BMC Health Services Research最新文献

Background: Unemployed people have higher morbidity compared to employed people. Both the frequent use and the underutilization of healthcare services are common among unemployed people, potentially leading to unmet healthcare needs. We studied the differences in self-reported no need and unmet need for healthcare services between unemployed and employed persons and the health-related factors associated with these differences.

Methods: We used the Healthy Finland Survey of 2022-2023, which included employed and unemployed respondents of working age (20-64, N = 9841). The outcomes were (1) no need for healthcare services and (2) unmet need for healthcare services in the previous 12 months. We used logistic regression, adjusting for sociodemographic and health-related factors, including limiting long-term illness, psychological distress, limited functional ability, very weak social inclusion, poor work ability, smoking, and excessive alcohol consumption.

Results: Among unemployed people, 23% reported no need for a doctor or nurse, whereas 41% reported unmet needs. Compared with employed people, unemployed people were more likely to perceive no need for doctor or nurse services (OR 1.36, 95% CI 1.02-1.82). When health-related factors, especially long-term illness and work ability, were controlled for, the difference increased. In the full model, the OR was 1.87 (95% CI 1.35-2.58). Unemployed people were more likely than employed people to have unmet need for doctor or nurse (OR 2.31, 95% CI 1.78-3.00). For most of the health-related factors, especially work ability, controlling decreased the difference, whereas controlling for smoking and alcohol had little effect. In the full model the OR was 1.33 (95% CI 0.98-1.81).

Conclusions: Unmet healthcare need among unemployed people was largely attributable to health-related factors, especially poor work ability. In some cases, unemployed people may not recognize their need for healthcare, highlighting the importance of low-threshold services and proactive outreach to ensure equitable access. Healthcare systems should ensure effective and timely use of services to prevent diagnostic delays or untreated illnesses and support more appropriate use of sickness benefits and rehabilitation services.

Practice placements are a substantive component of allied health student curriculum that are critical for developing allied health professional competence. Students are situated in practice settings during placement, where their learning opportunities are opportunistic, and shaped according to population, industry, and policy needs: which change over time and in relation to each other as well as external forces. Allied health practice-placements must respond and adapt to the complex and evolving landscapes of practice; and evidence about the processes and products of such innovation is critical. Realist thinking enables consideration of practice placements as open systems that occur within broader open systems - emerging dynamics of industry, workforce and policy. This helps to expose and explore the changing factors that enfold practice placements and render them workable for service providers who manage competing priorities. We contribute a realist-informed exploration of placement models developed for allied health learning during profound transition of the Australian disability sector: from government- to recipient-controlled funding. In the context of declining placement offerings and reports of practitioner fatigue and administrative load, we facilitated an action-research workforce project with university and placement providers of allied health services to develop and trial quality placement education amidst transitional policy implementation. Our investigation seeks to understand innovative placement models that 'worked' for placement providers and students during a time of policy and industry turbulence. We apply layered inferential techniques to synthesise qualitative data collection with 40 students, practitioners, educators and placement facilitators about the process/es of innovating student placements (n = 50 instances); novel placement features co-designed during the project; and the role of placement facilitation within processes of co-design. Our key findings show that a collaborative approach to practice-placement education supports reflection about novel models, and helps the needs of students and service recipients to become more visible in the relevant context/s of service provision. We further show the importance of developing reciprocity and partnerships for quality placement outcomes, without the need for resource-intensive placement facilitation approaches. This evidence is useful for promoting quality allied health education as the professions continue to expand and evolve, amidst open systems of policy and industry that influence practice and education.

Introduction: Challenges such as work overload, insufficient infrastructure, shortage of logistical supplies and healthcare providers and a standalone health service can hinder access to comprehensive healthcare. Integrated health services, therefore, can potentially improve service quality, lower costs, decrease facility visits, and reduce stigma and discrimination, particularly due to the religious, moral, cultural, and political factors surrounding abortion care.

Objective: To describe the challenges and potential advantages of integrating abortion care into HIV and family planning services.

Method: A facility-based cross-sectional quantitative study was conducted in public health centers and hospitals. Stratified random sampling methods were used to include 413 abortion care users and 306 healthcare providers, respectively. Data from individuals seeking abortion care were collected by data collectors using a questionnaire, while data from healthcare providers were obtained through a self-administered questionnaire. The collected data underwent verification, cleaning, and entry into EpiData version 3.1 software, followed by exportation and analysis using SPSS version 25.

Result: The study included 413 women receiving abortion care and 306 healthcare providers from 58 public health facilities. Healthcare providers identified factors such as enhancing regulatory documents (n = 271; 65.6%), providing training (n = 271; 65.6%), improving infrastructure (n = 268; 64.9%), ensuring a consistent supply of medical resources (n = 253; 60.8%), program monitoring and evaluation (n = 231; 55.9%) and fostering interaction between healthcare facility units (n = 182; 44.1%) as motivating factors for implementing integrated health services. Abortion care users emphasized that making health facilities available (n = 181; 43.8%) and equipping them with necessary materials, equipment, and supplies (n = 288; 69.7%) can enhance integrated abortion care services. The collected data underwent verification, cleaning, and entry into EpiData version 3.1 software, followed by exportation and analysis using SPSS version 25.

Conclusion: Successful implementation of integrated women's health services requires a strategic action plan addressing challenges and engaging with motivational factors.

Background: As a frontrunner in introducing cervical screening in India, the state of Tamil Nadu urgently needs to consider how to improve screening rates and switch to Human Papillomavirus (HPV) detection tests.

Methods: We used a mixed methods design to assess the readiness of the state health system for delivering the current cervical screening program, as well as for future HPV self-collection. Following a desk review, we surveyed 14 government health facilities in three districts of Tamil Nadu and calculated overall and domain-specific (service utilization, service availability, general service, cervical screening) readiness scores as percentages. We conducted four interviews and five focus group discussions with 37 participants [managers, primary care nurses, community health workers (CHWs)] to clarify findings and obtain suggestions regarding the introduction of HPV self-collection in tribal, rural, and urban low-resource settings.

Results: Scores for general services and readiness to offer visual inspection with acetic acid (VIA) and follow-up were more than 70% in the surveyed facilities. Despite the availability of trained nurses, infrastructure and resources, utilisation was primarily limited to symptomatic women attending health facilities due to poor acceptability of screening that would require facility visits. Most participants felt that self-collection could reduce women's fear and embarrassment and could be delivered through CHWs in the community or by nurses at facilities. However, motivation for screening may remain low as most asymptomatic women do not perceive a need for screening, and/or fear implications of a positive test. Tertiary laboratories appear ready for HPV testing, given availability of high-throughput PCR equipment, computerised laboratory information management systems, and a planned hub and spoke model of improving access to laboratory tests.

Conclusions: Despite relatively good infrastructure and staffing for VIA screening in public healthcare facilities, service utilisation was primarily by symptomatic women, contributing to low screening rates. HPV self-collection was highly acceptable to administrative and field staff. Widespread educational approaches to motivate asymptomatic women to screen using self-collection, with decentralised sample collection and treatment, could potentially improve cervical screening rates.

Clinical trial number: Not applicable.