Journal of Health Services Research & Policy最新文献

{"title":"Protected appointment-based waiting list strategies are associated with waiting time reductions in outpatient and community health services: A systematic review and meta-analysis.","authors":"Kate E Noeske, Nicholas F Taylor, Annie K Lewis, Katherine E Harding","doi":"10.1177/13558196261428359","DOIUrl":"10.1177/13558196261428359","url":null,"abstract":"<p><p>ObjectivesMany different approaches are used to manage demand and reduce waiting lists in outpatient and community health settings. This systematic review aimed to synthesise evidence for models of care which are based on the principle of protecting capacity for new patients.MethodsWe conducted a systematic search of Medline (Ovid), Embase, PyscINFO and CINAHL from inception until April 2024. Eligible studies included use of a protected appointment model in an outpatient and community health service and compared data on measures of waiting. Two reviewers independently extracted data and assessed risk of bias. Methodological quality was assessed using the Downs and Black checklist. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was used to evaluate evidence certainty for meta-analyses.ResultsA total of 26 studies were included in the review. Most studies described a specific, named model incorporating protected appointments, such as Open Access (n = 7), Advanced Access (n = 6), the Specific Timely Assessment and Triage Model (n = 6), and the Choice and Partnership Approach (n = 4). A single stepped wedge randomised controlled trial (n = 3,113) provided moderate certainty evidence of a large reduction in time from referral to first appointment (IRR -0.66, 95% CI -0.85 to -0.52), with a median reduction of 34%. Eight non-randomised studies of intervention (n = 43,655) provided moderate certainty evidence of a moderate to large reduction in waiting time (SMD = -0.66, 95% CI -0.95 to -0.36) with a weighted mean reduction of 81%. Studies that could not be included in the meta-analyses supported these findings. Five studies measured waiting list size and all reported reductions ranging from 44% to 98%. Other findings associated with interventions included increased service productivity and improved patient satisfaction.ConclusionsWaiting list reduction strategies incorporating protected appointments are associated with moderate to large reductions in waiting time in outpatient and community health services.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"286-300"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147276346","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":"Rapid adaptation of first contact physiotherapy services for musculoskeletal patients in the UK and Australia during the COVID-19 pandemic: A multiple case study.","authors":"Oluwatoyin Adenike Adeniji, Theopisti Chrysanthaki, Evangelos Pappas, Magdalena Zasada, Karen Stenner, Nicola Carey","doi":"10.1177/13558196261452621","DOIUrl":"10.1177/13558196261452621","url":null,"abstract":"<p><p>BackgroundThe disruption of health services by the COVID-19 pandemic prompted the WHO to advocate for rapid adaptation of healthcare. Little is known about the specific rapid adaptation strategies deployed in first contact physiotherapy services (FCPS) and how they were experienced by providers and patients.Study AimTo explore views and experiences of physiotherapists and key stakeholders on the rapid adaptation of FCPS during the COVID-19 pandemic in the UK and Australia.MethodsA multiple case study design was employed across four case sites; UK (n = 2), Australia (n = 2), involving online semi-structured interviews with 22 participants in 2024 and document review. A case-based approach using framework analysis was applied, drawing on the public health emergency framework of readiness, responsiveness, and sustainability, alongside the consolidated framework for implementation research (CFIR).ResultsGaps in readiness for adaptation, particularly in terms of planning and resources, were evident across FCPS in both countries. However, the findings highlight FCPS as an adaptable service, with strategies implemented within the first three to six months following the declaration of COVID-19 as a pandemic. The most notable adaptation variation was in telehealth, where alignment with service contexts influenced implementation and ongoing sustainability. New challenges not fully captured within CFIR constructs emerged, including the initial lack of acceptability, particularly related to telehealth, and the unpredictable nature of the pandemic.ConclusionTo strengthen FCPS preparedness for the future, policies should proactively equip services with the resources and capabilities required to manage emergencies and associated contingencies, while accounting for contextual variations. Such forward planning would support an effective response and the long-term integration of beneficial adaptations, thereby strengthening service resilience.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"267-279"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147987816","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":"Shared clinical governance arrangements between NHS and independent acute hospitals in England: Findings from a national survey of senior leaders.","authors":"Gemma Stringer, Jane Ferguson, Kieran Walshe, Christos Grigoroglou, Thomas Allen, Michael Anderson, Karen Bloor, Eleanor Gee, Nils Gutacker","doi":"10.1177/13558196261431315","DOIUrl":"10.1177/13558196261431315","url":null,"abstract":"<p><p>ObjectivesTo present the findings from a national survey of senior leaders in NHS and independent hospitals in England concerning the effectiveness of shared arrangements for clinical governance. To provide a comprehensive overview of shared arrangements for the oversight of consultants' practice, processes for appraisal and revalidation, and the management of significant concerns. The results from this study will improve understanding of the practical functioning of clinical governance processes at the interface between the NHS and the independent sector.MethodsBetween December 2023 and April 2024, an online survey was distributed to senior leads with governance responsibilities in NHS and independent hospitals in England.Results320 responses were received (response rate 42%), 235 from individuals working in NHS trusts (response rate 40%) and 85 from individuals in independent hospitals (response rate 48%). Respondents reported that some clinical governance arrangements are established across both sectors, with some relationships characterised as positive and relatively strong. However, relationships often depended on goodwill, personal connections, and consultant probity, rather than the systematic implementation of recommended processes. Respondents expressed concerns regarding the non-mandatory and unregulated nature of processes for sharing concerns, believing this led to insufficient resources and challenges in verifying information. They called for improved data quality, better communication and information sharing and more robust and formalised processes.ConclusionsShared clinical governance arrangements between the NHS and independent sectors are in place in some but not all of the organisations where respondents' consultants worked. This raises concerns about progress towards implementing the Paterson inquiry recommendations, including access to consultants' whole practice information and sharing concerns about consultants working across different providers. The findings may also hold relevance for international audiences where medical staff work across multiple healthcare providers. Further empirical research is needed to compare clinical governance arrangements between the NHS and independent sectors, and suggest how shared clinical governance can be organised to assure the quality and safety of care.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"234-244"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147486227","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":"A qualitative study on addressing COVID-19 vaccine hesitancy in marginalised communities in the UK - Professional and public perspectives.","authors":"Basharat Hussain, Helen Marson-Smith, Benjamin Duke, Mimi Gbadesire, Sadaf Khurshid, Stephen Timmons","doi":"10.1177/13558196251409115","DOIUrl":"10.1177/13558196251409115","url":null,"abstract":"<p><p>BackgroundVaccine hesitancy is known to be a significant issue for vaccination programmes. It has been shown to be particularly significant in communities marginalised by ethnicity, poverty and other social factors.ObjectiveIn this paper we report on the efforts of the UK COVID-19 vaccination programme to overcome vaccine hesitancy in one locality, and how those efforts were viewed by the people targeted by and delivering the initiatives.MethodWe conducted a qualitative study, interviewing staff delivering the vaccination programme (n = 8) and community members drawn from marginalised groups (n = 40). Framework thematic analysis was used.ResultsThe diversity of the marginalised communities in terms of their immigration status, language, cultural needs and other characteristics required extensive and varied efforts by services to deliver vaccine equity initiatives. These efforts included offering vaccines in community centres and places of worship, involving community and faith leaders to build trust among communities, delivering information in different languages and offering gift vouchers. Community members had a complex mixture of reasons for accepting or not accepting the vaccine. Reasons for not accepting the vaccine included a lack of trust in vaccine effectiveness and what were perceived as coercive measures by the state.ConclusionThe initiatives were perceived to be broadly successful in promoting COVID-19 vaccine uptake, however there were no precise measures of success or failure of individual components. Policy and health services need to consider the complex and dynamic nature of vaccine hesitancy and build trust and improve communication with marginalised groups.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"245-254"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804583","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":"Help and support for gambling harm among United Kingdom Armed Forces personnel: A mixed-methods study.","authors":"Blair Biggar, Hannah Champion, Matthew Jones, Glen Dighton, Justyn Larcombe, Matt Fossey, Simon Dymond","doi":"10.1177/13558196251409041","DOIUrl":"10.1177/13558196251409041","url":null,"abstract":"<p><p>ObjectivesTo explore the accessibility of mental health and gambling related support within the United Kingdom (UK) Armed Forces and investigate potential barriers to engagement.MethodsWe conducted a survey of Armed Forces service personnel (<i>n</i> = 438) and specialist healthcare and welfare staff (<i>n</i> = 94) regarding gambling harm and related challenges.ResultsPersonnel rarely sought on-base support and recognition of existing service provision was low. Among those who did seek help, healthcare and welfare staff were equally effective in engaging with personnel, with greater professional experience playing a key role in fostering meaningful interactions.ConclusionsImproving access to specialist gambling harm support may enhance help-seeking.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"255-266"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793769","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":"Addressing health worker migration in Africa.","authors":"Sunny C Okoroafor, James Avoka Asamani, San Boris Bediakon, Adam Ahmat, Egide Rwamatwara, Ogochukwu Chukwujekwu, Kasonde Mwinga","doi":"10.1177/13558196251409644","DOIUrl":"10.1177/13558196251409644","url":null,"abstract":"<p><p>The African region has experienced significant growth in health workforce development due to concerted efforts and investments. This progress has improved access to healthcare services and addressed critical shortages of health workers. However, the region still struggles to meet the Sustainable Development Goal (SDG) indicator threshold of 44.5 medical doctors, nurses, and midwives per 10,000 population. An estimated deficit of 6.1 million health workers is anticipated by 2030 unless urgent actions are taken. This shortage is exacerbated by increased health worker migration, driven by the demand in high-income nations and the dual challenges of an ageing workforce and population. Addressing the factors driving healthcare worker migration is crucial to strengthen local healthcare systems and ensure quality medical services. Weak mechanisms for tracking health worker migration, due to limitations in health planning and workforce information systems, impede understanding of this situation. Countries in the African region can undertake initiatives such as pursuing mutually beneficial bilateral or multilateral agreements to manage international migration of health workers. Additionally, harnessing the potential benefits of migrant health workers in improving health systems and protecting their labour rights is essential. African countries should conduct thorough health labour market analyses to plan the production, funding, employment, and retention of sufficient health workers. Exploring contextual factors and policies that influence health workers' choices and potential incentives to encourage the return of migrant health workers is also vital. Dialogues among internal stakeholders and between countries can lead to mutually beneficial mechanisms for skills exchange and proportionate investment.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"280-285"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145819718","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":"Assessing the resilience of a key health service: The response of acute surgical provision in England to the disruption of the COVID-19 pandemic.","authors":"Andrew Hutchings, Orlagh Carroll, Geoff Bellingan, David Cromwell, S Ramani Moonesinghe, Susan J Moug, Neil Smart, Ravinder Vohra, Robert J Hinchliffe, Richard Grieve","doi":"10.1177/13558196261426970","DOIUrl":"10.1177/13558196261426970","url":null,"abstract":"<p><p>ObjectiveInternational health systems had the opportunity to assess the resilience of core health services to severe disruption following the onset of the COVID-19 pandemic. This paper examines the resilience of a core health service to shocks from COVID-19. We compare outcomes following emergency admissions in England during the second (Winter 2020/21) and third (Winter 2021/22) major waves of COVID-19 with the first wave and historic admissions from 2016 to 2019.MethodsThis cohort study included adult emergency admissions for five common acute surgical conditions: appendicitis, symptomatic gallstone disease, intestinal obstruction, symptomatic diverticular disease, and abdominal wall hernia in 122 acute hospital Trusts in England. Participants were 647,367 admissions in the hospital episode statistics (HES) inpatient database including 34,560 in the second wave and 36,628 in the third wave. Outcome was all-cause mortality at 90 days.ResultsThere were 1308 deaths in wave two (3.8% of admissions) and 1235 (3.4%) in wave three compared with 3431 (3.4%) in the historic cohort and 577 (4.7%) in wave one. Compared with pre-COVID admissions, we found weak evidence of increased mortality in the second wave. There was no evidence of increased mortality in the third wave, compared to historic cohorts the case-mix adjusted odds ratios were: appendicitis 0.96 (95% CI 0.49-1.87); gallstone disease 1.27 (95% CI 0.94-1.72); diverticular disease 1.04 (95% CI 0.79-1.36); hernia 1.06 (95% CI 0.76-1.47); and intestinal obstruction 1.02 (95% CI 0.87-1.19).ConclusionsBy the end of wave three, outcomes for emergency admissions with five common acute conditions had returned to pre-pandemic levels. Lessons learnt during the disruption of the first wave of COVID-19 helped the NHS in England adapt emergency surgical services during subsequent waves. These findings emphasise the importance of maintaining, or quickly restoring core service capacity to help patient outcomes return to pre-pandemic levels.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"214-223"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147355395","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":"Improving the quality of residential care for people with disabilities - What is the experience of inspectors when implementing care quality regulations in Ireland?","authors":"Paul Dunbar, Laura Keyes, John P Browne","doi":"10.1177/13558196261437759","DOIUrl":"10.1177/13558196261437759","url":null,"abstract":"<p><p>BackgroundRegulation by an independent state authority is a common means by which governments seek to safeguard service users and ensure good quality health and social care services. Inspectors play a key role in this process as they work at the interface between regulator and regulatee. Our aim was to investigate the role played by inspectors in the implementation of care regulations in residential disability services in Ireland.MethodsWe conducted focus groups with inspectors of residential disability services in Ireland. Participant recruitment was facilitated with the permission of the regulator. Twenty-two people participated over five online focus groups. Thematic analysis was carried out on the interview data.ResultsFour parent themes were identified: overall views on the regulatory system; the importance of skill and strategy for the role of inspector; impediments to effective regulation and inspection; and, positive effects of regulation. While not directly responsible for implementing regulations in services, inspectors played a role by calling attention to poor practices, apportioning accountability at the appropriate level in regulated organisations, and behaving in a consultant-like fashion in support of managers. There were barriers that complicated and inhibited their work such as resource constraints and bureaucracy. Their observation of improvements in service quality led them to conclude that regulation was an effective intervention, despite some flaws.ConclusionInspectors had a clear sense of the part they played in terms of aiding the implementation effort in services. They shared the goals of managers: trying to improve the quality of services and the lives of those that use services. While there were barriers that impacted on the effectiveness of their work, most inspectors regarded regulation as a positive intervention and had first-hand experience of its impact.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"224-233"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147529740","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":"Beyond preparedness: Building resilient health systems through capabilities.","authors":"Giovanni Fattore","doi":"10.1177/13558196261484636","DOIUrl":"10.1177/13558196261484636","url":null,"abstract":"","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"211-213"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860368","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":"Integrated primary healthcare reform in Indonesia: Lessons learned from early community-level implementation.","authors":"Marwatunnisa Al Mubarokah, Hannah N Gilbert, Ari Probandari, Havivi Dwi Anggraeni, Rahayu Seffy Oktavia, Courtney M Yuen","doi":"10.1177/13558196261489144","DOIUrl":"https://doi.org/10.1177/13558196261489144","url":null,"abstract":"<p><p>ObjectivesIn many low- and middle-income countries, comprehensive, first contact primary health care is fragmented by the delivery of centralized programs focused on specific health conditions. Indonesia's 2023 primary health care reform restructured community health services to provide integrated rather than condition-specific services, representing one of the broadest primary health care integration efforts in a middle-income country to date. We sought to understand the outcomes, barriers, and facilitators of early implementation of this reform.MethodsWe conducted a convergent mixed-method study in one of the first areas to implement primary health care reform. We used descriptive statistics to quantify service delivery outcomes from a survey of 14 village health facilities and data extracted from monthly reports from two village health facilities and 11 community health posts. We sought to understand barriers and facilitators to implementation via 24 patient interviews, seven key informant interviews, and four focus group discussions with healthcare providers. We used deductive-inductive qualitative analysis guided by the Consolidated Framework for Implementation Research. Findings were integrated to understand factors that impacted service delivery outcomes.ResultsIn the initial months of implementation, both health facilities and health posts offered integrated services to all patients simultaneously, but neither introduced new screening services (e.g., mental health) immediately. At health facilities, patient visits substantially increased across all age groups, with more modest changes seen at health posts. The convenience of getting services at community health posts increased patient visits, but scheduling incompatibility and a low sense of belonging were barriers to attendance for teenagers and working adults. Insufficient training, staff, and resources posed barriers to introducing new services.ConclusionsIt is possible for a middle-income country to move from condition-specific community health programs toward integrated primary health care. Doing so requires investment in human resources, intersectoral collaboration, and outreach to less engaged segments of the population.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196261489144"},"PeriodicalIF":2.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069714","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}