BMC Health Services Research最新文献

{"title":"Performance indicators on long-term care for older people in 43 high- and middle-income countries: literature review, web search and expert consultation.","authors":"Mircha Poldrugovac, Joost D Wammes, Véronique L L C Bos, Erica Barbazza, Damir Ivanković, Hanneke Merten, Janet L MacNeil Vroomen, Niek S Klazinga, Dionne S Kringos","doi":"10.1186/s12913-025-12573-4","DOIUrl":"10.1186/s12913-025-12573-4","url":null,"abstract":"<p><strong>Background: </strong>Long-term care (LTC) for older people is an area of focus for many health and social policies in high- and middle-income countries. Performance Indicators are used to provide national and subnational jurisdictions with insights to ensure quality of the provided LTC services for older people. Although LTC systems vary across jurisdictions, there is demand for internationally comparable indicators to support countries in monitoring LTC and facilitate mutual learning. The aim of this study was to provide an overview of indicators currently employed to monitor the performance of LTC systems and services in high- and middle- income countries and describe their key characteristics.</p><p><strong>Methods: </strong>A review of the literature in six scientific databases (literature review) and web searches of relevant sites across 43 selected countries (web search) was conducted. We asked country representatives from the Working Party on Health Care Quality and Outcomes of the Organization for Economic Cooperation and Development, where most of these countries are represented, to cross-validate the sources of information found (expert consultation). We then extracted and analysed the data from all obtained sources based on a predetermined set of characteristics.</p><p><strong>Results: </strong>The search of scientific databases yielded 12,960 records, from which forty papers were selected for inclusion. The scientific literature findings were complemented by 34 grey literature sources. In total, we identified performance indicators being used to monitor LTC systems and services across 29 national and subnational jurisdictions in 24 out of 43 countries. In total, 620 indicators were identified. All jurisdictions used indicators related to institutional LTC and 16 also used indicators on home care. The most frequently monitored structures, processes, and results were pressure ulcers, falls, use of restraints and pain management.</p><p><strong>Conclusions: </strong>We identified LTC performance indicators currently being monitored in 29 jurisdictions across 24 countries. Many jurisdictions are monitoring similar structures, processes, and results. This presents an opportunity to develop internationally comparable LTC performance indicators based on existing efforts across countries.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"460"},"PeriodicalIF":2.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728293","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":"An assessment of the implementation of the HIV workplace policy in Akwa Ibom State: a cross-sectional descriptive study.","authors":"Helen M Idiong, Anyiekere M Ekanem, Esther Nwanja, Prince E Idiong, Emilia A Udofia","doi":"10.1186/s12913-025-12586-z","DOIUrl":"10.1186/s12913-025-12586-z","url":null,"abstract":"<p><strong>Background: </strong>Eliminating AIDS by 2030 will remain a mirage if obstacles to achieving zero new HIV infections and viral suppression, like stigma and discrimination against people living with HIV (PLHIV) are not eliminated. Several strategies and policies are targeted at this issue but it remains a huge challenge globally. Like other countries, Nigeria adopted the HIV in the Workplace policy (HIV WPP) in 2013, aimed at protecting the rights of PLHIV in the workplace. Akwa Ibom State (AKS), Nigeria, adopted this policy in 2014. However, since its adoption, its implementation has not been assessed. This study aimed to evaluate the availability and implementation of the HIV WPP in the state.</p><p><strong>Methods: </strong>A cross-sectional study using a mixed methods research approach was conducted for 591 consecutively recruited employees and 43 employers/ decision-makers across 23 organizations. Data was collected from October 2022 to February 2023. Seven criteria based on the Policy Implementation Assessment Tool were used to assess policy implementation. Scores above 70% were categorized as optimal policy implementation. The chi-square test was used to determine the factors associated with the level of implementation of the policy. Results were analyzed using STATA 15.1 for quantitative and NVivo 10 for qualitative data.</p><p><strong>Results: </strong>A total of 591 employees provided completed responses, the majority were females (59.7%) and 60.2% worked in government establishments. Of the employers, 55.6% were < 45 years old, 59.1% were males, 72.7% had a university education and the median duration working as a manager was 5.5 years. Of the 22 assessed establishments, the policy was available in 1 (4.5%) organization and 95% had a suboptimal implementation of the policy. The unavailability of the policy and resources for implementation were deterrents to the level of implementation of the policy.</p><p><strong>Conclusion: </strong>The level of implementation of the Akwa Ibom HIV in the workplace was suboptimal across both private and public sectors in the State. This was attributed to the unavailability of the policy and other resources for implementation. The State Agency for the Control of AIDS should consider improving access to the policy and strengthening implementation structures.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"459"},"PeriodicalIF":2.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728371","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 relationship between teamwork and the workload of nurses with missed nursing care in intensive care units in Iran: a cross-sectional study.","authors":"Ali Safdari, Fahimeh Ramezani, Erfan Ayubi, Efat Sadeghian","doi":"10.1186/s12913-025-12583-2","DOIUrl":"10.1186/s12913-025-12583-2","url":null,"abstract":"<p><strong>Background: </strong>Missed nursing care (MNC) is a major challenge faced by nurses working in intensive care units (ICU). Workplace characteristics, including teamwork and workload, can affect the extent of missed nursing care. Examining the relationship between these variables can help create strategies to enhance care. Thus, this study aimed to explore the connection between teamwork, workload, and missed nursing care in the intensive care units of hospitals in Iran.</p><p><strong>Methods: </strong>This descriptive cross-sectional study was conducted from August to November 2023 on 219 nurses working in the intensive care units of teaching hospitals affiliated with Hamadan University of Medical Sciences. Participants were selected through multi-stage sampling after meeting the inclusion criteria. Data were collected using the General Characteristics questionnaire, the Team-STEPPS^® Teamwork Perception Questionnaire (T-TPQ), the National Aeronautics and Space Administration Task Load Index (NASA-TLX), and the MISSCARE survey. Data analysis was performed using Stata software version 14.</p><p><strong>Results: </strong>Out of 219 returned questionnaires (92.79% response rate), 194 valid responses were analyzed. Missed nursing care showed a significant negative correlation with overall teamwork (r = -0.538, P < 0.001) and its subcomponents, including team structure (r = -0.472), leadership (r = -0.303), situation assessment (r = -0.486), mutual support (r = -0.325), and communications (r = -0.517). Tenure was also significantly related to missed nursing care (p = 0.040), with nurses having less than 2 years of experience reporting the lowest missed care scores. No significant relationships were found between workload scores and demographic variables.</p><p><strong>Conclusion: </strong>The relationship between teamwork, nurse workload, and missed nursing care is complex. The findings of this study emphasize the importance of effective teamwork and manageable workloads in reducing missed nursing care. However, contextual differences in nurses' work environments are of great importance in different countries.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"440"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717897","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":"Provision of respectful care for human dignity in health care service and associated factors in South Gondar hospitals, northwest, Ethiopia, multicenter study.","authors":"Gebrie Kassaw Yirga, Moges Wubneh Abate, Yeshiambaw Eshetie Ayenew, Yirgalem Abere, Tadila Dires, Kirubel Shiferaw","doi":"10.1186/s12913-025-12532-z","DOIUrl":"10.1186/s12913-025-12532-z","url":null,"abstract":"<p><p>Providing compassionate and respectful care is essential to quality health care, and it is the backbone of our health care system. This study was conducted to assess the provision of respectful care and human dignity and its associated factors among healthcare providers in South Gondar hospitals in 2024. A cross-sectional study design was conducted from March 18 to April 18, 2024. From 1177 care providers, 420 study units were selected by the simple random sampling technique. The collected data was entered into Epi Data version 3.1, and it was exported to Statistical Package for Social Sciences version 26 Windows statistical software for analysis. Factors that have a p-value ≤ 0.25 in binary logistic regression were a candidate for multivariate logistic regression. Factors with a p-value < 0.05 were considered predictors of the outcome variable. Respectful care among health care providers was reported as 52.4%. Income (P = 0.039), professional attitude (P < 0.001), and training (P = 0.032) were significantly associated with respectful care. In this study, about half of the health care providers had good, respectful practices. Healthcare providers should have a positive attitude towards respectful care according to strategy; different stakeholders in health sectors should be involved by providing supplies, facilitating training, and performing continuous monitoring and evaluation.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"453"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728372","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":"Stressful and potentially traumatic events and healthcare utilization: the 7^th Tromsø survey.","authors":"Jens C Thimm, Kamilla Rognmo, Ingunn Skre, Catharina E A Wang","doi":"10.1186/s12913-025-12604-0","DOIUrl":"10.1186/s12913-025-12604-0","url":null,"abstract":"<p><strong>Background: </strong>Stressful and potentially traumatic life events (SLEs/PTEs) can have a profound negative impact on the individual's mental and physical wellbeing and health. Consequently, an association of SLEs/PTEs with increased healthcare utilization has been found. However, most studies have been conducted in selected samples (e.g., veterans), and there is a paucity of studies in the general population. The present study examined the associations between SLEs/PTEs and the utilization of healthcare services in the general population using data from the seventh survey of the Tromsø study (Tromsø7).</p><p><strong>Methods: </strong>The sample comprised 20,069 participants aged 40 years and above (52.5% female, mean age 57.3 years, SD = 11.4 years) who completed measures of SLE/PTE exposure in childhood/adolescence and adulthood (including a question about mental preoccupation with SLEs/PTEs), utilization of a variety of healthcare services (general practitioner, medical specialist, hospital, emergency room, mental health services, physiotherapist, and complementary and alternative medicine provider) in the previous year, and self-reported feeling of being anxious or depressed.</p><p><strong>Results: </strong>The results showed that SLE/PTE exposure is associated with an increased use of all healthcare services, especially mental health professionals. Exposure to physical and emotional neglect in childhood/adolescence, violence, and sexual abuse showed the strongest associations with the utilization of mental health services. The strength of the associations with health service utilization increased with the number of SLEs/PTEs. Finally, mental preoccupation with the event(s) moderated the associations between SLE/PTE exposure and the utilization of healthcare services but not self-reported feeling of being anxious or depressed.</p><p><strong>Conclusion: </strong>It is concluded that the prevention of SLEs/PTEs and screening for SLE/PTE exposure in healthcare services to provide trauma-informed care should be a prioritized public health focus.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"455"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728374","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":"Evaluation of comprehensive abortion care service in University of Gondar Comprehensive Specialized Hospital in Northwest Ethiopia: mixed case study design.","authors":"Birtukan Demis Getaneh, Nigusu Worku, Kaleb Assegid Demissie, Tesfahun Zemene Tafere, Melak Jejaw","doi":"10.1186/s12913-025-12579-y","DOIUrl":"https://doi.org/10.1186/s12913-025-12579-y","url":null,"abstract":"<p><p>Despite Ethiopia's substantial progress in comprehensive abortion care, the consequences of abortion remain a major public health challenge. This study aimed to assess the implementation status and its determinants of comprehensive abortion care service at University of Gondar Comprehensive Specialized Hospital. A facility-based single case study with convergent parallel mixed-method evaluation was conducted from March 28 to April 28, 2023. Availability, patient-centered care, timeliness, and compliance dimensions with 35 indicators were used. A total of 379 exit interviews, five key informant interviews, six in-depth interviews, 411 medical charts reviewed, and 17 observations were done. Stata version 17 was used. Binary logistic regression analysis was computed to identify eligible variables for the multivariable logistic regression, and a variable with p-value < 0.05 at adjusted odds ratio with a 95% confidence interval was declared as statistically significant. The qualitative data were recorded through a tape recorder, transcribed in Amharic and translated to English, and analyzed thematically.The overall implementation status of comprehensive abortion care (CAC) was found to be 65.1%, which is considered fair according to judgment parameters. Availability of CAC resources, compliance of service providers, timeliness, and patient-centered care contributed scores of 85.7% (very good), 72.6% (fair), 40.6% (poor), and 61.3% (fair), respectively. Urban dwellers, married women, had family support, privacy to access abortion care, and those who communicated on medication were positive predictors of patient-centered care. There were stock outs of essential emergency drugs, shortages of equipment and trained manpower, and poor infrastructure. Besides, none of the providers comply with hand washing protocols and used personal protective equipment, and there were delays in providing abortion services. The overall CAC program service implementation needs urgent improvements, especially in timeliness, which was notably poor and needs major enhancements. Thus, to improve CAC services, the hospital should ensure the availability of essential drugs, equipment, and infrastructure. The Ministry of health should improver providers' compliance with CAC guidelines by providing training and enhancing continuous professional development programs. Moreover, policymakers and planners should focus on enhancing providers' communication skills and family involvement in care decisions, and warranting patient privacy and confidentiality according to established protocols.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"449"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728030","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":"Evaluation of the implementation of an insulin patient decision aid for patients with type 2 diabetes in an academic primary care clinic in Malaysia: a mixed method study.","authors":"Wen Ting Tong, Chirk Jenn Ng, Yew Kong Lee, Ping Yein Lee","doi":"10.1186/s12913-025-12588-x","DOIUrl":"https://doi.org/10.1186/s12913-025-12588-x","url":null,"abstract":"<p><strong>Background: </strong>Literature surrounding patient decision aid (PDA) focus on testing effectiveness such as measuring patient or practice outcomes, while few studies looked into evaluation of implementation outcomes. It is important to assess implementation outcomes because in order for PDA to deliver its intended effects, they should first be effectively implemented. This study aimed to evaluate the implementation of an insulin PDA in an academic primary care clinic specifically measuring implementation outcomes.</p><p><strong>Methods: </strong>A mixed-methods sequential explanatory design was used. This study was conducted at a primary care clinic in an academic hospital from April - November 2018. The insulin PDA was implemented using a tailored implementation intervention, which comprised of 11 strategies aiming to overcome 13 prioritised implementation barriers. Evaluation data were collected from: healthcare administrators such as the head of department, the clinic coordinator, and the nursing officer who oversees the clinic operations, doctors whose tasks were to deliver the insulin PDA to patients, nurses who were responsible for making sure the insulin PDAs were available, and patients with type 2 diabetes who were offered the insulin PDA. The study commenced with the quantitative approach to assess 'Reach', 'Adoption', 'Implementation' and 'Maintenance'of the insulin PDA. Subsequently, qualitative approach was employed and qualitative interviews were conducted with the relevant stakeholders to explain the quantitative outcomes. A total of six IDIs and six FGDs were conducted with healthcare providers (healthcare policymakers: 3, doctors: 35, and staff nurses: 5), and 62 IDIs were conducted with patients.</p><p><strong>Results: </strong>For 'Reach', 88.9% (n = 48/54) of doctors and 55% (n = 11/20) of nurses attended the insulin PDA training workshops. This was attributed to their self-motivation and the mandate from the Head of Department. The PDA reached 387 patients and was facilitated by the doctors who delivered the PDA to them and their own desire to know more about insulin. Doctors' 'Adoption' of the PDA was high (83.3%, n = 45/54) due to the positive personal experience with the usefulness of the PDA. Only 65.7% (n = 94/143) of patients who received the PDA read it. The degree of 'Implementation' of the PDA varied for different tasks (ranged from 19.2 to 84.9%) and was challenged by patient and system barriers. For 'Maintenance', 80% of the doctors were willing to continue using the PDA due to its benefits.</p><p><strong>Conclusion: </strong>This study highlighted that the implementation of an insulin PDA in a primary care setting is promising. Addressing the issues of social hierarchy, and healthcare providers' roles and responsibilities can further improve implementation outcomes.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"450"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728357","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 extent to which medical specialists provide Clinical Work-Integrating Care (CWIC) and their perceived role-responsibility: a mixed-methods study.","authors":"Lana Kluit, Astrid de Wind, Annechien Beumer, Coen A M van Bennekom, Angela G E M de Boer","doi":"10.1186/s12913-024-12137-y","DOIUrl":"https://doi.org/10.1186/s12913-024-12137-y","url":null,"abstract":"<p><strong>Background: </strong>Awareness among medical specialists about patient work concerns is important because work and health are linked. In Clinical Work-Integrating Care (CWIC), specialists adopt the notion that work can affect health, and medical actions can affect work participation, and they act according to that notion. This study aims to assess the extent to which specialists provide CWIC and to obtain perceptions of medical specialists about their professional role-responsibility in providing CWIC.</p><p><strong>Methods: </strong>This cross-sectional mixed-methods study involved quantitative questionnaires and qualitative interviews with medical specialists. The self-developed 18-item questionnaire evaluated the extent and type of CWIC provision (rating scale 0-4; Never = 0 to Always = 4) and how role-responsibility was perceived, while the interviews offered more in-depth insights. Descriptive statistics for the questionnaire data and thematic analyses for the interview data were applied.</p><p><strong>Results: </strong>We attained 160 questionnaires (female 64%, 93% non-surgical specialists) and 11 interviews (female 64%, 91% non-surgical specialists). Specialists often asked patients about work (mean score 3.1), sometimes about work history (mean score 2.2) and the conversation about work was usually started by the specialist (mean score 2.9). Conversations about work often concerned the influence of work on disease (2.4) and the influence of disease (2.5) or treatment (2.1) on work ability, but rarely about the legal aspects related to sick leave (1.5). The specialists' perceived role-responsibility was summarized in three themes: 1) understanding that work and health (problems) are linked including asking patients about work and investigating work factors, 2) supporting work participation within a specialist's expertise including focus on patients' health and prevention of sick leave, and 3) possibilities and limitations of the healthcare system including work participation as treatment goal and cooperation with occupational health care.</p><p><strong>Conclusions: </strong>Medical specialists in our survey usually asked about patients' work, but they often did not take a work history. Limitations within the healthcare system hinder comprehensive work-integrating support by specialists, defining the boundaries of CWIC to within hospital care.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"448"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728375","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":"Change of primary health care service provider model in Vantaa: the impact on mortality and causes of death among older adults - a register-based follow-up study.","authors":"Aina Enckell, Hanna-Maria Roitto, Hannu Kautiainen, Mika T Lehto, Kaisu H Pitkälä, Timo Kauppila, Merja K Laine","doi":"10.1186/s12913-025-12595-y","DOIUrl":"10.1186/s12913-025-12595-y","url":null,"abstract":"<p><strong>Background: </strong>Access to primary health care (PHC) has declined in Finland in recent years. To address this, the city of Vantaa, Finland, transitioned from a named general practitioner (GP) model to a restricted-list GP model in 2011 to increase access to named GPs for the most vulnerable population. This study evaluates the impact of this model change on mortality rates and causes of death among older adults.</p><p><strong>Methods: </strong>This register-based follow-up study was conducted in Vantaa, Finland, using data from the electronic health records. The study included all patient contacts aged 75 and older between 1 September 2004 and 31 August 2018. The primary outcome was the Standardised Mortality Ratio (SMR). We calculated excess deaths and examined cause-specific mortality trends before and after the restricted-list GP model implementation.</p><p><strong>Results: </strong>During the study period, 32,034 PHC contacts were recorded. The SMR remained stable during the named GP model years but began to decrease during the restricted-list GP model, falling below expected levels from 2016 onward. Excess deaths decreased from 615 in 2004 in the named GP model to -29 by 2018, when the restricted-list GP model was in operation. Leading causes of death were circulatory diseases (41.1%), cancers (20.4%) and neurological conditions (17.8%), with a decrease in circulatory disease deaths and an increase in cancer and dementia-related deaths over time.</p><p><strong>Conclusions: </strong>The transition to the restricted-list GP model was associated with a lower SMR and fewer excess deaths in older adults. These findings highlight the importance of ongoing assessment of PHC models to ensure they meet evolving healthcare demands.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"458"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727872","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":"Raising awareness and preparation for what may come: next of kin experiences of advance care planning with frail, home-dwelling older adults in geriatric units.","authors":"Karin Berg Hermansen, Rigmor Einang Alnes, Trygve Johannes Lereim Saevareid, Reidar Pedersen, Siri Faerden Westbye, Maria Romøren, May Helen Midtbust","doi":"10.1186/s12913-025-12609-9","DOIUrl":"10.1186/s12913-025-12609-9","url":null,"abstract":"<p><strong>Background: </strong>Acutely ill and frail older adults and their next of kin are often poorly involved in planning of decisions regarding treatment and care during the final phase of life. Although advance care planning is a well-documented tool to strengthen patient autonomy and involve next of kin, it remains underused in hospital settings. We present a qualitative sub-study embedded in a cluster-randomized controlled trial, whose purpose was to implement advance care planning in Norwegian geriatric units. Frail, home dwelling older adults acutely admitted to geriatric hospital units were invited to participate in advance care planning together with their next of kin. The aim of this study was to explore next of kin experiences of advance care planning.</p><p><strong>Methods: </strong>The study has a qualitative design, based on individual semi-structured interviews with 13 next of kin. A purposive sampling was used to select next of kin who had recently participated in advance care planning from five geriatric units in the intervention arm. The analysis was conducted using reflexive thematic analysis by Braun and Clarke.</p><p><strong>Results: </strong>Four themes were developed from the analysis; (1) Being informed and involved through open communication; (2) Getting prepared for what's to come; (3) The importance of the next of kin role in providing support and facilitation; (4) The need for documentation and collaboration across service levels.</p><p><strong>Conclusion: </strong>Advance care planning appears to provide a sense of security among next of kin by addressing their information needs regarding the patient's prognosis, encouraging discussions on possible courses of action, and clarifying the patient's end-of-life preferences. Next of kin played a crucial role in supporting the patient's autonomy, and they considered the hospital stay as an ideal time for advance care planning. Increased awareness of their role as next of kin seems to enhance agreement and trust when confronting challenging situations and existential questions.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier NTCT05681585. Registered 03.01.23.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"454"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728373","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}