Journal of Health Services Research & Policy最新文献

{"title":"Beyond mitigation: Adaptation, policy and resilience for health services facing climate change.","authors":"John Richmond, Cheryl Mitchell","doi":"10.1177/13558196261447201","DOIUrl":"10.1177/13558196261447201","url":null,"abstract":"","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"141-143"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773447","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":"Persistent use of body mass index policies as a barrier to surgery: Prevalence and analysis of policies across England in 2025.","authors":"Kevin Ofosu, Katie Whale, Joanna McLaughlin","doi":"10.1177/13558196251405207","DOIUrl":"10.1177/13558196251405207","url":null,"abstract":"<p><p>BackgroundIntegrated Care Boards (ICBs) in England are responsible for commissioning healthcare services and setting access policies for procedures such as hip and knee replacement surgery. While the National Institute for Health and Care Excellence (NICE) advises against body mass index (BMI)-based restrictions, many ICBs impose such criteria. This study examines the prevalence and content of these policies to understand their impact on equitable healthcare access.MethodsA qualitative content analysis was conducted to systematically evaluate the policies set by all 42 ICBs in England regarding access to hip and knee replacement surgery for patients living with obesity. Policies were collected from official ICB websites and Google searches, completed in February 2025, and categorised as: no policy, restrictive policy, and non-restrictive policy. The alignment of these policies with clinical guidance was assessed, focusing on their potential impact on equitable healthcare access.ResultsPolicy documents were identified for 41 ICBs: 26 included weight management guidance and 15 imposed BMI-based restrictions on joint replacement referral eligibility. Policies varied in naming, terminology, and specificity, risking inconsistencies in interpretation and implementation. Some ICBs (<i>n</i> = 3) had revoked BMI-based restrictions in recent policy updates, reflecting a shift towards individualised clinical assessments. These findings highlight variability in policy approaches and the evolving stance on BMI-related eligibility criteria.ConclusionsOne third of ICBs still use policies that contradict NICE guidance by restricting access to joint replacement surgery for those with high BMI, while many others apply ambiguous language. These inconsistencies highlight concerns about policies that may influence equitable access to care. Further work is required to evaluate how BMI-related eligibility criteria are applied in practice and their impact on health inequalities.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"173-180"},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654415","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":"Patient reported outcomes of home diagnostics with colon capsule endoscopy - results from the 5G-SUCCEEDS study.","authors":"Cassie Conway, Gohar Jalayeri Nia, Chander Shakher, Ramesh P Arasaradnam","doi":"10.1177/13558196261460333","DOIUrl":"https://doi.org/10.1177/13558196261460333","url":null,"abstract":"<p><p>ObjectiveTo evaluate patient experiences with a remote Colon Capsule Endoscopy (CCE) service delivered through the 5G-SUCCEEDS initiative, utilizing the InteliGI Smartbox for home-based diagnostics with remote clinical supervision.MethodsThis mixed-methods service evaluation involved 25 patients referred from primary care with low-to-intermediate colorectal cancer risk, or under post-polypectomy surveillance. Patients received a Smartbox with CCE equipment, including a capsule, receiver belt, and a tablet for remote videoconferencing with clinical staff. Data on patient experience, confidence, and satisfaction were collected through surveys and semi-structured interviews. Twenty-two participants returned the questionnaire, and eight completed semi-structured interviews. The Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework was used for thematic analysis.ResultsAnalysis of the technology showed that most patients rated the Smartbox as user-friendly, with bowel preparation noted as the most challenging aspect. Analysis of the value proposition of the innovation showed that most patients expressed satisfaction with remote CCE. Videoconferencing was essential for ensuring correct equipment setup and providing patient reassurance. Patients valued the convenience of performing the procedure at home, with most able to continue their daily activities. Analysis of the adopter system found that most patients reported that they did not need any assistance from a family member or a nurse while doing the procedure.ConclusionThis study indicates the patient acceptance of home-delivered CCE through the 5G-SUCCEEDS initiative. The results suggest that remote CCE, supported by 5G technology and the InteliGI Smartbox (or alternative), offers a viable and patient-centred alternative to in-clinic colonscopy procedures.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196261460333"},"PeriodicalIF":2.2,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301566","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 synchronous telehealth versus face-to-face care for asthma management: A systematic review.","authors":"Aisha Towhari, Victoria McCreanor, Xenia Dolja-Gore, Penny Reeves, Ebbah Jiriengwa, Finn Hamilton, Christine Paul","doi":"10.1177/13558196261452641","DOIUrl":"https://doi.org/10.1177/13558196261452641","url":null,"abstract":"<p><p>ObjectivesAsthma is a prevalent chronic condition that affects approximately 300 million people worldwide, posing a significant health and economic burden. Effective management is often hindered by barriers to in-person care. Telehealth has emerged as a potential solution to enhance access to asthma care, yet its economic implications remain unclear. This review synthesizes evidence on the cost-effectiveness of synchronous telehealth compared to standard asthma care.MethodsA systematic search of eight electronic databases (MEDLINE, EMBASE, Web of Science, CINAHL, Cochrane Library, Tufts Cost-Effectiveness Analysis Registry, NHS Economic Evaluations Database, and EconLit) was conducted from January 2000 to June 2024, with searches repeated in January 2026, for economic evaluations of telehealth interventions in asthma care. The reporting quality was assessed using the CHEERS checklist, and results were synthesized narratively.ResultsFour studies (published between 2005 and 2008) from high-income countries (UK and Australia) assessed telephone-based telehealth over periods ranging from 3 to 12 months compared to in-person care. Telehealth interventions resulted in higher asthma review rates, shorter visit durations, and lower costs per consultation but showed no consistent improvements in asthma control or quality of life.ConclusionsSynchronous telehealth appears to be a cost-effective approach for increasing asthma review rates. However, evidence of its impact on quality of life and symptom control remains limited. Further recent studies with improved reporting are required to assess the long-term health economic value of telehealth in asthma care.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196261452641"},"PeriodicalIF":2.7,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148031518","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":"Facilitators and barriers to implementing new models of care for patients in a rehabilitation care setting: A systematic review.","authors":"Nabila Binte Haque, Reidar P Lystad, Jeffrey Braithwaite, Rebecca J Mitchell","doi":"10.1177/13558196261454533","DOIUrl":"https://doi.org/10.1177/13558196261454533","url":null,"abstract":"<p><p>IntroductionThis systematic review aimed to synthesize evidence on the key findings of evaluations of implementation of models of care in rehabilitation and describe facilitators and barriers to implementing new models of care.MethodSix electronic databases were searched. Abstracts and full texts were screened and critically appraised. Facilitators and barriers were classified using the Consolidated Framework for Implementation Research version 2.0.ResultsOf the 64 studies identified, 52 (81%) were new care models implemented in a hospital and 12 (19%) were situated in a home or community-based setting. Common implementation evaluation metrics reported included fidelity (n = 15), adherence (n = 16), feasibility (n = 14), and acceptability (n = 12). Facilitator domains were innovation source (e.g., uncomplicated models), outer setting (e.g., positive attitude), inner setting (e.g., teamwork or motivation), individuals (e.g., skill) and implementation (e.g., planning according to need and context). Barrier domains were innovation source (e.g., model complexity), outer setting (e.g. .organisational culture), inner setting (e.g., staff turnover, training, or resources,), individuals (e.g., no champions) and implementation (e.g., lack of planning).ConclusionsThe review highlights the importance of planning before implementing new models of care in rehabilitation settings to address potential facilitators and barriers in a real-world environment.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196261454533"},"PeriodicalIF":2.7,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015794","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":"Moving toward integrated care for perinatal opioid use disorder and mental health in an urban safety-net hospital: A formative implementation evaluation.","authors":"Gretchen J R Buchanan, Tori Simenec, Biftu Abdullahi, Lauren K Graber, Sandra J Japuntich, Helen G Kim","doi":"10.1177/13558196261450422","DOIUrl":"10.1177/13558196261450422","url":null,"abstract":"<p><p>BackgroundOpioid use disorder (OUD) among pregnant and parenting individuals in the U.S. is a major public health concern. Current policies and procedures are not conducive to effective management of OUD in perinatal patients, who require multidisciplinary approaches. These approaches can challenge rigid healthcare structures, protocols, and staff beliefs. A formative evaluation was conducted of an integrated model of care, introduced as a first step in a system change process to provide comprehensive care to patients with perinatal OUD.MethodsRapid qualitative analysis was conducted of interviews with hospital staff (n = 19), staff at local organizations serving the population (n = 15), and patients (n = 5). Using the PRISM implementation framework, we evaluated current resources, gaps in care, treatment priorities, and feasibility, acceptability, and appropriateness of proposed changes.ResultsThere is a need for a centralized, long-term, healthcare system-linked space where pregnant and parenting women can obtain evidence-based, culturally- and life-stage-competent OUD treatment. Changing governmental policies is not enough to effect change; champions within the system are needed to advocate for changes in organizational policies and staff training. System-level changes must reduce departmental silos, improve integration with community and public health resources, and address the culture of stigma to create psychological safety for patients. Patients need to feel safe and supported throughout the healthcare system.ConclusionThe proposed integrated model of care was acceptable and appropriate; hospital employees provided clear guidance to ensure feasibility. Developing a multidisciplinary care team with coordinated care pathways, data reporting infrastructure, and staff education to reduce stigma are next steps.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196261450422"},"PeriodicalIF":2.7,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147930345","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":"Impediments to diabetes management among older women: A qualitative study from rural Meghalaya, India.","authors":"Alacrity Muksor, Daksha Parmar","doi":"10.1177/13558196261437023","DOIUrl":"https://doi.org/10.1177/13558196261437023","url":null,"abstract":"<p><p>ObjectivesThis study aims to explore the impediments to diabetes management among older women living in rural areas of Meghalaya, a northeastern state in India.MethodsThe study adopted a narrative inquiry approach. In-depth interviews were conducted with 29 older women (aged 60 and above), selected purposively. Findings were analyzed thematically using the open or inductive coding approach in NVivo 12.0.ResultsSeven key themes emerged from the study. These were: (i) negative impacts of physiological changes on diabetes management for the participants, (ii) weak social support which hindered diabetes care, (iii) experiences of ill-treatment by relatives and a sense of helplessness, (iv) caregiving roles as barriers to care, (v) difficulties in accessing treatment due to geographical barriers, (vi) expensive treatment due to comorbidities, and (vii) feelings of guilt due to financial dependency.ConclusionsOur study found a confluence of structural and individual-level barriers that hindered diabetes management among older women in rural Meghalaya. These barriers were linked not only to age and disease but also to gendered social roles, systemic health care gaps, and economic insecurity. This study emphasises the need to reinforce current healthcare policies and programmes targeting older women and to advocate for a comprehensive, multisectoral approach to address these issues effectively.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196261437023"},"PeriodicalIF":2.7,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147607993","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 is the quality of care at the end of life? Qualitative findings from a nationally-representative post-bereavement survey across England and Wales.","authors":"Joanna Goodrich, Sophie Pask, Chukwuebuka Okwuosa, Therese Johansson, Lynn Laidlaw, Cara Ghiglieri, Rachel Chambers, Anna E Bone, Stephen Barclay, Fliss E M Murtagh, Katherine E Sleeman","doi":"10.1177/13558196251398678","DOIUrl":"10.1177/13558196251398678","url":null,"abstract":"<p><p>ObjectivesTo explore the quality of end-of-life care in England and Wales using the experiences of bereaved family carers, and to develop person-centred quality of care domains for end-of-life care.MethodsQualitative analysis of free-text responses from a nationally-representative cross-sectional post-bereavement survey. Inductive thematic analysis of free-text responses to open-ended questions about care in last 3 months of life, circumstances of death, and experiences of care and bereavement, guided by the Institute of Medicine's quality domains. Participants were adults who registered the death of an adult relative in England and Wales between August and December 2022, identified using mortality data and stratified sampling (by age, gender, cause of death, place of death and geographical area).ResultsOf 1194 respondents, 1083 (90.7%) gave at least one free-text response. Six themes about quality of end-of-life care were identified: (1) accessing care; (2) timely and coordinated care; (3) individualised care; (4) the nature of communication and care; (5) family-centred care and support; and (6) safe and equitable care. Difficulty accessing care, challenges navigating a complex system, and poorly-coordinated care were interpreted as leading to a lack of physical and psychological safety. Timeliness of care was considered paramount but often not achieved. <i>How</i> care was provided was as important as <i>what</i> was provided: empathic relational care (in contrast to transactional, task-based care) led to dying people and their families reporting feeling reassured, supported and safe.ConclusionsWe identify aspects of quality important for care which are currently not always achieved, and provide a refined model of the quality of end-of-life care to guide policy and research.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"85-97"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12988001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850209","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":"Navigating North Carolina's Medicaid transformation: Caregivers' perspectives through a family-centered lens.","authors":"Brittany J Raffa, Monisa Aijaz, Brenda Amezquita-Castro, Paula H Song, Valerie A Lewis, Christopher M Shea","doi":"10.1177/13558196251395593","DOIUrl":"10.1177/13558196251395593","url":null,"abstract":"<p><p>BackgroundMedicaid provides health insurance for 40% of the United States (US) pediatric population. There is an increasing trend among states to transition from a fee-for-service model for Medicaid reimbursement to relying on risk-based delivery systems using Managed Care Organizations (MCOs). In 2021, most beneficiaries in North Carolina (NC) transitioned to one of five MCOs from Medicaid Direct. While research has examined the effects of these transitions, less is known on the impact of MCOs on the experiences of caregivers of children getting care for themselves and their children. This study aimed to explore the experiences of caregivers following the NC Medicaid Transformation, both in enrolling and accessing care for themselves, when applicable, and for their children.MethodsWe conducted a qualitative descriptive study to examine experiences of caregivers of children during the NC Medicaid Transformation. We identified participants from clinic sites and health services organizations in North Carolina. Nineteen caregivers participated in semi-structured interviews or a focus group. We conducted rapid qualitative analysis of transcripts for timely, action-oriented analysis. Rapid qualitative analysis involved developing a summary template with inductive domains from the interview guide categories.ResultsAmong caregivers, all were mothers, and the majority resided in urban areas. Eleven caregivers were adult Medicaid beneficiaries in addition to their child receiving Medicaid. Caregivers described a variety of experiences and three themes were identified: increased obstacles among families with health conditions requiring additional care and non-English speakers; crucial role of clinical staff in navigating the transformation and accessing care; satisfaction with MCOs despite challenges.ConclusionsIncreasing access to specialty care by strengthening network adequacy standards, investing trained support staff within MCOs on how to best serve families with health conditions requiring additional care and non-English speaking families, and reimbursing clinical staff who are already performing a care management role, could positively impact families receiving care through Medicaid MCOs.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"110-119"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding why health professionals are leaving the UK national health service (NHS) - A systematic review and narrative synthesis.","authors":"Chukwunwuba R Onyejesi, Tiffeny James, Kalpa Kharicha","doi":"10.1177/13558196251384845","DOIUrl":"10.1177/13558196251384845","url":null,"abstract":"<p><p>BackgroundThere is a global health care workforce crisis with staff shortages and difficulties with recruitment and retention, including in the UK's National Health Service (NHS). To address this, it is important to understand why people decide to leave the NHS. Previous reviews have focused on specific NHS professions and have rarely considered factors in other settings which attract staff away from the NHS. This review aimed to include all professions in a systematic review of factors which \"push\" clinical staff to leave, or consider leaving, the NHS and which \"pull\" them to other destinations.MethodsWe searched PubMed, Web of Science, CINAHL, and EMBASE for peer-reviewed articles and Google Scholar for grey literature using search terms related to all NHS professions and intentions to leave the NHS. We included qualitative, quantitative, and mixed methods studies and analysed data using a textual narrative synthesis with an integrated design.ResultsThirty-two papers were eligible for inclusion. We identified four key push factors: (1) high job demands due to, for example, staff shortages and increased workload; (2) failing organisational structures including poor pay and limited opportunities for career development; (3) personal and emotional factors such as work-related health issues and poor work/life balance, and (4) wider factors, including Brexit. The majority of factors identified as being responsible for high turnover were related to job demands and the organisational structure within the NHS. Factors pulling people to other destinations were discussed less frequently than push factors, but included perceptions of better: pay, working conditions, and work/life balance in other countries. Limitations to the studies included in the review were that evidence on all NHS professions was not available, and many of the studies were based on data collected retrospectively with the risk of recall bias.ConclusionPull and push factors affect multiple NHS professions. Further comparative studies comparing the UK with other countries can help inform potential interventions to improve staff retention.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"125-139"},"PeriodicalIF":2.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12988014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}