Journal of Health Services Research & Policy最新文献

{"title":"The impact of congenital cytomegalovirus infection among families and caregivers: A qualitative analysis of responses to a public consultation on newborn screening in the UK.","authors":"Rosamund Greiner, Sarah Dewar, Christine E Jones, Marthe Le Prevost, Tushna Vandrevala, Cristina Visintin, Heather Bailey","doi":"10.1177/13558196251382548","DOIUrl":"https://doi.org/10.1177/13558196251382548","url":null,"abstract":"<p><p>ObjectivesTo describe the impact associated with congenital cytomegalovirus (cCMV) infection and experiences and perceptions of people with experience of CMV in pregnancy and families / caregivers of children diagnosed with cCMV, who responded to a UK National Screening Committee (UK NSC) public consultation on cCMV screening.MethodsThe public consultation was conducted in 2021-22 on a draft evidence review and was aimed at informing the UK NSC's decision on newborn screening for cCMV. Data were analysed using framework analysis: a subgroup of responses was inductively coded, codes were refined and initial themes identified, before targeted coding of the remainder of the data and identification of final themes and sub-themes.ResultsOf a total 155 responses, 125 (describing 128 pregnancy/child outcomes) contained information relevant to the coding framework and were included. Most (n = 109) described a live birth of a surviving child, of whom 90% (98/109) were living with symptoms or long-term sequelae of cCMV at the time of the response. Two main themes were identified: missed opportunities and emotional impacts attributed by respondents to not screening for cCMV. Many families described delays in their child's cCMV diagnosis, including due to healthcare professionals' lack of awareness of cCMV, and viewed newborn screening as a solution to avoid delays in diagnostic pathways. Diagnostic delays resulted in a lasting sense of injustice and unfairness due to possible missed opportunities to improve outcomes (e.g., through antiviral treatment or early therapies), as well as uncertainty and anxiety.ConclusionsResponses were predominantly from parents and caregivers of children with cCMV who experienced long term disability. They highlight significant gaps in awareness, support and health care for affected children that need addressing, regardless of national screening policy decisions. These responses contribute to the literature on lived experiences of individuals and families affected by cCMV.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196251382548"},"PeriodicalIF":2.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding why health professionals are leaving the UK national health service (NHS) - A systematic review and narrative synthesis.","authors":"Chukwunwuba Richard Onyejesi, Tiffeny James, Kalpa Kharicha","doi":"10.1177/13558196251384845","DOIUrl":"https://doi.org/10.1177/13558196251384845","url":null,"abstract":"<p><p>BackgroundThere is a global health care workforce crisis with staff shortages and difficulties with recruitment and retention, including in the UK's National Health Service (NHS). To address this, it is important to understand why people decide to leave the NHS. Previous reviews have focused on specific NHS professions and have rarely considered factors in other settings which attract staff away from the NHS. This review aimed to include all professions in a systematic review of factors which \"push\" clinical staff to leave, or consider leaving, the NHS and which \"pull\" them to other destinations.MethodsWe searched PubMed, Web of Science, CINAHL, and EMBASE for peer-reviewed articles and Google Scholar for grey literature using search terms related to all NHS professions and intentions to leave the NHS. We included qualitative, quantitative, and mixed methods studies and analysed data using a textual narrative synthesis with an integrated design.ResultsThirty-two papers were eligible for inclusion. We identified four key push factors: (1) high job demands due to, for example, staff shortages and increased workload; (2) failing organisational structures including poor pay and limited opportunities for career development; (3) personal and emotional factors such as work-related health issues and poor work/life balance, and (4) wider factors, including Brexit. The majority of factors identified as being responsible for high turnover were related to job demands and the organisational structure within the NHS. Factors pulling people to other destinations were discussed less frequently than push factors, but included perceptions of better: pay, working conditions, and work/life balance in other countries. Limitations to the studies included in the review were that evidence on all NHS professions was not available, and many of the studies were based on data collected retrospectively with the risk of recall bias.ConclusionPull and push factors affect multiple NHS professions. Further comparative studies comparing the UK with other countries can help inform potential interventions to improve staff retention.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196251384845"},"PeriodicalIF":2.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exercise prescription in the management of chronic disease falling through an evidence-practice gap: Perspectives of doctors and nurses in specialist settings.","authors":"Shelley E Keating, Shelley A Wilkinson, Graeme A Macdonald, Ingrid J Hickman, Hannah L Mayr","doi":"10.1177/13558196251362133","DOIUrl":"10.1177/13558196251362133","url":null,"abstract":"<p><p>ObjectivesExercise is a frontline therapy for the management of chronic cardiometabolic disease, however traditional tertiary health care service models do not include exercise physiology. We aimed to explore professional roles, practices, and services regarding exercise care in chronic cardiometabolic disease from the perspectives of specialist doctors and nurses.MethodsUsing a qualitative description design, semi-structured individual interviews were conducted with 32 doctors and 26 nurses involved in the care of relevant patients with liver, kidney, or cardiac disease, or diabetes, across hospital and community settings in a Queensland metropolitan health service. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.ResultsFour overarching themes were identified. Despite universal acceptance of the multifactorial benefits of exercise, there was a lack of confidence in patients' capabilities to exercise and safety concerns due to complex comorbidities. Interviewees considered themselves 'promotors not prescribers' of exercise. There was no structured exercise history taken outside of cardiac rehabilitation units with significant variability in advice provided. Access to exercise specialist services was limited and disease-specific, with inconsistent and fragmented referral pathways. General Practitioners were considered responsible for facilitating exercise specialist involvement in ongoing care, with onus placed on patients to initiate.ConclusionsThere is an evidence-practice gap between the established benefits of exercise for chronic disease management and access to exercise professionals and services, resources, and knowledge. This deprioritises exercise as a frontline therapy with patient care implications. This study identified a need to transform the way that exercise care is accessed and delivered in tertiary settings.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"270-281"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"We can evaluate rapidly, but should we? Researchers' and research funders' perspectives on the uses, challenges and limitations of rapid health care evaluation.","authors":"Jo Ellins, Kelly Daniel, Manbinder Sidhu","doi":"10.1177/13558196251340549","DOIUrl":"10.1177/13558196251340549","url":null,"abstract":"<p><p>ObjectivesThere is increasing demand for rapid evaluation in health care to inform timely policy and practice decision-making. This qualitative study explored the perceived benefits, limitations and challenges of rapid evaluation, focusing on how considerations of timescale and research quality are balanced in study design and delivery in England.MethodsWe conducted fifteen semi-structured interviews with researchers and research funders involved in rapid evaluation, based in England. Data were thematically analysed using the Framework Method.ResultsResults are reported around five major themes: (i) rapid evaluations are purpose driven; (ii) 'good enough' evidence; (iii) trade-offs and limitations; (iv) mitigating the speed and rigour trade-off; and (v) deciding if and when to evaluate rapidly. Study participants agreed that rapid evaluation reflected a drive to better align evaluative processes and outcomes to the needs of service planners and policymakers. It was seen to generate quick data for short-term requirements, and information to justify the need for, and inform the design of, longer-term assessments. However, working rapidly could restrict or prohibit some research activities, and there were particular concerns about recruitment being limited to sites and participants that were easier to access in short timescales. Rapid evaluation was considered less suitable for 'high stakes' topics or decisions, where evidence robustness and generalisability was paramount. Several study participants had built an infrastructure to facilitate rapid working which, at least in part, reduced the need to make methodological compromises.ConclusionsRapid evaluation can support real-time learning for innovation and improvement and inform time-critical decisions, but timeliness is only one factor in the production of useful and usable evidence. It is a tool for specific circumstances and purposes, to be used alongside, rather than instead of, long-term and longitudinal designs.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"227-235"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring risk factors for COVID-19 mortality and infection in care homes in the west of England: A mixed-methods study.","authors":"Rebecca Wilson, Selin Siviş, Paul Scott, Jeremy Dixon, Karen Green, Judith Westcott, Alice Marriott, Jonathan Banks, Maria Theresa Redaniel","doi":"10.1177/13558196251344174","DOIUrl":"10.1177/13558196251344174","url":null,"abstract":"<p><p>ObjectivesIdentify and explore risk factors associated with COVID-19 infection and mortality rates in care homes in the West of England and gain an understanding of challenges faced during the pandemic, how they were addressed and how care homes can be better equipped for future pandemics.MethodsA mixed-methods study combined observational analysis of numbers of infections and deaths with potential risk factors supported by semi-structured interviews. Thirty-three care homes within a single local authority (LA) in the West of England were included in the quantitative analysis and, in the qualitative study, five care homes were included, including those located outside the participating LA. The quantitative analysis assessed two outcomes: number of weekly COVID-19 cases and deaths between 31/08/2020 and 21/02/2021. Associations with potential care risk factors were analysed using Poisson regression. 14 interviews were conducted with care home staff in various roles between November 2022 and September 2023. Data were analysed thematically.ResultsCare home size was associated with higher COVID-19 infection (large compared with small care homes: incidence rate ratio (IRR) = 12.60, 95% confidence interval (CI) 2.54 to 62.51) and mortality rates (large compared with small care homes: IRR = 16.48, 95% CI 0.81 to 335.88). Qualitative data revealed that care home managers recognized these risks and were focussed on the challenges of implementing infection control within the limitations of their buildings. The primary challenge identified was staff shortages, requiring care home staff to assume expanded responsibilities. There was no evidence of association between hospital discharges and COVID-19 cases (IRR = 0.45, 95% CI 0.11 to 1.83) or deaths (IRR = 0.61, 0.11 to 3.22). The qualitative data highlighted care home staff had feelings of separation and felt under-valued in relation to the wider health care sector. There was also concern that COVID-19 prevention measures prioritised infection control over the psycho-social welfare of residents.ConclusionResearch on the risk factors for infection spread and associated mortality should be prioritised to better protect care homes in future pandemics. This requires making routine data in social care more readily available for research purposes. Proactive planning for future pandemics, by care homes and local authorities, should recognise the individual nature of buildings and the needs of residents.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"247-257"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On the contribution of health care service provision to reducing health inequalities.","authors":"Gerry McCartney","doi":"10.1177/13558196251344864","DOIUrl":"10.1177/13558196251344864","url":null,"abstract":"","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"215-217"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trump and the future of health services research and policy in Europe: A view from the US.","authors":"Scott L Greer","doi":"10.1177/13558196251358621","DOIUrl":"10.1177/13558196251358621","url":null,"abstract":"","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"209-211"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From purges to broken partnerships: an international response to the global impact of Trump's war on science.","authors":"Christina Pagel","doi":"10.1177/13558196251353692","DOIUrl":"10.1177/13558196251353692","url":null,"abstract":"","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"212-214"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health care service interventions to improve the health care outcomes of hospitalised patients with extreme obesity: An evidence and gap map.","authors":"Caz Hales, Rebecca Chrystall, Mona Jeffreys, Ruth Weatherall, Anne M Haase","doi":"10.1177/13558196251349448","DOIUrl":"10.1177/13558196251349448","url":null,"abstract":"&lt;p&gt;&lt;p&gt;ObjectivesWe set out to produce an evidence and gap map (EGM) on health care service interventions to improve health care outcomes for hospitalised patients with extreme obesity. Hospitalised patients with extreme obesity have poorer health care outcomes compared to normal weight patients. We also considered how hospital services can be coordinated and delivered to meet the care needs of patients with extreme obesity.MethodsA standardised five-stage EGM method was used to develop an intervention-outcome framework; identify current evidence; critically appraise the quality of evidence, extract, code, and summarise data in relation to the EGM objectives; and create a visualisation map to present findings. EPPI Reviewer Web software was used to generate an interactive EGM. The intervention-outcome framework was developed from internationally recognised health system performance and quality standards. This framework consisted of nine intervention (specialist workforce, special care pathways, assessment tools, equipment, moving and handling, specialist care areas, education, care bundles/packages, patient mobility) and six outcome categories (safety, effectiveness, efficiency, timely access, patient experience, health equity). Inclusion criteria were systematic reviews and primary studies that reported on health service interventions aimed to improve health care outcomes for patients with extreme obesity in the inpatient setting. Thirteen electronic databases were searched to identify studies for eligibility. The original searches were completed between November 2021 and March 2022. A repeat search was completed in August 2023.ResultsOf the 64,574 studies retrieved, 247 met eligibility criteria. Most of the excluded studies specifically related to bariatric weight loss surgical procedures or interventional techniques which could not be more broadly generalised to health care service provision. Of the 247 studies included, most studies (210; 85%) involved special care pathway interventions that related to specific points on a patient's health care journey such as peri-operative care, surgical recovery pathways, and airway support and pain management. Few studies focused on interventions related to a holistic patient-centred approach to care for patients with extreme obesity. Limited evidence existed on specific interventions that focused on safe moving and handling (26; 12.4%) and patient mobility (5; 2%). The most frequently measured outcomes were patient deterioration (193; 78%), patient injury (145; 59%) and medication safety (84; 34%).ConclusionsCurrent evidence predominantly focuses on isolated bariatric surgery patients rather than system-wide care delivery with a lack of evidence on addressing health care inequities between patients with extreme obesity and those of normal weight. This EGM provides an interactive resource to guide policymakers and service commissioners in developing comprehensive hospital services and to support clinicians","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"282-291"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative exploration of the perceived barriers and enablers of providing mental health care in rural Australian general practice.","authors":"Belinda Fuss, Tania Shelby-James, Sharon Lawn, Paul Worley, Sam Manger, Caroline Phegan, Megan Rattray","doi":"10.1177/13558196251319654","DOIUrl":"10.1177/13558196251319654","url":null,"abstract":"<p><p><b>Objectives:</b> General practice plays an important role in delivering and supporting mental health care within communities, particularly for those living in rural areas where access to specialised support is limited. This study sought to understand the barriers and facilitators to providing mental health care in rural Australian general practices. <b>Methods:</b> A descriptive qualitative study was undertaken involving online interviews with 14 staff at three rural Australian general practices between June and September 2023. Participants included nurses (<i>n</i> = 4), GPs, (<i>n</i> = 4), reception staff (<i>n</i> = 3) and practice managers (<i>n</i> = 3). Data were analysed using inductive thematic analysis. <b>Results:</b> Our analysis identified three themes: (i) systemic challenges and supportive infrastructure; (ii) health care personnel factors; and (iii) patient characteristics and preferences. Systemic challenges included limited access to services and specialist support, and challenges with information transmission, while the clinic location and set-up were seen as beneficial. Health care personnel factors included interpersonal needs and challenges, time constraints and how to balance care needs, and the difficulties of attracting and retaining a local workforce. Patient characteristics and preferences included societal stigma and individual hesitancy, lack of awareness, understanding and education around mental health and willingness and affordability of travel and using technology. <b>Conclusions:</b> Rural general practice in Australia faces a range of barriers and enablers that shape the provision of mental health care. To address these challenges, collaboration across various sectors will be required. Improving infrastructure, better resource allocation, addressing workforce shortages, reducing stigma, enhancing mental health literacy, and ensuring the accessibility of mental health care services are all crucial steps. It will be important to align policy goals across sectors to improve the delivery of mental health care in rural general practice in Australia.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"218-226"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}