction in the number of clinical appointments needed to reach a diagnostic decision, with greatest benefit demonstrated in Paediatric sites. Data were impacted by COVID-19 therefore, further evaluation is warranted.

Background: There is broad scientific evidence for the effectiveness of individual trauma-focused evidence-based treatments (EBTs) such as "trauma-focused cognitive behavioural therapy" (TF-CBT) for children and adolescents with posttraumatic stress symptoms. However, there is a significant research-to-practice gap resulting in traumatized children in high-income countries in Europe having only very limited access to these treatments. The aim of this study was, therefore, to identify common barriers and successful dissemination and implementation (D&I) strategies of evidence-based trauma-focused treatments (in particular TF-CBT) in seven European countries.

Methods: For this study, we chose a mixed-method approach: an online survey among certified European TF-CBT trainers (N = 22) and the collection of country-based narratives from TF-CBT experts in different European countries (Finland, Germany, Italy, Netherlands, Norway, Sweden).

Results: Common modifiable barriers to the implementation of TF-CBT were identified on different levels (e.g. government or treatment level), and successful D&I strategies were highlighted across all countries, such as translations of materials. Additionally, the experts from the country narratives put together a broad overview of TF-CBT research in Europe.

Conclusions: The results of this study revealed that especially learning collaborations and the development of joint European efforts in funding and researching D&I strategies are crucial for future implementation of trauma-focused EBTs in Europe.

Background: During COVID-19, scientists advising policymakers were forced to deal with high uncertainty and risks in an environment of unknowns. Evidence on which policies and measures were effective in responding to the pandemic remains underdeveloped to answer the key question 'what worked and why?'. This study aims to provide a basis for studies to go further to answer this critical question, by starting to look efficacy or how countries ensured that health services remained available and what measures were enacted to protect and treat their populations and workers.

Methods: We applied a three-phase sequential mixed methods design. In phase one, we started with a qualitative content analysis of the EU Country Profile reports to retrieve and analyse data on COVID-19 responses taken by 29 countries in the European region. Phase two is the step of data transformation, converting qualitative data into numerical codes that can be statistically analysed, which are then used in a quantitative cross-national comparative analysis that comprises phase three. The quantifying process resulted in a numerical indicator to measure the 'response efficacy' of the 29 countries, which is used in phase three's association of the response measure with country performance indicators that were derived from European Centre for Disease Control (ECDC) COVID-19 case and death rate data.

Results: Through comparing the frequency of COVID-19 measures taken, we found that many countries in the European region undertook similar actions but with differing effects. The cross-national analysis revealed an expected relationship: a lower COVID-19 response efficacy appeared to be related to a higher case and death rates. Still, marked variation for countries with similar response efficacy indicators was found, signalling that the combination and sequence of implementation of COVID-19 responses is possibly just as important as their efficacy in terms of which response measures were implemented.

Conclusions: Many European countries employed similar COVID-19 measures but still had a wide variation in their case and death rates. To unravel the question 'what worked and why?', we suggest directions from which more refined research can be designed that will eventually contribute to mitigate the impact of future pandemics and to be better prepared for their economic and human burden.

Background: To improve the capacity of county medical and health services, China encourages all localities to pilot the close-type county medical alliance. In Shandong Province, medical alliances have been piloted in 47 counties, ranking first in the country. The objective of this study is to comprehensively evaluate the implementation of close-type county medical alliance in Shandong Province, identify the differences between different county regions, and analyze the reasons, so as to provide a reference for the construction of a new county medical and health service system with clear goals, powers and responsibilities, and division of labor.

Methods: The implementation of the close-type county medical alliance was comprehensively evaluated in 47 national pilot counties in Shandong Province using entropy weight TOPSIS method and non-integer rank sum ratio method. Variance analysis was used for comparison of the comprehensive evaluation results.

Results: The weight coefficient of evaluation indicators was highest for information interconnection, at 18.06%, and lowest for orderly referral of patients, at 3.64%. There was no difference in results of the comprehensive evaluation of entropy weight TOPSIS method and non-integer rank sum ratio method. Comprehensively order the implementation status of each pilot county according to the relative paste progress, 13 counties Y₅, Y₁₁, Y₁₄, Y₁₆, Y₂₀, Y₂₅, Y₂₆, Y₂₇, Y₂₈, Y₃₂, Y₃₃, Y₄₀ and Y₄₂ were ranked highest, whereas county Y₃₇ was ranked lowest. Non-integer rank sum ratio method graded counties into three grades: excellent, good and average. Kruskal-Wallis nonparametric test showed that the difference between the grades was statistically significant (H[Formula: see text]37.099, p[Formula: see text]0.001). Variance analysis based on comprehensive evaluation results showed that implementation status was not correlated with the county economic development level, the level of health resources input and the medical service ability of the lead hospital.

Conclusions: Our findings indicated that the implementation of the close-type county medical alliance is significantly different between pilot counties, with a marked differentiation within the same urban area. Therefore, effective measures are recommended to reduce this gap, including promoting informatization empowerment of the county medical community, strengthening government responsibility and improving policy effectiveness.

Background: People with end-of-life chronic obstructive pulmonary disease (COPD) experience debilitating physical limitations, with a high mortality rate. Our research has shown health system design and delivery leads to inequitable outcomes. Enabling people with end-of-life COPD, their support people, and health professionals to partner in setting the agenda for resource allocation may inform health service improvement.

Design: Qualitative methodology utilising focus groups including patients, family, friends, informal support people, health care workers and professionals.

Methods: The analysis, utilising critical theory and Actor-Network theory, positioned people with severe COPD, their support people and health professionals as experts in end-of-life care. Analyses triangulated these perspectives, and were reviewed by the research investigators and an expert reference group.

Results: Participants (n=74) in seven focus groups reported their experiences of inequity within the healthcare system. Equity was an overarching phenomenon identified by participants, with three specific themes being described: policy design, system design, and service design.

Conclusion: Experiences of patients, their support people and health professionals as experts in end-of-life COPD care can inform health systems and health service design to address current inequities in funding and delivery of care for end-of-life COPD.

Background: Workplace dignity is defined as a person's perception of respect and trust, equal and fair treatment, valuing the person, independence, freedom of expression, and decision-making enjoyed by the employee in the workplace. Therefore, this study aimed to develop the Workplace Dignity Scale (WDS) and evaluate its psychometric properties.

Methods: In this methodological study, WDS was translated based on Beaton et al. Guideline. After assessing face and content validity (using CVI, CVR, modified kappa, and item impact), 250 nurses were selected by random sampling from Kashan hospitals in 2023. Then, WDS was assessed through expletory factor analysis (EFA), known-groups comparison, internal consistency, and stability. The ceiling and floor effects were also examined. Data were analyzed using SPSS v16 by Kruskal-Wallis test, Cronbach's alpha, McDonald's Omega, interclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable changes (MDC).

Results: The scale's CVI, CVR, and modified kappa were above 0.79. Item impact was higher than 1.5. EFA extracted three factors, including "general dignity, respect, and indignity", that could explain 70.6% of the total variance in scale. WDS could differentiate between the three groups in terms of occupation satisfaction status. Cronbach's alpha, McDonald's Omega, ICC, SEM, and STC of scale were 0.949, 0.950, 0.970, 2.793, and 7.742, respectively.

Conclusion: The Persian version of the WDS has shown validity and reliability for measuring workplace dignity among nurses in the Iranian context.

Background: In Canada, a new federal public dental insurance plan, being phased in over 2022-2025, may help enhance financial access to dental services. However, as in many other countries, evidence is limited on the supply and distribution of human resources for oral health (HROH) to meet increasing population needs. This national observational study aimed to quantify occupational, geographical, institutional, and gender imbalances in the Canadian dental workforce to help inform benchmarking of HROH capacity for improving service coverage.

Methods: Sourcing microdata from the 2021 Canadian population census, we described workforce imbalances for three groups of postsecondary-qualified dental professionals: dentists, dental hygienists and therapists, and dental assistants. To assess geographic maldistribution relative to population, we linked the person-level census data to the geocoded Index of Remoteness for all inhabited communities. To assess gender-based inequities in the dental labour market, we performed Blinder-Oaxaca decompositions for examining differences in professional earnings of women and men.

Results: The census data tallied 3.4 active dentists aged 25-54 per 10,000 population, supported by an allied workforce of 1.7 dental hygienists/therapists and 1.6 dental assistants for every dentist. All three professional groups were overrepresented in heavily urbanized communities compared with more rural and remote areas. Almost all dental service providers worked in ambulatory care settings, except for male dental assistants. The dentistry workforce was found to have achieved gender parity numerically, but women dentists still earned 21% less on average than men, adjusting for other characteristics. Despite women representing 97% of dental hygienists/therapists, they earned 26% less on average than men, a significant difference that was largely unexplained in the decomposition analysis.

Conclusions: Accelerating universal coverage of oral healthcare services is increasingly advocated as an integral, but often neglected, component toward achieving the health-related Sustainable Development Goals. In the Canadian context of universal coverage for medical (but not dentistry) services, the oral health workforce was found to be demarcated by considerable geographic and gendered imbalances. More cross-nationally comparable research is needed to inform innovative approaches for equity-oriented HROH planning and financing, often critically overlooked in public policy for health systems strengthening.

Background: Community based health insurance (CBHI) is characterized by voluntary involvement, pooling of health risks and of funds occur within a community. It is becoming increasingly popular way to increase the use of healthcare services in low- and middle-income nations. Understanding the effect of CBHI on the level of health services utilization is a paramount for evidence based decision making. Hence, this study aimed to estimate the pooled effect of CBHI on health services utilization in Ethiopia.

Methods: Studies were searched from PubMed, Google scholar, Web of Science, Research4life, Science Direct, African Journal Online and national websites for grey literatures. We were adhered to the PRISMA guidelines. Cross sectional and quasi experimental studies were included. Studies were screened, and critically appraised for quality using Joanna Briggs Institute Critical Appraisal tools. The data were extracted using Microsoft excel and exported to STATA 17 and RevMan 5.4.1 for further analysis. Heterogeneity between studies was assessed using Cochran's Q statistic and quantified with I². A random-effects model was used to estimate the pooled effect size. Subgroup analysis was done to show variations of the effect sizes across study years.

Result: A total of 1501 studies were identified, out of which only 14 of them were included in the final meta-analysis. Health services utilization among CBHI members and non-members was 69.1% [95%CI (57.1-81.1%)] versus 50.9% [95%CI (40.6-61.3%)] respectively (difference in the effect was 18.2%). The CBHI members were nearly three folds more likely to utilize health services as compared with their counterparts [OR = 2.54, 95%CI: (1.81, 3.57). On average, CBHI users had 1.14 increased health facility visits as compared to non-insured, mean difference (MD) = 1.14 visits with 95% CI (0.65-1.63).

Conclusion: The CBHI has a significantly increased health service utilization in Ethiopia. Hence, it will have a great contribution to meet the health for all agenda in resource limited countries.