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Personal and Organizational Responsibility in the Delivery of Healthcare Services: Breaking the Code of Silence. 提供医疗保健服务中的个人和组织责任:打破沉默准则。
IF 2.4
Health Services Insights Pub Date : 2025-07-10 eCollection Date: 2025-01-01 DOI: 10.1177/11786329251356095
George Miaoulis, Ivan M Manev
{"title":"Personal and Organizational Responsibility in the Delivery of Healthcare Services: Breaking the Code of Silence.","authors":"George Miaoulis, Ivan M Manev","doi":"10.1177/11786329251356095","DOIUrl":"10.1177/11786329251356095","url":null,"abstract":"<p><strong>Background: </strong>This exploratory study investigates the code of silence in healthcare, exploring its origins and outlining its negative impact on healthcare quality and patient safety. Drawing parallels with other professions where similar codes exist, the research delves into the reasons healthcare professionals may choose not to report inappropriate practices.</p><p><strong>Objective: </strong>This article outlines the reasons for the existence of the code of silence in healthcare, assesses its prevalence, and suggests strategies to address it.</p><p><strong>Design and methods: </strong>This is a qualitative study which uses in-depth interviews with 88 licensed healthcare providers (physicians, nurses, administrators, and pharmacists) to identify common types of inappropriate practices, the actions taken to address them, and the reasons why observers chose to remain silent.</p><p><strong>Results: </strong>We find that the majority of healthcare providers in the sample (nearly 70%) either witnessed or were made aware of incidents of inappropriate practices. In a substantial proportion (about 40%) of the cases, no action was taken after reporting the inappropriate practice. The findings are discussed in the context of existing codes of professional ethics and the organizational cultures that either encourage or discourage transparency. The study highlights the tension healthcare professionals face between their personal values, institutional goals, and fear of retribution.</p><p><strong>Conclusion: </strong>Breaking the code of silence is both a personal and organizational responsibility. The paper concludes with actionable recommendations to break the code of silence, such as fostering a supportive reporting culture, improving anonymous reporting mechanisms, and encouraging leadership to prioritize accountability.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"18 ","pages":"11786329251356095"},"PeriodicalIF":2.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Amplifying Community Health Worker Voices to Examine the Implementation and Scaling of a Community Health Program: A Qualitative Study in the Philippines. 放大社区卫生工作者的声音来检查社区卫生计划的实施和规模:菲律宾的一项定性研究。
IF 2.4
Health Services Insights Pub Date : 2025-06-30 eCollection Date: 2025-01-01 DOI: 10.1177/11786329251352658
Warren Dodd, Laura Jane Brubacher, Monica Bustos, Melinda Kelly Mijares, Krisha Lim-Mar, Lincoln Lau
{"title":"Amplifying Community Health Worker Voices to Examine the Implementation and Scaling of a Community Health Program: A Qualitative Study in the Philippines.","authors":"Warren Dodd, Laura Jane Brubacher, Monica Bustos, Melinda Kelly Mijares, Krisha Lim-Mar, Lincoln Lau","doi":"10.1177/11786329251352658","DOIUrl":"10.1177/11786329251352658","url":null,"abstract":"<p><strong>Background: </strong>Scaling community-based health programs can contribute to efforts to achieve universal health coverage. Implementers of community-based health programs, such as community health workers (CHWs), hold valuable insights and experiences that can inform how these programs scale up and out.</p><p><strong>Objectives: </strong>(1) To assess implementer experiences and perceptions of a community-based health program delivered by CHWs that underwent recent changes to broaden its programing and reach (ie, scaling up); and (2) to describe facilitators and barriers to the implementation of this community-based health program to inform subsequent scaling out.</p><p><strong>Methods: </strong>In April 2023, an evaluation of an NGO-led CHW program was conducted with program implementers across 6 geographic regions in Negros Oriental, Philippines (n = 64 semi-structured interviews). Data were analyzed using a hybrid inductive-deductive analysis, informed by the Medical Research Council's framework for process evaluation of complex interventions. Ethics approval was provided by the University of Waterloo Research Ethics Board (Certificate #: 44828).</p><p><strong>Results: </strong>CHWs perceived that the scaled up version of the program was more useful and impactful, given its expanded reach and provision of basic treatment; however, new program components also required significant time, effort, and strategy to implement which created new opportunity costs for CHWs. Implementation of the scaled up version of the program was facilitated via clear communication structures and supportive group training spaces. Pre-existing roles and social networks held by CHWs further facilitated the implementation of the scaled up version of the program. Overall, new individual-level and community-based strategies were leveraged by CHWs to implement the scaled up program, and participants described facilitators (eg, expanded reach) and barriers (eg, increased time and effort) that influenced program implementation.</p><p><strong>Conclusion: </strong>This study contributes insights into how individuals involved in the scaling of a community-based health program may experience this process.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"18 ","pages":"11786329251352658"},"PeriodicalIF":2.4,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Six Sigma Applied to Healthcare: A Global Scientometrics Analysis of Health Services Quality Improvement Research. 六西格玛应用于医疗保健:医疗服务质量改进研究的全球科学计量学分析。
IF 2.4
Health Services Insights Pub Date : 2025-06-30 eCollection Date: 2025-01-01 DOI: 10.1177/11786329251352018
Yorjanis Galván-Pérez, Matilde Herrera-Polo, David A Hernández-Páez, Dionicio Neira Rodado, Katherinne Salas-Navarro, Alba Marina Rueda-Olivella, Tulia Beltrán-Venegas, Ivan David Lozada-Martinez, Patricia Delgado
{"title":"Six Sigma Applied to Healthcare: A Global Scientometrics Analysis of Health Services Quality Improvement Research.","authors":"Yorjanis Galván-Pérez, Matilde Herrera-Polo, David A Hernández-Páez, Dionicio Neira Rodado, Katherinne Salas-Navarro, Alba Marina Rueda-Olivella, Tulia Beltrán-Venegas, Ivan David Lozada-Martinez, Patricia Delgado","doi":"10.1177/11786329251352018","DOIUrl":"10.1177/11786329251352018","url":null,"abstract":"<p><strong>Aim: </strong>To provide a comprehensive scientometrics analysis of Six Sigma research in healthcare, a field gaining momentum due to its capacity to address missed improvement opportunities and inefficient cost-control strategies across global health systems.</p><p><strong>Design: </strong>A cross-sectional mixed-methods study combining quantitative research and health metrics with thematic content analysis to explore trends and research patterns.</p><p><strong>Methods: </strong>The study analyzed publications indexed in PubMed, Scopus, Web of Science, SciELO, and KCI, using thematic mapping techniques through term co-occurrence networks and cluster analysis. Also, correlation analysis with healthcare quality indicators and global health metrics were executed.</p><p><strong>Results: </strong>A total of 883 publications were analyzed. (1) Geographical analysis showed 70.8% from high-income countries and 0.7% from low-income countries. (2) Thematic clusters were centered on hospital applications and patient safety. (3) Temporal trends revealed an increasing focus on \"big data\" and \"health innovation.\" (4) Strong correlations were found between publication output and health/research expenditure (<i>P</i> < .01 for all cases); negative associations emerged with out-of-pocket expenditures and researcher density in low-income settings.</p><p><strong>Conclusions: </strong>Findings provide a roadmap for aligning global research priorities and highlight the need for inclusive strategies that build research capacity and foster context-sensitive applications of Six Sigma in healthcare.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"18 ","pages":"11786329251352018"},"PeriodicalIF":2.4,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12214308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Remote Eye Triage: Health Economic Perspectives on Resource Prioritization. 远程眼科分诊:资源优先排序的卫生经济观点。
IF 2.4
Health Services Insights Pub Date : 2025-06-26 eCollection Date: 2025-01-01 DOI: 10.1177/11786329251347684
Casper van der Zee, Robert P L Wisse, Saskia M Imhof, Miriam P van der Meulen
{"title":"Remote Eye Triage: Health Economic Perspectives on Resource Prioritization.","authors":"Casper van der Zee, Robert P L Wisse, Saskia M Imhof, Miriam P van der Meulen","doi":"10.1177/11786329251347684","DOIUrl":"10.1177/11786329251347684","url":null,"abstract":"<p><strong>Background: </strong>The TeleTriageTeam (TTT) is a novel system for remote eyecare delivery.</p><p><strong>Objectives: </strong>Explores the impact of TTT on costs by depicting program theory of care prioritization. Moreover, a quantification of longer-term effects of delay (and inversely earlier treatment) on costs is performed.</p><p><strong>Design: </strong>Mixed-methods health economic evaluation.</p><p><strong>Methods: </strong>First, we depicted the program theory of prioritization into a LOGIC-model using existing TTT-data and expert interviews outlining the causal pathways how and why a program is expected to work. Second, we identified the most relevant key diagnoses to be appraised based on incidence, severity, and presumed triage impact. Third, we estimated the impact of delay (or inversely earlier treatment) on societal costs and quality of life (QoL) based on literature searches. Cost data were updated to 2023. Results were reported per delayed patient per 6 months (the average TTT delay).</p><p><strong>Results: </strong>Five key diagnoses were selected: cataract, diabetic retinopathy (DRP), age-related macular disease (AMD), glaucoma, and dry-eye-syndrome (DES). The LOGIC-model showed how the TTT actions could influence costs and QoL. Semi-structured interviews revealed delay results in adverse events, at the expense of shorter waiting times in prioritized patients, and overall decreases personnel burden. Reduced waiting times were also believed to decrease burden and costs in prioritized patients. Literature showed that a delay in glaucoma treatment results in savings (-€409), while the other diagnoses suggested higher societal costs (cataract €3298, DES €2156, AMD €1455, DRP €117). QoL reduction and increased costs due to delay were more apparent when delay results in longer duration of curable symptoms compared to delay in stable disease (up to 0.09 vs 0.003 QALYs and €3298 vs €1455, respectively).</p><p><strong>Conclusions: </strong>Eye care delay results reduced QoL and increased societal costs, yet this is compounded by gains attributable to justified prioritization of more urgent and more severe patients.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"18 ","pages":"11786329251347684"},"PeriodicalIF":2.4,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Healthcare-Seeking Behaviour for Obstetric Complications in Ethiopia: A Multilevel Mixed-Effect Analysis. 埃塞俄比亚产科并发症的求医行为:多层次混合效应分析
IF 2.4
Health Services Insights Pub Date : 2025-06-24 eCollection Date: 2025-01-01 DOI: 10.1177/11786329251347353
Alehegn Bishaw Geremew, Claire T Roberts, Shahid Ullah, Jacqueline H Stephens
{"title":"Healthcare-Seeking Behaviour for Obstetric Complications in Ethiopia: A Multilevel Mixed-Effect Analysis.","authors":"Alehegn Bishaw Geremew, Claire T Roberts, Shahid Ullah, Jacqueline H Stephens","doi":"10.1177/11786329251347353","DOIUrl":"10.1177/11786329251347353","url":null,"abstract":"<p><strong>Background: </strong>Healthcare-seeking behaviour, and its associated factors, for obstetric complications are an important determinant of maternal deaths and adverse foetal outcomes. However, there is limited evidence on healthcare-seeking behaviours from health facilities in response to obstetric complications among Ethiopian women.</p><p><strong>Objective: </strong>To investigate women's healthcare-seeking behaviour in response to obstetric complications, and its associated factors, in Ethiopia.</p><p><strong>Methods: </strong>Data were sourced from the Performance Monitoring for Action (PMA-E) longitudinal survey national database. Andersen's health service use model was utilised to group individual and contextual factors. A multilevel mixed-effect logistic regression model was employed, with adjusted Odds Ratio (aOR) and 95% confidence intervals reported.</p><p><strong>Results: </strong>Data were derived from a weighted sample of 1750 women who experienced obstetric complications during pregnancy, childbirth, and immediately postpartum. Overall healthcare-seeking at health facilities for obstetric complication symptoms during the maternity continuum was 62% (95%CI: 59.6-64.3), with 47.8% (95%CI: 45.0-50.5), 64.5% (95%CI: 61.3-67.5), and 52% (95%CI: 48.3-55.6) seeking healthcare from health facilities during pregnancy, childbirth, and the immediate post-partum period, respectively. Antenatal care attendance (aOR = 3.43, 95%CI: 2.4-5.0), nulliparity (aOR = 2.1; 95%CI: 1.0-4.4), household access to media (aOR = 1.5, 95%CI: 1.0-2.1), no intimate partner violence (IPV) during pregnancy (aOR = 1.8, 95%CI: 1.1-3.1), high community wealth status (aOR = 1.2, 95%CI: 1.1-2.4), community encouragement of facility childbirth (aOR = 2.2, 95%CI: 1.1-4.3), community non-acceptance of the traditional birth attendant (TBA; aOR = 2.4, 95%CI: 1.6-3.7), and high community participation in health developmental army (HDA; aOR = 2.1, 95%CI: 1.1-3.9) were significantly associated with healthcare seeking behaviour.</p><p><strong>Conclusions: </strong>The healthcare-seeking behaviour of women from health facilities in response to obstetric complication symptoms was low and varied across the different stages of the maternity continuum. Key programme priority interventions should focus on reducing community reliance on TBA care, enhancing community encouragement of facility childbirth, and strengthening the HDA.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"18 ","pages":"11786329251347353"},"PeriodicalIF":2.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Contextual Factors Affecting Continuity of Follow-Up Care After Hospital Discharge for Patients with Chronic Diseases in Sudan: A Qualitative Study with Causal Loop Diagram Insights. 影响苏丹慢性病患者出院后随访护理连续性的环境因素:一项具有因果循环图见解的定性研究。
IF 2.4
Health Services Insights Pub Date : 2025-06-24 eCollection Date: 2025-01-01 DOI: 10.1177/11786329251349916
Asma MohamedSharif, Armin Gemperli
{"title":"Contextual Factors Affecting Continuity of Follow-Up Care After Hospital Discharge for Patients with Chronic Diseases in Sudan: A Qualitative Study with Causal Loop Diagram Insights.","authors":"Asma MohamedSharif, Armin Gemperli","doi":"10.1177/11786329251349916","DOIUrl":"10.1177/11786329251349916","url":null,"abstract":"<p><p>This study aims to identify factors influencing the continuity of follow-up care after hospital discharge from the perspectives of physicians and key healthcare stakeholders and map their interactions to facilitate understanding of dynamic relationships. We conducted audio-recorded semi-structured interviews with 17 participants (10 medical doctors, 3 state key informants, and 4 federal key informants) in Khartoum State, Sudan. Data analysis included thematic analysis to identify the factors and purposive text analysis to develop a causal loop diagram. We identified 39 factors affecting the continuity of follow-up care from hospital to home, categorized into 5 challenges: follow-up care adherence, quality of pre-discharge patient education, efficiency of the referral system, primary healthcare center accessibility, and quality improvement efforts. The study identified 2 balancing loops and 5 reinforcement feedback loops affecting follow-up care post-hospital discharge. The low adherence to follow-up care proposes quality improvement efforts as a solution, however, the high workload, resource depletion, referral system inefficiency, and quality improvement stagnation reinforcing loops impede progress in this direction. We recommend enhancing pre-discharge patient education and using multisectoral approaches to improve primary healthcare, optimize referrals with digital tools, and address staff turnover, to strengthen follow-up care.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"18 ","pages":"11786329251349916"},"PeriodicalIF":2.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cultural Malpractices and Associated Factors Among Mothers Attending Postnatal Care Within Six Weeks After Delivery at Gelemso General Hospital, Eastern Ethiopia. 埃塞俄比亚东部Gelemso总医院产后6周内接受产后护理的母亲的文化弊端及相关因素
IF 2.4
Health Services Insights Pub Date : 2025-06-24 eCollection Date: 2025-01-01 DOI: 10.1177/11786329251349921
Jemaludin Sadik, Dureti Abdurahman, Adera Debella, Elias Yadeta, Rudwan Yasin Abrahim, Nano Belema, Bilisuma Girma, Magarsa Lami, Tegenu Balcha
{"title":"Cultural Malpractices and Associated Factors Among Mothers Attending Postnatal Care Within Six Weeks After Delivery at Gelemso General Hospital, Eastern Ethiopia.","authors":"Jemaludin Sadik, Dureti Abdurahman, Adera Debella, Elias Yadeta, Rudwan Yasin Abrahim, Nano Belema, Bilisuma Girma, Magarsa Lami, Tegenu Balcha","doi":"10.1177/11786329251349921","DOIUrl":"10.1177/11786329251349921","url":null,"abstract":"<p><strong>Background: </strong>Cultural malpractices are socially shared perspectives and traditionally accepted behaviors experienced in a certain society that harm maternal health. In Ethiopia, about 18% of infant deaths occur due to cultural malpractice. However, evidence of cultural malpractice during the postnatal period is not well understood in Ethiopia, particularly in West Hararghe. Moreover, there is no study conducted on cultural practice during the postnatal period in this study area. Therefore, this aimed to assess the magnitude and factors associated with cultural malpractice among mothers attending postnatal care within 6 weeks after delivery at Gelemso General Hospital, Eastern Ethiopia.</p><p><strong>Methods: </strong>Institutional-based cross-sectional study design was conducted among 407 mothers attending postnatal care with their babies at Gelemso General Hospital. The study participants were selected by systematic random sampling technique. Data were collected using a pretested and structured interviewer-administered questionnaire. The collected data were entered into EpiData version 4.6 and exported to Statistical Package of Social Sciences version 27 for analysis. Descriptive statistics were computed to describe the characteristics of the participants. Bivariable and multivariable logistic regression analyses were fitted to identify factors associated with the outcome variable. Adjusted odds ratios along a 95% confidence interval were used to report the result and show the strength of the association. A <i>P</i>-value < .05 was used to declare a significant association. The results were presented using figures, tables, graphs, and text.</p><p><strong>Results: </strong>The study revealed that the magnitude of cultural malpractice during the postnatal period was 70.0% (95% CI: 65%, 74%). Lack of ANC visit (AOR = 3.3; 95% CI: 1.03, 10.27), partner's being a farmer (AOR = 7.4; 95% CI: 2.11, 26.48), distance to health facility (AOR = 3.6; 95% CI: 1.68, 7.65), having greater than 5 alive children (AOR = 3.5; 95% CI: 1.25, 9.84) were factors significantly associated with cultural malpractice during the postnatal period.</p><p><strong>Conclusions: </strong>This study noted that more than two-thirds of participants committed cultural malpractice during the postnatal period. Therefore, emphasizing the importance of ANC follow-up, and encouraging home visits of postnatal mothers by professionals especially for those rural residents and remoter to health facilities may contribute to reducing the cultural malpractice.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"18 ","pages":"11786329251349921"},"PeriodicalIF":2.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Healthcare Providers' Perceptions of Vulnerability to Domestic Sex Trafficking in Ontario: A Qualitative Study. 安大略省医疗服务提供者对家庭性交易脆弱性的看法:一项定性研究。
IF 2.4
Health Services Insights Pub Date : 2025-06-24 eCollection Date: 2025-01-01 DOI: 10.1177/11786329251348295
Corinne Rogers, Soumyaa Veerakumar Subramanium, Rhonelle Bruder, Robin Mason, Janice Du Mont
{"title":"Healthcare Providers' Perceptions of Vulnerability to Domestic Sex Trafficking in Ontario: A Qualitative Study.","authors":"Corinne Rogers, Soumyaa Veerakumar Subramanium, Rhonelle Bruder, Robin Mason, Janice Du Mont","doi":"10.1177/11786329251348295","DOIUrl":"10.1177/11786329251348295","url":null,"abstract":"<p><strong>Background: </strong>Domestic sex trafficking is a prevalent health and human rights issue in Ontario, Canada. Although providers working in healthcare settings are uniquely positioned to identify and care for individuals who are sex trafficked, they may be hampered by a limited understanding of who is vulnerable to being sex trafficked and, thereby, fail to recognize those in need of support.</p><p><strong>Objectives: </strong>This qualitative study, part of a larger program of research, sought to apply critical social theory, and intersectionality to explore providers' perceptions of who is vulnerable to domestic sex trafficking.</p><p><strong>Methods: </strong>Thirty-one healthcare providers of diverse identities and professional backgrounds were interviewed, using open-ended semi-structured questions, between November 2022 and February 2023. The interviews were analyzed using Braun and Clarke's reflexive thematic analysis framework and organized by a modified Taxonomy of Vulnerability.</p><p><strong>Results: </strong>Three themes were generated: Traumatic history, social identities and relationships, and structural determinants. Providers consistently identified being female as a vulnerability to domestic sex trafficking. Few providers referenced the intersections of being female with other sociodemographic characteristics or acknowledged the complex ways in which larger systems have perpetuated the marginalization and inequitable status of some persons.</p><p><strong>Conclusion: </strong>The findings emphasize the urgent need to understand vulnerability as more than just an individual condition. Further, provider training must cultivate critical consciousness to recognize the contextual roots of vulnerability and how the role and socialization processes of larger systems in perpetuating vulnerabilities differently across individuals' lives.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"18 ","pages":"11786329251348295"},"PeriodicalIF":2.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Acceptability of Components for a Mandatory Quality Improvement Framework: A Survey Among Swiss General Practitioners. 强制性质量改进框架组件的可接受性:瑞士全科医生的调查。
IF 2.4
Health Services Insights Pub Date : 2025-06-21 eCollection Date: 2025-01-01 DOI: 10.1177/11786329251346828
David Wirth, Oliver Senn, Jakob M Burgstaller, Sima Djalali, Leander Muheim, Adrian Rohrbasser, Joel Lehmann, Stefan Markun
{"title":"Acceptability of Components for a Mandatory Quality Improvement Framework: A Survey Among Swiss General Practitioners.","authors":"David Wirth, Oliver Senn, Jakob M Burgstaller, Sima Djalali, Leander Muheim, Adrian Rohrbasser, Joel Lehmann, Stefan Markun","doi":"10.1177/11786329251346828","DOIUrl":"10.1177/11786329251346828","url":null,"abstract":"<p><strong>Background: </strong>In Switzerland, recently introduced legislation requires the implementation of a framework for mandatory quality improvement at the level of individual general practitioners (GPs) and includes the introduction of quality indicators (QIs) amongst other components. The GP-sided acceptance of potential components of such a framework is important to its success.</p><p><strong>Objectives: </strong>To identify components of a potential framework for mandatory quality improvement that are most likely to be accepted by Swiss GPs.</p><p><strong>Design: </strong>Cross-sectional web-based survey conducted among employed and self-employed Swiss GPs in 2024.</p><p><strong>Methods: </strong>The survey was distributed to 1103 Swiss GPs via their physician networks. The survey inquired the acceptability of 62 possible components of a mandatory framework for quality improvement. Components were categorized as \"acceptable\" if they were rated as \"acceptable\" or \"very acceptable\" by more than 50% of participants, in contrast to those rated as \"neutral\" or \"not acceptable.\"</p><p><strong>Results: </strong>A total of 244 GPs participated (participation rate 22.1%, 53.0% male, 51.2% <50 years old, 50.8% employed). The majority of participants rated 31 of the proposed 62 components as acceptable. Among these were QIs pertaining to structures and processes of care (rated as acceptable by 58.3%-83.4%) and sharing QI achievement data with peers from different group practices and physician networks (53.9%-92.2%). A majority of participants accepted physician networks, medical associations, and academic institutions as entities that could establish QIs and manage QI data (acceptance 62.1%-88.8%).</p><p><strong>Conclusions: </strong>Swiss GPs appear to accept QIs that reflect structures and processes of care established by physician networks, medical associations or academic institutions, exclusively shared among their peers.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"18 ","pages":"11786329251346828"},"PeriodicalIF":2.4,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prescribing Vitamin-K-Antagonists Versus Direct Oral Anticoagulants Among Bavarian General Practitioners: A Qualitative Study. 巴伐利亚全科医生处方维生素k拮抗剂与直接口服抗凝剂:一项定性研究。
IF 2.4
Health Services Insights Pub Date : 2025-06-21 eCollection Date: 2025-01-01 DOI: 10.1177/11786329251341083
Nikoletta Zeschick, Julia Gollnick, Julia Muth, Franziska Hörbrand, Peter Killian, Norbert Donner-Banzhoff, Thomas Kühlein, Maria Sebastião
{"title":"Prescribing Vitamin-K-Antagonists Versus Direct Oral Anticoagulants Among Bavarian General Practitioners: A Qualitative Study.","authors":"Nikoletta Zeschick, Julia Gollnick, Julia Muth, Franziska Hörbrand, Peter Killian, Norbert Donner-Banzhoff, Thomas Kühlein, Maria Sebastião","doi":"10.1177/11786329251341083","DOIUrl":"10.1177/11786329251341083","url":null,"abstract":"<p><strong>Background: </strong>Direct oral anticoagulants (DOACs) have been increasingly prescribed instead of vitamin-K-antagonists (VKA) although VKAs cost considerably less than DOACs. In 2014, a new system for drug expenditures, the Wirkstoffvereinbarung (WSV, Active substance agreement), was implemented in Bavaria, Germany to control pharmaceutical expenditures transparently. Achieving the targets for the VKAs set by the WSV was difficult for general practitioners (GPs). We explored the determinants of prescribing VKAs (specifically phenprocoumon) versus DOACs.</p><p><strong>Methods: </strong>Qualitative interviews (n = 18) and two small group discussions (n = 10) were conducted with GPs. For the qualitative content analysis, we formed a system of categories based on the domains of the Theoretical Domains Framework (TDF).</p><p><strong>Results: </strong>Participants actively weighed various factors when deciding between prescribing phenprocoumon or DOACs. Costs played a subordinate role although all participants were aware that DOACs come at a higher cost than phenprocoumon. Trend reports served as a tool for GPs to assess their prescribing practices, however did not lead to a change in prescribing behaviour. The interviewees had a very heterogeneous view of safety, effect, and evidence of phenprocoumon or DOACs. The cooperation of the patients is crucial. Time is a significant challenge for participants when initiating patients on or switching them to phenprocoumon, which is especially problematic as all of the patients discharged from the hospital are put on DOACs.</p><p><strong>Conclusions: </strong>GPs are caught between economic requirements, patients' wishes, and good collegial cooperation when deciding for or against phenprocoumon. As oral anticoagulant therapy (OAC) is mostly initiated in the hospital, and as physicians almost exclusively prescribe DOACs there, participating GPs feel overchallenged in reaching the targets set by the WSV.</p><p><strong>Trial registration number: </strong>Main ID: DRKS00019820 (German Register of Clinical Studies and World Health Organization).</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"18 ","pages":"11786329251341083"},"PeriodicalIF":2.4,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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