Journal of Health Services Research & Policy最新文献

{"title":"CORRECTION NOTICE \"Family physician services and blood pressure control in China: A population-based retrospective cohort study\".","authors":"","doi":"10.1177/13558196231158944","DOIUrl":"https://doi.org/10.1177/13558196231158944","url":null,"abstract":"","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196231158944"},"PeriodicalIF":2.4,"publicationDate":"2023-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9105179","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 to the delivery of clinical diabetes services in Ghana created by the COVID-19 pandemic.","authors":"Eunice Twumwaa Tagoe,&nbsp;Justice Nonvignon,&nbsp;Robert van Der Meer,&nbsp;Itamar Megiddo,&nbsp;Brian Godman","doi":"10.1177/13558196221111708","DOIUrl":"https://doi.org/10.1177/13558196221111708","url":null,"abstract":"<p><strong>Objective: </strong>The barriers to delivering clinical non-communicable disease services in low- and middle-income countries have risen with the onset of COVID-19. Using Ghana as a case study, this article examines the changes COVID-19 has brought to diabetes service delivery and considers policy responses to deal with future such outbreaks.</p><p><strong>Methods: </strong>We conducted 18 interviews between November 2020 and February 2021 with health professionals and administrators from primary, secondary and tertiary facilities within the Ghana Health Service. The analysis was performed using deductive and inductive methods.</p><p><strong>Results: </strong>There were six general themes in interviewees' responses: (1) COVID-19 had exacerbated the problems of high medicine and service costs and medicine shortages, (2) the pandemic had exacerbated problems of poor patient record keeping, (3) COVID-19 had reduced the availability of suitably trained health providers, (4) staff had become demoralized by management's unwillingness to make innovative changes to cope with the pandemic, (5) COVID-19 led to a reorganization of diabetes services, and (6) the country's national health insurance scheme lacked flexibility in dealing with the pandemic.</p><p><strong>Conclusions: </strong>Access to resources is limited in LMICs. However, our study highlights practical policy responses that can improve health providers' response to COVID-19 and future pandemics.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"28 1","pages":"58-65"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9253720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9189789","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":"Engagement of patient and family advisors in health system redesign in Canada.","authors":"Shannon L Sibbald,&nbsp;Kristina M Kokorelias,&nbsp;Gayathri Embuldeniya,&nbsp;Walter P Wodchis","doi":"10.1177/13558196221109056","DOIUrl":"https://doi.org/10.1177/13558196221109056","url":null,"abstract":"<p><strong>Objectives: </strong>Globally, there has been a shift towards integrated care delivery and patient-centredness in the design of health services. Such a transformation is underway in Ontario, which is progressively using an interprofessional team-based approach known as Ontario Health Teams (OHTs) to deliver care. During their initial development, OHTs were required to integrate patient and families' preferences, experiences and opinions in the form of consultation and partnership with patient and family advisors (PFAs). This study aimed to understand how PFAs were involved in the early stages of planning for health system change and the perceived benefits of including PFAs in system reform.</p><p><strong>Methods: </strong>This study used a qualitative descriptive design. Semi-structured interviews were conducted with 126 participants at 12 OHTs, including PFA (<i>n</i> = 16) and non-PFA (<i>n</i> = 110) members (e.g. clinicians). Data were analysed thematically.</p><p><strong>Results: </strong>We identified four themes; mechanisms of engagement, motivations to engage, challenges to PFA engagement and PFAs' impact and added value. Overall, participants viewed PFA engagement positively and PFAs felt valued and empowered. There remain logistical challenges around PFA compensation, and the amount of time and training expected of PFAs. However, all participants believed that developing an understanding of the patient, caregiver and family experience will strengthen the engagement of PFAs in OHT planning, decisions and policies.</p><p><strong>Conclusions: </strong>Diverse approaches to and stages of PFA engagement fostered meaningful and highly valued contributions to OHT development. These were considered critical to successfully achieving the mandate of patient-centred care reform.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"28 1","pages":"25-33"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5a/b6/10.1177_13558196221109056.PMC9850384.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10689808","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":"Immigrants' and refugees' experiences of access to health and social services during the COVID-19 pandemic in Toronto, Canada.","authors":"Doris Leung,&nbsp;Charlotte Lee,&nbsp;Angel He Wang,&nbsp;Sepali Guruge","doi":"10.1177/13558196221109148","DOIUrl":"https://doi.org/10.1177/13558196221109148","url":null,"abstract":"<p><strong>Objective: </strong>In 2020, the World Health Organization reported that immigrants were the most vulnerable to contracting COVID, due to a confluence of personal and structural barriers. This study explored how immigrants and refugees experienced access to health and social services during the first wave of COVID-19 in Toronto, Canada.</p><p><strong>Methods: </strong>This study analyzed secondary data from a qualitative study that was conducted between May and September 2020 in Toronto that involved semi-structured interviews with 72 immigrants and refugees from 21 different countries. The secondary data analysis was informed by critical realism.</p><p><strong>Results: </strong>The vast majority of participants experienced fear and anxiety during the COVID-19 outbreak but through a combination of self-reliance and community support came to terms with the realities of the pandemic. Some even found the lifestyle changes engendered by the pandemic a positive experience.</p><p><strong>Conclusions: </strong>Self-reliance may hinder help-seeking and augment the threat of COVID-19. This is particularly a concern for the most vulnerable immigrants, who experience multiple disruptions in their health care, have limited material resources and social supports, and perhaps are still dealing with the challenges of settling in the new country.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"28 1","pages":"34-41"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fd/0d/10.1177_13558196221109148.PMC9382571.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9203307","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":"Readmission trends before and after a national reconfiguration of emergency departments in Denmark.","authors":"Søren Bie Bogh,&nbsp;Marianne Fløjstrup,&nbsp;Sören Möller,&nbsp;Mickael Bech,&nbsp;Annmarie T Lassen,&nbsp;Mikkel Brabrand,&nbsp;Christian B Mogensen","doi":"10.1177/13558196221108894","DOIUrl":"https://doi.org/10.1177/13558196221108894","url":null,"abstract":"<p><strong>Objective: </strong>In order to achieve better and more efficient emergency health care, the Danish public hospital system has been reconfigured, with hospital emergency care being centralised into extensive and specialised emergency departments. This article examines how this reconfiguration has affected patient readmission rates.</p><p><strong>Methods: </strong>We included all unplanned hospital admissions (aged ≥18 years) at public, non-psychiatric hospitals in four geographical regions in Denmark between 1 January 2007 and 24 December 2017. Using an interrupted time-series design, we examined trend changes in the readmission rates. In addition to analysing the overall effect, analyses stratified according to admission time of day and weekdays/weekends were conducted. The analyses were adjusted for patient characteristics and other system changes.</p><p><strong>Results: </strong>The seven-day readmission rate increased from 2.6% in 2007 to 3.8% in 2017, and the 30-day rate increased from 8.1% to 11.5%. However, the rates were less than what they would have been had the reconfiguration not been introduced. The reconfiguration reduced the seven-day readmission rate by 1.4% annually (hazard ratio [CI 95%] 0.986 [0.981-0.991]) and the 30-day rate by 1% annually (hazard ratio [CI 95%] 0.99 [0.987-0.993]).</p><p><strong>Conclusions: </strong>Reconfiguration reduced the rate of increase in readmissions, but nevertheless readmissions still increased across the study period. It seems hospitals and policymakers will need to identify further ways to reduce patient loads.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"28 1","pages":"42-49"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9203305","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":"Financing primary health care in low- and middle-income countries: A research and policy agenda.","authors":"Kara Hanson,&nbsp;Dina Balabanova,&nbsp;Nouria Brikci,&nbsp;Darius Erlangga,&nbsp;Timothy Powell-Jackson","doi":"10.1177/13558196221135741","DOIUrl":"https://doi.org/10.1177/13558196221135741","url":null,"abstract":"","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"28 1","pages":"1-3"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10628170","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":"Audit of submissions: July 2021-June 2022.","authors":"","doi":"10.1177/13558196221148050","DOIUrl":"https://doi.org/10.1177/13558196221148050","url":null,"abstract":"","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"28 1","pages":"4"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9090699","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":"Encouraging openness in health care: Policy and practice implications of a mixed-methods study in the English National Health Service.","authors":"Graham Martin, Sarah Chew, Imelda McCarthy, Jeremy Dawson, Mary Dixon-Woods","doi":"10.1177/13558196221109053","DOIUrl":"10.1177/13558196221109053","url":null,"abstract":"<p><strong>Objective: </strong>The National Health Service (NHS) in England has introduced a range of policy measures aimed at fostering greater openness, transparency and candour about quality and safety. We draw on the findings of an evaluation of the implementation of these policies in NHS organisations, with the aim of identifying key implications for policy and practice.</p><p><strong>Methods: </strong>We undertook a mixed-methods policy evaluation, comprising four substudies: a longitudinal analysis of data from surveys of NHS staff and service users; interviews with senior stakeholders in NHS provider organisations and the wider system; a survey of board members of NHS provider organisations and organisational case studies across acute, community and mental health, and ambulance services.</p><p><strong>Results: </strong>Our findings indicate a mixed picture of progress towards improving openness in NHS organisations, influenced by organisational history and memories of past efforts, and complicated by organisational heterogeneity. We identify four features that appear to be necessary conditions for sustained progress in improving openness: (1) authentic integration into organisational mission is crucial in making openness a day-to-day concern; (2) functional and effective administrative systems are vital; (3) these systems must be leavened by flexibility and sensitivity in implementation and (4) a spirit of continuous inquiry, learning and improvement is required to avoid the fallacy that advancing openness can be reduced to a time-limited project. We also identify four persistent challenges in consolidating and sustaining improvement: (1) a reliance on goodwill and discretionary effort; (2) caring for staff, patients and relatives who seek openness; (3) the limits of values-driven approaches on their own and (4) the continued marginality of patients, carers and families.</p><p><strong>Conclusions: </strong>Variation in policy implementation offers important lessons on how organisations can better deliver openness, transparency and candour. These lessons highlight practical actions for policymakers, managers and senior clinicians.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"28 1","pages":"14-24"},"PeriodicalIF":1.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/36/9e/10.1177_13558196221109053.PMC9850378.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10627628","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":"Trauma and resilience informed research principles and practice: A framework to improve the inclusion and experience of disadvantaged populations in health and social care research.","authors":"Natalie L Edelman","doi":"10.1177/13558196221124740","DOIUrl":"https://doi.org/10.1177/13558196221124740","url":null,"abstract":"<p><p>Trauma, socio-economic, cultural and structural issues are associated with poor outcomes for most health conditions and may also make research participation difficult and onerous, perpetuating intervention-generated inequalities by generating evidence from those least in need. Trauma-informed and resilience-informed approaches to care may help address these concerns across health and social care research. These approaches take an empowerment-based response to adversity, and are suitable for integration and extension as Trauma and Resilience Informed Research Principles and Practice (TRIRPP) for studies beyond the topics of resilience and trauma. Four TRIRPP aims were identified: addressing the adversity context that may underpin the lives of research participants and the phenomenon under study; improving study accessibility and acceptability for individuals and populations facing adversity; recognising and addressing traumatisation in potential participants; and recognising and promoting resilience. Recommendations include interview participant control of recording devices, over-sampling of under-represented populations in population surveys, and actively seeking to engage disenfranchised individuals in patient and public involvement from design to dissemination. The practice of research has the power to address adversity and trauma or to perpetuate it at both an individual and a societal level. It is feasible and worthwhile to integrate trauma-informed and resilience-informed approaches across research topics and designs. Further work should extend the TRIRPP recommendations and evaluate their use.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"28 1","pages":"66-75"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4c/d1/10.1177_13558196221124740.PMC9850377.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10634846","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":"General practice managers' motivations for skill mix change in primary care: Results from a cross-sectional survey in England.","authors":"Jon Gibson,&nbsp;Anne McBride,&nbsp;Katherine Checkland,&nbsp;Mhorag Goff,&nbsp;Mark Hann,&nbsp;Damian Hodgson,&nbsp;Imelda McDermott,&nbsp;Matt Sutton,&nbsp;Sharon Spooner","doi":"10.1177/13558196221117647","DOIUrl":"https://doi.org/10.1177/13558196221117647","url":null,"abstract":"<p><strong>Objectives: </strong>The objectives are to determine the factors that motivated GP practice managers in England to employ non-medical roles, and to identify an ideal hypothetical GP practice workforce.</p><p><strong>Methods: </strong>Cross-sectional survey of GP practice managers in England (<i>n</i> = 1205). The survey focused on six non-medical roles: advanced nurse practitioner, specialist nurse, health care assistant, physician associate, paramedic and pharmacist.</p><p><strong>Results: </strong>The three most commonly selected motivating factors were: (i) to achieve a better match between what patients need and what the practitioner team can deliver; (ii) to increase overall appointment availability and (iii) to release GP time. Employment of pharmacists and physician associates was most commonly supported by additional funding. Practice managers preferred accessing new non-medical roles through a primary care network or similar, while there was a clear preference for direct employment of additional GPs, advanced nurse practitioners or practice nurses. The ideal practice workforce would comprise over 70% of GPs and nurses, containing, on average, fewer GPs than the current GP practice workforce.</p><p><strong>Conclusion: </strong>This study confirms that more diverse teams of practitioners are playing an increasing role in providing primary care in England. Managers prefer not to employ all new roles directly within the practice. A more detailed investigation of future workforce requirements is necessary to ensure that health policy supports the funding (whether practice or population based), recruitment, training, deployment and workloads associated with the mix of roles needed in an effective primary care workforce.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"28 1","pages":"5-13"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9850398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10689837","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}