BMC Health Services Research最新文献

Background: Clinical decision support systems (CDSS) for renal anemia among hemodialysis patients are gaining clinical attention. However, wide adoption remains challenging, and critical factors concerning physician acceptance remain elusive. This qualitative study conducted in-depth interviews with nephrologists to determine the relevant factors influencing physician acceptance.

Methods: Seventeen nephrologists in the hemodialysis center at Far Eastern Memorial Hospital participated in semi-structured, in-depth interviews to explore their views and concerns regarding CDSS. The qualitative study was performed under the well-established framework of the unified theory of acceptance and use of technology (UTAUT).

Results: The majority of participating physicians (14 of the 17) believed that a CDSS could streamline their workflow and save time. All participants agreed that robust clinical evidence of CDSS efficacy was critical to enhance CDSS acceptance. In addition, physicians noted that CDSS provides educational value, promotes patient safety and quality of care, and aligns with future technological trends. Despite these benefits, physicians raised concerns regarding dependence, distrust, and potential interference, which related to the physician professionalism. The UTAUT model should be extended with additional construct of autonomy in recognition of physician professionalism.

Conclusion: This qualitative study revealed that nephrologists expressed positive views on the CDSS for anemia management. They acknowledged that the CDSS could enhance their work efficiency, improve patient safety, enhance care quality, and provide educational value. To optimize the acceptance of the CDSS under the UTAUT-Autonomy framework, the design and implementation of the CDSS should also address three additional key factors: over-dependence, distrust, and workflow interruption.

Background: Recent inflation in Nigeria could hinder access to medicines. The aim of the study was to evaluate the prices, availability, and affordability of selected medicines for asthma management in Nigeria.

Methods: This cross-sectional survey (January 2024 - March 2024) was conducted in community pharmacies in the six geopolitical zones of Nigeria. Data for Originator Brand (OB) and Lowest-Priced Generic (LPG) were collected with the Medicine Price Data Collection Form developed by the World Health Organization/Health Action International (WHO/HAI). Twenty-three (23) selected medicines for asthma management were utilised. The Median Price Ratio (MPR) was the ratio of the median local unit price to the international reference unit price (IRP). The IRPs were South African government procurement prices. Availability was reported as the percentage of medicine outlets in which the medicine was found on the day of data collection. Affordability was the number of days of work by the lowest-paid unskilled national government worker to purchase a defined course of treatment for a specific condition.

Results: Of the 300 community pharmacies that were sampled, 214 responses were retrieved (participation rate: 71.3%). The majority of the medicines (n = 18 of 21, 85.7%) were more than two times the international reference unit prices (IRPs). Salbutamol 100 mcg inhaler Originator Brand (OB) was 11.8 times the IRP, while the Lowest-Priced Generic (LPG) was 5.3 times the IRP. The average per cent availability across OBs (11.2%), LPGs (18.8%), and all medicines (15.0%) was less than 50%. The majority of the medicines (n = 36 of 39, 92.3%) cost more than a day's wages. Salmeterol 25 mcg/Fluticasone 125 mcg inhaler would require 31.0 days' wages with OB and 9.5 days' wages with LPG.

Conclusions: The findings reveal high medicine prices, poor availability, and low affordability of asthma medicines. There is a need for targeted subsidies on medicines for the management of asthma, insurance reforms, and local manufacturing incentives.

Background: Opportunities to improve individuals' health and reduce health inequalities are increasingly being sought at the community and neighborhood levels. Neighborhood features can be of great importance, especially for the health of residents in vulnerable circumstances. However, little attention has been paid to their perspectives. This qualitative study was conducted to explore the views of these residents on how their neighborhoods can support their health needs.

Methods: Interviews (January-March 2024) structured by eight dimensions of resident-centered neighborhood approaches were conducted with 15 residents in vulnerable circumstances (ages 44-85) of three neighborhoods in Rotterdam, the Netherlands. The participants' views were analyzed thematically.

Results: The interviewees considered physical, mental, and social aspects, including physical activity, having a positive outlook on life, social contact, and independence, to be important for their health.

Conclusions: The insights obtained in this study are crucial for the development of effective neighborhood initiatives that align with the needs and preferences of residents in vulnerable circumstances, ultimately contributing to their health and overall well-being.

Background: Structured pathology datasets enhance communication and management by improving clarity, completeness, and accuracy. This study aimed to audit pathology reports of skin cancer in Palestine.

Methods: Comprehensive, time-driven sampling was employed by reviewing all pathology reports of melanoma, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC) from January 2021 to December 2024. The data included sociodemographic variables and the core items published in the dataset for the histological reporting of skin cancers by the Royal College of Pathologists. A completion rate of 90% was selected as the standard of measurement.

Results: None of the included 113 reports documented all items. The macroscopic items were completely reported in 25% and 39.1% of BCC and SCC reports, respectively. For both BCC and SCC, specimen type was reported for all cases, and clinical site was missing in one case of each. The lesion margins were recorded in most reports of BCC (68.7%) and SCC (67.4%). However, macroscopic lesion dimensions were absent in 51.6% of BCC reports and 48.4% of SCC reports. The other items were not mentioned in any report. Only clinical site, specimen type, and the three dimensions of the specimen were included in all melanoma reports. The histopathological subtype was mentioned in only one report.

Conclusions: Skin cancer reports did not document most core items. Implementation of standardized reporting is limited by resource constraints and suboptimal health information system. However, transition from narrative to structured reporting requires the development of national regulations and organizational policies, supported by committed leadership. Exploratory research is recommended to identify the barriers to implementation of structured reporting.

Background: Following a severe burn injury, individuals embark on a lifelong process of managing and integrating the physical, psychological, and social consequences, including functional limitations, fatigue, altered body image, and psychological trauma. To aid in this process, healthcare professionals can provide self-management support. To date, however, no self-management support intervention has been developed to meet the unique needs and preferences of burn survivors within the context of burn aftercare. In this article, we describe the process of developing a self-management support intervention for burn aftercare and present the resulting intervention.

Methods: A structured, multi-stage process was followed from May 2021 to December 2023 to develop the intervention, guided by established frameworks for the development and adaptation of complex interventions. The process included evidence review, stakeholder consultation, and participatory observations to identify needs, inform design decisions, and ensure contextual fit. A hybrid approach to intervention development was adopted, combining adaptation of an existing intervention with augmentation through five co-creative workshops involving burn survivors, healthcare professionals, researchers, and burn care decision-makers. The final prototype was refined through expert reviews and real-world pilot-testing to assess its feasibility and acceptability.

Results: The structured, multistage process resulted in a self-management support intervention addressing the physical, psychological, and social needs of burn survivors. The intervention was named BreeZe (Brandwonden en Zelfmanagement/Burns and self-management). Intervention Core components of the intervention include a holistic care approach, goal setting and action planning, solution-focused brief therapy, motivational interviewing, case management, and the acknowledgment and involvement of informal caregivers. BreeZe is supported by materials like the Self-Management Web, a patient booklet, training for healthcare professonials, and a comprehensive manual. BreeZe is delivered by trained healthcare professionals and is structured into five phases, focusing on holistic needs assessment, goal setting, progress monitoring, and ongoing motivational support.

Conclusions: The structured, multi-stage development process was thorough and carefully considered, balancing diverse stakeholder perspectives with scientific evidence and theory. BreeZe offers an evidence-based model tailored to the Dutch context that can be integrated into routine practice that shows the potential to enhance the effectiveness of care and support a more collaborative, patient-centred approach.

Trial registration: Not applicable.

Background: Telemedicine, characterized as the provision of healthcare services remotely, has the potential to enhance clinical management, expand service accessibility, strengthen communication among care team members, and improve the coordination of patient care.

Objectives: Assess the knowledge, attitude, skills, and perceived barriers to telemedicine within medical professionals in the Fayoum Governorate.

Methodology: It is a descriptive cross-sectional study performed using an online Google Form and face to face interview questionnaire. A total of 305 healthcare professionals took part in this study.

Result: The mean knowledge level of our participants was 65%. The most reported barrier to telemedicine adoption was a lack of qualified personnel, cited by 91.5% of respondents. About 50% of the physicians use telemedicine daily, weekly, or monthly. Despite limited formal training (7.9%), most HCWs had basic technical skills, and comfort levels were generally neutral or low. Higher education and experience were substantial predictors of good understanding, while age and education level were key predictors of an appropriate attitude.

Conclusions: The study revealed that physicians had a positive attitude towards telemedicine and showed good knowledge. Although they were highly aware of TM, the rate of TM utilization by physicians was less than satisfactory. The government must establish the necessary infrastructure and regulations to enable the implementation of telemedicine.