Journal of Health Services Research & Policy最新文献

{"title":"Health care providers' perceptions of burnout and moral distress during the COVID-19 pandemic: A qualitative study from Saskatchewan, Canada.","authors":"Jacob Albin Korem Alhassan, Noelle Rohatinsky, Taylor Peru, Carmen Levandoski, Dennis Kendel, Jeff Dmytrowich, Tenille Lafontaine, Matthew Cardinal, Juan Nicolás Peña-Sánchez","doi":"10.1177/13558196241287336","DOIUrl":"https://doi.org/10.1177/13558196241287336","url":null,"abstract":"<p><strong>Objectives: </strong>This study sought to describe feelings and perceptions of burnout and moral distress experienced by health care providers in the Canadian province of Saskatchewan during the COVID-19 pandemic.</p><p><strong>Methods: </strong>This study was part of a larger mixed methods project, and we here report on the qualitative results relating to burnout and moral distress experienced by medical doctors, registered nurses and respiratory therapists. We used an exploratory, qualitative descriptive design involving one-one-one interviews with 24 health care providers. Interview data were analysed using a reflexive thematic analysis approach.</p><p><strong>Results: </strong>We identified three overarching themes each for health care provider burnout and moral distress. Interviews revealed that providers experienced burnout through (i) increased expectations and (ii) unfavourable work environments, which led most of them to recognise (iii) a need to step back. Regarding moral distress, key themes were: (i) a sense of compromised care, (ii) feelings of bumping heads with authorities and patient families, and (iii) seeing patients make difficult decisions.</p><p><strong>Conclusion: </strong>Our study found that medical doctors, registered nurses and respiratory therapists working during the COVID-19 pandemic experienced and continue to experience significant burnout and moral distress. This was often driven by both institution- and system-level factors. There is a need for sustained investment to build and support a motivated health care workforce to prepare for future pandemics and health emergencies.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196241287336"},"PeriodicalIF":1.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365499","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":"Does income matter for the policy effect of public long-term care insurance on informal care use in China? A quasi-experimental study.","authors":"Jing Ning, He Chen, Man Li","doi":"10.1177/13558196241252394","DOIUrl":"10.1177/13558196241252394","url":null,"abstract":"<p><strong>Objective: </strong>Since 2016, the Chinese government has been piloting a public long-term care insurance (LTCI) scheme. This study examined whether the LTCI scheme reduced the use of informal care and how this has varied across income groups.</p><p><strong>Method: </strong>We used data from the 2011, 2014, and 2018 waves of Chinese Longitudinal Healthy Longevity Survey, focusing on community-dwelling older adults aged 65 years and older. We used staggered difference-in-differences analyses with propensity score matching to examine the effects of the policy.</p><p><strong>Results: </strong>The LTCI scheme reduced the probability and intensity of informal care use by 5.7% (<i>p</i> < .05) and 17.4% (<i>p</i> < .05), respectively. The policy impact was limited to older people in the middle-income group, reducing the probability and intensity of informal care use by 15.6% (<i>p</i> < .001) and 43.1% (<i>p</i> < .05), respectively. We did not find a statistically significant policy effect for older adults with high or low incomes.</p><p><strong>Conclusions: </strong>The LTCI scheme had different effects on reducing the informal care burden for family caregivers by income level. We suggest that the scheme should entitle people with low incomes to a preferential co-payment rate, thereby enhancing their access to formal care.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"248-256"},"PeriodicalIF":1.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848925","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":"Trust in COVID-19 information sources and vaccination status: Exploring social inequalities and differences within the four United Kingdom nations using a representative survey.","authors":"Valeria Skafida, Elke Heins","doi":"10.1177/13558196241227749","DOIUrl":"10.1177/13558196241227749","url":null,"abstract":"<p><strong>Objectives: </strong>To explore how the use of, and trust in, different sources of advice and information on COVID-19 differed across the four UK nations and between different sociodemographic groups and their associations with COVID-19 vaccination status.</p><p><strong>Methods: </strong>We used a UK-wide representative survey conducted in July 2021, which included data on uptake of COVID-19 vaccination, trust in information sources, use of sources and geographical and sociodemographic variables. We used multivariate logistic regression to identify factors associated with completed or planned COVID-19 vaccination.</p><p><strong>Results: </strong>Trust in the NHS, followed by trust in scientists, were the strongest predictors of vaccination intention. NHS websites were the most used (56% across the UK); only the Scottish government website had a higher level of reported use (58%). Using either source was associated with a positive vaccination status as were use of the GP and television as sources of advice. Use of social media, family and friends, and 'none' of the sources enquired about, were all linked to a lower likelihood of being or intending to get vaccinated. Compared to those in England, respondents in other UK nations were less likely to trust the central UK government for advice on COVID-19. There was considerable variation by age in trust and use of some, but not all, sources of advice, with predicted probabilities ranging from 35% among the youngest age group to 62% among those aged 65 years or older. There were also significant differences by annual household income and by occupational class for trust in government, with higher incomes correlating with greater likelihood of trust.</p><p><strong>Conclusions: </strong>This study demonstrates high levels of trust in the key sources of public health advice and there was a positive association between using official sources of advice and vaccination intentions, even in the context of overall high vaccination rates. Our findings highlight the need for the UK and devolved governments to value the importance of public trust in the health system and take appropriate measures to avoid undermining such trust.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"153-162"},"PeriodicalIF":1.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139692021","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":"Indigenous identity identification in administrative health care data globally: A scoping review.","authors":"Mandi Gray, Kienan Williams, Richard T Oster, Grant Bruno, Annelies Cooper, Chyloe Healy, Rebecca Rich, Shayla Scott Claringbold, Gary Teare, Samara Wessel, Rita I Henderson","doi":"10.1177/13558196231219955","DOIUrl":"10.1177/13558196231219955","url":null,"abstract":"<p><strong>Objective: </strong>Both Indigenous and non-Indigenous governments and organizations have increasingly called for improved Indigenous health data in order to improve health equity among Indigenous peoples. This scoping review identifies best practices, potential consequences and barriers for advancing Indigenous health data and Indigenous data sovereignty globally.</p><p><strong>Methods: </strong>A scoping review was conducted to capture the breadth and nature of the academic and grey literature. We searched academic databases for academic records published between 2000 and 2021. We used Google to conduct a review of the grey literature. We applied Harfield's Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT) to all original research articles included in the review to assess the quality of health information from an Indigenous perspective.</p><p><strong>Results: </strong>In total, 77 academic articles and 49 grey literature records were included. Much of the academic literature was published in the last 12 years, demonstrating a more recent interest in Indigenous health data. Overall, we identified two ways for Indigenous health data to be retrieved. The first approach is health care organizations asking clients to voluntarily self-identify as Indigenous. The other approach is through data linkage. Both approaches to improving Indigenous health data require awareness of the intergenerational consequences of settler colonialism along with a general mistrust in health care systems among Indigenous peoples. This context also presents special considerations for health care systems that wish to engage with Indigenous communities around the intention, purpose, and uses of the identification of Indigenous status in administrative databases and in health care settings. Partnerships with local Indigenous nations should be developed prior to the systematic collection of Indigenous identifiers in health administrative data. The QAT revealed that many research articles do not include adequate information to describe how Indigenous communities and stakeholders have been involved in this research.</p><p><strong>Conclusion: </strong>There is consensus within the academic literature that improving Indigenous health should be of high priority for health care systems globally. To address data disparities, governments and health organizations are encouraged to work in collaboration with local Indigenous nations and stakeholders at every step from conceptualization, data collection, analysis, to ownership. This finding highlights the need for future research to provide transparent explanation of how meaningful Indigenous collaboration is achieved in their research.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"210-221"},"PeriodicalIF":1.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138805408","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":"Engaging health care professionals in quality improvement: A qualitative study exploring the synergies between projects of professionalisation and institutionalisation in quality improvement collaborative implementation in Denmark.","authors":"Kathrine Carstensen, Joanne Goldman, Anne Mette Kjeldsen, Stina Lou, Camilla Palmhøj Nielsen","doi":"10.1177/13558196241231169","DOIUrl":"10.1177/13558196241231169","url":null,"abstract":"<p><strong>Objective: </strong>To examine the projects of professionalisation and institutionalisation forming health care professions' engagement in quality improvement collaborative (QIC) implementation in Denmark, and to analyse the synergies and tensions between the two projects given the opportunities afforded by the QICs.</p><p><strong>Methods: </strong>This was a cross-sectional interview study with professionals involved in the implementation of two national QICs in Denmark involving 23 individual interviews and focus group discussions with 75 people representing different professional groups. We conducted a reflexive thematic analysis of the data, drawing on institutional contributions to organisational studies of professions.</p><p><strong>Results: </strong>Study participants engaged widely in QIC implementation. This engagement was formed by a constructive interplay between the professions' projects of professionalisation and institutionalisation, with only few tensions identified. The project of professionalisation relates to a self-oriented agenda of contributing professional expertise and promoting professional recognition and development, while the project of institutionalisation focuses on improving health care processes and outcomes and advancing quality improvement. Both projects were largely similar across professional groups. The interplay between the two projects was enabled by the bottom-up approach to implementation, participation of QI specialists, and a clear focus on developing and delivering high-quality patient care.</p><p><strong>Conclusions: </strong>Future strategies for QIC implementation should position QICs as a framework that promotes the integration of professions' projects of professionalisation and institutionalisation to successfully engage professionals in the implementation process, and thereby optimise the effectiveness of QICs in health care.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"163-172"},"PeriodicalIF":2.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139672008","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":"Minding the gaps: Recognising ancillary staff contributions in care homes during the COVID-19 pandemic.","authors":"Fiona Marshall","doi":"10.1177/13558196241249347","DOIUrl":"10.1177/13558196241249347","url":null,"abstract":"","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"141-142"},"PeriodicalIF":2.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858167","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 happens when private general practitioners receive incentivisation offers from pharmaceutical sales representatives? A qualitative study in Pakistan.","authors":"Muhammad Naveed Noor, Afifah Rahman-Shepherd, Sabeen Sharif Khan, Rumina Hasan, Amna Rehana Siddiqui, Iqbal Azam, Faiza Bhutto, Afshan Khurshid Isani, Sameen Siddiqi, Robyna Irshad Khan, Sadia Shakoor, Mishal Khan","doi":"10.1177/13558196241230853","DOIUrl":"10.1177/13558196241230853","url":null,"abstract":"<p><strong>Objectives: </strong>Pharmaceutical incentivisation of physicians for profit maximisation is a well-documented health system challenge. This study examined general practitioners' (GPs) reactions to pharmaceutical incentivisation offers in one region in Pakistan.</p><p><strong>Methods: </strong>We used the Standardised Pharmaceutical Sales Representative (SPSR) method and qualitative interviews with GPs. SPSRs were field researchers representing mock pharmaceutical companies who recorded their observations of 267 GPs' responses to pharmaceutical incentivisation offers. We triangulated SPSR data using qualitative interviews with a subset of the same GPs to gather information about how they interpreted different interaction outcomes.</p><p><strong>Results: </strong>We found four major outcomes for GPs being offered incentives by pharmaceutical companies for prescribing medications. GPs might agree to make incentivisation deals, reject incentivisation offers, disallow PSRs to access them, or remain indeterminate with no clear indication of acceptance or rejection of incentivisation offers. GPs rejecting SPSRs' incentivisation offers indicated having active commitments to other pharmaceutical companies, not being able to work with unheard-of companies, and asking SPSRs to return later.</p><p><strong>Conclusions: </strong>The GP-pharmaceutical sales representative interaction that centres on profit-maximisation is complex as offers to engage in prescribing for mutual financial benefit are not taken up immediately. The SPSR method helps understand the extent of distortion of practices impacted by incentivisation. Such an understanding can support the development of strategies to control unethical behaviours.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"173-181"},"PeriodicalIF":1.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139650902","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":"'I'm a bit of an invisible worker' - Health care and social sector students' experiences of casual and temporary agency work.","authors":"Marja Hult, Jessie Gevaert, Leena Rekola, Raili Honkanen-Korhonen, Kati Ylikahri","doi":"10.1177/13558196231224362","DOIUrl":"10.1177/13558196231224362","url":null,"abstract":"<p><strong>Objectives: </strong>In the wake of national and global personnel shortages, it is becoming increasingly common for students to undertake casual and temporary agency work in the health care and social sectors. This phenomenon can have both advantages and disadvantages for these workers. The objective of this study was to describe health care and social sector students' experiences of such work.</p><p><strong>Methods: </strong>Students currently undertaking casual work in the health care and social sector in Finland were recruited (<i>n</i> = 28). Qualitative semi-structured interviews of these students were conducted in March to May 2021. The data were analysed using inductive content analysis.</p><p><strong>Results: </strong>Respondents reported some positive aspects of casual work. In particular, they liked the freedom to choose the workplace and working times that suited them. However, respondents' experiences were mostly negative. They perceived the induction into work as being insufficient, felt they had too few opportunities to give and receive feedback and believed they were not accepted into the working community.</p><p><strong>Conclusions: </strong>Students who have bad experiences while undertaking causal work in the health care and social sectors may develop an aversion towards working in those sectors after graduating. In order to ensure the sectors are attractive to graduates, casual student workers' induction and experience of the workplace must be improved.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"182-190"},"PeriodicalIF":2.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139485704","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":"Single-handed versus multiple-handed general practices: A cross-sectional study of quality outcomes in England.","authors":"Ian Holdroyd, William Chadwick, Adam Harvey-Sullivan, Theodore Bartholomew, Efthalia Massou, Victoria Tzortziou Brown, John Ford","doi":"10.1177/13558196231218830","DOIUrl":"10.1177/13558196231218830","url":null,"abstract":"<p><strong>Objectives: </strong>As general practice increasingly moves towards large group practices, there is debate about the relative benefits, safety and sustainability of different care delivery models. This study investigates the performance of single-handed practices compared to practices with multiple doctors in England, UK.</p><p><strong>Methods: </strong>Practices in England with more than 1000 patients were included. Workforce data and a quality control process classified practices as single-handed or multiple-handed. Outcomes were (i) GP patient survey scores measuring access, continuity, confidence in health professional and overall satisfaction; (ii) reported diabetes and hypertension outcomes; and (iii) emergency department presentation rates and cancer detection (percentage of cancers diagnosed by a 2-week wait). Generalised linear models, controlling for patient and practice characteristics, compared outcomes in single and multiple-handed practices and assessed the effect of GP age in single-handed practices.</p><p><strong>Results: </strong>Single-handed practices were more commonly found in areas of high deprivation (41% compared to 20% of multiple-handed practices). Single-handed practices had higher patient-reported access, continuity and overall satisfaction but slightly lower diabetes management and cancer detection rates. Emergency department presentations were higher when controlling for patient characteristics in single-handed practices but not when also controlling for practice rurality and size. Increased deprivation was associated with lower performance in seven out of eight outcomes.</p><p><strong>Conclusions: </strong>We found single-handed practices to be associated with high patient satisfaction while performing slightly less well on selected clinical outcomes. Further research is required to better understand the association between practice size, including increasing multidisciplinary working, on patient experience and outcomes.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"201-209"},"PeriodicalIF":2.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138805414","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":"Has the NHS national extended access scheme delivered its policy aims? A case study of two large scale extended access providers.","authors":"Patrick Burch, William Whittaker, Peter Bower, Katherine Checkland","doi":"10.1177/13558196231216657","DOIUrl":"10.1177/13558196231216657","url":null,"abstract":"<p><strong>Objectives: </strong>In 2018, NHS England mandated that all patients in England should be able to access general practice services outside of ordinary hours. While some patients would access additional hours at their own practice, others would need supra-practice level provision - that is, they would be seen in a different location and by a different care team. The policy aim was to enhance patient access to care, with a particular focus on those who work during the day. This study examines (a) how supra-practice level provision of extended access appointments for general medical problems are operationalised and (b) whether the aims of the policy are being met.</p><p><strong>Methods: </strong>This study presents qualitative comparative case studies of two contrasting service providers offering extended access. The data collected included 30 hours of clinician-patient observations, 25 interviews with staff, managers, and commissioners, 20 interviews with patients, organisational protocols/documentation, and routinely collected appointment data. Thematic analysis ran concurrently with data gathering and facilitated the iterative adaptation of data collection.</p><p><strong>Results: </strong>Three cross-cutting themes were identified: extended access is being used to bolster a struggling primary care system, extended access provides a different service to in-hours general practice, and it is difficult for extended access to provide seamless care.</p><p><strong>Conclusions: </strong>Supra-practice access models can provide effective care for most patients with straightforward issues. When ongoing management of complex problems is required, this model of patient care can be problematic.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"191-200"},"PeriodicalIF":2.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136397747","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}