BMC Health Services Research最新文献

Background: In the last decades all health systems have experienced a lack of resources. Against this background, the idea of ​​applying personal responsibility of the patient as a criterion for allocation of resources (PRCAR) is gaining increasing attention. Bulgarian healthcare reform has been marked by the implementation of many new strategies, that grounded our scientific interest towards investigating PRCAR in Bulgarian public health law and social legislation.

Methods: Through a search of national legal databases 7 documents were selected and subjected to content analysis.

Results: Prospective responsibility was found in two and retrospective responsibility - in three documents, two of which imposed explicit penalties on the patient. Two documents did not distinguish between the types of patient responsibility. PRCAR was found to be controversial through the prism of the social justice principle. The discussion was conducted through the perspectives of evidence translation of research to law, particularities of social cohesion in Bulgaria, and the interpretation of principles of public health ethics.

Conclusion: Although PRCAR was traceable in Bulgarian legislation, no supporting arguments for its introduction were deduced. The applicability of PRCAR should be further studied and wider public debate should be initiated.

Background: The use of digital health applications (German acronym DiGA) for comprehensive patient care is increasing rapidly. Patients with non-organic insomnia can be prescribed an application to manage insomnia. Due to the high prevalence of insomnia in patients with cancer, we were interested in the effect of it and what barriers need to be overcome for its use. The focus of existing studies on acceptance and benefits prompted us to emphasise the analysis of barriers and thus to formulate possible solutions.

Methods: To analyse the barriers of use, the study population (patients with self-reported tiredness or sleep disturbance via validated instruments and cancer disease) was divided into 3 groups. In groups 1 (patients who refused to participate in advance) and 2 (patients who refused a prescription), short close-ended questionnaires were used for non-response assessment by treating oncologists. Problem-centred guidelines were used for the telephone interviews with group 3 (patients who did not provide information on DiGA use). Alternatively, group 3 was invited to complete and return the close-ended questionnaire. A quantitative analysis of the non-response reasons was conducted using SPSS in groups 1 and 2, while MAXQDA was used for the qualitative data in group 3.

Results: Patients refused to participate at several stages of our study. Quantitative data are available for groups 1 and 2. In the largest group 1, 62% of patients refused to participate due to non-subjective sleep disturbance (177 out of 189 patients) during recruitment by treating oncologists, despite high scores on the screening tool. In the small group 2 (11 out of 15), the most common reasons for withdrawal documented by the oncologists were loss of interest and deteriorating health. The problem-centred qualitative interviews with group 3 (17 patients) revealed that some of them used the prescribed DiGA, despite not being included in the main study and being categorized as lost to follow-up.

Conclusion: Analysis of barriers to DiGA use showed that reducing administrative barriers and providing digital and personal support can increase acceptance of the use of DiGAs among cancer patients. Additionally, screening tools can act as a door opener to further communication regarding DiGAs.

Trial registration: German Register of Clinical Trials DRKS00034198, registration date: 7/05/24 (retrospectively registered).

Background: Social integration (i.e., reciprocal interactions with peers and community members) is a notable challenge for many homeless-experienced adults with serious mental illness (SMI). In this study, we examine a range of housing services offered to homeless-experienced adults with SMI and identify the impacts of supportive services on participants' social integration outcomes, with the goal of improving services in transitional and permanent housing settings for homeless-experienced adults with SMI.

Methods: Through semi-structured interviews with homeless-experienced adults with SMI (n = 30), we examine the impacts of housing and service settings on participants' social integration. Participants received services in a variety of housing settings, including transitional housing with congregate/shared living (n = 10), transitional housing with individual quarters (n = 10), and permanent supportive housing (n = 10).

Results: Participants expressed caution in developing social relationships, as these could pose barriers to recovery goals (e.g., substance use recovery). For many, social integration was secondary to mental and physical health and/or housing stability goals. Individual quarters gave individuals a place of respite and a sense of control regarding when and with whom they socialized. Meeting recovery goals was strongly related to connecting to and receiving a range of supportive services; interviews suggest that proximity to services was critical for engagement in these resources.

Conclusions: Programs serving homeless experienced adults with SMI should seek to understand how individuals conceptualize social integration, and how social relationships can either support or hinder participants' recovery journey.

Introduction: Assessing the methodological quality of economic evaluations (EEs) is crucial for evidence-based decision-making. The study aimed to evaluate EEs in restorative dentistry and endodontics, while also analyzing the scientific landscape of researchers and publications through co-authorship and citation network analysis providing an insight into the distribution of scientific expertise.

Methodology: A systematic search for relevant articles from 2012 to 2022 was conducted using PubMed, Scopus, and EBSCO. The ten-point Drummond checklist was used to appraise the methodological quality of included studies. Bibliometric data for network analysis were extracted from the Dimensions database and visualized using VOSviewer software.

Results: Of the 37 articles, 81.08% scored good, 16.21% average, and 2.7% poor on the methodological rating scale. Most of the included studies were in Q1 journals, with limited representation in Q2 and Q3 journals. Compliance was highest in Q2 journals (95%), followed by Q1 (88.36%), while it dropped to 40% for Q3 journals. Co-authorship analysis revealed a dense network of researchers, with Prof. Falk Schwendicke V. having a significant influence. Moreover, the Journal of Dentistry had the highest impact, followed by Journal of Endodontics and BMC Oral Health.

Conclusions: Despite a diverse scientific landscape, participation from developing countries was limited emphasizing the need for inclusivity and diversity in the scientific network. While the quantity of good-quality studies was encouraging, the overall quality of evidence remains paramount for decision-making in healthcare policy and practice. Therefore, continuous efforts to improve methodological rigor and reporting practices are essential to contribute robust evidence.

Background: Among the many pressing concerns of the Somali-American community, and other similar immigrant and refugee communities as they grow in the United States, is the provision of care for older adults and adults with disabilities. The implications of effective caregiving range from the facilitation of community building and place-making to the delivery and management of healthcare on a systemic level. However, little is currently known about Somali-American family caregivers, including their duties and responsibilities, primary concerns, and the impacts of surrounding influences on their ability to fulfill their role.

Methods: Semi-structured interviews were conducted with 10 Somali-American family caregivers in Somali language. The resulting transcripts were translated into English by a professional interpreter and analyzed using an inductive thematic analysis approach. A key informant from the community was additionally consulted for insights regarding cultural nuances and interpretations of idiomatic expressions and concepts.

Results: Thematic analysis of the reports revealed the principal themes of visitation, patient accompaniment, and self-sacrifice through acceptance and God-consciousness as pervasive and salient concerns across participants. Furthermore, the heightened stresses of the COVID-19 pandemic revealed just how severe the consequences can be when access to culturally habituated navigational tools and coping mechanisms are restricted.

Conclusions: In light of our findings, the growing concern for discrimination and sociocultural discord in the Somali-American community presents a particularly prescient threat to the well-being and sustainability of family caregivers. Their experiences must be understood and used to promote education and partnership between the healthcare system and the community in order to build trust and ensure a healthy future for this indispensable population.

Background and aim: China has used traditional Chinese medicine (TCM) to treat diseases for more than 2000 years. Traditionally, TCMs in medicine cabinets are arranged alphabetically or on the basis of experience, but this arrangement greatly affects dispensing efficiency. However, owing to the unique properties and qualities of TCM, very few automatic approaches or systems have specifically addressed TCM dispensing problems. Therefore, it is necessary to establish a method of optimizing the traditional Chinese medicine placement scheme (TCMPS) via computer algorithms to improve the work efficiency of pharmacists.

Methods: A prescription dataset from a hospital in 2022 was obtained, and the association rule algorithm (ARA) was used to calculate the frequency of use for each type of TCM and the associations between different types of TCMs. On the basis of these association and frequency data, the optimal TCMPS was calculated using the simulated annealing algorithm (SAA) and then verified using the prescription dataset from 2023.

Results: A total of 10,601 prescriptions were collected in 2022, involving 360 different TCMs, and each prescription contained an average of 9.485 TCMs, with Danggui (3628) being the most frequently used. When the threshold of support was set to 0.05 and the confidence was set to 0.8, 78 couplet medicines used in orthopedics clinics were found through ARA. When the threshold value of support was set to 0, the confidence was set to 0, and the rule length was 2, a total of 129,240 rules were obtained, indicating support between all pairwise TCMs. The TCMPS, calculated using SAA, had a correlation sum of 14.183 and a distance sum of 3.292. The TCMPS was verified using a prescription dataset from 2023 and theoretically improved the dispensing efficiency of pharmacists by approximately 50%.

Conclusions: In this study, the ARA and SAA were successfully applied to pharmacies for the first time, and the optimal TCMPS was calculated. This approach not only significantly improves the dispensing efficiency of pharmacists and reduces patient waiting time but also enhances the quality of medical services and patient satisfaction, and provides a valuable reference for the development of smart medicine.

Background: Hospital resilience has been well recognized among healthcare managers and providers as disruption of hospital services that threatens their business environment. However, the shocks identified in the recent hospital resilience concept are mainly related to disaster situations. This study aims to identify potential shocks that hospitals face during disruptions in Indonesia.

Method: This qualitative study was conducted in Makassar, Indonesia in August-November 2022. Data was collected through semi-structured interviews with hospital managers and resilience experts using a semi-structured interview guide. 20 key informants were interviewed and data were analyzed by thematic analysis.

Results: The study identified seven shocks to hospitals during the disruption era: policy, politics, economics, hospital management shifting paradigms, market and consumer behavior changes, disasters, and conflicts. It also identified barriers to making hospitals resilient, such as inappropriate organizational culture, weak cooperation across sectors, the traditional approach of hospital management, inadequate managerial and leadership skills, human resources inadequacies, a lack of business mindset and resistance to change.

Conclusion: This study provides a comprehensive understanding of hospital shocks during disruptions. This may serve as a guide to redesigning the instruments and capabilities needed for a resilient hospital.

Background: While digital health and social services offer promising solutions, they often overlook the perspectives and needs of older adults. This study aims to comprehensively investigate the preferences of older adults regarding the use and development of digital health and social services.

Methods: The survey spanned from 19 March to 31 March 2023. The study population comprised 1100 Finnish individuals aged 75 and over from across Finland. The study used qualitative inductive content analysis to examine the open-ended responses obtained in the survey.

Results: We identified eight main categories for the older adults' preferences: usability, service design, and security; training, support, instructions, and information; flexibility of compatible devices; understandable language and interpretation of laboratory results; available and accessible services; desired functionalities; delivery of information for viewing, and personalization.

Conclusions: Older adults' involvement in digital services' strategy development is crucial, emphasizing value co-creation and segmentation while avoiding value co-destruction. Segmenting users and understanding their needs aids in customizing services, improving healthcare provision. Further research should assess the impact of segmentation-based training and digital device provision on older adults' adoption of digital health and social services.

Background: Health systems underwent substantial changes to respond to COVID-19. Learning from the successes and failures of health system COVID-19 responses may help us understand how future health service responses can be designed to be both effective and sustainable. This study aims to identify the role that innovation played in crafting health service responses during the COVID-19 pandemic.

Methods: Semi-structured interviews were conducted online, exploring 19 health professionals' experiences in responding to COVID-19 in a large State health system in Australia. The data were collected from April to September 2022 and analysed utilising constant comparative analysis. The degree of innovation in health service responses was assessed by comparing them to pre-pandemic services using 5 categories adopted from the IMPISCO (Investigators, Methods, Population, Intervention, Setting, Comparators and Outcomes) framework, which classifies interventional fidelity as: 1/ Identical: No differences are found between health services; 2/ Substitution with alternatives that perform the same function, 3/ In-class replacement with elements that delivers roughly the same functionality, 4/ Augmentation with new functions, 5/ Creation of new elements. Services were decomposed into bundles and fidelity labels were assigned to individual bundle elements.

Results: New services were typically created by reconfiguring existing ones rather than being created de novo. The presence of pre-existing infrastructure (foundational technologies) was seen as critical in mounting fast health service responses. Absence of infrastructure was associated with delays and impaired system responses.

Conclusions: The need to reconfigure rapidly and use infrastructure to support this suggests we reconceive health services as a platform (a general-purpose service upon which other elements can be added for specific functions), where a common core service (such as a primary care practice) can be extended by adding specialised functions using mediators which facilitate the connection (such as virtual service capabilities). Innovation can be costly and time consuming in crises, and during the COVID-19 pandemic, innovations were typically patched together from pre-existing services. The notion of platforms seems a promising way to prepare the health system for future shocks.

Background: Female physicians with children often work fewer hours and take fewer shifts due to additional family responsibilities. This can contribute to a gender pay gap in the medical profession. However, limited research in Japan has quantitatively examined the factors contributing to this gap. This study aims to address this gap in the literature.

Methods: We analyzed the alumni data from a medical school in Hokkaido, Japan, for 260 physicians (198 males and 62 females). We used multivariable regression models to identify factors influencing earnings from medical practice, with a focus on gender, work schedules, parenthood, and any career interruptions related to childcare.

Results: Our analysis revealed a 25.0% earnings gap between male and female physicians. Nearly all female physicians with children experienced career interruptions due to childcare, while this was uncommon for male physicians. When these childcare-related interruptions were factored in, the gender pay gap narrowed by 9.7%. After adjusting for work schedules and specialty choices, female physicians with children still earned 37.2% less than male physicians, while those without children earned only 4.4% less. This suggests that motherhood is a significant driver of the gender pay gap among physicians.

Conclusions: These findings highlight the negative impact of motherhood on female physicians' earnings. This emphasizes the need for policy measures to mitigate the disadvantages faced by mothers in the medical profession.