BMC Health Services Research最新文献

Background: The experience of pregnancy and having a baby is a time of significant change and transition. One in five perinatal women experience problems with their emotional wellbeing and mental health in this period; adjustment, anxiety and depressive illnesses being most common. Whilst investment in specialist perinatal mental health pathways continues, there is limited understanding of healthcare professionals' views and experiences of these pathways and of support available for women with mild or moderate mental health problems. This study explored healthcare professionals' views on the barriers and facilitators to identification and management of perinatal anxiety, and on how to optimise care pathways.

Methods: In-depth semi-structured interviews were conducted with a purposive sample of healthcare professionals in universal perinatal services (including maternity, primary care, and health-visiting) and specialist (including talking therapies, maternal and perinatal) mental health services. Data were analysed using framework analysis.

Results: Interviews were conducted with 62 healthcare professionals from England and Scotland. 40% of the sample stated they had received no training in perinatal mental health, and 45% reported that they did not use standardised or validated questions or scales when enquiring about mental health. Themes related to barriers, facilitators, and service optimisation are presented for each stage of their care pathway: identification; disclosure; referral and assessment; care and treatment. Recommendations for optimising care included improving mental health education and training to strengthen perinatal healthcare and developing a sustainable perinatal mental health pathway, including for women with mild mental health problems.

Conclusions: Healthcare professionals considered that the healthcare pathway for women with severe mental health problems was clear and well-developed, but that healthcare for women with mild and moderate anxiety and mental health problems was under-developed. Improvements in perinatal mental health education, in mandatory training for healthcare professionals, should be put in place in order to improve care. Increasing the number of staff and time available to address perinatal mental health is vital but requires additional resources and should be part of long-term strategies for funding.

Background: To understand the current status of knowledge, attitude and practice (KAP) of occupational therapy (OT) among healthcare professionals in intensive care unit (ICU) and analyze the influencing factors, to provide reference for nursing managers in developing targeted measures to promote the adoption of OT.

Methods: From January to March 2025, we conducted a cross-sectional survey using convenience sampling among 511 ICU healthcare professionals across 13 cities in Jiangsu Province. Participants completed anonymous online questionnaires, including a general information form and a validated, self-developed Knowledge, Attitudes, and Practices (KAP) questionnaire to OT for ICU healthcare professionals. The KAP instrument comprised three dimensions: knowledge (12 items), attitude (16 items), and practice (14 items). We performed univariate analysis and multivariable logistic regression using SPSS 25.0 to identify associated factors.

Results: A total of 464 valid questionnaires was received (90.8% response rate). The overall KAP performance showed an average score of 156.58 ± 31.16. Attitudes achieved the highest average score (67.54 ± 10.99), while knowledge showed the lowest (37.88 ± 13.56). Knowledge correlated positively with attitude and practice. Multivariate logistic regression identified age, professional title, ICU experience, hospital level, and OT-related knowledge training as factors influencing ICU healthcare professionals ' KAP levels.

Conclusion: This KAP survey provides a diagnostic foundation for OT implementation, it indicates that educational training is a necessary, high-impact strategy. However, the negative association with seniority and hospital level indicates that a simple educational strategy may be insufficient; tailored strategies addressing organizational culture, workload, and professional role expectations in those specific contexts will be required.

Clinical trial registration: Not applicable (This study did not require registration in a clinical trials registry because it is an observational cross-sectional study).

Background: This study aims to identify the social and healthcare needs of patients with rare diseases (RD) and their physicians within a Universal Health Care System. It seeks to provide valuable insights for policymakers, patient organizations, and healthcare professionals while informing about these diseases, raising awareness, and designing strategies to improve access to quality, timely medical care, including therapies and medication at a local and regional level.

Methods: Two semi-structured surveys were conducted between May 2023 and August 2024, targeting family members of patients with RD (N = 64) and physicians (N = 56) in Uruguay. Surveys were self-administered via email or conducted by an interviewer, and were disseminated through healthcare professionals, RD associations, and social media, using "snowball" methodology and word-of-mouth references.

Results: Uruguay faces significant deficiencies in access to diagnosis and treatment for rare diseases, leading to a prolonged "diagnostic odyssey" for families and multiple barriers for physicians, ranging from lack of training to limited access to specialized tools. The low reporting rate to the National Registry of Congenital Defects and Rare Diseases and the lack of updates to the Comprehensive Health Care Plan exacerbate inequities in access to diagnosis and treatment. A key finding is inequality in access to whole-exome sequencing (WES), despite its proven effectiveness in reducing diagnostic times and improving accuracy. Its use remains restricted due to high costs and lack of universal coverage, highlighting the need for a national genomic medicine strategy and medical training in molecular diagnosis.

Conclusion: The survey results indicate that RDs have a significant physical, emotional, and economic impact on patients and families. The main concerns raised include diagnostic delays, partly due to difficulties accessing specific tests and treatments. The medical community also acknowledges these issues. The healthcare system needs to update its coverage to include genomic diagnostics, improve medical training, strengthen coordination, and ensure equitable treatment access. These results mimic what is seen in other countries in Latin America and the Southern Cone. They call for a comprehensive, formalized framework for diagnosis, treatment, and care of rare diseases at local and regional levels, accounting for family experiences and prioritizing family wellbeing.