BMC Health Services Research最新文献

{"title":"Emergency department care experiences among 2SLGBTQQIA+ patients: a mixed methods study.","authors":"Sidonie Chard, Sawyer Karabelas-Pittman, Kel Martin, Elliot Chapple, David Messenger, Susan A Bartels, Melanie Walker","doi":"10.1186/s12913-025-12684-y","DOIUrl":"10.1186/s12913-025-12684-y","url":null,"abstract":"<p><strong>Background: </strong>Equity-deserving groups (EDG), including those who identify as two-spirit, lesbian, gay, bisexual, transgender, queer, questioning, intersex, and/or asexual (2SLGBTQQIA+), are disproportionately treated in the Emergency Department (ED). This study aimed to understand ED care experiences of 2SLGBTQQIA+ individuals compared to those who do not identify with an equity-deserving group in Kingston, Canada, ultimately aiming to enhance inclusivity and better meet healthcare needs.</p><p><strong>Methods: </strong>Data were collected through a mixed qualitative/quantitative cross-sectional study using a novel electronic survey tool (Spryng.io), which purposely integrates qualitative and quantitative data, while minimising researcher bias. A community-based participatory approach was employed to involve community stakeholders. Participants were recruited from the Kingston Health Sciences Centre's ED, Urgent Care Centre, and at community-based organisations. Quantitative data were analysed using chi-squared tests, while qualitative data underwent thematic analysis. Results were triangulated. Focus group discussions with community partners were then undertaken to contextualise findings.</p><p><strong>Results: </strong>Compared to persons who did not identify as belonging to an EDG (n = 949), 2SLGBTQQIA+ individuals (n = 118) felt their identity had a more negative impact on their care (p < 0.0001) and experienced more judgment and disrespect from healthcare providers (HCPs) (p < 0.0001). Four themes emerged from triangulation of qualitative and quantitative data: (1) mixed emotions regarding ED care; (2) transgender and non-binary health care considerations; (3) unmet mental health needs; and (4) lack of patient-centred care for 2SLGBTQQIA+ patients.</p><p><strong>Conclusions: </strong>2SLGBTQQIA+ individuals often face unmet mental health care needs, requiring tailored mental health care provision in the ED. Intersectionality within the 2SLGBTQQIA+ population underscores the importance of trauma-informed care. Strategies to improve 2SLGBTQQIA+ healthcare include implementing safer spaces, clear feedback mechanisms, referrals to gender-affirming specialists, and privacy in triage. Further research should assess the impact of educational interventions on HCP knowledge and patient experiences in the ED.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"751"},"PeriodicalIF":2.7,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141345","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":"Personalized and collaborative use of digital measurement-based care tools enhances engagement among young adults: a mixed-methods study.","authors":"Min K Chong, Ian B Hickie, Mahalakshmi Ekambareshwar, Adam Poulsen, Sarah McKenna, Alexis Hutcheon, Samuel J Hockey, Elizabeth M Scott, Frank Iorfino","doi":"10.1186/s12913-025-12889-1","DOIUrl":"https://doi.org/10.1186/s12913-025-12889-1","url":null,"abstract":"<p><strong>Background: </strong>Measurement-based care (MBC) enables personalised and proactive mental healthcare through regular symptom monitoring and review, allowing clinicians to make timely adjustments to clients' interventions for improved outcomes. Yet, its uptake in youth mental health services remains minimal. This study aims to explore perceived barriers and facilitators for sustained use of MBC and potential of digital technologies to enhance its engagement in young adults.</p><p><strong>Methods: </strong>A mixed-methods study, comprising focus groups and surveys, was conducted with young adults who had previously accessed mental health services. Template analysis was used to analyze qualitative data, and descriptive analyses were performed with quantitative data.</p><p><strong>Results: </strong>Eighteen young adults (mean age = 21.7 years; SD = 3.4) participated in this study. Survey results showed that young adults agreed with the value of MBC in their care (15/18) and reported low rates of discomfort with progress evaluation (11/18). Focus groups revealed collaborative data review with clinicians as a key facilitator in MBC uptake, driving repeated engagement with data input and review. Participants expressed that generalized interpretation of data that does not consider individual context, and the use of standard measures that were perceived to be irrelevant to their personal treatment goals discouraged their future engagement with MBC. Digital features that improve accessibility and data interpretation were expected to enhance consistent engagement with MBC.</p><p><strong>Conclusions: </strong>The findings indicate that the motivation and sustained engagement in MBC stem from young adults' comprehension of how collected data fosters shared decision-making and personalize treatment. Therefore, regular, collaborative data reviews would be crucial in cultivating a sense of autonomy and purpose within MBC for young adults. This study highlights the importance of data review in enhancing the uptake of MBC, a factor that is often overlooked. By demonstrating this, the study provides a deeper understanding of motivators in MBC and valuable insights for mental health services to explore strategies that could support clinicians to integrate data review as part of routine care. To this end, one effective approach could be developing technologies that facilitate client-clinician communication and empower young adults to advocate for personalized care.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"752"},"PeriodicalIF":2.7,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149133","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":"National stakeholders' consensus to optimise research awareness through mandatory induction training using the Nominal Group Technique: the INTRO project.","authors":"Maria Joao Cardoso Teixeira, Diane L McCarter, Lucy Ainsworth, Verna Lavender","doi":"10.1186/s12913-025-12768-9","DOIUrl":"10.1186/s12913-025-12768-9","url":null,"abstract":"<p><strong>Background: </strong>Research provides the agency for step-change and improvement in health care. Research is, however, often viewed as disconnected from, or irrelevant to, everyday healthcare delivery. Mandatory induction training for new healthcare staff offers a means to increase research awareness and promote wider integration of research in practice.</p><p><strong>Method: </strong>This study reports findings from an adapted version of the Nominal Group Technique, as the initial planning stage of a quality improvement project. The aim was to identify recommendations for raising research awareness within mandatory corporate, clinical, and local induction. Nationwide stakeholders representing patients and professional groups from numerous organisations were invited to participate in three online consultations workshops, during which suggestions for mandatory induction training were generated and distilled.</p><p><strong>Results: </strong>Sixty-seven stakeholders from 37 tertiary, community, and mental health organisations in England participated in the workshops. Of the initial 307 candidate items proposed, 20 (6.3%) achieved consensus. Core recommendations included: (i) concise, bite-sized, high-quality videos for mandatory corporate induction; (ii) a blend of resources (PowerPoint templates, interactive online modules, signposting websites) for mandatory clinical and local inductions; (iii) clear delineation between research and quality improvement projects; and (iv) recommendations about delivery responsibility and governance.</p><p><strong>Conclusion: </strong>Recommendations developed from the final 20 candidate items provide a coherent framework for raising research awareness in mandatory induction training. They are designed to be integrated into mandatory induction, promoting staff-awareness and, ultimately, contributing to the advancement of research and improving patient outcomes. Further work is in progress to implement and evaluate these recommendations, as part of a Plan-Do-Study-Act quality improvement cycle.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"748"},"PeriodicalIF":2.7,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender-based differences in associated factors of perceived salary satisfaction among physicians: a cross-sectional study.","authors":"Xiaoying Jiang, Jing Ma, Wei Wei, Ning Hu, Aiping Zhu, Chunyu Zhang","doi":"10.1186/s12913-025-12925-0","DOIUrl":"https://doi.org/10.1186/s12913-025-12925-0","url":null,"abstract":"<p><strong>Background: </strong>Perceived salary satisfaction of physicians is crucial because it affects work enthusiasm and team stability. However, research on whether perceived salary satisfaction and its determinants differ by gender is limited. This study aimed to fill this gap and promote equity in health policy in the medical field.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey in six hospitals in China from April to May 2024 to collect data on sociodemographic information, perceived salary distribution scheme transparency, and perceived salary satisfaction. Ultimately, 343 valid questionnaires were included in the final analysis. A factor analysis was conducted to determine the common factors of perceived salary transparency and salary satisfaction, whereas generalized linear regression was used to analyse the determinants of perceived salary satisfaction by gender.</p><p><strong>Results: </strong>No differences in perceived salary satisfaction were identified between male and female physicians. Perceived salary distribution scheme transparency is associated with perceived salary satisfaction in both groups. Higher salary levels contributed to higher perceived salary satisfaction for male physicians, whereas fewer weekly working hours and higher academic rank led to higher perceived salary satisfaction for their female peers.</p><p><strong>Conclusions: </strong>The determinants of perceived salary satisfaction for male and female physicians were inconsistent. The identified similarities and differences in perceived salary satisfaction determinants across genders will enable health organizations to facilitate a transparent salary distribution scheme and equitable promotion regardless of gender and promote flexible working hours for female physicians.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"749"},"PeriodicalIF":2.7,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141318","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 illness management and recovery program: a contribution to recovery-oriented secondary mental health services.","authors":"Kristin B Ørjasæter, Tone Winnem, Kristin Heiervang, Ottar Ness, Kim T Mueser","doi":"10.1186/s12913-025-12907-2","DOIUrl":"https://doi.org/10.1186/s12913-025-12907-2","url":null,"abstract":"<p><strong>Background: </strong>In recent decades, mental health services have been challenged to offer evidence-based practices (EBPs) that are person-centered, human rights- and recovery-oriented. The Illness Management and Recovery (IMR) program aims to promote recovery and enhance individuals' ability to live well. Investigating the IMR program from the perspective of mental health practitioners is crucial to improve recovery-oriented care and optimize program delivery.</p><p><strong>Methods: </strong>This study aimed to develop knowledge whether IMR, as an EBP, can function as a recovery-oriented practice (ROP) within secondary mental health care services. Seven focus groups were conducted, each consisting of two to eight mental health practitioners with different professional backgrounds and experiences. Altogether, 36 practitioners from five mental health hospitals and district psychiatric centers in Norway participated. Reflexive thematic analysis was used to analyze the data.</p><p><strong>Results: </strong>The results show that IMR (a) actively facilitates the alignment of coping mechanisms with patients' lives, and (b) emphasizes a recovery-oriented approach in the delivery of services. Mental health practitioners perceive IMR as inherently recovery-oriented. Although ROPs and EBPs are often considered to function in opposition, to the practitioners in our study they were neither contradictory nor mutually exclusive but complementary and with the potential to bring out the best in each other to support patients' recovery processes.</p><p><strong>Conclusion: </strong>IMR, as an evidence-based, recovery-oriented program, bridges psychiatry and mental health recovery. However, challenges arise from its illness-oriented approach and language, as well as its emphasis on individual recovery aspects. While IMR underscores the social aspects of recovery, it is essential to highlight the social, and societal factors in individuals' recovery processes within the program.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"750"},"PeriodicalIF":2.7,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141319","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":"Collaborative tailoring of the Reach Out, Stay Strong Essentials (ROSE) program for pregnant veterans in the U.S. Veterans Health Administration: a qualitative case study of contextual conditions and adaptations.","authors":"Erin P Finley, Alison B Hamilton, Ismelda Canelo, La Shawnta S Jackson, Rachel Lesser, Rebecca S Oberman, Julia Yosef, Joya G Chrystal, Erica H Fletcher, Bevanne Bean-Mayberry, Tannaz Moin, Melissa M Farmer, Ariel J Lang","doi":"10.1186/s12913-025-12871-x","DOIUrl":"10.1186/s12913-025-12871-x","url":null,"abstract":"<p><strong>Background: </strong>Reach Out, Stay Strong Essentials (ROSE) is an evidence-based intervention for preventing post-partum depression being implemented across U.S. Veterans Health Administration (VA) sites as part of the EMPOWER 2.0 implementation trial comparing Replicating Effective Programs (REP) and Evidence-Based Quality Improvement (EBQI) strategies for improving women's health care. As both REP and EBQI support adaptation to meet local needs, the EMPOWER 2.0 implementation team and participating sites have collaboratively developed adaptations of ROSE to better serve pregnant veterans. We describe contextual conditions arising during the first three years of implementation, associated adaptations to the intervention and implementation approach, and implications for pragmatic tailoring and diffusion of evidence-based interventions.</p><p><strong>Methods: </strong>We conducted a qualitative case study that included rapid qualitative analysis of 50 periodic reflections (brief guided discussions with templated notes) completed with EMPOWER 2.0 implementation team members February 2021-February 2024. Contextual conditions were characterized according to domains of the updated Consolidated Framework for Implementation Research (CFIR); adaptations were characterized using the Framework for Reporting Adaptations and Modifications to Evidence-Based Interventions (FRAME) and Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS).</p><p><strong>Results: </strong>Sites reported high demand for ROSE in response to perceived gaps in care for pregnant veterans' mental health needs. Site-level challenges included the need to locate ROSE within existing services, although the salience of contextual conditions evolved across implementation phases. Notable adaptations included updates to the ROSE intervention (e.g., improving alignment with VA clinical practice guidelines) and adaptations to the implementation approach (e.g., offering training to VA providers beyond the original EMPOWER sites). Although the trial is ongoing, expansion of ROSE training has resulted in a total of 256 VA providers trained across 48 VA facilities nationwide.</p><p><strong>Conclusions: </strong>In implementing ROSE across a national sample of VA sites, co-produced adaptations emerged to improve feasibility of delivery and increase acceptability of ROSE for pregnant veterans. Implementation of ROSE in EMPOWER 2.0 provides a pragmatic model for supporting rapid iteration and diffusion of adaptations to address perinatal mental health needs within large healthcare systems.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: Enhancing Mental and Physical Health of Women Veterans (NCT05050266). Registration Date: 09/09/2021. https://clinicaltrials.gov/study/NCT05050266?term=EMPOWER%202.0&rank=1 .</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"746"},"PeriodicalIF":2.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12100789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"A banana in the tailpipe\": a qualitative study of patient flow in the healthcare system.","authors":"Mahnaz Samadbeik, Andrew Staib, Justin Boyle, Sankalp Khanna, Emma Bosley, Elizabeth McCourt, Daniel Bodnar, James Lind, Jodie A Austin, Clair Sullivan","doi":"10.1186/s12913-025-12873-9","DOIUrl":"10.1186/s12913-025-12873-9","url":null,"abstract":"<p><strong>Background: </strong>Suboptimal patient flow and impaired hospital access can lead to adverse outcomes, including lower care quality, higher mortality risk, and patient dissatisfaction. Despite awareness, optimizing patient flow remains an area requiring further development. This study aimed to comprehensively identify factors hindering patient flow in a large healthcare system and explore potential solutions, using a qualitative approach for context-specific insights.</p><p><strong>Methods: </strong>This qualitative study followed COREQ guidelines. We conducted four focus group discussions (FGDs) involving 23 healthcare workers (HCWs) and patients selected through purposive sampling. The data were analysed using the directed content analysis method, ensuring rigor through methods such as credibility, dependability, authenticity, and transferability. The study also mapped qualitative findings to outcomes from our recent umbrella review (UR) to enhance comprehensiveness.</p><p><strong>Results: </strong>Patient flow challenges were categorized into population (patients and providers), capacity, and process. Population challenges included community-based care, staffing issues, and inequities in access. The capacity challenges involved inefficient resource allocation, resource constraints, and patient volume growth. The process challenges included bed management, modernization struggles, private hospital issues, funding model problems, information sharing gaps, coordination challenges, transition issues, particularly delayed discharges from inpatient wards, and problems in healthcare management and patient communication. The solutions focused on human factors, infrastructure, and management, organization, and policy. FGDs identified new challenges and solutions were not covered in the recent UR.</p><p><strong>Discussion: </strong>The participants' insights highlight the critical necessity for systemic improvements, which include enhancing infrastructure, communication, and collaboration. These improvements include early identification of discharge barriers, facilitating community discharge, addressing diverse patient needs, optimizing prehospital services, and improving patient communication. Shifting the focus from traditional emergency department processes to a system-wide approach is crucial. The comparative mapping between FGDs and the UR insights into both common and specific challenges and solutions enriches discussions on healthcare reform.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"745"},"PeriodicalIF":2.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12100811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the capacity of health facilities in preventing and managing non-communicable diseases in selected regions of Somaliland.","authors":"Opeolu O Ojo, Omar O Hersi, Ayodele A Falobi, Nura Ali, Lawrence Tan, Yusuf A Ali","doi":"10.1186/s12913-025-12913-4","DOIUrl":"10.1186/s12913-025-12913-4","url":null,"abstract":"<p><strong>Background: </strong>The recently published Somaliland Demographic and Health Survey indicated a growing prevalence of non-communicable diseases (NCDs) in Somaliland. However, evidence about the capacity of Somaliland's health system for effective management of NCDs is limited. This study assesses the capacity of hospitals selected from two regions of Somaliland for effective NCD management.</p><p><strong>Methods: </strong>A previously validated questionnaire based on the World Health Organisation Package of Essential Noncommunicable Disease Intervention for Primary Health Care (WHO-PEN) was used to survey seven hospitals selected from Togdheer and Maroodi Jeex regions of Somaliland. The survey focused on assessing the capacity of selected hospitals in detecting and managing NCDs by collecting data on the availability of health workers, equipment, screening and management services, medications, and laboratory tests. The impact of location, level of care provided and source of funding on the capacity of hospitals was assessed.</p><p><strong>Results: </strong>This study observed shortage of essential health workers and lack of workers with specialist knowledge across all hospitals surveyed. Higher average number of doctors in urban (4.3-fold, P < 0.001), referral centres (3.1-fold, P < 0.001) and public (3.1-fold, P < 0.001) hospitals compared to rural, general, and private hospitals respectively. A similar trend was observed for the number of nurses across the different category of hospitals. All hospitals have adequate quantity of functional basic equipment, but advanced diagnostic facilities were generally lacking. Where available, they were either not functional or there is a lack of expertise for effective utilization. Laboratories are across all hospitals categories were sufficiently staffed but there is a need for training in cutting edge diagnostic procedures. Imaging and laboratory services were observed as major cost drivers of NCDs expenditure. All hospitals surveyed have access to first line NCD medicines, lack community engagement activities, and have guidelines and referral systems that need updating. Imaging and laboratory services were observed as major cost drivers of NCDs expenditure.</p><p><strong>Conclusion: </strong>Though there are differences in the capacity of hospitals assessed, none of the hospitals met the WHO-PEN standard for human resources, equipment, and medicines for effective NCDs management. Interventions to train specialist health workers and laboratory technologists, procure advanced equipment, and update guidelines and referral systems in Somaliland are needed.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"744"},"PeriodicalIF":2.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12100831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges to accessing community dementia care services: a qualitative study.","authors":"Chandrika Ramakrishnan, Chetna Malhotra","doi":"10.1186/s12913-025-12895-3","DOIUrl":"10.1186/s12913-025-12895-3","url":null,"abstract":"<p><strong>Background: </strong>Community dementia care services are designed to support persons with dementia (PWDs) and their caregivers. Despite their importance, these services are underutilized. Previous studies have typically focused on challenges in accessing specific types of dementia care services from the perspective of a single stakeholder group. To address this limitation, we conducted a qualitative study exploring the challenges faced by caregivers in accessing the full spectrum of community dementia care services, incorporating insights from both informal caregivers and healthcare providers.</p><p><strong>Methods: </strong>We conducted semi-structured in-depth interviews with 22 participants: 11 caregivers of PWDs, 8 healthcare providers, and 2 policy makers. The thematic analysis employed was guided by Levesque's framework for access to care.</p><p><strong>Results: </strong>We synthesized caregivers' multiple challenges under five themes - (1) lack of information and awareness limit perceived need for services, (2) cultural norms and values influence decision to seek services, (3) complex processes and long waiting times hinder ability to reach services, (4) financial constraints and high costs force alternate care arrangements, and (5) inability to meet expectations and lack of family support limit engagement with services. To overcome the challenges, participants suggested public education to reduce stigma around dementia; leveraging digital health to improve caregivers' access to information, healthcare providers, and social and emotional support; and revisiting financial policies to reduce high caregiving costs for dementia.</p><p><strong>Conclusion: </strong>The study highlights a range of challenges that hinder access to community dementia care services. There is an urgent need to redesign these services to better meet the needs of PWDs and their caregivers, thereby creating a more supportive and responsive care ecosystem.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"747"},"PeriodicalIF":2.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and potential value of a local governmental frail check-up program for the risk assessment of long-term care in apparently healthy older citizens: a prospective study.","authors":"Yoji Nagai, Yasumasa Kakei, Tatsuo Kagimura, Shinsuke Kojima, Hisatomo Kowa, Tohmi Osaki, Ryoma Kayano, Yasuji Yamamoto","doi":"10.1186/s12913-025-12918-z","DOIUrl":"10.1186/s12913-025-12918-z","url":null,"abstract":"<p><strong>Background: </strong>Earlier identification of individuals at risk of needing long-term care can increase the opportunities for preventive/therapeutic interventions, leading to a reduced social burden.</p><p><strong>Methods: </strong>We examined the feasibility and potential value of a frailty check-up program implemented by the local government for risk assessment of long-term care needs in 1,528 apparently healthy older (aged 64/65 years) citizens in Kobe, Japan, between August 2017 and March 2018. The program comprised a questionnaire on general frailty (Comprehensive score) and evaluation of other frailty-related measures, cognitive function-related activities of daily living (Cognitive Function Instrument), and health-related quality of life (EQ-5D-5L). In March 2020, these measures were merged with data on long-term care or support certification, where the latter represented a condition requiring care for a certain period preceding long-term care needs.</p><p><strong>Results: </strong>Overall, 15 citizens were certified as having long-term care needs and 38 as having long-term care or support needs. Using receiver operating characteristic curve analysis, certain measures, including the Comprehensive score and EQ-5D-5L, significantly predicted the incidence of long-term care or support needs.</p><p><strong>Conclusions: </strong>The frailty checkup program conducted by the local government may be feasible and valuable for risk assessment of long-term care needs in apparently healthy older citizens.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"743"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}