BMC Health Services Research最新文献

{"title":"Healthcare professionals' views on healthcare-related factors influencing symptom course in persistent somatic symptoms: a qualitative study of four European countries.","authors":"Aleksandra Kustra-Mulder, Brodie McGhie-Fraser, Tara Petzke, Karolina Fila-Pawłowska, Judith Rosmalen, Fiammetta Cosci, Bernd Löwe, Angelika Weigel","doi":"10.1186/s12913-025-12986-1","DOIUrl":"10.1186/s12913-025-12986-1","url":null,"abstract":"<p><strong>Background: </strong>The care trajectory for patients with Persistent Somatic Symptoms (PSS) is complex due to variability in diagnoses and treatments, with differences across European healthcare systems. Existing findings predominantly come from individual Western European countries, and comparative studies are lacking. This study aimed to explore how healthcare systems are perceived to influence PSS courses across four European countries and how professionals view their respective systems regarding PSS.</p><p><strong>Methods: </strong>We used semi-structured interviews to conduct a qualitative study with healthcare professionals from Germany, Italy, the Netherlands, and Poland. Sixteen participants were recruited purposively through international and national networks focusing on PSS, ensuring representation from primary care, secondary care medical specialists, mental health, and other healthcare fields.</p><p><strong>Results: </strong>We found that the interaction of structural and interpersonal factors within the healthcare system influenced the course of PSS symptoms. Systemic barriers such as limited consultation times and issues in care pathways or insurance coverage were prevalent in Germany and the Netherlands, while access and trust issues were more prominent in Italy and Poland. Key improvements suggested included reimbursement and treatment eligibility for PSS, establishing collaborative care pathways, and sufficient consultation times. Additionally, enhancing professional-patient relationships and improving education for healthcare professionals and patients were identified as crucial steps.</p><p><strong>Conclusions: </strong>The results show that although expertise is improving, current healthcare system structures prevent professionals from using them effectively. Therefore, systemic reforms and better professional training are needed to improve care for patients with PSS.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"823"},"PeriodicalIF":2.7,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274203","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":"Assessing the efficiency and effectiveness of community-based voluntary counseling and testing for HIV in Turin: insights from the fast-track cities initiative - a cross-sectional study.","authors":"Valerio Brescia, Paolo Ragusa, Edoardo Miserere, Fabrizio Bert","doi":"10.1186/s12913-025-12865-9","DOIUrl":"10.1186/s12913-025-12865-9","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the efficiency and effectiveness of Community-Based Voluntary Counseling and Testing (CBVCT) for HIV in Turin as part of the Fast-Track Cities initiative. It aimed to understand demographic characteristics and risk behaviors to identify factors associated with routine testing. The findings can help to better tailor interventions for reducing HIV transmission and improving public health outcomes.</p><p><strong>Methods: </strong>A cross-sectional design was employed, utilizing anonymous questionnaires administered throughout 2022. Participants were individuals attending rapid serological testing sessions for HIV organized by third-sector associations in Turin, Northern Italy. The sample comprised 795 participants who attended HIV testing sessions. Data were collected via paper-based questionnaires (n = 495), later digitized for analysis. Descriptive statistics, univariate, and logistic regression analyses were conducted to examine socio-demographic characteristics, risk behaviors, and testing outcomes. Cost-effectiveness was evaluated using a Markov model stratifying patients by CD4 + levels to assess QALYs and direct healthcare costs.</p><p><strong>Results: </strong>The study achieved a high HIV testing rate of 99.9%, with a positivity rate of 0.5%. All individuals with reactive tests were successfully linked to care. Syphilis testing had a lower uptake (76.7%) and identified a positivity rate of 0.7%. Significant demographic and behavioral differences were found: previously tested participants are more likely to be older (p < 0.001, OR = 1.15) than first-time testers, more likely to be MSM (Men who have Sex with Men) than MSF (Men who have Sex with Female) and FSM (Female who has Sex with Male) (p < 0.001, OR = 0.132; p < 0.001, OR = 0.183); and are more likely to have had a history of sexually transmitted infections (STIs)(p = 0.003, OR = 0.128). Immediate HIV diagnosis and access to antiviral therapy reduce healthcare costs by €3,841 per patient, with total savings of €23,808 due to lower treatment expenses before immunodeficiency onset.</p><p><strong>Conclusions: </strong>CBVCT programs in Turin demonstrated high feasibility and effectiveness in engaging the target population and ensuring linkage to care. However, syphilis testing requires greater integration. The findings highlight the need for targeted interventions to address disparities in testing behaviors and reinforce the economic sustainability of early HIV diagnosis and treatment.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"820"},"PeriodicalIF":2.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257286","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":"Effects of using different rural measurements on estimates of hospitalizations for depression and substance use.","authors":"Robin Danek, Justin Blackburn, Marion Greene, Olena Mazurenko, Lindsey Sanner, Nir Menachemi","doi":"10.1186/s12913-025-12815-5","DOIUrl":"10.1186/s12913-025-12815-5","url":null,"abstract":"<p><strong>Background/purpose: </strong>To examine how the choice of rural measurements affects estimates of hospitalization rates for depression and substance use disorders (SUD).</p><p><strong>Methods: </strong>We conducted cross-sectional analyses using the 2018 State Inpatient Database (SID) for 5 states, including Arizona, Kentucky, Maryland, Washington, and Florida, to determine how (1) estimates of hospitalization rates for depression and SUDs; and (2) patient characteristics among those hospitalized differ. Five measurements of rurality including rural-urban commuting areas (RUCA) codes, core-based statistical areas (CBSA), urban-rural category four (URCategory4) and two definitions of rural urban continuum codes (RUCC) were used. For each measurement, we calculated frequencies and percentages for age, race, sex, and insurance type. We conducted Spearman's rank correlations to compare associations and internal agreement. We created an UpSet chart to visualize the overlap in different measurements.</p><p><strong>Results: </strong>There were 152,771 hospitalizations for depression and 43,760 hospitalizations for SUDs. The percentage of hospitalizations for depression or SUD differed significantly (3.2-8.1% for depression and 5.0-11.6% for SUDs ) based on rurality measure. Race and insurance characteristics of those identified as rural varied by rural measurement for depression and SUD hospitalizations. Spearman's correlations were higher for hospitalizations for SUD than for depression, ranging from r = 0.61 (RUCC and RUCA) to r = 0.99 (CBSA and URCategory4).</p><p><strong>Conclusions: </strong>Different rurality measurements result in differing estimates of hospitalizations for SUD or depression. Stakeholders should be aware that the choice of rural measurements can impact policy decisions and resource allocation for programs intended to improve care in rural areas.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"818"},"PeriodicalIF":2.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257287","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":"Improved management of hospital-acquired infections with DRG-based payment system: an interrupted time‑series analysis.","authors":"Yuhua Yuan, Yanqiu Wang, Weiwei Huang, Xia Sun, Xianquan Hu, Yanyun Jiang, Nihan Zhang, Xiufen Chen, Yexuzi Li, Huan Xu, Jin Zhao, Baihuan Feng","doi":"10.1186/s12913-025-12854-y","DOIUrl":"10.1186/s12913-025-12854-y","url":null,"abstract":"<p><strong>Background: </strong>While diagnosis-related group (DRG) payment system has been shown to improve healthcare quality and reduce costs in high-income countries, its effectiveness in developing countries, particularly in terms of hospital-acquired infection (HAI) management, remains unclear.</p><p><strong>Methods: </strong>HAI surveillance data were collected from nine public hospitals in Zhejiang province, China, that implemented the DRG system in 2020. Changes in HAI incidence rates following DRG adoption were assessed using interrupted time-series analysis with a generalized additive model, covering the period from January 2016 to September 2023.</p><p><strong>Results: </strong>The HAI incidence rate demonstrated a general downward trend both before and after the DRG system's implementation. While no immediate change in the HAI rate was observed (-0.0124%; 95% CI: -0.1375%, 0.1127%) in the month immediately following DRG implementation (January 2020) when compared with December 2019, a significant monthly decline of 0.0072% (95% CI: -0.0124%, -0.0020%) was detected from January 2020 to September 2023, following the system's implementation. Additionally, a significant reduction in hospital stays prior to acquiring infection was noted post-implementation of the DRG system. The rising trend in the proportion of female patients, from 31.52% in 2016 to 40.00% in 2019, was eliminated after DRG adoption, with the proportion stabilizing thereafter. The age distribution, infection sites, and pathogen profiles remained largely stable throughout the study period.</p><p><strong>Conclusions: </strong>These findings suggest that the implementation of the DRG system may contribute to improving HAI management, with notable reductions in the HAI incidence rate over time. Our study serves as a reference for other developing countries facing similar healthcare challenges, and provides valuable insights for improving healthcare quality and enhancing patient safety.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"821"},"PeriodicalIF":2.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257289","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":"The effect of the nurse-patient relationship on the job performance of nurses in tertiary public hospitals in China: a cross-sectional survey.","authors":"Jiquan Zhang, Fan Xu, Jijun Wu, Jinlei Du, Jianzhong Ding, Peimin Zhuang, Wei Qing","doi":"10.1186/s12913-025-12850-2","DOIUrl":"10.1186/s12913-025-12850-2","url":null,"abstract":"","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"812"},"PeriodicalIF":2.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246269","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 water, sanitation and hygiene services within nineteen Rohingya camps in Cox's Bazar, Bangladesh in 2022.","authors":"Saira Butt, Md Samiur Rahman Chowdhury, Sohana Sadique, Abdullah Al Faisal, Adrien Mahama, Alexander Gorski, Biserka Pop-Stefanija, David Beversluis, Jackson Mojong Lochokon, Kalyan Velivela, Kennedy Uadiale, Md Mahbubur Rahman, Teju Gebeyaw Worku, Thok Johnson Gony Billiew, Patrick Keating","doi":"10.1186/s12913-025-12874-8","DOIUrl":"10.1186/s12913-025-12874-8","url":null,"abstract":"<p><strong>Background: </strong>Since August 2017, approximately 960,000 Rohingya refugees have settled in Cox's Bazar, Bangladesh. Water, sanitation, and hygiene (WASH) infrastructure and programs were implemented across the camps to address the needs of the population and reduce the burden of linked infectious diseases. However, monitoring and maintenance of this infrastructure has been inconsistent. This study aimed to assess progress in WASH in the camps of Cox's Bazar since the early emergency phase in 2018, and to update the priorities for intervention.</p><p><strong>Methods: </strong>From January to March 2022, a lot quality assurance sampling (LQAS) survey was conducted across 19 camps. Nineteen households were randomly selected per camp. Data on access to and quality of WASH services, household practices, and health outcomes including skin infections among children under five years of age were collected. Crude and weighted averages with 95% confidence intervals were calculated for each indicator and compared with targets pre-defined based on Sphere guidelines and Médecins Sans Frontières WASH experts. Chi-squared tests were used to compare the results to a 2018 LQAS survey.</p><p><strong>Results: </strong>More than half of the indicators (59%; 16/27) did not meet the pre-determined targets. Performance was adequate on three of five water quality and supply indicators, with less than half of households (44%, 95% CI: 39-49%) reporting that water was continuously available in the past week. Regarding water storage, performance on three indicators was considered adequate, as the proportion of households that keep water for less than one day was 27% (95% CI: 23-32%). Of six hygiene indicators, adequate performance was identified for only one. Performance on the sanitation indicators was inadequate, with 11% (95% CI: 8-15%) of households using an improved sanitation facility. In solid waste management, two of four indicators suggested adequate performance, and for health outcomes, the proportion of children who hadn't shown any skin infection was inadequate at 69% (95% CI: 64-73%).</p><p><strong>Conclusions: </strong>Improvements in the WASH situation in Cox's Bazar have been observed in 2022 compared to 2018. However, significant gaps remain in water supply, sanitation facilities, and hygiene services. LQAS can be an effective monitoring tool to support long-term multisectoral interventions in protracted emergencies.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"814"},"PeriodicalIF":2.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246267","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":"Estimating the causal effect of a quality assurance program on quality of care in Germany.","authors":"Stefan Gehrig, Britta Zander-Jentsch, Maurilio Gutzeit, Silvia Klein, Johannes Rauh","doi":"10.1186/s12913-025-12939-8","DOIUrl":"10.1186/s12913-025-12939-8","url":null,"abstract":"","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"815"},"PeriodicalIF":2.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257288","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":"Inequity in access to medications among communities in Eastern Ethiopia: a decomposition analysis.","authors":"Dumessa Edessa, Fekede Asefa Kumsa, Girmaye Dinsa, Lemessa Oljira","doi":"10.1186/s12913-025-12963-8","DOIUrl":"10.1186/s12913-025-12963-8","url":null,"abstract":"","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"816"},"PeriodicalIF":2.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257290","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":"Intangible cost and its associated factors among caregivers of individuals with Type 2 Diabetes Mellitus managed at primary healthcare settings: a scoping review.","authors":"Siti Bazlina Mohd Rawi, Muhammad Ridzwan Rafi'i, Roszita Ibrahim, Norfazilah Ahmad, Rosnah Sutan, Cassidy Devarajooh","doi":"10.1186/s12913-025-12944-x","DOIUrl":"10.1186/s12913-025-12944-x","url":null,"abstract":"<p><strong>Background: </strong>The chronic and debilitating nature of Type 2 Diabetes Mellitus (T2DM) not only places a significant burden on patients but also imposes high intangible costs on their caregivers. This review aimed to critically assess the intangible costs and their associated factors among caregivers of people with T2DM treated in primary healthcare settings.</p><p><strong>Method: </strong>A systematic search using several combinations of keywords was conducted in Scopus, WoS, and PubMed databases. The primary outcome was the score or levels of intangible costs, while the secondary outcome was the factors associated with such burden.</p><p><strong>Result: </strong>The review included seven cross-sectional designs (six employing a quantitative approach and one a mixed-methods approach) that adopted the Zarit Burden Interview or Zarit Caregiver Burden Scale, with four reporting a mild level, two reporting a high level, and one reporting a moderate level. Associated factors identified were characteristics of the caregiver (e.g., female, housewife, and no or low income), caregiving characteristics (longer duration and time spent in taking care of the individual with T2DM), and clinical characteristics of individuals with T2DM (i.e., presence of complication and their health status).</p><p><strong>Conclusion: </strong>It was found that T2DM caregivers in primary healthcare settings experienced moderate to high levels of intangible costs. The identified vulnerable subgroup should be regularly screened for their levels of intangible costs to prevent poor outcomes in T2DM caregiving. Furthermore, the implementation of targeted support interventions for these caregivers could improve their well-being and the quality of care provided to individuals with T2DM, ultimately enhancing patient outcomes and reducing their intangible costs.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"822"},"PeriodicalIF":2.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257291","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":"The nursing service needs of old adults in long term care facilities: current status and associated factors.","authors":"Haiyan Wu, Peier Lu, Chaoer Wu, Xia Liu","doi":"10.1186/s12913-025-12927-y","DOIUrl":"10.1186/s12913-025-12927-y","url":null,"abstract":"","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"819"},"PeriodicalIF":2.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257293","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}