Journal of Health Services Research & Policy最新文献

{"title":"Counseling and other factors associated with contraceptive use among active duty US military servicewomen.","authors":"Kyle E Manetz, Anwar E Ahmed, Catherine T Witkop, Jaqueline E Hamrick, James D Mancuso","doi":"10.1177/13558196251344866","DOIUrl":"10.1177/13558196251344866","url":null,"abstract":"<p><p>ObjectivesContraceptive prescriptions among U.S. service women rose to 68.7% between 2008 and 2013, which was higher than that seen nationally among women between 2017 and 2019 (65.3%). The objective of this study was to provide estimates of contraceptive use and its determinants among active duty service women, with a particular focus on the associations with contraceptive counseling.MethodsThis was a cross-sectional study using the 2018 Department of Defense Health Related Behaviors Survey of active duty service members. Data from 5353 active duty service women were analyzed. Weighted logistic regression models were used to identify factors associated with contraceptive use. We used a previous survey from 2015 to examine trends in contraceptive use.ResultsThe overall prevalence of contraceptive use was 60.6%, and only 40% had discussed contraception with a health care provider in the past year. Contraception counseling was associated with decreased contraceptive nonuse (adjusted odds ratio = 0.63). Being older, Black or Hispanic race or ethnicity, in the Army, enlisted, identifying as lesbian, gay, or bisexual, and having one or more same sex partners were associated with higher odds of contraceptive nonuse.ConclusionsDespite universal eligibility for free health care, contraceptive counseling and use among US military service women remain suboptimal, and significant disparities in contraceptive use exist by rank, race, ethnicity, and sexual orientation. Improving implementation and enforcement of existing military directives to provide routine contraceptive counseling and services during health care visits, such as through informatics tools, could lower unintended pregnancies, reduce inequities, and increase readiness.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"258-269"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119871","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":"Tackling health inequalities: What exactly do we mean? Evidence from health policy in England.","authors":"Kath Checkland, Donna Bramwell, Jonathan Hammond, Simon Bailey, Lynsey Warwick-Giles","doi":"10.1177/13558196251334571","DOIUrl":"10.1177/13558196251334571","url":null,"abstract":"<p><p>ObjectivesTo develop a model to support health systems in clarifying how they might target action to reduce health inequalities, and to use it to understand current policy on health inequalities in England.MethodsWe used the wider literature on the definitions of health inequalities to draw together a schematic model which attempts to link together the different conceptualisations of health inequalities present in the literature with potential sites of action that could be taken by local health systems. We then undertook a document analysis of the policy documents and programmes underlying the recent reorganisation of the NHS in England.ResultsThe need to tackle health inequalities is cited as one of the main rationales underlying the changes. However, there is a lack of clarity within the documents around: the type of inequality being addressed; the identification of the group(s) suffering from inequalities; and the ways in which the assumed ameliorative mechanisms will work in practice. The documents place considerable emphasis on the assumption that closer partnership working will address inequalities, although the mechanisms by which this will be achieved are not specified and previous research demonstrates how difficult this can be.ConclusionsThe aspiration to tackle health inequalities through newly constituted Integrated Care Systems and Boards is welcome. However, it is well known that the contribution that health care services can make to addressing inequalities is relatively limited. Greater clarity is required of policy and local strategy if efforts are to be appropriately targeted.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"236-246"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024805","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":"Critically ill patients are not just luggage: The experiences of health workers on the transportation of critically ill patients in hospitals in Tanzania.","authors":"John Maiba, Elibariki Mkumbo, Karima Khalid, Tamara Mulenga Willows, Onesmus Onyango, Carl Otto Schell, Jacob McKnight, Jacquie Oliwa, Tim Baker","doi":"10.1177/13558196251378299","DOIUrl":"https://doi.org/10.1177/13558196251378299","url":null,"abstract":"<p><p>BackgroundCritical illness is a life-threatening condition impacting millions of patients globally each year. Critically ill patients often need to be transported within the hospital during their care and the safety and efficiency of transportation are key for good health outcomes. There is a lack of knowledge about the processes and safety of intra-hospital patient transport in low-resourced health care settings.ObjectiveThis study aimed to understand health workers' experiences of the process and the safety of intra-hospital transportation of critically ill patients in Tanzania.MethodsQualitative in-depth interviews were conducted with 15 health workers involved in the care and transportation of critically ill patients in five Tanzanian hospitals. Purposive sampling identified participants. Data were analysed using thematic analysis, guided by the Donabedian quality of care framework.ResultsThree themes of health workers' experiences of patient transportation were identified, the first two related to structures and the third to processes: (i) the design and organisation of hospitals did not facilitate the initiation and conduct of quick, short and safe transport for critically ill patients; (ii) hospitals lacked resources for safe, effective transportation of critically ill patients; (iii) there were weaknesses in the preparation for, conduct of, and handover of information concerning the transportation of critically ill patients. Health workers in Tanzania faced substantial challenges in ensuring safe transportation due to hospital infrastructure limitations, resource shortages, and inadequate processes.ConclusionWe conclude that the transport of critically ill patients is overlooked in hospital services in Tanzania, despite the importance of safe intra-hospital transportation in preventing deaths. Feasible solutions to these challenges are necessary for reducing high mortality and morbidity among critically ill patients.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196251378299"},"PeriodicalIF":2.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176070","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":"Challenges, benefits, and strategies for delivering pregnancy care to people with disabilities: A qualitative study of service providers and decision-makers in Ontario, Canada.","authors":"Lesley A Tarasoff, Yona Lunsky, Keat Welsh, Laurie Proulx, Meredith Evans, Susan M Havercamp, Simone N Vigod, Hilary K Brown","doi":"10.1177/13558196251376146","DOIUrl":"https://doi.org/10.1177/13558196251376146","url":null,"abstract":"<p><p>ObjectivesTo (1) understand the challenges and benefits of providing pregnancy care to people with disabilities and (2) identify strategies to address challenges, from the perspectives of health care and social service providers and decision-makers.MethodsWe undertook a qualitative descriptive study in Ontario, Canada, of 31 health care and social service providers and decision-makers. Participants completed semi-structured interviews about their education, training, and clinical or administrative experience working with pregnant and/or parenting people with physical, sensory, and intellectual or developmental disabilities, including challenges and benefits in pregnancy care provision, programming, and policies, as well as their recommendations to improve care. We took a directed content analysis approach.ResultsParticipants identified challenges in providing pregnancy care to people with disabilities, including a lack of data to inform care, the influence of social determinants of health on disabled people's lives, inadequate infrastructure, poor coordination and communication across services, minimal disability-related training, and ableist attitudes among providers. Benefits to providing pregnancy care for people with disabilities included becoming advocates for system-level change, personal fulfillment, opportunities to confront one's own biases, and development of humility related to the expertise of people with disabilities. Reflecting on these challenges and benefits, participants identified strategies for improving care, through creative resource-sharing solutions, accessibility measures, interprofessional and coordinated care, enhanced provider training, and respectful care approaches.ConclusionsFindings show the need for changes at system, institutional, and service provider levels to improve pregnancy care for people with disabilities.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196251376146"},"PeriodicalIF":2.7,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015556","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":"What determines health insurance ownership in Nepal? Findings from the Nepal multiple indicator cluster survey 2019.","authors":"Prabhat Lamichhane, Rajeev Banjara, Bishnu Prasad Dulal","doi":"10.1177/13558196251372438","DOIUrl":"https://doi.org/10.1177/13558196251372438","url":null,"abstract":"<p><p>ObjectiveIn Nepal, various health insurance schemes including community-based and national health insurance programmes have been implemented to reduce financial burdens on the population and improve access to health care, towards the goal of Universal Health Coverage. Despite these efforts, there are limited studies on health insurance ownership in Nepal. This study aimed to determine factors influencing insurance ownership at individual and household level in Nepal.Study designThis study utilized cross-sectional data from the Nepal Multiple Indicator Cluster Survey 2019, a nationally representative survey. This paper reports on analysis of data from 14,769 women and 5491 men aged 15-49 years and 4113 households, using logistic regression and the Cragg hurdle model.ResultsThe study found that less than 6% of respondents had health insurance: 5.8% of women (95% CI 4.82 - 6.88) and 5.1% of men (95%CI: 4.5 - 5.8), with higher rates among older women with higher education, belonging to the Newar ethnic group, and living in urban areas. Age and education were significant predictors of individual insurance ownership. Higher socio-economic status of the household and higher education of the individual were associated with greater likelihood of insurance ownership, while belonging to disadvantaged ethnicities and living in the Sudurpaschim and Madhesh provinces were associated with lower likelihood of insurance ownership.ConclusionHealth insurance ownership is low in Nepal, particularly among disadvantaged ethnicities and low socio-economic status households. Efforts to increase health insurance coverage need to focus on addressing the inequities related to socio-economic status, ethnicity, and regions. Further research is necessary to identify reasons for lower coverage among the specific population groups.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196251372438"},"PeriodicalIF":2.7,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000744","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":"Evaluating patient characteristics and trends of avoidable emergency department visits: Informing community health services to reduce emergency department utilization.","authors":"Ryan P Strum, Andrew P Costa, Brent McLeod, Ravi Sivakumaran, Shawn Mondoux","doi":"10.1177/13558196251358761","DOIUrl":"https://doi.org/10.1177/13558196251358761","url":null,"abstract":"<p><p>BackgroundThere is a growing debate on whether avoidable emergency department (ED) visits, those involving health issues that could have been managed in community settings, represent a significant workload for the department. Until recently an ED physician-validated measure of avoidable visits has not been available, hindering our understanding of these patients, services rendered in the ED and the nature of their conditions. We examined patient characteristics of ED visits retrospectively classified as avoidable and potentially avoidable at a Canadian academic hospital.MethodsWe conducted a retrospective cohort study using administrative ED data from an academic hospital in Hamilton, Canada from April 1, 2018 to August 31, 2023. We categorized all ED visits as avoidable, potentially avoidable, and not avoidable using the Emergency Department Avoidability Classification (EDAC). For each class, we analyzed patient characteristics and the top five physician interventions and diagnoses. We applied linear regression, locally weighted scatterplot smoothing (LOWESS) regression, and statistical process methods to examine monthly trends in avoidable and potentially avoidable visits. Additionally, we reported annual totals and length of stay for patients transported to the ED by paramedics.ResultsOverall, 58,528 (29.0%) of 201,741 ED visits were classified as either avoidable (11,302; 5.6%) or potentially avoidable (47,226; 23.4%). These patients were predominantly young-to-middle aged, with average visit durations of 3 hours 33 minutes (avoidable) and 4 hours 26 minutes (potentially avoidable). Their primary interventions were predominantly diagnostic imaging, skin repairs and mental health assessments. The proportion of ED visits in the study period that were avoidable increased from 2.1% to 7.7% and potentially avoidable from 18.2% to 21.2%. Approximately one-in-five paramedic transported patients were classified as having either an avoidable or potentially avoidable ED visit. Transported patients had an average length of stay of 4 hours 22 minutes for avoidable visits and 4 hours 35 minutes for potentially avoidable visits.ConclusionsA notable rise in the proportion of ED visits that could have been managed in non-ED settings was observed. Providing community clinicians with resources and capacity to manage and refer patients for diagnostic imaging, skin repairs and mental health assessments may reduce avoidable ED attendance. Further exploration of avoidable ED visits transported by paramedics could support refining ED diversion care models. Hospitals and health service policymakers could benefit from similar analyses using validated measures to identify care gaps that inform the development of new health services and models tailored to the specific needs of their communities.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196251358761"},"PeriodicalIF":1.9,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591435","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":"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 views of older people on community-based multi-disciplinary team caseloads and informal carers about health and care services in two Integrated Care Pioneer sites in England.","authors":"Mary Alison Durand, Lavanya Thana, Mustafa Al-Haboubi, Agata Pacho, Lucia Rehackova, Gerald Wistow, Nick Douglas, Nicholas Mays","doi":"10.1177/13558196251349400","DOIUrl":"10.1177/13558196251349400","url":null,"abstract":"<p><p><b>Objectives:</b> Community-based multi-disciplinary teams (MDTs) were among the most widely reported health and care integration initiatives in the Integrated Care Pioneers in England. Such MDTs bring together staff from different sectors to co-ordinate and plan care for patients, who are often older, have multiple long-term conditions and risk hospital admission. As part of our evaluation of MDTs in two contrasting Pioneers, we explored MDT patients' and informal carers' perspectives on health and care services. As the COVID-19 pandemic started during data collection, we also wanted to understand its impact on patients' access to services. <b>Methods:</b> We conducted qualitative interviews with 44 patients aged 60 or over, with long-term conditions, and on the caseload of one of 11 participating MDTs. We also undertook qualitative interviews with 15 carers. Interviews took place between November 2019 and March 2021. Interview transcripts were coded in NVivo-12 and analysed thematically. <b>Results:</b> In addition to formal services, patients often relied on informal care. Valued aspects of care included equipment and home modifications that supported independence, timely access to and continuity in care, effective information-sharing, professionals who made them feel that their needs mattered, and having a named contact. Where challenges were experienced (e.g. with accessing professionals, communication, and care quality), patients and carers sometimes felt abandoned. While some patients mentioned being on an MDT caseload, few reported having a care plan. The impacts of caring on informal carers were sometimes considerable. COVID-19 affected patient and carer wellbeing, but the new ways of accessing care generated by the pandemic were valued by some participants. <b>Conclusions:</b> As long as challenges remain, patients and carers are unlikely to perceive care as joined-up and patient-centred. If truly integrated and holistic care is to be provided, barriers (such as the lack of shared patient records) must be addressed. Even where MDTs function primarily to co-ordinate rather than deliver care, they could better communicate their co-ordinating role, and MDT discussion outcomes, including care decisions, to patients. Informal carers' needs also require greater attention by MDTs.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"30 1_suppl","pages":"48S-57S"},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12423458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667800","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":"Evaluating the role of community-based multi-disciplinary teams in integrated health and social care in England: Overview of findings from the Pioneer evaluation and their implications for health and social care integration.","authors":"Mary Alison Durand, Gerald Wistow, Mustafa Al Haboubi, Nick Douglas, Bob Erens, Ties Hoomans, Tommaso Manacorda, Robin Miller, Agata Pacho, Lucia Rehackova, Judith Smith, Lavanya Thana, Nicholas Mays","doi":"10.1177/13558196251349398","DOIUrl":"10.1177/13558196251349398","url":null,"abstract":"<p><p>ObjectivesThis paper synthesises the findings of an evaluation of community-based multi-disciplinary teams (MDTs), primarily serving older people with long-term conditions, undertaken as part of a wider evaluation (2015-2022) of the Integrated Care and Support Pioneer Programme (2013-2018) in England. The MDT evaluation was undertaken in two contrasting Pioneers with 11 MDTs covering four models of MDT functioning.MethodsThe synthesis, set against our conceptual framework of MDT functioning, draws principally on the findings of semi-structured interviews with local strategic level health and care leaders, frontline MDT staff, and patients and their informal carers, observations of MDT meetings, and an online survey of MDT staff.ResultsMDTs were seen as an essential means of working towards local health and care integration. While local contexts shaped the precise aims, structure, composition and ways of working of the different MDT models studied, there were strong similarities across the teams in how staff viewed the nature and benefits of MDT working. MDTs were perceived as having the potential to provide more holistic care to patients, speed up access to care, improve access to a wider range of services and enhance care at home. Benefits to staff included better information sharing; reduced duplication of tasks; enhanced collective responsibility and problem-solving, which enriched decision-making; opportunities to learn from, and about, the remits of other professional groups and services; and the erosion of traditional professional hierarchies. However, barriers to MDT working, including the absence of shared patient records, inadequate infrastructure and resources, and concerns about the ability to measure and demonstrate the value of MDT working, were also identified. Patients and their informal carers reported valuing good communication with their health and care providers but often appeared unaware of an MDT's involvement in planning their care. This suggests there is some distance to travel in terms of how MDTs communicate their roles to those they serve.ConclusionsAt the service delivery level, our findings' implications for policy and practice include the need for greater integration across patient records and data systems, and greater investment in specialist services (e.g., housing) currently absent from MDTs. However, our research also highlighted challenges to evaluating the outcomes of 'integration' both as a concept and at the service delivery level. Changes to both the research environment and the approach to evaluation are also warranted.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"30 1_suppl","pages":"69S-81S"},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12423453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667796","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}