BMC Health Services Research最新文献

{"title":"Barriers and facilitators to telerehabilitation implementation: a mixed-methods study of German physiotherapists.","authors":"Marco Stahn, Martin Roemhild, Christian Kopkow, Anne-Kathrin Rausch","doi":"10.1186/s12913-026-14636-6","DOIUrl":"https://doi.org/10.1186/s12913-026-14636-6","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic accelerated telehealth service adoption in physiotherapy, including telerehabilitation (TR). However, the extent of TR use and factors influencing its implementation in Germany remain unclear. This study aimed to evaluate TR use in physiotherapy (during COVID-19 lockdowns, current use, future intentions, conditions treated, content, setting, and session type) and identify barriers and facilitators from physiotherapists' (PTs) perspectives.</p><p><strong>Methods: </strong>A mixed-methods sequential explanatory design was employed, combining a cross-sectional online survey (n = 152) with two focus group interviews (n = 9). The survey collected data on demographics, TR use, barriers, and facilitators. Focus groups explored themes emerging from the survey in greater depth. Data were analyzed using descriptive statistics and content analysis, integrating quantitative and qualitative findings. Quantitative and qualitative findings were integrated through explanatory linking and joint display in a comparative analysis table.</p><p><strong>Results: </strong>TR use peaked during COVID-19 lockdown (32.26%) but decreased to 18.06% by October 2022, with 26.45% intending future use and 43.87% considering it. Among TR users, musculoskeletal conditions were most commonly treated (75%), followed by sports (38%), pulmonology (33%), and neurology (27%). The primary barrier was lack of physical examination (74% agreement). While technical challenges were not reported as a major barrier in the survey, interviews revealed significant concerns about insufficient internet bandwidth and technical infrastructure. Common reasons for using TR included promoting patient self-management (78% agreement) and broadening therapy options (69% agreement). Qualitative data identified additional implementation facilitators, including structured implementation processes, appropriate technical infrastructure, and patient involvement in decision-making.</p><p><strong>Conclusion: </strong>While TR implementation in German physiotherapy shows growth potential, several barriers currently limit its adoption. Successful implementation requires addressing PTs capabilities, knowledge gaps, professional identity concerns, and environmental factors. Addressing these issues could enhance patient care quality, increase service accessibility, and advance healthcare delivery models.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic value of physiotherapy interventions in headache management: a scoping review.","authors":"Sarah Mingels, Marita Granitzer, Ina Diener, Wim Dankaerts","doi":"10.1186/s12913-026-14701-0","DOIUrl":"https://doi.org/10.1186/s12913-026-14701-0","url":null,"abstract":"<p><strong>Background: </strong>Headache disorders impose a substantial economic burden. Health economic evaluations are vital for informing healthcare decisions by assessing the costs and benefits of interventions, including physiotherapy. Evaluating the cost-benefit impact of integrating physiotherapy into headache management is therefore essential.</p><p><strong>Objective: </strong>To map studies including economic evaluations of physiotherapy interventions for headache management, defined as systematic comparisons of alternative treatments in terms of costs and outcomes.</p><p><strong>Methods: </strong>Scoping review (PCC framework) conducted in PubMed, Embase, Web of Science, Scopus, INHTA databases (April 2026). Adults with headache receiving physiotherapy were included. Economic evaluations and cost measures were extracted. Studies were screened in two stages and synthesised descriptively. Reviews, trials, cohort, case report, case-control studies in English, Dutch, German were considered (Open Science Framework, https://doi.org/10.17605/OSF.IO/FVHXA).</p><p><strong>Results: </strong>Physiotherapy, as monodisciplinary, part of an interdisciplinary or multidisciplinary approach, was only included in eight out of 1271 studies. Interventions varied by setting (inpatient/outpatient) and delivery (individual/group). Three studies conducted cost-effectiveness analyses. A multimodal, interdisciplinary or multidisciplinary approach reduced medication-use, consultations, inpatient admissions (direct), and improved work status (indirect). However, evidence is insufficient to conclude that incorporating physiotherapy reduces healthcare costs.</p><p><strong>Conclusion: </strong>A significant gap exists regarding the cost-reducing potential of physiotherapy in headache management. Rigorous economic analyses are needed to determine its clinical and economic value. Greater transparency and consensus on cost variables are recommended, along with investigation of which physiotherapy components yield optimal cost savings without compromising individual benefits.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulation research on the clinical path of non-small cell lung cancer surgery based on time petri net.","authors":"Chen Da, Song Haitao, Song Jun, Zhong Hui, Xu Chuangchuang, Gao Junli","doi":"10.1186/s12913-026-14617-9","DOIUrl":"https://doi.org/10.1186/s12913-026-14617-9","url":null,"abstract":"<p><strong>Background: </strong>Clinical pathways are increasingly adopted to control costs and enhance quality management, becoming a standardized approach in treatment. This study aims to develop a hospital-specific clinical pathway for non-small cell lung cancer (NSCLC) surgery based on national standards and actual treatment practices, and evaluate its service efficiency through simulation.</p><p><strong>Methods: </strong>We analyzed 94 electronic medical records of NSCLC surgeries performed between May 2020 and November 2022, evaluating the need for localization by statistically examining treatment process delays. A Time Petri Net model was established for this pathway, with simulations conducted to measure post-implementation changes in hospital length of stay (LOS).</p><p><strong>Results: </strong>The hospital's existing processes were generally consistent with national standards. Validation of the Time Petri Net model confirmed its effectiveness. Simulation results showed that the average LOS was reduced from a baseline of 8.20 days to 7.76 days, saving a total of ~ 10.28 h (individual diagnostic/treatment processes were shortened by 0.15-5.04 h).</p><p><strong>Conclusion: </strong>Implementing this tailored clinical pathway significantly improved service efficiency by aligning it with national guidelines, enabling better integration and optimization of medical resources while improving overall clinical pathway management quality.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived organizational support profiles and their moderating role in the association between emotional labor and work engagement among Chinese healthcare workers: a latent profile analysis.","authors":"Hongbin Cong, Afei Qin, Xinru Bian, Hongwei Nie, Ligang Xu","doi":"10.1186/s12913-026-14626-8","DOIUrl":"https://doi.org/10.1186/s12913-026-14626-8","url":null,"abstract":"<p><strong>Background: </strong>Emotional labor is a common job demand in healthcare and may reduce healthcare workers' work engagement, potentially affecting workforce sustainability and service quality. Perceived organizational support (POS) may buffer this adverse effect, yet its potential latent heterogeneity is often overlooked. This study aimed to identify latent POS profiles and examine whether these profiles moderate the association between emotional labor and work engagement among Chinese healthcare workers.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted between August and November 2023 among 1503 healthcare workers from 16 tertiary public hospitals in Shandong Province, China. POS was measured using the 24-item Chinese Employee Perceived Organizational Support Scale, WE was assessed with the Utrecht Work Engagement Scale, and emotional labor was measured using the Emotional Labor Scale. Latent profile analysis (LPA) was used to identify POS profiles. Multivariable ordinary least squares regression models examined associations and moderating effects. Supplementary analyses examined moderation using continuous POS measures and restricted cubic spline models.</p><p><strong>Results: </strong>Three distinct POS profiles were identified: low (18.1%), medium (52.0%), and high (29.9%). Emotional labor was significantly negatively associated with work engagement (β = -0.35, p < 0.001). Compared with the low POS profile, healthcare workers in the medium (β = 10.65, 95% CI: 8.61-12.70, p < 0.001) and high (β = 21.74, 95% CI: 19.34-24.14, p < 0.001) profiles reported higher work engagement. Moderation analyses showed that the negative association between emotional labor and WE was significantly attenuated in the high POS profile (interaction β = 0.43, p < 0.001), whereas the medium POS profile did not show a significant buffering effect (interaction β = 0.11, p = 0.226). Findings were consistent when POS was modeled as a continuous variable, and restricted cubic spline analyses suggested that the buffering effect of POS may become more pronounced at higher levels of support.</p><p><strong>Conclusion: </strong>POS showed clear latent heterogeneity and may function as an important buffering resource in the association between emotional labor and work engagement. Strengthening organizational support systems, particularly for employees with low perceived support, may help sustain work engagement in high-demand healthcare settings.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of war on Primary Health Care in Ukraine: a cross-sectional survey and qualitative interviews with service providers.","authors":"Adrianna Murphy, Kaija Kasekamp, Olga Demeshko, Jarno Habicht","doi":"10.1186/s12913-026-14555-6","DOIUrl":"https://doi.org/10.1186/s12913-026-14555-6","url":null,"abstract":"<p><strong>Background: </strong>Primary Health Care (PHC) is vital to supporting emergency preparedness and health care resilience. There is limited evidence of the impact of crises on PHC services and financing. We aimed to explore the impact of the full-scale invasion of Ukraine in February 2022 on PHC services in the country.</p><p><strong>Methods: </strong>We used a mixed-methods approach. Survey data were collected using an online questionnaire sent to a sample (n = 86) of PHC providers in Ukraine in January-February 2023. Fifteen providers were then randomly selected for semi-structured interviews from among those that reported an impact of war and from those areas most affected by conflict. Interviews took place in March 2023.</p><p><strong>Results: </strong>37% of PHC providers reported being affected by the full-scale invasion. Qualitative data revealed greater impacts at the beginning of the invasion, to which facilities adapted by the time of the survey. The most reported disruptions were electricity cuts (76%) and currency depreciation/price increases (72%). The most reported increased medical need was cardiovascular disease (CVD; 58%) (with qualitative data suggesting an increase in CVD among younger patients) followed by mental illnesses and disorders (55%). 59% of PHC providers reported an increase in remote consultations. Among those facilities that reported a change in revenues, the nature of the change depended on the type of ownership. For example, only 9% of private providers reported increased revenues from humanitarian aid, while 79% (n = 58) of public providers indicated an increase in these sources.</p><p><strong>Conclusion: </strong>To continue strengthening Ukraine's PHC system, the benefit package must be aligned with clinical guidelines, particularly for CVD and mental health; increases in remote consultations should be closely monitored for quality; and payment systems must be adjusted to ensure equity of financing regardless of provider ownership. These findings offer insights for strengthening PHC and emergency-preparedness in other contexts.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clear Conversations: a mixed methods evaluation of a verbal health literacy initiative for health service providers.","authors":"Cheryl Grindell, Jo Hall, Laura Connolly, Jane Hawley, Alicia O'Cathain","doi":"10.1186/s12913-026-14684-y","DOIUrl":"https://doi.org/10.1186/s12913-026-14684-y","url":null,"abstract":"<p><strong>Background: </strong>Understanding health information can be difficult, which can limit people's ability to manage their health and adopt healthy practices, leading to poorer health outcomes. This study aimed to evaluate a verbal health literacy training initiative designed to support clear conversations between health service providers and users. The initiative incorporated Teach-back, Chunk and Check, Simple Language, and Open Questions, alongside implementation support from a health literacy officer.</p><p><strong>Methods: </strong>A concurrent mixed-methods evaluation was conducted across two health programmes serving a population of approximately one million people in the United Kingdom: A Pulmonary Rehabilitation Programme delivered by five physiotherapists in a hospital setting, and a Weight Management Programme delivered by 12 health improvement advisors within a regional government authority. The evaluation comprised five components: (1) Surveys of 110 service providers' perceptions of the training; (2) Observations of 11 service providers before and after training; (3) Two focus groups with 11 service providers six months post-training; (4) Change in 73 service users' health literacy levels using two domains of the Health Literacy Questionnaire; (5) Change in service users' health and wellbeing between baseline and programme completion.</p><p><strong>Results: </strong>Service providers found the initiative useful. Changes in communication practice, such as increased use of Chunk and Check and Open Questions, were observed. Both programmes were delivered in group settings. Teach-back was reported to be challenging to apply in this context but beneficial in one-to-one interactions in wider practice. Implementation support from the health literacy officer was helpful but difficult to deliver to busy teams. Service users' health literacy levels improved by the end of their programme, but there was no evidence that the initiative improved health and wellbeing outcomes. For example, no significant difference was observed in the primary outcome for Weight Management participants in the intervention group compared with controls (0.2 kg, - 2.3 to 1.9; p = 0.84).</p><p><strong>Conclusions: </strong>In this small evaluation, the initiative was well received and enhanced service providers' communication skills. Further evaluation of a strengthened initiative should focus on controlled before-and-after designs using larger samples to determine the effect on service users' health literacy and health and wellbeing outcomes.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and regional distribution of radiographers in Saudi Arabia: a national cross-sectional study.","authors":"Jaber Hussain Alsalah","doi":"10.1186/s12913-026-14670-4","DOIUrl":"https://doi.org/10.1186/s12913-026-14670-4","url":null,"abstract":"<p><strong>Background: </strong>Radiographers play vital roles in diagnostics and therapeutic healthcare. Despite ongoing health sector reforms in Saudi Arabia, comprehensive national data on the radiographer workforce remain limited. This study aimed to examine the characteristics and distribution of radiographers in Saudi Arabia by identifying their demographic patterns, educational qualifications, and employment distribution across healthcare sectors and regions.</p><p><strong>Methods: </strong>A national cross-sectional analysis was conducted using data obtained from the Saudi Commission for Health Specialties (SCFHS) on 11 September 2025. Descriptive statistics were used to analyse practitioners' demographics, educational qualifications, professional classifications, employment sectors, and geographical distribution in Saudi Arabia to inform workforce planning under the Health Sector Transformation Program.</p><p><strong>Results: </strong>A total of 22,626 active radiographers were registered with the SCFHS. Approximately 60% were women, and 74% were under 40 years of age (mean 34.3 ± 8.9 years). More than half (52%) held a bachelor's degree, 43% held a diploma, and 5% held a postgraduate qualification. Most (78%) had completed their education in Saudi Arabia. More than half were employed in the public sector (56.8%) and specialists comprised the largest professional category (52.5%). Workforce distribution was uneven, with over half concentrated in the Central and Western regions, particularly Riyadh and Makkah. The national average density was 640 radiographers per million inhabitants, with substantial regional variations.</p><p><strong>Conclusions: </strong>Saudi Arabia has a relatively young workforce with a clearly defined professional classification system; however, significant regional disparities persist. Targeted redistribution strategies, the expansion of advanced training pathways, and continuous workforce monitoring are required to support equitable access to imaging services and align with the objectives of the Saudi Health Sector Transformation Program and Vision 2030.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of 'Location of Dialysis Care in Kidney Life', a service delivery intervention to eliminate unwarranted variation in home dialysis uptake between kidney services and to optimise home dialysis use.","authors":"Louise Weight, Iestyn Williams, Hilary L Bekker, David Coyle, James Fotheringham, Harry Hill, Mark Lambie, Sarah Damery, Kerry Allen, Ivonne Solis-Trapala, Lisa Dikomitis, Simon J Davies","doi":"10.1186/s12913-026-14461-x","DOIUrl":"https://doi.org/10.1186/s12913-026-14461-x","url":null,"abstract":"<p><strong>Aim: </strong>To introduce a new service delivery intervention to improve equity of access to home dialysis therapy and describe the process of intervention development.</p><p><strong>Background: </strong>Despite strong evidence in favour of home dialysis, its uptake remains stubbornly low in England and elsewhere. Furthermore, uptake levels vary between kidney services and between population groups. The Inter-CEPt study identified several enablers of access to home dialysis, including: receptive organisational cultures; adoption of reflective practice; engagement in quality improvement, and shared belief in the benefit of home dialysis.</p><p><strong>Methods: </strong>Drawing on the Inter-CEPt study, and using established intervention development frameworks, we developed 'Location of Dialysis Care in Kidney Life' as a targeted intervention for improving the uptake of home dialysis. In this paper, the intervention and the processes involved in its design are described. This involved co-design workshops with professional stakeholders and people with lived experience.</p><p><strong>Proposed service intervention: </strong>The Location of Dialysis Care in Kidney Life intervention consists of two principal components: (1) quality improvement activities focussed on supporting dialysis care in the home, and (2) dedicated home therapies leadership roles and activities in kidney services. The rationale of the intervention is to develop and sustain a culture that improves equitable access to home dialysis.</p><p><strong>Conclusion: </strong>We report a staged process of intervention development that combines the principles of evidence-based intervention development and user co-design. The resulting intervention proposal can be adapted by kidney services to meet their specific needs and challenges. The study identifies organisational culture as one of the biggest determinants of uptake in home dialysis. No other study to our knowledge has fully investigated this as a barrier to home dialysis, nor indeed how to begin to change it. The Location of Dialysis Care in Kidney Life intervention requires future piloting and evaluation.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lifestyle front offices in dutch hospitals: a cross-sectional survey on similarities, differences and future needs.","authors":"Florien Ham, Mariëtte R Boon, Janke F de Groot, Meike J van Boxtel, Ghislaine A P G van Mastrigt, Judith G M Jelsma, Elisabeth F C van Rossum","doi":"10.1186/s12913-026-14506-1","DOIUrl":"https://doi.org/10.1186/s12913-026-14506-1","url":null,"abstract":"<p><strong>Background: </strong>Since 2019, Dutch hospitals have been developing approaches aiming to bridge the gap between hospital care and community-based lifestyle support. This has led to the introduction of the so called 'Lifestyle Front Office\" (LFO) in 2022. The LFO enables healthcare professionals to refer patients for lifestyle and (psycho)social support adjacent to medical treatment in the context of specialist medical care. After a consultation at the LFO, patients are referred to the appropriate community-based lifestyle interventions. LFOs have been quickly adopted in Dutch hospitals, leading to conceptual differences. This study aimed to evaluate similarities, differences and future needs of LFOs in the Netherlands, striving for a more unified concept.</p><p><strong>Methods: </strong>A cross-sectional survey was sent out between December 2023 and September 2024 to all Dutch hospitals with an operational LFO (n = 17 hospitals). The survey focused on referral processes, patient eligibility criteria, departmental involvement, screening methods, consultation practices, follow-up procedures, financing, and capacity. The collected data were analyzed quantitatively and qualitatively to identify common practice, challenges, and opportunities for improvement.</p><p><strong>Results: </strong>The survey response rate was 82% (14/17). Primary referral groups were patients with lifestyle-related conditions such as obesity, type 2 diabetes mellitus and cardiovascular diseases. Most LFOs conducted pre-visit screenings by using questionnaires, employed lifestyle care coordinators with diverse professional backgrounds, utilized structured tools during consultations and used the electronic patient records for screening and communication. Future needs included the need for (long-term) funding, which was only secured in 21% of the LFOs. Furthermore, inconsistent eligibility criteria, limited capacity, and follow-up procedures were seen as priorities for future attention.</p><p><strong>Conclusion: </strong>This study highlights the similarities, differences and future needs of LFOs in the Netherlands. To achieve a more unified concept, LFOs need to better align patient-related eligibility criteria, use of structured tools, referral to community-based support, follow-up strategies and long-term funding. While the LFO concept emphasizes strong inter-organizational collaboration, further research is needed to assess its impact by investigating success rate of referrals and (long-term) health outcomes after referral. Additionally, for maintaining LFOs in the Dutch healthcare system, additional research is required to better understand the barriers and facilitators regarding structural implementation.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The geographic digital divide among dementia caregivers in the U.S.: a cross-sectional study.","authors":"Jingjing Gao, Eric C Jones, Louis D Brown, Benjamin J Radford, Jiaming Liang, Jack Tsai","doi":"10.1186/s12913-026-14690-0","DOIUrl":"https://doi.org/10.1186/s12913-026-14690-0","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Digital health tools, particularly patient portals, can support caregiving, but there is limited understanding of how sociodemographic and geographic factors influence digital health engagement among U.S. caregivers, especially dementia caregivers. Dementia caregiving involves complex coordination, medication management, and frequent healthcare interactions. Therefore, access to online medical records is particularly valuable. Moreover, most previous research focuses on general digital health adoption or patient portal use among patients, not caregivers, particularly among dementia caregivers, and rarely considers geographic differences or the interaction effects between age and caregivers' self-rated health. Comparing dementia caregivers to those without is essential because dementia caregiving entails more extensive care, longer duration, behavioral challenges, and emotional strain. These factors may increase reliance on digital health tools like online medical records. However, national studies often do not distinguish between dementia and non-dementia caregiving in digital health analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study explored how sociodemographic and geographic factors are associated with caregivers' frequency of accessing care recipients' online medical records, especially for caregivers of individuals living with dementia compared to those caregivers of individuals without dementia. We also evaluated the interaction effect between age and health condition, motivated by the hypothesis that digital engagement is influenced not only by age but also by functional health status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study examined caregivers' portal access frequency using data from the 2022 National Health Interview Survey, collected between March 7th and November 8th, 2022. Descriptive statistics captured differences in access frequency and sociodemographic characteristics between dementia caregivers and non-dementia caregivers. Three ordered logistic regression models examined predictors of accessing online medical records for dementia caregivers, non-dementia caregivers, and all caregivers, followed by an all-caregiver model with interaction terms to assess moderation effects between caregiver age and self-reported health. ArcGIS Pro was adopted to visually capture the geographic regional divide in portal access frequency across the U.S.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 6,252 total responses, 916 caregivers provided data on portal access frequency. More than half of dementia caregivers (60.25%) and non-dementia caregivers (51.11%) did not access online medical records in the past 12 months. Frequent access (≥ 10 times/year) was low across both groups (dementia caregivers (7.03%) vs. non-dementia caregivers (12.66%)). Survey-weighted ordered logistic regression models identified significant sociodemographic and geographic disparities in portal access frequency. Being female (OR = 1.931, SE:","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}