Journal of evaluation in clinical practice最新文献

{"title":"The Effect of Prehabilitation on Health Resource Use and 1-Year Survival: An Observational Cohort Evaluation of the Active Together Service.","authors":"Kerry Rosenthal, Nik Kudiersky, Gabriella Frith, Gail Phillips, Carol Keen, Daniel Howdon, Shaun Barratt, Diana M Greenfield, Gary H Mills, Anna Myers, Liam Humphreys, Robert Copeland","doi":"10.1111/jep.70425","DOIUrl":"https://doi.org/10.1111/jep.70425","url":null,"abstract":"<p><strong>Introduction: </strong>Research suggests that multi-modal prehabilitation can improve quality of life and clinical outcomes. There is, however, limited evidence on the effect of prehabilitation on hospital resource use.</p><p><strong>Methods: </strong>This is a non-randomised observational cohort evaluation. The intervention group were patients receiving multi-modal prehabilitation (Active Together) before surgery for colorectal, lung or upper gastrointestinal cancer between January 2022 and March 2024. Patients who declined to participate in Active Together and historical patient data (2017-2021) were used as comparator groups. Outcome measures were length of hospital stay, length of critical care stay, total number of days spent in hospital as a readmission within 90 days following surgery, and one-year survival rate.</p><p><strong>Results: </strong>Three hundred and five patients completed prehabilitation, 96 patients declined to join the service, and 869 patients were included in the historical dataset. Active Together colorectal patients spent less time in critical care than historical colorectal patients (0.9 vs 1.2 days, p = 0.011). Whereas Active Together lung patients spent longer in critical care than historical lung patients (2.5 vs 1.7 days, p < 0.001). One-year survival rate was greater in Active Together patients compared to the declined group (95% vs 85%, p = 0.013) but did not differ significantly from the historical group (95% vs 92%, p = 0.140). The probability of prehabilitation being more cost-effective than not receiving prehabilitation was 58%, 60%, and 59% for colorectal, lung and upper gastrointestinal patients, respectively.</p><p><strong>Conclusion: </strong>The impact of prehabilitation on healthcare resource use was mixed with promising evidence of a positive effect of prehabilitation and rehabilitation on overall survival. There were notable differences between tumour groups in these outcomes which warrants further investigation. Future research is needed to build on these findings by including a larger sample size, a wider range of tumour groups, and a longer follow up period.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 3","pages":"e70425"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773128","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":"Detail Coverage and Evidence Integration: Evaluating ChatGPT 5.0 and DeepSeek R1 in Guideline-Based Crohn's Disease Applications.","authors":"Hutao Zhou, Tao Yuan, Yueji Ning, Boneng Mao, Mengping Zhu","doi":"10.1111/jep.70440","DOIUrl":"https://doi.org/10.1111/jep.70440","url":null,"abstract":"<p><strong>Background: </strong>Crohn's disease (CD) requires accurate, guideline-based diagnosis and management, yet the growing complexity of therapeutic options and international recommendations creates challenges for timely clinical decision-making. Large language models (LLMs) have emerged as potential tools for clinical decision support, but their performance in guideline-based gastroenterology remains insufficiently characterized.</p><p><strong>Methods: </strong>We conducted a structured comparative evaluation of ChatGPT 5.0 and DeepSeek R1 using 47 standardized clinical questions derived from the 2023 Chinese guidelines for the diagnosis and treatment of CD. Each question was submitted independently to both models under identical conditions, without iterative clarification. Responses were assessed across multiple dimensions, including coverage, guideline consistency, agreement, response length, detail coverage, readability, and structural clarity. Domain-specific analyses were performed for diagnostic, therapeutic, and surgical/management questions.</p><p><strong>Results: </strong>Both models demonstrated high alignment with guideline-based recommendations, with guideline consistency rates of 93% for ChatGPT 5.0% and 96% for DeepSeek R1, and an inter-model agreement rate of approximately 87%. ChatGPT 5.0 showed complete detail coverage across diagnostic, therapeutic, and surgical/management domains (100%) and generated shorter, more concise responses (mean 208 words; range 142-300) with higher readability (mean 4.6/5). DeepSeek R1 achieved 87.5% overall detail coverage, with slightly lower performance in diagnostic (88.2%) and therapeutic (85.2%) categories but equivalent performance in surgical/management questions. Its responses were longer (mean 291 words; range 128-417) and incorporated more trial data, drug comparisons, and cross-guideline references, although readability was lower (mean 3.4/5).</p><p><strong>Conclusions: </strong>ChatGPT 5.0 and DeepSeek R1 demonstrated distinct yet complementary strengths in guideline-based CD applications. ChatGPT 5.0 functioned more effectively as a clinical-ready assistant by providing concise, highly readable, and actionable outputs, whereas DeepSeek R1 was better suited to academic and research-oriented contexts through deeper evidence integration. A hybrid workflow combining rapid point-of-care support from ChatGPT 5.0 with evidence synthesis from DeepSeek R1 may offer optimal utility. Further real-world validation is needed before routine clinical implementation.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 3","pages":"e70440"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773566","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":"Knowledge, Attitudes, Practices and Education Needs of Dentists on Domestic Violence: A Systematic Review.","authors":"Sthefanie Del Carmen Perez Puello, Vitor Rafael Gomes, Brunna Verna Castro Gondinho, Júlia Vitório Octaviani, Eva Zafra Aparici, Luciane Miranda Guerra","doi":"10.1111/jep.70438","DOIUrl":"https://doi.org/10.1111/jep.70438","url":null,"abstract":"<p><p>The objective of the present systematic review was to evaluate the scientific evidence on the knowledge, attitudes, practices level (KAP) and education needs among dentists in the identification of clinical signs and notification of domestic violence (DV). Electronic searches were performed in PubMed/Medline, ScienceDirect, EBSCOHost, Scopus databases, and grey literature using the keywords 'Domestic Violence', 'Abused Women', 'Dentistry', 'Oral health', 'Women's Health Services' and 'Health Knowledge, Attitudes, Practice'. Cross-sectional or longitudinal studies, without restriction on publication year, published in English, using calibrated or validated questionnaires to assess the dentist KAP level and education needs for identification of clinical signs and notification of DV were considered. The Ottawa Scale was applied to assess the risk of bias. In the final analysis, 5 studies were included, conducted in the United States, France, Brazil and Pakistan. The total sample was 1735 general and specialist dentists. All studies showed that the participants had a low level of CAP in identifying clinical signs and reporting DV. In addition, 27% reported having identified at least one case in clinical practice. Most of participants stated that they had not received training on care for victims of DV. The studies had a low risk of bias. Scientific evidence suggests that dentists have a low level of KAP in the identification of clinical signs and notification of DV and have a high need for education in this area.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 3","pages":"e70438"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13103688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773645","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 Cross-Sectional Association of Health Literacy With Medication Self-Management in the Turkish Population: A Systematic Review and Meta-Analysis.","authors":"Gazi Ünlü, Selma Altındiş","doi":"10.1111/jep.70445","DOIUrl":"10.1111/jep.70445","url":null,"abstract":"<p><strong>Background: </strong>Health literacy (HL) is a cornerstone of effective medication use. Yet research has traditionally focused on adherence, producing inconsistent findings. Evidence linking HL to medication knowledge suggests that broader medication self-management frameworks may better capture how HL supports patients as active partners in medication use. This study examines this relationship in the Turkish healthcare system, where high medication use and diverse HL levels provide a relevant context for challenges faced by health systems worldwide.</p><p><strong>Objective: </strong>To systematically evaluate the association between HL and medication self-management in Turkish populations. (1) examining differential associations with medication adherence versus supporting self-management behaviors, (2) explore links with specific subdomains (e.g., knowledge, safe storage), and (3) identify potential moderators such as age and region.</p><p><strong>Methods: </strong>A systematic search of six international databases and the Turkish National Thesis Center identified 47 studies (N = 20,716). HL was assessed with validated tools. Study quality was evaluated using a modified Newcastle-Ottawa Scale. Random-effects meta-analyses estimated pooled effect sizes.</p><p><strong>Results: </strong>Meta-analysis revealed a significant positive association between HL and overall medication self-management (r = 0.248), with a weaker association observed for adherence alone (r = 0.192). Strongest correlations were found for medication literacy and information seeking (r = 0.372), followed by healthcare communication and support utilization (r = 0.290), safe medication handling (r = 0.173), and responsible medication access (r = 0.110). Age significantly moderated the HL-medication self-management relationship, with stronger effects among older adults.</p><p><strong>Conclusions: </strong>HL supports a wide range of medication self-management behaviors, most profoundly in knowledge-based domains. Adopting a person-centered, self-management framework is essential to fully understand HL's role. The findings, contextualized within Türkiye's health system, highlight the global importance of HL-focused interventions, particularly for older populations, to support safe and effective medication use.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 3","pages":"e70445"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729205","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":"Fixed-Effect or Random-Effects Models? How to Choose, Perform and Interpret Meta-Analyses in Clinical Research.","authors":"Javier Arredondo Montero","doi":"10.1111/jep.70431","DOIUrl":"https://doi.org/10.1111/jep.70431","url":null,"abstract":"<p><strong>Rationale: </strong>Meta-analysis is central to evidence-based medicine, yet the implications of model choice remain poorly understood among clinicians. The distinction between fixed-effect and random-effects models is often treated as a technical detail, although it fundamentally defines the scope of inference.</p><p><strong>Aims and objectives: </strong>To provide a conceptually grounded and practically oriented tutorial on how to choose, perform, and interpret fixed-effect and random-effects meta-analyses in clinical research.</p><p><strong>Method: </strong>This tutorial combines conceptual explanations, simulated data and re-analyses of published meta-analyses to illustrate how different modelling frameworks influence pooled estimates, uncertainty intervals and clinical interpretation. Contemporary methodological guidance, including Cochrane recommendations, is integrated throughout.</p><p><strong>Results: </strong>Fixed-effect models yield conditional inferences restricted to the included studies, often producing narrower confidence intervals by ignoring between-study variability. In contrast, random-effects models account for heterogeneity and provide unconditional inferences that generalise to a broader range of clinical settings, typically resulting in wider intervals. Re-analyses demonstrate that statistically significant findings under fixed-effect models may become non-significant when appropriate random-effects methods are applied, particularly when using robust estimators and Hartung-Knapp-Sidik-Jonkman adjustments. Prediction intervals further illustrate the expected variability of effects across future comparable settings.</p><p><strong>Conclusion: </strong>Model choice in meta-analysis is not a statistical afterthought but a conceptual decision that determines the inferential target. Random-effects models will often be more appropriate when the aim is to inform clinical practice across diverse settings, whereas fixed-effect models are appropriate only under strict assumptions or as sensitivity analyses. Transparent reporting and alignment with contemporary methodological standards are essential to ensure valid and clinically meaningful evidence synthesis.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 3","pages":"e70431"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773554","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":"Implementing Systematic Assessment of Physical Function in Hospitalised Medical Patients: Description and Evaluation Guided By the Quality Implementation Framework.","authors":"Helene Nørgaard Kristensen, Jannie Rhod Bloch-Nielsen, Morten Tange Kristensen, Helle Høgh, Loui Hannibal, Anne Mette Schmidt","doi":"10.1111/jep.70447","DOIUrl":"https://doi.org/10.1111/jep.70447","url":null,"abstract":"<p><strong>Rationale: </strong>Although older adults comprise 16%-22% of the population, they account for up to 75% of hospital admissions and nearly half of related costs. Frailty, multimorbidity and reduced physical function are common, requiring assessment and follow-up. Systematic assessment of physical function using the Cumulated Ambulation Score (CAS), 30-second sit-to-stand test (30s-STS), and handgrip strength (HGS) has shown predictive value for outcomes such as length of hospital stay, complications, readmission and survival in hospitalised older patients. This underscores the importance of early intervention in rehabilitation. The successful integration of evidence-based practices necessitates the use of an evidence-based implementation model, such as the Quality Implementation Framework (QIF), which clearly outlines what to address and which actions to take to secure the quality of the implementation process and patient outcomes in the clinical setting.</p><p><strong>Aims and objectives: </strong>This study aims to describe and evaluate the implementation process of systematic assessment of physical function in hospitalised medical patients using QIF.</p><p><strong>Method: </strong>A prospective implementation study, incorporating both quantitative and qualitative methods, was conducted at two medical wards in a Danish hospital. QIF was employed to guide the implementation and the evaluation of the systematic assessment.</p><p><strong>Results: </strong>Implementation of the systematic assessment showed that early stakeholder engagement and leadership support ensured ownership and staff buy-in. A structured implementation plan clarified roles and accountability. Process evaluation revealed high penetration and acceptability, with improved fidelity over time. Workflow challenges remained, and adoption into daily practice among therapists was limited due to time constraints and documentation burden. Expansion to new departments demonstrated scalability.</p><p><strong>Conclusion: </strong>A structured QIF-based approach to implementing systematic assessments in hospitalised medical patients proved feasible, acceptable, and potentially scalable. Stakeholder engagement, management support and strengthened cross-sector collaboration were key to success. Sustainability depends on workflow integration, timely data-driven feedback and continued training.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 3","pages":"e70447"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773591","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":"Transparency in Conflict of Interest Meta-Research: Author Identification and Implications for Clinical Evidence.","authors":"Clovis Mariano Faggion","doi":"10.1111/jep.70448","DOIUrl":"https://doi.org/10.1111/jep.70448","url":null,"abstract":"","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 3","pages":"e70448"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13103689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773396","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 Perceptions of Delays in Audiology Services in Johannesburg: A Secondary Analysis of Waiting Times and Alternative Service Models.","authors":"Katijah Khoza-Shangase, Theresa-Joy Munyembate","doi":"10.1111/jep.70437","DOIUrl":"10.1111/jep.70437","url":null,"abstract":"<p><strong>Background: </strong>Delays in accessing audiology services are a persistent challenge in South Africa's public healthcare sector, leading to late diagnosis, reduced hearing aid uptake and poor rehabilitation outcomes. Beyond individual access barriers, such delays reflect systemic misalignment between service demand, workforce capacity, procurement systems and service delivery models.</p><p><strong>Objective: </strong>This study explored patient perspectives on waiting times and possible service innovations, using a secondary qualitative analysis of interview transcripts.</p><p><strong>Methods: </strong>Fifteen de-identified interviews with adult hearing aid users from Johannesburg's public sector were re-analysed thematically to identify experiences of service delays, systemic barriers and views on alternative delivery models.</p><p><strong>Results: </strong>Participants reported prolonged delays-ranging from several months to over a year-for assessments, hearing aid fittings and follow-up care. Reported systemic barriers included audiologist shortages, inefficient scheduling and delays in hearing aid procurement. Financial constraints and transport difficulties further hindered access, particularly for unemployed participants. Mobile audiology units and tele-audiology were suggested by many participants as potential strategies to improve accessibility, indicating patient support for decentralised and digitally enabled service delivery models, although not all respondents were supportive of remote options.</p><p><strong>Conclusions: </strong>Findings highlight key planning-relevant leverage points for improving audiology service delivery in resource-constrained urban health systems. Larger-scale, multi-site studies are needed to evaluate the feasibility, cost-effectiveness and acceptability of mobile and digital service models before broad policy adoption.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 3","pages":"e70437"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13088938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698860","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":"Evaluation of the Quality of Japanese Clinical Practice Guidelines Using Appraisal of Guidelines for Research and Evaluation II Instrument: A Time Trend Analysis From 2011 to 2022.","authors":"Kanako Seto, Yosuke Hatakeyama, Ryo Onishi, Ryosuke Hayashi, Kunichika Matsumoto, Tomonori Hasegawa","doi":"10.1111/jep.70449","DOIUrl":"https://doi.org/10.1111/jep.70449","url":null,"abstract":"<p><strong>Background: </strong>Clinical Practice Guidelines (CPGs) play a crucial role in promoting evidence-based practice and reducing variations in healthcare delivery. In Japan, approximately 50 CPGs are published annually. However, few studies have systematically evaluated their methodological quality or examined how it has evolved over time using validated assessment tools.</p><p><strong>Aims and objectives: </strong>This study aimed to evaluate trends in the methodological quality of Japanese CPGs published between 2011 and 2022 using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument.</p><p><strong>Methods: </strong>We identified Japanese CPGs published between 2011 and 2022 using the Japanese guideline clearinghouse, jointly operated by the Toho University Medical Media Center and the Japan Medical Abstracts Society. This clearinghouse comprehensively collects all CPGs published in Japan. A total of 658 CPGs were identified by expert librarians based on predefined criteria. Three trained reviewers independently assessed the CPGs using the AGREE II, a validated tool that includes 23 items across 6 domains and one overall assessment item. CPGs intended primarily for patients, translated versions and those not based on evidence-based methodologies were excluded. Domain scores were calculated as percentages of the maximum possible scores. Time trends were evaluated using Spearman's rank correlation coefficient, and inflection points were assessed using joinpoint regression. Paired and independent t-tests were used to compare domain scores between first and revised editions, and between CPGs published in 2011-2014 and those published in 2015-2022.</p><p><strong>Results: </strong>Of the 604 CPGs evaluated, 248 were first editions and 356 were revised editions. Domain 1 (Scope and Purpose) had the highest average score (81.5%), followed by Domain 4 (Clarity of Presentation, 77.0%), while Domain 5 (Applicability) had the lowest (47.7%). Domain 6 (Editorial Independence) showed a significant upward trend (p = 0.01), whereas Domains 1 and 4 declined over time (p < 0.001). Inflection points were identified in 2015 for Domain 4 and in 2018 for overall quality scores. Revised editions showed significant improvements in Domain 5 (p < 0.001) and 6 (p = 0.005), while Domain 1 significantly declined (p = 0.001). CPGs revised and published in 2015-2022 showed fewer improvements than those revised and published in 2011-2014.</p><p><strong>Conclusions: </strong>This study highlights both progress and persistent challenges in the quality of Japanese CPGs. Improvements in editorial independence suggest increased awareness of conflict of interest management.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 3","pages":"e70449"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773581","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 Flow of Healthcare Information in Rural and Remote Settings: A Qualitative Approach.","authors":"Sophie Macklin, Leanna Woods, Clair Sullivan","doi":"10.1111/jep.70446","DOIUrl":"https://doi.org/10.1111/jep.70446","url":null,"abstract":"<p><strong>Rationale: </strong>Connected healthcare delivery ensures that the right healthcare information is exchanged with the right healthcare workers, at the right time. Due to the vast distances and dispersed workforce, achieving connected healthcare across rural and remote settings remains a global challenge. Workforce perspectives may help understand how digital transformation can contribute to consumer-centered healthcare information flow.</p><p><strong>Aims and objectives: </strong>To answer the research question: how consumer-centered is the healthcare information flow across rural and remote health services?</p><p><strong>Method: </strong>A qualitative study was conducted involving semi-structured interviews with staff (n = 57) from rural and remote healthcare systems (n = 6). Transcripts were analyzed to elicit the current state of information exchange between and within health services and associated themes. The findings were evaluated with a subject matter expert and member checking.</p><p><strong>Results: </strong>The mode of healthcare information flow was largely paper-based, however frequent use of hybrid (paper and digital records) and digital Clinical Information Systems (CISs) was evident. Transferability of healthcare information could be improved as some systems lack sufficient communication with CISs in other health service types. Resourcing and workforce capabilities were identified to limit transparency of healthcare information. Provided adequate support was available, the rural and remote healthcare workforce support digital transformation and encourage the expansion of digital CISs.</p><p><strong>Conclusion: </strong>Digital transformation and better integration of CISs can enable a healthcare information journey that is consumer-centered, ensuring secure, reliable, and efficient exchange of information. Specific recommendations include the expansion of digital health information exchange applications, enhancing local digital infrastructure support, and building a digitally skilled workforce.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 3","pages":"e70446"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773407","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}