BMC Health Services Research最新文献

Background: While evidence of efficacy, safety, and technical feasibility is crucial when introducing a vaccine, it is equally important to consider the psychological, social, and political factors influencing vaccine acceptance. This study aims to identify the factors contributing to COVID-19 vaccine hesitancy among adults in Tehran, Iran.

Methods: The study employed a descriptive and analytical cross-sectional design carried out from 2021 to 2022. It involved 260 eligible individuals residing in the catchment areas of Tehran and Shahid Beheshti Universities of Medical Sciences who declined to receive the COVID-19 vaccine, selected through systematic sampling. Data collection was accomplished through a researcher-developed questionnaire and analyzed using SPSS 26 software. The analysis utilized descriptive statistics and non-parametric tests including Mann-Whitney U, Kruskal-Wallis, and Multiple Linear Regression, to examine the relationships between variables.

Results: The average scores (SD) across dimensions were as follows: the individual's health status and perceived risk, 15.53 (1.70); contextual and social effects, 17.68 (2.53); awareness, 14.81 (2.34); and beliefs and concerns. 14.91 (2.64), indicating a concerning situation regarding contextual and social impacts and a moderate status as to other areas. The primary reasons for vaccine refusal included fear, lack of belief in the vaccine, concerns about its reliability, illness, and lack of access or time. Acceptance of the vaccine was associated with education, occupation, marital status, number of children at home, and income reduction due to COVID-19.

Conclusion: The findings indicate that fear, lack of belief in the vaccine, concerns regarding its reliability, illness, and lack of access or time were the most important factors influencing reluctance to receive the vaccine. Health organizations should consider these factors when encouraging the population to receive the COVID-19 vaccine.

Background: Healthcare fragmentation and lack of care coordination are longstanding problems in cancer care. This study's goal was to provide in-depth understanding of how the organization and fragmentation of healthcare impacts the experiences of patients with advanced cancer and their families, especially near the end-of-life.

Methods: This mixed-methods quality improvement study took place at a large multi-specialty healthcare organization in Northern California. Electronic health record data was used to identify patients with advanced cancer and their characteristics. Data were collected 10/2019-05/2022 through periodic patient surveys and in-depth interviews with sampled family members, including open-ended questions about overall healthcare experiences. Data were analyzed using inductive thematic analysis.

Results: Overall, 281/482 (58.3%) patients with advanced cancer completed surveys. Surveyed patients' mean age was 68 (SD: 12.8) years, 53% were male, 73% White, 14.2% Asian, 1.4% Black, 3.9% Other; 8.9% Hispanic, and 19.2% were deceased within 12 months. Twenty-four family members completed in-depth interviews: 17/24 (70.8%) were spouses, 62.5% were female and 50% were interviewed after the patient's death. Respondents were generally positive about health care team interactions, but consistently brought up the negative impacts of the organization of healthcare, "It is not the fault of the health care team - it is the way the system works." Three major challenges were identified. (1) Systemic healthcare care fragmentation, including difficulties navigating care across providers and institutions, "It seems like everything is like an isolated incident… there's no overall, big picture viewpoint." (2) Administrative burdens, "In the end I gave up [scheduling care] because I was tired of calling." (3) Financial burdens, "This oncologist wanted to put him on a drug…but it was $4000 a month." Respondents described these challenges leading to worse quality of care, health, and quality of life, and loss of trust in the national healthcare system.

Conclusions: These findings illustrate how care fragmentation and administrative and financial burdens lead to worse quality care and distrust of healthcare. Better coordination of patient-centered care, and a fundamental restructuring of a highly fragmented national healthcare system are required to meet the needs of patients with complex conditions like advanced cancer and their families.

BACKGROUND : The efficiency of medical services directly impacts the economic burden of healthcare, making it crucial to analyze the input-output efficiency of various types of medical institutions. However, while hospitals had been extensively analyzed for their efficiency, other types of medical institutions had received limited attention in this regard. METHODS : In this study, we employed data envelopment analysis (DEA) methods based on time series and internal benchmarks to autonomously assess the efficiency of 18 distinct categories of healthcare facilities in China over the past decade. The verification was conducted through the utilization of the critical incident technique (CIT). Additionally, we utilized the Delphi process (AHP) method to evaluate suppliers of medical consumables, implemented a multi-population genetic algorithm for managing these consumethod and analytic hierarchymables efficiently, and applied stakeholder theory to manage medical personnel efficiency.  RESULTS : Our findings indicated that medical institutions capable of providing clinical services exhibited higher levels of efficiency compared to those unable to do so. Multiple indicators suggested redundancy within these institutions. Notably, comprehensive benefit evaluation revealed that clinical laboratory had performed poorly over the past decade. We selected an inefficient medical institution for intervention in reagent management and the work efficiency of medical staff. After implementing the Delphi method and multi-population genetic algorithm for consumable replenishment, the reagent cost was reduced by 40%, 39% and 31% respectively in each of the three experimental groups, compared to the control group. By applying stakeholder theory and process reengineering methods, we were able to shorten quality control management time for medical staff in the experimental group by 41 min per day, reduce clinical service time by 25 min per day, and extend rest time by 70 min per day, while the quality indicators were all meeting the targets. CONCLUSION: By employing various mathematical models as described above, we were able to reduce costs associated with medical consumables and enhance medical personnel work efficiency without compromising quality objectives.

Background: In 2016, Burkina Faso adopted a new community-based model for disease surveillance, appointing two community-based health workers (CBHWs) per village. The CBHWs play a crucial yet under-researched role in Burkina Faso's health system. This study aimed to analyze the factors influencing their practices in relation to their official roles in epidemic disease surveillance.

Methods: Conducted in the Dandé Health District in southwestern Burkina Faso, this qualitative study collected data through semi-structured interviews with 15 CBHWs and 25 health professionals, supplemented by observations of the CBHWs' working conditions. Data analysis employed a qualitative content analysis.

Results: Analysis showed major challenges in the current community health strategy, particularly in capacity building and the working conditions of CBHWs (e.g., lack of monthly report sheets and financial incentives). Recognition from the community was the key motivation for volunteering as a CBHW in Dandé Health District where rural populations are under great financial pressure. Consequently, financial incentives (monthly remuneration and extra incentives) and non-financial rewards in terms of status and prestige, play a crucial role in sustaining volunteer enegagment and effectiveness.

Conclusions: This study underscores the necessity of establishing a clear policy on compensation and protection for CBHWs to motivate and optimize their work. Such policies are essential for enhancing their contribution to a robust national community surveillance system, ultimately improving public health outcomes in Burkina Faso.

Background: To address the rational use of medicines in healthcare institutions, the Chinese government enacted legislation for pharmacists in 2021, emphasizing the importance of pharmacists in medical services. The allocation and equity of pharmacist human resources in healthcare institutions directly affect people's accessibility to pharmaceutical services. The study aims to analyze the supply and demand of pharmacist human resources in Chinese healthcare institutions and evaluate the equity of their distribution to provide a reference for the rational management of pharmacist resources.

Methods: This was a time-series study that was conducted using data obtained from Health and Health Statistical Yearbook that is performed every year by the National Health Commission of the People's Republic of China. The study included 31 provinces, municipalities, and autonomous regions and 34,354 medical institutions in mainland China, which were classified into different economic regions based on their level of economic development. The study collected healthcare technicians and pharmacist data from national healthcare institutions between 2016 and 2020. The study evaluated the level of pharmacist human resource allocation using the health resource density index. The study explored the equity of pharmacist human resource allocation from two aspects: population and geographic area, using the Gini coefficient and Theil index.

Results: The average annual growth rates of healthcare technical staff and pharmacists in Chinese medical institutions from 2016 to 2020 were 5.67% and 3.03%, respectively. The Gini coefficients of healthcare personnel resources based on population distribution were all below 0.119, while those based on geographical area were all above 0.655. The total Theil indexes of pharmacist human resources based on population distribution were all below 0.010, while those based on geographical area were all above 0.511. In addition, the contribution rates of the within-group Theil indexes of pharmacist human resources based on population and geographical area distributions to the total Theil index were all greater than or equal to 50%.

Conclusions: The allocation level of pharmacist human resources in China continues to improve, but there are differences in different economic development areas. Currently, allocation based on population shows equity, but allocation based on geographic area shows inequity. In the future, more attention should be paid to the geographic accessibility of pharmacist human resources, and resource allocation should consider both the population served and geographic area.

Background: Several actions have been taken to improve the sick listing process, patient safety and return to work. One of them is the implementation of the rehabilitation coordinator function, of which the benefits have not yet been fully explored. Neither has the role of the manager, who has significant impact on the implementation and support of a new function. This study aimed to explore how first line managers', who employed a rehabilitation coordinator that had completed a one-year specialized study program, perceived, and experience the function rehabilitation coordinator.

Methods: This is an interview study using a semi structured interview guide for data collection and thematic analysis was applied to the data. Ten first line managers in health care were interviewed.

Results: Four themes were identified: The Saviour, A personalized function, Change takes time and Strengthen status and legitimacy. The managers experienced the rehabilitation coordinator as a valuable function who facilitates collaboration in the team and with external stakeholders and perceived them as a much-needed resources, supporting physicians with sick leave issues. The assignment was ambiguous and dependent on the rehabilitation coordinators individual characteristics, which may result in a risk of overload. The managers were engaged in the implementation process, but this required time. They considered it important to strengthen legitimacy for the function which required support and encouragement to take part in specialized education and training.

Conclusions: The managers experienced the rehabilitation coordinators as playing a crucial role in the return-to-work process. They were willing to support how this new function will improve and develop. The results from this can serve as a guidance for the implementation and support of the function rehabilitation coordinator.

Introduction: Organizational commitment (OC) significantly impacts the quality of care provided by healthcare staff. It reflects employees' connection to and engagement with their organization, affecting job satisfaction, employee turnover, and the overall success of the healthcare organization. This research seeks to assess OC levels and identify its influencing factors among health sector staff in Shiraz, southwestern Iran.

Methods: In this cross-sectional study, the staff of the health sector including physicians/family physician (FP), midwives, healthcare workers, psychologists, dentists, and nutritionists were selected through a multi-stage sampling; they filled out an online 36-item questionnaire (12 demographic items and 24-item Allen and Mayer OC questionnaire). The data were analyzed using SPSS software (version 25). Descriptive statistics of OC scores were provided. Also, independent samples t-test and analysis of variance were used as statistical tests, and P-value < 0.05 was considered the significant level.

Results: Overall, 289 staff with a mean age of 32 ± 7.6 years participated in this study. The OC total mean score was higher in the public sector compared with the private sector and higher in the non-FP team compared with the FP team. The mean score of all types of OC among all job positions was low. Moreover, education level, workplace, job experience in current job, engagement in other jobs for making money, and FP staff showed a significant association with the total mean score of OC.

Conclusion: According to the results, OC among health sector staff is low. Therefore, policymakers in the health sector are strongly recommended to implement immediate measures to enhance this critical factor among their workforce.

Background: Healthcare policy implemented during the COVID-19 pandemic may have impacted the health of patients with heart failure. Australian data provide a unique opportunity to examine service disruption independent of significant COVID-19 burden. This study aimed to examine heart failure care during the pandemic in New South Wales (NSW).

Methods: Analysis of hospital utilisation among patients aged ≥ 18 years with a primary diagnosis of heart failure conducted using linked administrative health records from hospital admission, emergency department, non-admitted services, and mortality data collections. Health service utilisation and outcomes were compared "Pre-pandemic" (PP): 16th March 2018 - 28th August 2019 and "During pandemic" (DP): 16th March 2020 - 28th August 2021. Mortality data were available until December 2021.

Results: Heart failure-related ED presentations and hospital admissions were similar between the periods (PP = 15,324 vs DP = 15,023 ED presentations, PP = 24,072 vs DP = 23,145 hospital admissions), though rates of admission from ED were lower DP (PP = 12,783/15,324 (83.4% [95% CI 82.8-84.0]) vs DP = 12,230/15,023 (81.4% [95% CI 80.8-82.0%]). There was no difference according to age, sex, rurality, or socioeconomic status. Outpatient volume reduced DP (PP = 44,447 vs DP = 35,801 occasions of service), but telehealth visits increased nearly threefold (PP = 5,978/44,447 (13.4% [95% CI 13.1-13.8%]) vs DP = 15,901/35,801 (44.4% [95% CI 43.9-44.9%]) with highest uptake among the wealthy and those in major cities. Time to heart failure-related ED presentation, hospitalisation or all-cause mortality following index admission was longer DP (PP = 273 [IQR 259, 290] days, DP = 323 [IQR 300, 342] days, HR 0.91 [95% CI 0.88, 0.95]).

Conclusions: Policies implemented DP had minimal impact on volumes of inpatient heart failure care in NSW hospitals, but there were fewer admissions from ED and reduced volumes of publicly funded outpatient care. A rapid shift from patient-facing to remotely delivered care enabled compliance with restrictions and was associated with increased time to heart failure-related adverse events, but access was not afforded equally across the socio-demographic spectrum.

Background: Participation of health service staff in research improves health outcomes and adherence to clinical guidelines. To increase research participation, many health services seek to build research capacity which adds to the development of individual and organisational skills and abilities in order to conduct health research. Numerous approaches to research capacity building have been trialed with inter- and intra-institutional, or university-health service collaborative approaches being frequently described strategies. University-health service research collaborations have potential for high impact and mutual benefit, by harnessing respective strengths across both organisations. However, the range and scope of research capacity building approaches, including their relative value and success have not been consolidated. The aim of this review was to examine and describe the collaborative strategies employed by health services in conjunction with educational partners to enhance the research capability of health service staff.

Methods: The scoping review framework by Arksey and O'Malley was used to inform the review method. A systematic search was conducted of four major databases: Medline, CINAHL, Embase, and Cochrane, focusing on publications after 1995. Inclusion and exclusion criteria were established through iterative team discussions. The two-stage screening process and data extraction was managed in Covidence. Collaboration, Research Capacity, Health Services, and Health workforce were the primary concepts, contexts and populations guiding the search.

Results: Of the 1462 studies identified, 61 were selected for the review. These studies reported on partnerships between universities and health services with a specific focus on building research capacity of health service staff. Studies predominantly hailed from Australia, USA, UK, and Canada. Collaboration approaches varied and leveraged different activities to build research capacity included training, mentoring, shared funding, and networking. Training partnerships emerging as the most prevalent. Findings emphasised the importance of localisation in approaches, with some studies indicating the intrinsic value of such collaborations for both partners involved. Despite the emphasis on individual interventions like training and mentoring, team-level interventions were notably scarce.

Conclusion: This review highlights the diverse range of approaches in research capacity building collaborations between health services and educational partners. It advocates for a shared understanding of goals, highlighting the critical nature of relationship-building and the pivotal role of sustainable infrastructure in long-term collaboration success. Future directions should consider the tangible impacts of these models on clinical outcomes.

Background: In April 2019, Texas Association of Community Health Centers launched the Trauma-Informed Care (TIC) program in community health centers across Texas. This initiative aimed to transform organizational culture for consistent delivery of TIC by providing training and coaching opportunities for Trainers and Champions in each health center. This study is an interim qualitative evaluation to gain participants' insights into their experiences of and perceptions about TIC training as part of the TIC initiative.

Methods: We conducted semi-structured key informant interviews via Zoom with Trainers across four cohorts of participating health centers between February 2020 and April 2023. We used rapid assessment procedures to conduct analysis in tandem with data collection given the ongoing TIC training. We present salient quotes to illustrate the emergent themes.

Results: We interviewed a total of 36 Trainers and identified the following emergent themes from the interviews: (1) Perceived need for the TIC training, (2) Perspective shift in patient care, (3) Increased support for staff wellness, (4) Importance of equal involvement of staff at all levels, (5) Need for leadership buy-in, and (6) Lack of self-efficacy and empowerment to train others.

Conclusions: A trauma-informed environment in a healthcare setting can bolster patient-centered care as well as a culture of staff wellness. This qualitative evaluation revealed that after TIC training, Trainers had improved attitudes and behaviors to commit to organizational TIC transformation to prevent unintended consequences of trauma for both patients and staff. Trainers' experiences with and suggestions for enhancing the TIC training should be considered for training future cohorts as they continue to strive for TIC transformation in their health centers.