Frontiers in health services最新文献

{"title":"Therapeutic intensity and patient-reported outcomes among heart failure patients in a pharmacist-led medication therapy adherence clinic program in Malaysia.","authors":"Abdullah Faiz Zaihan, Shairyzah Ahmad Hisham, Nurul Ameera Huda Mohamad Hafiz, Nur Irdina Athilah Khairul Hazamy, Aisyah Zahraa Termizy, Nurul Izzah Roslan, Perishithaa M Ganesan, Noor Salihah Yahaya, Zhiyun Wong, Muhammad Iqbal Mohd Arqam, Chia Siang Kow","doi":"10.3389/frhs.2026.1784432","DOIUrl":"https://doi.org/10.3389/frhs.2026.1784432","url":null,"abstract":"<p><strong>Introduction: </strong>Guideline-directed medical therapy (GDMT) and newer agents such as sodium-glucose cotransporter 2 inhibitors (SGLT2i) have significantly improved outcomes in heart failure (HF). However, their impact on patient experience-including medication adherence, treatment burden, and quality of life (QOL)-remains less understood in Malaysia, especially in structured outpatient settings such as Medication Therapy Adherence Clinic (MTAC).</p><p><strong>Aim: </strong>To evaluate associations between therapeutic intensity (full GDMT, SGLT2i use, and medication load) and patient-reported outcomes (PROs) in HF patients enrolled in an MTAC program.</p><p><strong>Method: </strong>A cross-sectional study was conducted among 78 HF patients at a secondary hospital MTAC in Shah Alam, Malaysia. PROs were assessed using the Malaysia Medication Adherence Assessment Tool (MyMAAT-12), the Treatment Burden Questionnaire (TBQ), and WHOQOL-BREF. Full GDMT was defined as concurrent use of a RAAS inhibitor, beta blocker, MRA, and SGLT2i. Group comparisons were performed using Mann-Whitney U tests, and associations between medication load and PROs were assessed using Spearman correlation.</p><p><strong>Results: </strong>The mean age of patients was 57.3 ± 11.5 years; 74.4% were male. Most were on polypharmacy (mean medication classes: 6.6 ± 1.2); 64.1% were on full GDMT and 82.1% were prescribed SGLT2i. Median adherence, burden, and QOL scores were 47.0 (IQR: 40.0-53.0), 39.0 (IQR: 24.0-58.0), and 88.0 (IQR: 77.0-98.0), respectively. Patients on full GDMT or ARNI had similar adherence, burden, and QOL scores compared to those not on these therapies. However, SGLT2i users reported significantly lower adherence (<i>p</i> = 0.037) and QOL (<i>p</i> = 0.018). Medication load was positively correlated with QOL (<i>r</i> = 0.295, <i>p</i> = 0.009), but not with adherence or burden.</p><p><strong>Conclusion: </strong>In this MTAC-supported cohort, polypharmacy and full GDMT were not associated with increased burden or reduced adherence. A modest positive association between medication count and QOL was observed. SGLT2i use was associated with lower adherence and QOL, although these findings are exploratory and may reflect differences in disease severity or treatment complexity rather than a direct effect of therapy. Overall, these results provide observational insights into the relationship between therapeutic intensity and PROs within a pharmacist-led care setting, and warrant confirmation in larger, longitudinal studies with appropriate adjustment for clinical variables.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1784432"},"PeriodicalIF":2.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcultural utility in the implementation of digital SRH interventions in sub-saharan Africa: a scoping review protocol.","authors":"Relebohile Ntsoane, Mathildah Mpata Mokgatle, Elizabeth Nkabane-Nkholongo, B W Jack","doi":"10.3389/frhs.2026.1770265","DOIUrl":"https://doi.org/10.3389/frhs.2026.1770265","url":null,"abstract":"<p><strong>Background: </strong>Digital health interventions (DHIs) have gained momentum in improving access to sexual and reproductive health (SRH) education and services. DHIs are increasingly recognised for reducing healthcare providers' workload, minimizing patients' long waiting times, and decreasing the distance patients must walk to access health care, thereby enhancing the quality of health services. However, the limited cultural adaptation of DHIs has undermined their usability and acceptability for improving SRH education. Evidence in sub-Saharan Africa indicates that DHIs often fall short of achieving the expected outcomes because they lack cultural relevance and are misaligned with local belief systems and sociocultural contexts. Given these gaps, this scoping review aims to systematically map existing SRH education initiatives that utilize DHIs, to assess the extent of cultural adaptation and to identify evidence-based strategies that could enhance transcultural utility in SRH DHIs.</p><p><strong>Methods and analysis: </strong>This scoping review will be guided by the framework of Arksey and O'Malley. A systematic search will be undertaken across major sources, such as PubMed, Scopus, PsycINFO, Web of Science, and other relevant sources. The review selection process will be reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (Prisma-ScR) flow diagram to ensure transparency, and EndNote will be used to eliminate duplicates during the selection of eligible studies. Eligible studies will be screened against predefined inclusion and exclusion criteria, and data will be charted to capture key characteristics, and by paying particular attention to cultural adaptation strategies of SRH-focused DHIs. Findings will be synthesised to map the current evidence base and highlight gaps for future research and practice.</p><p><strong>Clinical trial registration: </strong>This scoping review protocol was registered with Open Science Framework and can be accessed at https://osf.io/fx75p.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1770265"},"PeriodicalIF":2.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health infrastructure under pressure: spatial-temporal analysis of King Saud Medical City expansion.","authors":"Hala A Alosaimi, Zainab Al-Mughassil, Alfayo Omayio, Jose M Valderas, Hasan Alghamdi","doi":"10.3389/frhs.2026.1767964","DOIUrl":"https://doi.org/10.3389/frhs.2026.1767964","url":null,"abstract":"<p><p>King Saud Medical City (KSMC), Riyadh's largest public medical city, has undergone a profound spatial and institutional transformation between 2000 and 2025. Using multi-temporal remote sensing and geographic information system analysis, this study provides quantitative evidence of medical city densification in Saudi Arabia. The built-up footprint expanded by more than 19 hectares, and the Normalized Difference Built-up Index increased by +0.36, reflecting a shift from a low-rise, dispersed campus to a vertically integrated medical complex. This physical transformation coincided with major institutional growth: total bed capacity increased from approximately 450 to over 1,500, including 200 intensive care beds; the emergency department expanded to 102 beds, becoming one of the largest in the Kingdom; and annual surgical volume exceeded 20,000 major procedures. These changes occurred alongside rapid population growth in Riyadh and national health system reforms such as the Medical Cities Law, the Health Cluster Model, and Vision 2030. The findings demonstrate how spatial densification enabled operational expansion and accelerated the adoption of advanced medical infrastructure. The study offers a scalable spatial framework for guiding the future development of large medical facilities in rapidly urbanizing settings.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1767964"},"PeriodicalIF":2.7,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13106379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators to using patient-reported experience measures for diabetes care: a qualitative study in Thailand.","authors":"Soe Sandi Tint, Wichuda Jiraporncharoen, Nida Buawangpong, Myo Zin Oo, Kittipan Rerkasem, Kanokwan Kulprachakarn, Hataichanok Chuljerm, Timothy E O'Brien, Rohini Mathur, Petch Rawdaree, Chaisiri Angkurawaranon","doi":"10.3389/frhs.2026.1799682","DOIUrl":"https://doi.org/10.3389/frhs.2026.1799682","url":null,"abstract":"<p><strong>Background: </strong>Patient-reported experience measures (PREMs) provide valuable insights into care quality from the patient's perspective and are particularly relevant for chronic conditions such as type 2 diabetes mellitus (T2DM). However, evidence on their implementation in primary care settings of low- and middle-income countries (LMIC) remains limited.</p><p><strong>Objective: </strong>This study explored barriers and facilitators to implementing a diabetes-specific PREM in routine outpatient care in a district-level hospital setting in northern Thailand, to inform strategies for its feasible and sustainable use in similar resource-constrained settings.</p><p><strong>Methods: </strong>A qualitative study was conducted using in-depth interviews and a group interview with patients aged 20 years and older living with T2DM, healthcare providers, and the hospital executive team. A total of 25 participants were purposively selected from a hospital-based non-communicable disease (NCD) clinic. Data were collected using a semi-structured interview guide informed by the Consolidated Framework for Implementation Research (CFIR) and analysed using inductive thematic analysis. Patient demographic data were analysed descriptively.</p><p><strong>Results: </strong>Among the 19 patients included, the mean age was 59.7 years (SD = 11.9), with a range of educational and occupational backgrounds. Thematic analysis revealed three overarching themes influencing PREM implementation: patient-related factors, instrument characteristics, and contextual and implementation factors. Key facilitators included patients' perceived value of the PREM, trust in healthcare providers, and supportive organizational structures that enable workflow integration and staff allocation. Major barriers were limited literacy, functional constraints among older adults, and challenges related to instrument wording, format preferences, and insufficient resources for staff assistance.</p><p><strong>Conclusion: </strong>Addressing these factors through tailored questionnaires, flexible administration, and institutional commitment can support the routine collection of patient-reported experiences, strengthen patient-centred care, and inform implementation strategies in similar primary care settings across Southeast Asia.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1799682"},"PeriodicalIF":2.7,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13106585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burnout in the allergy nursing workforce in the United States.","authors":"Olga Kagan, Lilly Mathew, Hemant Sharma, Sarah Pederson, Ali Doppelt, Anil Nanda, Anita Wasan, Theresa A Bingemann","doi":"10.3389/frhs.2026.1669523","DOIUrl":"https://doi.org/10.3389/frhs.2026.1669523","url":null,"abstract":"<p><strong>Introduction: </strong>Burnout among nurses remains a pervasive workforce issue in the United States, with limited data on allergy nursing. This study aimed to estimate the prevalence of burnout among U.S. allergy nurses and identify factors associated with burnout.</p><p><strong>Methods: </strong>A descriptive correlational study was conducted using the Mini Z survey and a demographic questionnaire. Responses were dichotomized into \"with burnout\" and \"without burnout\" based on validated thresholds. Descriptive statistics, Spearman's Rho correlations, and binary logistic regression were used to examine associations between burnout and workplace factors.</p><p><strong>Results: </strong>Of 241 responses, 201 met inclusion criteria. Burnout prevalence was 34% (<i>n</i> = 69). Burnout was positively correlated with job stress and work area chaos, and negatively correlated with job satisfaction, workload control, documentation time satisfaction, and professional values alignment. In the final logistic regression model, higher work area chaos (OR = 2.66; 95% CI, 1.19-5.95; <i>P</i> < 0.05) and higher job stress (OR = 4.60; 95% CI, 2.14-9.87; <i>P</i> < 0.05) were associated with increased odds of burnout, while alignment of professional values was protective (OR=0.38; 95% CI, 0.18-0.83; <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Burnout in allergy nursing was common and associated with factors such as work environment and nurse-leadership value-alignment. Interventions that reduce practice chaos, increase workload control, streamline documentation, and strengthen alignment between nurses' professional values and leadership may mitigate burnout. These findings can inform targeted organizational strategies, aid in the selection of existing tools, and guide the development of evidence-based interventions to reduce burnout in allergy nursing practice.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1669523"},"PeriodicalIF":2.7,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13106482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, attitudes, and practices of healthcare providers toward gender dysphoria in Saudi Arabia.","authors":"Waled M Albalawi, Mohammed A Alhassan, Muhammad H Aldossary, Jamal Alothaim, Abdulaziz S Albalawi, Khalil A Alghalayini, Majed B Abaalkhail, Samah H Alkhawashki","doi":"10.3389/frhs.2026.1767076","DOIUrl":"https://doi.org/10.3389/frhs.2026.1767076","url":null,"abstract":"<p><strong>Background: </strong>Gender dysphoria (GD) involves a marked incongruence between an individual's experienced gender and their sex assigned at birth. Individuals with GD often experience a strong desire to be treated as another gender and frequently face significant health disparities, including limited access to care, higher risks of depression, and suicide. These challenges are often exacerbated by healthcare providers' knowledge gaps and discriminatory attitudes. This study's objective is to assess the knowledge, attitudes, and practices (KAP) of healthcare providers in Saudi Arabia regarding GD and to identify gaps that could inform targeted educational interventions.</p><p><strong>Methods: </strong>A cross-sectional online survey was conducted with healthcare providers in Saudi Arabia (Nov 2024-Jun 2025). A total of 156 responses were gathered. The questionnaire included domains of knowledge (9 items), attitude (11 items), and practice (4 items) on a 7-point Likert scale. Missing responses, including \"I don't know,\" were imputed. Descriptive statistics were used to summarize participant responses. Associations among knowledge, attitude, and practice scores were examined using Spearman's rank-order correlation, with additional subgroup analyses conducted to explore variations by demographic characteristics.</p><p><strong>Results: </strong>Participants demonstrated moderate to strong knowledge and generally positive attitudes toward individuals with GD, particularly regarding pronoun use, mental health assessment, and awareness of health disparities. However, practical engagement was limited, with only 19% reporting direct clinical experience and a few having received GD-related training. Scores varied by age, training level, and specialty, as respondents aged 24-39 years showed the strongest knowledge and attitude scores, and practice scores were highest among those aged 40-49 years, while senior registrars demonstrated the highest overall KAP scores, and psychiatry showed the strongest overall specialty profile.</p><p><strong>Conclusion: </strong>Healthcare providers demonstrate foundational knowledge and supportive attitudes but limited practical experience in managing GD. Targeted training and structured clinical exposure are recommended to improve culturally competent and inclusive care.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1767076"},"PeriodicalIF":2.7,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13106186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-cultural adaptation of an implementation science glossary into simplified Chinese: study protocol.","authors":"Xiaomeng Ye, Wyatt Xixuan Wu, Tina Yen-Ting Chen, Qian Yang, Nick Sevdalis","doi":"10.3389/frhs.2026.1799760","DOIUrl":"https://doi.org/10.3389/frhs.2026.1799760","url":null,"abstract":"<p><strong>Introduction: </strong>Implementation science (IS) relies on standardized terminology, yet existing glossaries are largely English and Western-centric, creating risks of misinterpretation in other contexts. In China, with over one billion Chinese speakers and a rapidly expanding IS community, the absence of a unified glossary hinders training and knowledge exchange. We report a prospective, multi-stage cultural and linguistic adaptation study of the Implementation Science Research Glossary produced by the Centre for Implementation Science at King's College London, UK, from its original English version into Simplified Chinese.</p><p><strong>Methods: </strong>This study follows an established cross-cultural adaptation framework, modified to reflect the nature of a glossary rather than a psychometric instrument. The process includes: (1) forward translation of the English glossary into Simplified Chinese by a bilingual translator with IS expertise; (2) independent back translation by another bilingual individual blinded to the original glossary; (3) structured reconciliation involving the forward translator, back translator, and an additional reviewer with IS knowledge; (4) first expert panel review-conducted by 5 experts in IS and public health, who will also participate in the final review-to assess semantic, idiomatic, experiential, and conceptual equivalence, leading to a refined version of the glossary; consensus will be defined <i>a priori</i> as ≥80% agreement on each term and definition (5) evaluation of the refined glossary through two complementary quantitative validation procedures: (a) content validation by 6-10 eligible faculty members using the Content Validity Index (CVI), and (b) response process validation by 10-30 Chinese-speaking postgraduate students using the Face Validity Index (FVI); items will be considered acceptable if I-CVI ≥0.83 and glossary-level S-CVI/Ave ≥0.90 for content validity, and I-FVI ≥0.80 with glossary-level S-FVI/Ave ≥0.90 for face validity; and (6) final expert panel review to reach consensus on the adapted glossary. Ethical approval will be obtained prior to data collection.</p><p><strong>Discussion: </strong>The study will produce the first, to our knowledge, culturally and linguistically adapted IS glossary for Chinese-speaking contexts. This resource is expected to enhance clarity and accessibility of implementation concepts, supporting research and practice in local settings. The documented adaptation process will provide a methodological reference for future translation of IS resources in other languages.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1799760"},"PeriodicalIF":2.7,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13095681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical decision fatigue as a reversible state in the continuum of professional exhaustion.","authors":"Serena Petrocchi, Luca Gabutti, Nicola Grignoli","doi":"10.3389/frhs.2026.1810631","DOIUrl":"10.3389/frhs.2026.1810631","url":null,"abstract":"<p><p>Concerns about clinician fatigue typically focus on burnout and workload, yet less attention has been paid to how the process of making repeated, emotionally and ethically challenging decisions may transiently affect decision quality. The concept of clinical decision fatigue (CDF) remains debated, partly because empirical findings differ across clinical contexts. We propose that CDF is best understood as a short-term, reversible state arising from sustained self-regulatory demands during emotionally and morally salient clinical decision-making. Drawing on contemporary process models of self-regulation, we argue that repeated exposure to empathic strain, moral conflict, and responsibility for consequential outcomes can shift clinicians' motivational and attentional priorities away from effortful, reflective decision-making toward simplified or defensive strategies. This state is distinct from compassion fatigue and burnout in its timescale, mechanisms, and phenomenology, but may interact with these conditions when episodes recur without recovery. We argue that clinical decision fatigue is a reversible state of regulatory strain that can be situated within a broader continuum of professional exhaustion. Clinical environments that intensify emotional and moral load may accelerate the onset of CDF, whereas structures that support emotion regulation, ethical clarity, and shared decision-making may mitigate it. Recognizing CDF as a modifiable systems risk highlights opportunities to protect decisional integrity, patient safety, and clinician mental health.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1810631"},"PeriodicalIF":2.7,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13083051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mobilizing the banking sector for universal health coverage: a new frontier for public-private partnerships.","authors":"Chidera Gabriel Obi, Faith Udochukwu Uzor","doi":"10.3389/frhs.2026.1750156","DOIUrl":"10.3389/frhs.2026.1750156","url":null,"abstract":"<p><strong>Background: </strong>The attainment of Universal Health Coverage (UHC) remains difficult in most low- and middle-income countries (LMICs) due to gaps in health funding, high out-of-pocket spending and further worsening due to recent donor cuts. Existing literature predominantly focuses on traditional sources which include government budgets, donor aid, social health insurance, and household payments while the role of commercial banks as strategic health system financiers remains largely untapped beyond Corporate Social Responsibility (CSR) activities.</p><p><strong>Aim: </strong>This perspective examines how commercial banks can provide innovative solutions and utilize their untapped resources to become strategic partners in health financing which can be harnessed towards attaining UHC.</p><p><strong>Approach: </strong>Anchored in Financial Intermediation Theory and the World Health Organization's health financing framework, the paper reviews evidence from peer-reviewed literature, policy documents, and illustrative country experiences.</p><p><strong>Key arguments: </strong>Commercial banks possess significant liquidity, risk-assessment capacity, and extensive networks that can be potentially leveraged through health-targeted savings and insurance products, ESG-aligned health bonds, de-risked lending to health SMEs. Structured public-private partnerships can further improve health outcomes while maintaining profitability. Empirical examples from Nigeria and other LMICs demonstrate the feasibility of these approaches.</p><p><strong>Concerns: </strong>The involvement of commercial banks in health financing involves the risk of equity concerns (urban bias, over-indebtedness, technicality of the products and profit-equity alignment), especially in weak regulatory context while PPPs can carry political undertones with higher political risks.</p><p><strong>Recommendations: </strong>Commercial Banks and policy makers should promote health focused and inclusive products with literacy support, mobilize capital through bonds/guarantees, expand health SME credit, leverage PPPs, and monitor outcomes to mitigate risk.</p><p><strong>Conclusions: </strong>The integration of commercial banks into UHC as strategic partners can bridge financing gaps, improve health access, and strengthen health system resilience in LMICs, provided supportive regulation, ethical frameworks, and contextual adaptation guide their engagement.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1750156"},"PeriodicalIF":2.7,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13083139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of PDCA cycle on critical value management in primary healthcare institutions: an interrupted time series study.","authors":"Xiaolong Cui, Chen Liang, Shijie Jia, Ying Bi, Qing Li, Xiaomin Zhao, Min Wang, Zhongquan Tang, Ting Ou, Xinyu Dai, Jingqing Yao, Yuntao Li, Hong Ding","doi":"10.3389/frhs.2026.1745945","DOIUrl":"https://doi.org/10.3389/frhs.2026.1745945","url":null,"abstract":"<p><strong>Background: </strong>Critical value management represents a core component of medical safety, yet primary healthcare institutions continue to face challenges including non-standardized processes, incomplete documentation, and insufficient IT support. Although the PDCA cycle is widely adopted as a quality management tool, most evaluations of its effectiveness rely on simple pre-post comparisons, failing to distinguish true intervention effects from underlying secular trends.</p><p><strong>Methods: </strong>We conducted a prospective, multicenter study implementing a 24-month PDCA cycle intervention across 62 primary healthcare institutions in Jiangsu Province. Quality improvement initiatives included implementing a unified Critical Value Reporting Protocol, standardizing logbooks, and establishing monitoring mechanisms. We employed an interrupted time series model to analyze 24 months of data, assessing both immediate and sustained intervention effects.</p><p><strong>Results: </strong>Following PDCA implementation, the standardized critical value management rate increased from a pre-intervention average of 93.8% to 98.9%. Interrupted time series analysis revealed a significant immediate improvement (OR = 1.721, <i>p</i> = 0.012) and a progressively strengthening trend effect (OR = 1.298, <i>p</i> < 0.001). The model demonstrated excellent fit with no residual autocorrelation, and statistical inferences based on robust standard errors proved reliable.</p><p><strong>Conclusion: </strong>The PDCA cycle effectively enhances the standardized management of critical values in primary healthcare settings. Interrupted time series analysis provides a scientific foundation for evaluating its effectiveness. This model offers substantial operational practicality and scalability, contributing to continuous improvement in healthcare quality.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1745945"},"PeriodicalIF":2.7,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13083069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}