BMC Health Services Research最新文献

{"title":"Transport time as a potential limiting factor for thrombolytic treatment of stroke in Norway.","authors":"Jørgen Ibsen, Maren Ranhoff Hov, Torunn Varmdal, Christian Georg Lund, Christian Hall","doi":"10.1186/s12913-025-12503-4","DOIUrl":"https://doi.org/10.1186/s12913-025-12503-4","url":null,"abstract":"<p><strong>Background: </strong>Rapid diagnosis and treatment of stroke is important for good outcome. In some cases, patients with ischemic stroke arrive at hospital too late for reperfusion therapy. This may be the case especially in rural areas where time spent during transport may delay or even preclude thrombolytic treatment after hospital arrival. We aimed to estimate the extent and clinical relevance of this problem in the Norwegian population.</p><p><strong>Methods: </strong>We collected data for all reported acute ischemic strokes for the years 2017 and 2018. Transport times from home to hospital were calculated from geographical data and related to frequency of thrombolysis, thrombectomy and clinical outcome after 3 months.</p><p><strong>Results: </strong>The frequency of reperfusion therapy decreased significantly as transport time increased. Six percent (564) of 9 428 patients were classified as having a prolonged time in transport. In this group, frequency of intravenous thrombolysis was 10,5% as opposed to 28,2% when prolonged transport was not present. Thrombectomy was performed in 2.1% versus 4.9% in the two groups respectively. We did not find a statistically significant difference between the two groups with regard to clinical outcome as judged by the modified Rankin Scale.</p><p><strong>Conclusion: </strong>In the years 2017 and 2018 a relatively small group of Norwegian patients with prolonged time in transport was disfavored concerning access to reperfusion therapy for ischemic stroke. In such cases a prehospital solution for diagnostic work up and treatment might improve access to acute stroke treatment.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"377"},"PeriodicalIF":2.7,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623374","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":"Challenges for remote patient monitoring programs in rural and regional areas: a qualitative study.","authors":"Joel Fossouo Tagne, Kara Burns, Teresa O'Brein, Wendy Chapman, Portia Cornell, Kit Huckvale, Ishaan Ameen, Jaclyn Bishop, Alison Buccheri, Jodie Reid, Anna Wong Shee, Marc Budge, Catherine E Huggins, Anna Peeters, Olivia Metcalf","doi":"10.1186/s12913-025-12427-z","DOIUrl":"https://doi.org/10.1186/s12913-025-12427-z","url":null,"abstract":"<p><strong>Background: </strong>Access to healthcare significantly influences health outcomes, and rural, regional and remote populations face greater challenges in accessing healthcare than urban populations. Digital health tools, such as remote patient monitoring (RPM), have significant potential to address these healthcare challenges, yet there is little research on the facilitators and barriers of RPM in these regions.</p><p><strong>Aim: </strong>This study aims to identify and understand the facilitators and barriers healthcare staff face implementing RPM in rural and regional Australia, with focus on challenges that arose after the onset of the COVID-19 pandemic.</p><p><strong>Methods: </strong>Semi-structured focus groups were conducted with healthcare professionals from publicly funded health services in western rural and regional Victoria, Australia. An open-ended interview guide based on the Consolidated Framework for Implementation Research (CFIR) was used to identify key themes and strategies for effective RPM implementation. The analysis considered barriers and facilitators at micro, meso, and macro levels.</p><p><strong>Results: </strong>Several barriers to RPM implementation were identified across different levels: (1) Micro-Level Factors, such as perceived low digital literacy and language barriers among individuals; (2) Meso-Level Factors, including disparities in IT infrastructure and device availability, limited training opportunities, and the need for enhanced governance within healthcare settings; and (3) Macro-Level Factors, encompassing evolving funding models and the reliability of service providers. Despite these challenges, participants acknowledged potential benefits such as improved technological interoperability, enhanced community engagement, and a data-driven approach to quality improvement. Importantly, a flexible, tailored RPM approach to accommodate specific rural and regional needs was deemed valuable.</p><p><strong>Conclusion: </strong>Effective RPM deployment in rural and regional areas is viewed by health professionals as crucial for bridging healthcare divides. However, if strategies developed for urban settings are not recalibrated to address rural challenges, the risk of RPM failure may escalate. Future initiatives must prioritize region-specific strategies and policy reforms aimed at ensuring equitable digital infrastructure and financial resource allocation to enhance healthcare access in rural and regional settings. This approach may ensure that RPM solutions are both adaptable and effective, tailored to the unique needs of each community.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"374"},"PeriodicalIF":2.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623213","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":"Urban-rural differences in the health care of people living with dementia and mild cognitive impairment in shared-housing arrangements in Germany - have inequities in urban vs. rural locations been overcome?","authors":"Carolin Donath, Antonia Keck, Elmar Graessel, Janissa Altona, Susanne Stiefler, Julia Misonow, Serhat Guenay, Karin Wolf-Ostermann, André Kratzer","doi":"10.1186/s12913-025-12508-z","DOIUrl":"https://doi.org/10.1186/s12913-025-12508-z","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have identified inequities in the diagnostic and therapeutic procedures used with community-dwelling people living with dementia (PlwDs) or people living with mild cognitive impairment (PlwMCIs) depending on the urban vs. rural location of their residence. Whether those differences in health care and health services utilization still exist for people residing in shared-housing arrangements (SHAs) remains unclear at this point.</p><p><strong>Methods: </strong>In a prospective, multicenter, mixed-methods, cluster-randomized controlled trial, the \"DemWG study,\" 341 PlwDs or PlwMCIs living in a total of 97 SHAs across Germany were recruited. 31 of the participating SHAs were rural (133 participants), 66 were urban (208 participants). As a secondary analysis we evaluated health care data (e.g. vaccinations, medication), utilization of inpatient/outpatient medical services, non-pharmacological therapies according to the German Remedies Directive, provision of health and medical aids and structural data of the SHAs. Variables were assessed at baseline by trained staff from the SHAs using validated instruments (e.g. FIMA - questionnaire for health-related resource use in an elderly population). Descriptive and inferential statistical methods were applied. P-values were corrected with the Benjamini-Hochberg procedure.</p><p><strong>Results: </strong>The majority of the assessed health care data did not show significant differences between urban and rural SHA inhabitants. After the p-values were corrected, only two variables remained different: inhabitants of rural SHAs were prescribed a significantly larger number of total drugs, while urban inhabitants had significantly more appointments with neurologists/psychiatrists in the last 6 months. There were no significant differences in the use of all other type of inpatient/outpatient services, non-pharmacological therapies, use of health and medical aids. Also, the structural data of the SHAs like staffing did not significantly differ between urban and rural place of living.</p><p><strong>Discussion: </strong>While it seems that most inequities in the care of PlwDs/PlwMCIs living in SHAs between rural and urban areas have been overcome, there is still the one crucial difference in this non-representative sample of SHAs: the contact with neurologic/psychiatric specialists who offer elaborated diagnostic procedures is less frequent in rural areas.</p><p><strong>Trial registration: </strong>ISRCTN89825211 (Registered prospectively, 16 July 2019).</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"371"},"PeriodicalIF":2.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623358","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":"Process evaluation of a complex intervention in augmentative and alternative communication care in Germany: a mixed methods study.","authors":"Sarah Anna Katharina Uthoff, Anna Zinkevich, Jens Boenisch, Stefanie Kalén Sachse, Tobias Bernasconi, Lena Ansmann","doi":"10.1186/s12913-025-12452-y","DOIUrl":"https://doi.org/10.1186/s12913-025-12452-y","url":null,"abstract":"<p><strong>Background: </strong>In Germany, clear care pathways for people without natural speech who require augmentative and alternative communication (AAC) are currently lacking. Therefore, AAC is often not sustainably implemented in everyday life. For this reason, a complex intervention was developed that supplements existing AAC consultation with additional AAC training, AAC therapy, and case management. This article presents the results of the process evaluation of the complex intervention. It examines (1) how caregivers and AAC consultants rate the intervention (2), which contextual factors influence its implementation, and (3) the acceptance, use competence, and use of the new AAC system.</p><p><strong>Methods: </strong>The process evaluation used a mixed methods design. Quantitative data were collected with a longitudinal survey of caregivers of AAC users in the intervention and comparison groups at three time points (T0: after AAC consultation; T1: 4 weeks after AAC system receipt; T2: 4 months after AAC system receipt). Semi-structured focus group interviews were conducted with caregivers of AAC users and with AAC consultants. The quantitative data were analysed descriptively and with nonparametric mean value comparisons. The qualitative results were analysed using structured qualitative content analysis.</p><p><strong>Results: </strong>The evaluation and presentation of results were based on the Medical Research Council process evaluation guidance by Moore et al. The intervention elements were rated positively. AAC training and therapy enabled the participants to use the AAC system effectively in different contexts. Case management provided support, particularly in the event of problems in the care process. However, the results also show the heterogeneity of the intervention, as it depended on various contextual factors. Overall, acceptance, use competence, and use of the AAC system were rated higher in the intervention group than in the comparison group.</p><p><strong>Conclusions: </strong>The process evaluation illustrates various contextual factors that can influence the implementation of the AAC intervention. The results highlight the potential of the intervention to improve AAC care and establish a sustainable use of AAC systems in everyday life. In addition, the process evaluation provides indications of how AAC interventions can be adapted for successful implementation.</p><p><strong>Trial registration: </strong>Grant number 01NVF17019.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"373"},"PeriodicalIF":2.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623355","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 use of telemedicine in family medicine: a scoping review.","authors":"Sajjad Mahdavi, Mehra Fekri, Soma Mohammadi-Sarab, Mahdi Mehmandoost, Ehsan Zarei","doi":"10.1186/s12913-025-12449-7","DOIUrl":"https://doi.org/10.1186/s12913-025-12449-7","url":null,"abstract":"<p><strong>Background: </strong>Telemedicine is becoming increasingly important in primary health care globally. It is recognized as safe, convenient, and cost-effective. The aim of this study is to explore the use of telemedicine in family medicine services, focusing on identifying its areas of application, advantages, disadvantages, and the infrastructure required for effective implementation of this technology.</p><p><strong>Methods: </strong>This scoping review was conducted in 2024 using the 5-step framework of Arksey and O'Malley. Comprehensive searches were carried out in the Web of Science, PubMed, and Scopus databases, using keywords such as telemedicine, telehealth, virtual care, teleconsultation, family physician, and family medicine. The search was limited to publications from 2015 to 2024. A total of 37 relevant articles were included in the analysis.</p><p><strong>Results: </strong>Telemedicine is utilized in four primary areas of family medicine: prevention, treatment, monitoring and control, and consultation/administration. According to the frequency of mention in the studies reviewed, the key advantages of telemedicine include improved patient access, enhanced convenience for both patients and healthcare providers, increased patient safety, and greater flexibility in service delivery. However, several challenges were also noted, including the lack of physical examinations, communication and cognitive barriers, low digital literacy among patients and family physicians, and concerns about patient privacy. Essential infrastructure for effective telemedicine implementation comprises reliable information and communication technology, appropriate devices for patients and family physicians, robust technical support, well-defined guidelines and initiatives to enhance digital literacy.</p><p><strong>Conclusion: </strong>Recognizing the advantages of telemedicine in family medicine, it is essential for national health systems to prioritize its integration and development. Telemedicine has the potential to transform the delivery of family medicine services by enhancing access for remote and underserved communities while substantially reducing costs for both patients and providers. However, achieving this potential necessitates the establishment of appropriate legal, technical, and cultural infrastructure.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"376"},"PeriodicalIF":2.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623370","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":"Drivers of primary care appointment volumes before and after the COVID-19 pandemic: a longitudinal study.","authors":"Tianchang Zhao, Rachel Meacock, Matt Sutton","doi":"10.1186/s12913-025-12488-0","DOIUrl":"https://doi.org/10.1186/s12913-025-12488-0","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic led to significant reconfiguration of primary care systems internationally. For example, a large proportion of face-to-face appointments have been replaced by telephone or online consultations. As a result, the relationship between primary care appointment provision and some of its key determinants, such as workforce and demographic characteristics, are likely to have changed. Conclusions from previous studies which used only pre-pandemic data may no longer be applicable under these new configurations.</p><p><strong>Methods: </strong>This study aims to investigate whether the relationships between primary care appointment rates and their determinants, including workforce composition and the age structure of registered patients, have changed after the COVID-19 pandemic. We conducted longitudinal analysis on the 106 Clinical Commissioning Groups (CCGs) in England over two periods of 24 months (March 2018 to February 2020 and March 2021 to February 2023). We used fixed-effects regression models to relate monthly general practice appointment rates per registered patient to workforce size and composition and population age structure, and compared the results between the two periods.</p><p><strong>Results: </strong>In the pre-pandemic period, changes in full time equivalent (FTE) numbers of GP trainees and nurses were the only time-varying variables associated with appointment rates. In the post-lockdown period, the age profile of registered patients became a key determinant of appointment rates. A 1% increase in the proportion of registered patients over 80 years was associated with a 0.165 (38.7%) increase in appointments per patient per month. Changes in FTE numbers of qualified GPs and direct patient care staff were not found to influence the appointment rate in either period.</p><p><strong>Conclusion: </strong>The relationships between primary care appointment rates and the workforce composition and population age structure have changed following the COVID-19 pandemic. The proportion of registered patients over the age of 80 years is now the most significant time-varying driver of appointment rates. General practices serving older patients may face much higher demand and have a bigger challenge providing sufficient appointments in the future compared to before the pandemic.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"372"},"PeriodicalIF":2.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623218","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":"A look into telepsychology in the Philippines: an exploratory-cross-sectional research.","authors":"Jason Clark Perez","doi":"10.1186/s12913-024-12091-9","DOIUrl":"https://doi.org/10.1186/s12913-024-12091-9","url":null,"abstract":"<p><p>The debate surrounding telepsychology and its integration into professional practice remains a critical issue. This study explores telepsychology in the Philippines, focusing on its acceptance, appropriateness, and feasibility during the COVID-19 pandemic. Employing an exploratory cross-sectional research design, data were collected through an online survey using purposive sampling. Results indicate that Filipinos generally perceive telepsychology as acceptable, suitable, and feasible under pandemic conditions. This aligns with studies emphasizing telepsychology's potential to enhance accessibility and address geographic barriers. The findings contribute to the growing body of evidence supporting telepsychology as a viable mental health intervention.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"375"},"PeriodicalIF":2.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623295","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":"Nurses' perspectives on clinical competence to identify loneliness and depression in older people in home care: a qualitative study.","authors":"Birgit Hauger, Randi Martinsen, Knut Hestad, Liv Skomakerstuen Ødbehr","doi":"10.1186/s12913-025-12428-y","DOIUrl":"10.1186/s12913-025-12428-y","url":null,"abstract":"<p><strong>Background: </strong>Loneliness and depression in older people are increasing worldwide. Proficient nursing practice requires the continuous and long-term development of clinical knowledge. Lifelong learning is essential and enhances clinical nursing practice. Nursing includes various functional areas that illustrate registered nurses' wide range of responsibilities to ensure healthcare quality. Registered nurses are committed to working comprehensively, observing patients and identifying symptoms of both physical and mental ill-being. The aim of this study is to explore how registered nurses perceive their clinical competence in observing signs of loneliness and depression in older people in home care, and which barriers in home care services prevent quality improvement.</p><p><strong>Methods: </strong>Fifteen registered nurses from home care units in Norway were individually interviewed, and the interviews were analysed using qualitative content analysis.</p><p><strong>Results: </strong>The analysis revealed three themes in accordance with the study aim: I) Uncertainty about knowledge of mental health, II) Lack of opportunities to meet the patients' needs regarding mental ill-being, III) Feelings of guilt for not doing enough for patients.</p><p><strong>Conclusions: </strong>Lack of education and training in mental health creates uncertainty and limits registered nurses' ability to effectively address signs of loneliness and depression. Registered nurses often feel unprepared to handle psychological aspects of care. Organizational barriers hinder effective care. Additionally, the emotional toll on registered nurses, who experience guilt and moral distress due to their limited ability to provide sufficient care, highlights the impact of these systemic issues on patients. The study underscores the need for improved training, better collaboration, and stronger leadership to prioritize mental health and ensure that registered nurses have the necessary resources and support to meet the needs of older people with signs of mental ill-being in home care.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"370"},"PeriodicalIF":2.7,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613414","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":"Application of the LDA model to identify topics in telemedicine conversations on the X social network.","authors":"Mario Sierra Martín, Fang-Wei Chen, Pilar Alarcón Urbistondo","doi":"10.1186/s12913-025-12493-3","DOIUrl":"10.1186/s12913-025-12493-3","url":null,"abstract":"<p><p>The evolution experienced by global society, in the post-COVID 19 era, is marked by the quite obligatory use of digital media in many sectors, as is the case for the health sector. Quite frequently, both patients and health professionals use social media to express their telemedicine concerns or interests. The present research focuses on these social media comments as they represent a very interesting data source for researchers. In the present analysis, we focus on unstructured tweet texts written by Internet users and apply both machine learning and the Latent Dirichlet Allocation algorithm to model X databases and identify tweet topics. The results gathered provide professionals with information on the most important issues and factors of influence for telemedecine consumers.BackgroundThe use of new technologies has transformed society, affecting communication, information seeking and ways of working. Telemedicine, as a remote health practice through ICTs, has grown exponentially, especially after the pandemic.ObjectiveWe do apply a mixed methodology in our study and use both qualitative and quantitative techniques to explore the conversational topics generated about telemedicine through comments posted by users on X. This allows us to identify primary, secondary, and residual themes.MethodsNatural Language Processing (NLP) and Machine Learning techniques, specifically the Latent Dirichlet Allocation (LDA) model, were used to analyse 156,633 comments extracted from \"X\" related to telemedicine topics.ResultsThe study revealed several issues to be addressed. Data was collected using keywords such as \"teleconsultation\" and \"telemedicine\". We can see that the most frequent words in the comments include words such as \"health\", \"service\", \"doctor\" and \"patient\". The themes identified were grouped into four dimensions: general information, benefits sought, specific information and professional issues. The results showed that 60.1% of the comments focused on generic telemedicine topics, ease of use and service information. \"X\" queries were observed to be public and general in nature, focusing on benefits and accessibility, while disease or treatment specific topics were less frequent.ConclusionsThe results provide information for the proper development and study of telemedicine through social networks. \"X\" is a platform mainly used for general telemedicine queries, with convenience and accessibility as the main benefits mentioned. The results suggest that online telemedicine interactions are complex and offer valuable insights for improving telemedicine communication strategies. Future research could explore the use of hashtags and analyse differences in interaction patterns according to user profile, providing a deeper understanding of audiences' behaviour on social networks. These findings underline the importance of considering audience preferences to improve the effectiveness of telemedicine communications.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"369"},"PeriodicalIF":2.7,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613360","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":"Predicting total healthcare demand using machine learning: separate and combined analysis of predisposing, enabling, and need factors.","authors":"Fatih Orhan, Mehmet Nurullah Kurutkan","doi":"10.1186/s12913-025-12502-5","DOIUrl":"https://doi.org/10.1186/s12913-025-12502-5","url":null,"abstract":"<p><strong>Objective: </strong>Predicting healthcare demand is essential for effective resource allocation and planning. This study applies Andersen's Behavioral Model of Health Services Use, focusing on predisposing, enabling, and need factors, using data from the 2022 Turkey Health Survey by TUIK. Machine learning methods provide a powerful approach to analyze these factors and their combined impact on healthcare utilization, offering valuable insights for health policy.</p><p><strong>Methods: </strong>Seven different machine learning models-Decision Tree, Random Forest, Support Vector Machine (SVM), K-Nearest Neighbors (KNN), Logistic Regression, XGBoost, and Gradient Boosting-were utilized. Feature selection was conducted to identify the most significant factors influencing healthcare demand. The models were evaluated for accuracy and generalization ability using performance metrics such as recall, precision, F1 score, and ROC AUC.</p><p><strong>Results: </strong>The study identified key features affecting healthcare demand. For predisposing factors, gender, educational level, and age group were significant. Enabling factors included treatment costs, community interest, and payment difficulties. Need factors were influenced by smoking status, chronic diseases, and overall health status. The models demonstrated high recall (approximately 0.90) and strong F1 scores (ranging from 0.87 to 0.88), indicating a balanced performance between precision and recall. Among the models, Gradient Boosting, XGBoost, and Logistic Regression consistently outperformed others, achieving the highest predictive accuracy. Random Forest and SVM also performed well, showing robust classification capability.</p><p><strong>Conclusions: </strong>The findings highlight the effectiveness of machine learning methods in predicting healthcare demand, providing valuable insights for health policy and resource allocation. Gradient Boosting, XGBoost, and Logistic Regression emerged as the most reliable models, demonstrating superior generalization and classification performance. Understanding the separate and combined effects of predisposing, enabling, and need factors on healthcare demand can contribute to more efficient and data-driven healthcare planning, facilitating strategic decision-making in resource allocation and service delivery.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"366"},"PeriodicalIF":2.7,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613415","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}