Journal of Health Services Research & Policy最新文献

{"title":"The appropriateness of self-care policy for urinary tract infections among women from racialised minorities and low-income households in the United Kingdom: A qualitative study.","authors":"Agata Pacho, Nicholas Mays, Rebecca E Glover","doi":"10.1177/13558196251313736","DOIUrl":"10.1177/13558196251313736","url":null,"abstract":"<p><p>ObjectivesUrinary tract infections (UTIs) can negatively impact quality of life, especially when recurring. Patients often seek medical advice to relieve painful symptoms. UTIs are also the second most common reason antibiotics are prescribed in English primary care. However, overuse and long-term use of antibiotics for suspected UTIs in women can lead to antibiotic-resistant bacteria, making future treatments less effective. The UK's 2019-24 Antimicrobial Resistance National Action Plan aims to raise public awareness about the risks of overusing antibiotics and encourages self-care for minor infections, like uncomplicated UTIs. We explored how feasible and appropriate this approach is.MethodsThe transcripts from four online focus groups and 19 one-to-one online interviews involving 25 racialised minority and/or low-income women were analysed thematically. Meetings with lay members of the public with similar socio-demographics and experiences to those we planned on recruiting for the research helped to orientate the study, refine its materials and enhance its recruitment strategies.ResultsAll participants spoke about UTI-related anxieties, which they experienced differently depending on the frequency and the course of UTI episodes, and how knowledgeable they were about the symptoms. Participants often practised self-care for UTIs before seeking professional advice. They saw consultations with health care professionals as valuable for managing the symptoms of UTIs and navigating self-care options. Those with recurrent UTIs felt they could recognise when they required antibiotics and, therefore, they felt they could take responsibility for minimising overprescribing. Barriers to self-care included high pressure working days and not being able to take time off work to recover.ConclusionsParticipants in our study were often able to self-diagnose and assess the severity of their symptoms, which makes them partners in efforts to improve antibiotic stewardship. They still valued consulting professionals for advice and support about their UTIs, irrespective of whether they received a prescription.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"189-197"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006720","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":"'Come and work here!' a qualitative exploration of local community-led initiatives to recruit and retain health care staff in remote and rural areas of the UK.","authors":"Andrew Maclaren, Louise Locock, Zoë Skea, Lorraine Angell, Jennifer Cleland, Topher Dawson, Alan Denison, Christina Dobson, Rosemary Hollick, Peter Murchie, Diane Skåtun, Verity Watson","doi":"10.1177/13558196251318607","DOIUrl":"10.1177/13558196251318607","url":null,"abstract":"<p><p>ObjectivesThe recruitment and retention of health care staff to remote and rural communities is a major challenge. This study explored the experiences of remote and rural communities in trying to attract and retain health care staff and their families in the UK.MethodsQualitative case studies in five remote and rural communities, two in England and three in Scotland. We conducted interviews with 22 participants across the five sites, including community members actively involved in recruitment and retention, health care professionals, and their family members. Fieldwork combined remote and in-person data collection. We used thematic analysis across cases drawing on asset-based community development as our theoretical framework.ResultsCommunities undertook various activities such as making promotional videos, social media campaigns, getting involved on interview panels, and informal social integration efforts. They drew on a range of local assets to encourage health care staff to come to the area, including showcasing local landscapes, outdoor activities, a safe, welcoming community for children and families, and good quality of life. They also drew on the skills of local people with backgrounds in marketing, design, communications and photography or film-making. The absence of some key assets posed challenges, particularly lack of housing, schooling provision, employment opportunities for other family members, and cultural activities. Community-led initiatives were often prompted by local dissatisfaction with health organisations' efforts to recruit health care staff, and a wish to exercise some control over recruitment initiatives. Activities were commonly driven by a small number of individuals. While this worked well in some communities, the burden of responsibility could be substantial. This also sometimes led to tension within communities. Retention efforts commonly relied on informal networks of key individuals who intentionally forged social links for incoming families.ConclusionsThere is a key role for communities to play in recruitment and retention in remote and rural regions. There is an opportunity to actively engage community members in collaboratively crafting a campaign that highlights the area's key attractions while being mindful of limitations on reliance on an asset-based approach. Retention is a neglected topic, relying on key individuals going out of their way to help newcomers integrate. The formation of a community stakeholder group could help formalise this and reduce reliance on the goodwill and energy of individuals.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"180-188"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537237","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":"The impact of COVID-19 policy stringency on patient satisfaction with community pharmacies in China: A cross-sectional standardized patient study.","authors":"Ruijian Huang, Dong Roman Xu, Jay Pan, Xiaohui Wang, Yingsong Chen, Qingyuan Xue, Jiamei Liu, Jingyun Xu, Yue Xiao, Feng Jiang, Yanfei Chen, Siyu Ding, Di Wang, Jifang Zhou","doi":"10.1177/13558196251330586","DOIUrl":"10.1177/13558196251330586","url":null,"abstract":"<p><p>ObjectivesCommunity pharmacies play a crucial role in China's primary health care system. This study aimed to assess the impact of stringent COVID-19 policy responses - such as lockdowns, travel restrictions and operational closures - on unannounced standardized patients' (USPs) satisfaction with community pharmacy services.MethodsA cross-sectional study was conducted from April 2021 to September 2022, using an USPs approach in community pharmacies across China. USPs' satisfaction was measured using validated tools, with closure policies related to COVID-19 as the primary exposure variable.ResultsThe study included 1076 eligible USP visits to community pharmacies. Results indicated that stricter closure policies had a significant negative impact on USPs' satisfaction (β = -0.18, <i>p</i> = 0.019). This negative effect may be attributed to worsened capability of pharmaceutical service providers (β = -0.17, <i>p</i> = 0.002) and accessibility (β = -0.12, <i>p</i> = 0.019). Subgroup analyses demonstrated a negative correlation between stricter closure policies and lower satisfaction levels with regard to accessibility, capability, and communication.ConclusionsCOVID-19 closure policies in China had adverse consequences for the quality of pharmacy services. These findings highlight that governments must act with urgency when addressing abrupt infectious diseases or public health emergencies. Enhancing access to pharmacy services and capability of providers are critical strategies to ensure an effective response to sudden public health crises.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"171-179"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743040","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":"Learning from the past and building for the future: Who is <i>Journal of Health Services Research & Policy</i> for?","authors":"Gemma Hughes, Gregory Maniatopoulos","doi":"10.1177/13558196251331441","DOIUrl":"10.1177/13558196251331441","url":null,"abstract":"","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"150-151"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752982","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":"Looking back as thoughts turn to the future of the <i>Journal of Health Services Research & Policy</i>.","authors":"Jacqueline Cumming, Ellen Nolte","doi":"10.1177/13558196251333961","DOIUrl":"10.1177/13558196251333961","url":null,"abstract":"","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"149"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029250","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":"Public perspectives on the benefits and harms of lung cancer screening: A systematic review and mixed-method integrative synthesis.","authors":"Manisha Pahwa, Alexandra Cernat, Julia Abelson, Paul A Demers, Lisa Schwartz, Katrina Shen, Mehreen Chowdhury, Caroline Higgins, Meredith Vanstone","doi":"10.1177/13558196241288984","DOIUrl":"10.1177/13558196241288984","url":null,"abstract":"<p><p>ObjectiveScreening for lung cancer with low dose computed tomography aims to reduce lung cancer mortality, but there is a lack of knowledge about how target populations consider its potential benefits and harms.MethodsWe conducted a systematic review of primary empirical studies published in any jurisdiction since 2002 using an integrative meta-synthesis technique. We searched six health and social science databases. Two reviewers independently screened titles, abstracts, and potentially eligible full-text studies. Quantitative assessments and open-ended perspectives on benefits and harms were extracted and convergently integrated at analysis using a narrative approach. Study quality was assessed.ResultsThe review included 26 quantitative, 18 qualitative, and 5 mixed methods studies. Study quality was acceptable. Lung cancer screening was widely perceived to be personally beneficial for early detection and reassurance. Radiation exposure and screening accuracy were recognised as harms, but these were frequently considered to be justified by early detection of lung cancer. Stigma, anxiety, and fear related to screening procedures and results were pervasive among current smokers. People with low incomes reported not participating in screening because of potential out-of-pocket costs and geographic access.ConclusionsPopulations targeted for lung cancer screening tended to consider screening as personally beneficial and rationalised physical, but not psychological, harms. Screening programmes should be clear about benefits, use non-stigmatising design, and consider equity as a guiding principle.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"198-207"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467442","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":"Use of digital facilitation to support the use of digital services in general practice in England: An interview study with key stakeholders.","authors":"Bethan Mair Treadgold, Rachel Winder, Helen Atherton, Carol Bryce, John Campbell, Christine Marriott, Jenny Newbould, Stephanie Stockwell, Emma Pitchforth","doi":"10.1177/13558196251316446","DOIUrl":"10.1177/13558196251316446","url":null,"abstract":"<p><p>ObjectiveDigital services in primary care are becoming more common, yet access to and use of services can create inequities. Our aim was to explore the drivers, priorities, and evolving policy context influencing digital facilitation in primary care as reported by national, regional and local level stakeholders in England.MethodsWe conducted online semi-structured qualitative interviews with stakeholders, including those in NHS England organisations, local commissioners for health care, statutory and third sector organisations, those working within the research community, and digital platform providers. Interviews were analysed using a thematic approach.ResultsThe majority of stakeholders worked in national level roles, in commissioning or statutory and third sector organisations working in relation to digital inclusion and patient access. Demographic inequalities, poor usability of digital primary care services, and low digital skills were perceived to comprise some of the barriers facing patients in accessing and using digital primary care services. Demand pressures in general practice, inconsistent training opportunities in digital services for staff, and conflicting perceptions around who should be responsible in organising digital facilitation were reported as barriers in the organisation and provision of digital facilitation in primary care. Stakeholders shared future visions for digital primary care and recommended focusing on establishing the concept of digital facilitation and promoting the benefits in its adoption.ConclusionsPolicy that is specific to digital facilitation and not just to digital services is required to establish clear lines of responsibility, investment in staff time and training, and the development of digital services that work well for various groups of patients and practice staff. A multi-organisational working team involving decision-makers and those working on the ground in general practice is encouraged to establish principles for supporting patients and staff in accessing and using digital primary care services in the NHS in England.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"161-170"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065908","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":"'Misfit' and 'jack of all trades': A qualitative exploration of the structure and functions of a network administrative organisation in Ontario, Canada.","authors":"Jenna M Evans, Elana Commisso, Meena Andiappan","doi":"10.1177/13558196251330524","DOIUrl":"10.1177/13558196251330524","url":null,"abstract":"<p><p>ObjectivesLarger, more complex inter-organisational networks with strong, centralised governance structures, often in the form of a network administrative organisation (NAO), have developed in recent years in response to wicked health and social problems. Set in Ontario, Canada, this study explored how NAOs and networks are structured, how they function, and how they evolve.MethodsWe conducted a case study of a NAO and network consisting of 40 member networks in the province of Ontario, Canada. We analysed secondary sources, including policy documents, legislation, contracts, websites, and existing qualitative data.ResultsThe NAO and member networks developed in tandem and dialectically. They ultimately took on a form that defies categorisation within the existing literature due to their structure as a 'network of member networks' and by acting simultaneously as a policy network, service delivery coordination network, and governance network, by executing numerous complex mandates and functions in service of multiple stakeholders, and by exemplifying both high control and high collaboration.ConclusionsWe classified the NAO and its network as a 'misfit' and 'jack of all trades'. These features may help explain its perceived effectiveness. The complexity and hybrid nature of the NAO and network may position it to best address multifaceted health care problems.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"152-160"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743035","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":"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":"https://doi.org/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":"13558196251349448"},"PeriodicalIF":1.9,"publicationDate":"2025-06-11","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":"Cost-effectiveness of specialized trauma care: A systematic review.","authors":"Soualio Gnanou, Jason Robert Guertin, Pier-Alexandre Tardif, Blanchard Conombo, Mélanie Bérubé, Natalie Yanchar, Simon Berthelot, Janyce Gnanvi, Lynne Moore","doi":"10.1177/13558196251348409","DOIUrl":"https://doi.org/10.1177/13558196251348409","url":null,"abstract":"<p><p>ObjectivesSeveral meta-analyses have shown the effectiveness of specialized trauma care, but evidence on cost and cost-effectiveness remains unestablished. We aimed to systematically review evidence on the cost or cost-effectiveness of hospitals specialized in advanced trauma care compared to non or less-specialized hospitals.MethodsWe conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched PubMed, EMBASE, Cochrane Library, Web-of-Science, EconLit, and grey literature up until June 2024. Two reviewers independently assessed eligibility and extracted relevant data. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist. Per Cochrane recommendations, findings were synthesized qualitatively.ResultsWe identified 4 cost-effectiveness, 3 cost-consequence, and 3 cost-analysis studies, mostly US-based retrospective cohorts. Reporting quality was rated high for 4 studies. All cost-effectiveness studies found specialized trauma centres to be more costly but more effective than non-specialized centres, with incremental cost-effectiveness ratios ranging from 655 to 46,175 Int.$2022 (2022 international dollars) per quality-adjusted life-year (QALY) gained, 43,208 to 999,912 Int.$2022 per life-saved, and 48,567 Int.$2022 per life-year gained. Among cost-consequence studies, two found specialized trauma centres to be costlier and less effective, while one found the opposite. All cost analyses indicated higher costs at specialized trauma centres.ConclusionsFull economic evaluations identified in this review suggest that specialized trauma care may be cost-effective according to a threshold of $50,000 per QALY. However, our ability to draw conclusions is hampered by the low number of studies, high heterogeneity in study populations and settings, and lack of consideration of trauma systems and of costs beyond the acute phase. Results highlight a critical gap in evidence to guide policymakers in the development of cost-efficient trauma systems.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196251348409"},"PeriodicalIF":1.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216044","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}