BMC Health Services Research最新文献

{"title":"The challenging road to sustainable kangaroo mother care practice and service: reflections from a South African health district.","authors":"Anne-Marie Bergh, Elise van Rooyen, Alta Kritzinger, Maria Rinah Skhosana, Mphailele Tshukudu, Ute Feucht","doi":"10.1186/s12913-025-12581-4","DOIUrl":"10.1186/s12913-025-12581-4","url":null,"abstract":"<p><strong>Background: </strong>Kangaroo mother care (KMC) was introduced in the Tshwane Health District in South Africa in 1999. After more than two decades of the expansion of KMC services, we describe the KMC implementation trajectory in the district.</p><p><strong>Methods: </strong>A group of district clinical specialists, clinicians and academics involved in KMC implementation wrote a reflection on the status of KMC in Tshwane District and lessons for sustaining KMC services and practice.</p><p><strong>Results: </strong>The KMC implementation trajectory is described according to three phases: (1) a slow start (1999-2012); (2) consolidation (2012-2023); and (3) sustaining KMC beyond the COVID-19 pandemic. The Tshwane KMC programme activities are interpreted using a 10-component model for scaling up care for small and/or sick newborns at the district level. Major lessons for the sustainability of KMC practice and service include embedding system-wide supportive supervision in the health system's budget, encouraging multidisciplinary teamwork, conducting regular KMC refresher activities, and working on improving data to enable meaningful action.</p><p><strong>Conclusion: </strong>Despite great strides in KMC implementation and ongoing services in the Tshwane Health District, the road to continued sustainability remains challenging.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"425"},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699494","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 cross-sectional needs assessment for a trauma-informed care curriculum for multidisciplinary healthcare providers.","authors":"Dana C Ross, Kaniz Fatema Farhat, Negar Sayrafizadeh, Annie K Truuvert, Louloua Ashikhusein Waliji, Mahum Musheer, Julie Blair, Lesley Hughes, Sue MacRae, Simone N Vigod, Sophie Soklaridis, Nancy McCallum","doi":"10.1186/s12913-025-12568-1","DOIUrl":"10.1186/s12913-025-12568-1","url":null,"abstract":"<p><strong>Background: </strong>Trauma-informed care (TIC) is a framework that recognizes the pervasive impact of trauma, aiming to enhance both patient outcomes and provider well-being. Given the high prevalence of trauma among individuals seeking healthcare, it is essential for healthcare providers (HCPs) to be trauma informed. However, standardized TIC curricula for training healthcare staff are lacking. This study assessed perceptions towards TIC among multidisciplinary HCPs, patients, and leadership staff at two urban hospitals in Canada.</p><p><strong>Methods: </strong>This mixed-methods prospective cross-sectional study employed Kern's six-step approach for curriculum development. A needs assessment was conducted via an online questionnaire for HCPs and semi-structed interviews with individuals from the three participant groups: HCPs, patients, and leadership staff. The questionnaire assessed knowledge, skills, and attitudes regarding TIC. Semi-structured interviews explored perspectives on TIC, including curriculum priorities and potential implementation barriers. Findings informed the development of a virtual TIC curriculum, with iterative feedback collected to refine and assess its acceptability.</p><p><strong>Results: </strong>Among 106 HCP questionnaire respondents including Medical Doctors, Social Workers and Registered Nurses, 96 (90.6%) identified as women, and 97 (91.5%) as providers of direct patient care. Despite 93 (87.7%) having prior TIC education, 77 (72.6%) reported low confidence in applying TIC knowledge in clinical practice. Key perceived challenges to TIC training implementation included time constraints and lack of standardization across disciplines. A multimedia, self-paced course was the preferred solution. Thematic analysis of interviews with 28 participants (10 HCPs, 10 patients, 8 leadership staff) revealed six major themes: healthcare interactions, TIC implementation, training needs, system level barriers, curriculum preferences, and systems level improvements. Participants underscored the risk of re-traumatization to patients in healthcare settings without TIC and emphasized the need for universal TIC training for all staff.</p><p><strong>Conclusion: </strong>This study revealed a strong interest in a TIC course for multidisciplinary HCPs, supports the translation of knowledge into practice and incorporates a focus on cultural humility. Integrating insights from key stakeholders in this needs assessment phase resulted in the development of a TIC curriculum inclusive of diverse voices and viewpoints and strengthened the understanding of contextual factors that will support effective TIC implementation.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"426"},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699485","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":"Impact evaluation of an interdisciplinary approach to patients with chronic non-cancer pain in Chilean primary care.","authors":"Paula Zamorano, Teresita Varela, Isidora Salvatierra, Alvaro Tellez, Manuel Espinoza, Gustavo Torres, Victoria Rodríguez, María José Figueroa, Alejandro Rodríguez, Denisse Figueroa, Leonardo Silva, Sheila Salazar, Víctor Lucero, Francisco Suarez","doi":"10.1186/s12913-025-12560-9","DOIUrl":"10.1186/s12913-025-12560-9","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic non-cancer pain affects one-third of the global population. In Chile, its prevalence is estimated at 34%, surpassing the prevalence of diabetes mellitus and hypertension. Its high costs reveal that clinical treatment causes the greatest economic impact, followed by days of work absenteeism.</p><p><strong>Objective: </strong>This study aims to evaluate the impact on resource consumption, quality of life, and pain perception in patients with CNCP, an interdisciplinary approach implemented in Chilean primary care public health.</p><p><strong>Methods: </strong>A concurrent cohort study was conducted with patients aged 25 to 64 with chronic non-cancer musculoskeletal pain. The population studied was 698 patients receiving primary health services in centers with similar size and territorial proximity. The clinical intervention introduced patient-centered care, psychotherapy and physiotherapy from the perspective of the neuroscience of pain. The impact analysis was conducted using negative binomial regression models, generalized linear models, and ordered logistic regressions.</p><p><strong>Results: </strong>Results show that the patients who were intervened increased the number of physician consultations at primary care (IRR: 1.56; 95% CI 1.30-1.87) and increased medication consumption (coef 2.38; 95% CI 2.10-2.67) compared to control patients. Intervened patients improved their quality of life (COEF 0.14; 95% CI 0.09-0.19), and pain perception was statistically significant. Despite the health system's structural, cultural, and organizational barriers, the intervention was implemented and consolidated in daily operation, providing learnings for a further scale-up.</p><p><strong>Conclusion: </strong>The study demonstrates that an interdisciplinary approach to chronic non-cancer pain management in Chilean primary care improves quality of life and pain perception while increasing healthcare resource use. Despite system barriers, the intervention was successfully implemented and sustained within patient-centered care. These findings highlight the need for resource reallocation to ensure long-term sustainability and scalability through the public health system.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"423"},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699504","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":"Using normalisation process theory to understand implementation of effective early-onset type 2 diabetes treatment and care within England: a qualitative study.","authors":"Radhika Chauhan, Melanie J Davies, Carl May, Shivani Misra, Jack A Sargeant, Mike Skarlatos, Jane Speight, Emma G Wilmot, Caroline Wilson, Michelle Hadjiconstantinou","doi":"10.1186/s12913-025-12616-w","DOIUrl":"10.1186/s12913-025-12616-w","url":null,"abstract":"<p><strong>Background: </strong>Despite increasing prevalence, early-onset type 2 diabetes (EOT2D) has received little clinical and qualitative research attention within England. This qualitative study aimed to explore and understand the unmet needs of people living with early-onset type 2 diabetes (PEOT2D) and their diabetes care within England.</p><p><strong>Methods: </strong>Using semi-structured interviews, data was collected, transcribed and analysed from 25 PEOT2D and 25 healthcare professionals (HCPs). Taking an abductive approach, data for both cohorts were analysed and interpreted according to four constructs of Normalisation Process Theory (NPT): coherence (sense-making), cognitive participation (engagement), collective action (enactment) and reflexive monitoring (formal and informal appraisal).</p><p><strong>Results: </strong>Our findings revealed several unmet needs in current treatment and care for PEOT2D. The main unmet need was access to specialist care. Having GP (general practitioner) practices as their main caregivers presented a significant barrier to this population successfully carrying out their diabetes self-care. HCPs in specialist roles expressed similar views and were keen to see PEOT2D receive access to holistic and specialist care via a multidisciplinary team. Data interpretation according to the four constructs of NPT found that implementation of this approach would involve fostering an environment of support that allowed HCPs across the primary and secondary interface to do the following: (1) provide consultations incorporating person-centred care, shared decision-making, and non-judgemental and non-stigmatising behaviours and (2) work in an integrated and synchronous manner using streamlined referrals, interprofessional collaborations and team-based learning. Provision of tailored financial, human (additional staffing) and learning resources was found to be integral to allow creation of tailored multidisciplinary teams, and individual and collective skill enhancement of both specialist and primary care providers.</p><p><strong>Conclusion: </strong>Although both PEOT2D and specialist care providers are keen for young adults with EOT2D to receive access to specialist and holistic care, there are several resource barriers that must be addressed to allow implementation of their desired approach to treatment and care. Further qualitative research with primary care providers (for example, GPs and practice nurses) involved in EOT2D care is needed to understand if (and how) their views and experiences differ from those providing specialist care.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"422"},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699502","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":"Determinants of the number of dental visits in the general adult population in Germany during the COVID-19 pandemic.","authors":"André Hajek, Hans-Helmut König, Berit Lieske, Loujain Wees, Tjore Model, Larissa Zwar, Ghazal Aarabi","doi":"10.1186/s12913-025-12577-0","DOIUrl":"10.1186/s12913-025-12577-0","url":null,"abstract":"<p><strong>Background: </strong>Oral health is essential to general health and well-being. The utilization of oral health care services represents an important factor in reducing oral health morbidities. In order to understand the disparities in the frequency of dental visits, it is necessary to identify determinants that influence the use of those services. The aim of the current study was to investigate the determinants of the number of dental visits in Germany during the COVID-19 pandemic.</p><p><strong>Methods: </strong>We used data from the general adult population in Germany with n = 2,807 individuals in the analytical sample. Average age was 46.5 years (SD: 15.2 years, range 18 to 74 years) and 48.2% of the individuals were female. The number of dental visits in the preceding 12 months served as outcome measure. Grounded on the extended Andersen model, various determinants were included in regression analysis. Multiple negative binomial regressions were used.</p><p><strong>Results: </strong>Negative binomial regressions showed that a higher number of dental visits was significantly associated with personality-related (higher conscientiousness, IRR: 1.09, 95% CI: 1.03-1.15; higher neuroticism, IRR: 1.06, 95% CI: 1.00-1.12) and psychosocial factors (higher loneliness, IRR: 1.12, 95% CI: 1.02-1.22). In contrast, only very few predisposing characteristics, and none of the enabling resources and need factors were significantly associated with the outcome measure.</p><p><strong>Conclusions: </strong>This study particularly emphasized the importance of personality-related factors and psychosocial factors (in terms of loneliness) for the number of dental visits during the pandemic. These factors, often overlooked in prior research, deserve further attention in upcoming studies dealing with the number of dental visits.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"420"},"PeriodicalIF":2.7,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690956","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":"Performance-based financing in Rwanda: a qualitative analysis of healthcare provider perspectives.","authors":"Costase Ndayishimiye, Richard Nduwayezu, Christoph Sowada, Katarzyna Dubas-Jakóbczyk","doi":"10.1186/s12913-025-12605-z","DOIUrl":"10.1186/s12913-025-12605-z","url":null,"abstract":"<p><p>Results-based healthcare financing policies have been adopted in countries worldwide, including those with limited resources. We conducted a retrospective, semistructured interview study to evaluate healthcare providers' experiences with Rwanda's performance-based financing (PBF) policy and the factors influencing its implementation. Guided by the health policy evaluation model-context, content, process, and actors-as a deductive framework supplemented by inductive coding, we analysed data from 21 participants (doctors, n = 13; nurses, n = 5; midwives, n = 3). Providers described PBF as a key motivator, supplementing incomes, increasing accountability, and fostering teamwork to meet performance targets. PBF was credited with improving patient outcomes, particularly in incentivized services; however, concerns arose regarding disparities in service prioritization. Key facilitators of and barriers to the implementation of PBF were identified, providing insights into its operational dynamics. Strong political commitment and integration into national strategies, such as Imihigo, along with decentralization through district steering committees, were key contextual enablers, enhancing the program's flexibility and alignment with local priorities. The content factors centred on a two-tiered contracting system, combining national accreditation processes with individual performance incentives. Process factors supporting PBF were characterized by decentralized evaluations, audits, and multilevel communication, which collectively bolstered accountability mechanisms. The engagement and capacity of stakeholders were highlighted as crucial to the success of PBF. Nonetheless, significant barriers, such as payment delays, manual documentation, untimely evaluations, insufficient training, limited provider participation in decision-making, and the exclusion of patients as stakeholders, were identified. These findings offer practical recommendations for policymakers aiming to improve or adapt provider payment mechanisms in similar contexts.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"418"},"PeriodicalIF":2.7,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676800","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":"African nurses on the move: decisions, destinations and recruitment practices - a scoping review.","authors":"Fuseini Adam, Sioban Nelson, Bukola O Salami, Quinn Grundy, Osman Wahab","doi":"10.1186/s12913-025-12531-0","DOIUrl":"10.1186/s12913-025-12531-0","url":null,"abstract":"<p><strong>Background: </strong>The transnational migration of African nurses negatively impacts nurse-to-population ratios and life expectancy indices in many African countries. Understanding migration decisions, destination preferences, and recruitment practices of African nurses is crucial for identifying appropriate and effective retention interventions.</p><p><strong>Objective: </strong>The objectives of this scoping review are to examine the state of evidence in relation to the decisions surrounding international African nurse migration, as well as destinations preferences and recruitment practices employed to attract African nurses.</p><p><strong>Methods: </strong>Guided by the updated Joanna Briggs Institute (JBI) methodology for scoping reviews, we conducted a comprehensive search on empirical studies and grey literature on African nurse migration published in English from 2000 onwards and indexed in health and interdisciplinary databases. Studies on African nurse or student nurse migration intention were excluded.</p><p><strong>Results: </strong>We included 28 studies, twenty-one of which were peer-reviewed and seven from the grey literature. Synthesis of included studies found that international African nurse migration is influenced by economic challenges and income disparities, and career dynamics and job sustainability in home countries. The choice of destination by African nurses is impacted by African countries' past colonial relationships with destination countries, linguistic and cultural similarities. African nurses are recruited through international inter-agency collaboration and via direct recruitment by destination country health systems.</p><p><strong>Conclusion: </strong>Low income, poor economic growth and inadequate investment in African health systems significantly drive African nurse emigration, complicating efforts to attain universal health coverage. Recruitment strategies for nurse from African are often unregulated and can lead to exploitation and human trafficking. Again, as African nurse migration continues to rise, further studies are needed to examine their migration and transition experiences, as well as the support systems available in their destinations. Finally, improving workforce policies to meet the evolving needs of nurses is vital for retaining nurses in Africa.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"419"},"PeriodicalIF":2.7,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676797","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":"Implementation of a nurse-delivered, community-based liver screening and assessment program for people with metabolic dysfunction-associated steatotic liver disease (LOCATE-NAFLD trial).","authors":"Michelle J Allen, Ruth Tulleners, David Brain, James O'Beirne, Elizabeth E Powell, Adrian Barnett, Patricia C Valery, Sanjeewa Kularatna, Ingrid J Hickman","doi":"10.1186/s12913-025-12580-5","DOIUrl":"10.1186/s12913-025-12580-5","url":null,"abstract":"<p><strong>Background: </strong>With the high burden of Metabolic dysfunction-associated steatotic liver disease (MASLD), (previously known as Non-Alcoholic Fatty Liver Disease - NAFLD) in the community, current models of care that require specialist review for disease risk stratification overwhelm hospital clinic capacity and create inefficiencies in care. The LOCal Assessment and Triage Evaluation of Non-Alcoholic Fatty Liver Disease (LOCATE-NAFLD) randomised trial compared usual care to a community-based nurse delivered liver risk assessment. This study evaluates the implementation strategy of the LOCATE model.</p><p><strong>Methods: </strong>The evaluation used mixed methods (quantitative trial data and qualitative framework analysis of semi-structured interviews) to explore the general practitioner (GP) and patient perspectives of acceptability (Acceptability Framework), and factors associated with reach, effectiveness, adoption, implementation, and maintenance (RE-AIM framework) of the LOCATE model of care.</p><p><strong>Results: </strong>The LOCATE model was considered highly acceptable by both patients and GPs. The model of care achieved appropriate reach across the participating health services, reaching high-risk patients faster than usual care and with predominantly positive patient experiences. A notable reduction in anxiety and stress was experienced in the intervention group due to the shorter waiting times between referral and assessment. There was an overall perception of confidence in nursing staff capability to perform the community-based screening and GPs indicated confidence in managing low-risk MASLD without the need for specialist review. Challenges to implementation, adoption and maintenance included variable prioritisation of liver disease assessment in complex cases, the need for further GP training in MASLD assessment and treatment pathways, available funding and referral pathways for community screening, and accessibility of effective diet and exercise professional support.</p><p><strong>Conclusion: </strong>Nurse delivered community-based liver screening is highly acceptable to GPs and patients and has shown to be an effective mechanism to identify high risk patients. Adoption and maintenance of the model of care faces significant challenges related to affordable access to screening, prioritisation of liver disease in complex patient cohorts, and unresolved difficulties in prescribing effective strategies for sustained lifestyle intervention in the primary care setting.</p><p><strong>Trial registration: </strong>The trial was registered on 30 January 2020 and can be found via Australian New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12620000158965.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"421"},"PeriodicalIF":2.7,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690959","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 budget impact analysis of nicotine replacement therapy among patients who smoke tobacco and have mental illness in South Africa and the implications.","authors":"Basetsana Maphanga, Moliehi Matlala, Rajesh Vagiri, Brian Godman, Letlhogonolo Makhele","doi":"10.1186/s12913-025-12533-y","DOIUrl":"10.1186/s12913-025-12533-y","url":null,"abstract":"<p><strong>Background: </strong>Tobacco use is the world's leading preventable cause of death, with the highest burden in low and middle-income countries (LMICs). Those who have mental illness are particularly vulnerable, with a smoking rate two to five times higher than that of the general population. Quitting smoking has demonstrated benefits for mental health, including reducing stress and improving the quality of life. However, the economic feasibility of introducing Nicotine Replacement Therapy (NRT) in the psychiatric medical environment in South Africa has not yet been explored. This study aims to address this gap by assessing the impact on the budget of implementing an NRT-based smoking cessation program in a psychiatric hospital.</p><p><strong>Methods: </strong>This retrospective and cross-sectional study followed a budget impact analysis framework. Data were retrieved between May 19 and Aug 18, 2023, from 214 patients' medical records. Using primary and secondary data, an ingredients costing approach was used to estimate direct treatment costs of NRT smoking cessation. All costs were expressed in ZAR (South African currency). The economic evaluation was conducted from the payer's perspective, and the results were reported at a 5% discount rate. A two-way 10% sensitivity analysis was conducted.</p><p><strong>Results: </strong>The study showed that study participants were primarily black, male, unemployed, diagnosed with schizophrenia and smoked lightly (69.16% ±3.46). Implementing the 3-month treatment period of NRT smoking cessation program would result in an expenditure of R1 478 915.42 for 214 patients. The hospital will require an additional 0.15% (±0.0095) of the total hospital budget and 6.09% (±0.31) of the hospital pharmacy budget.</p><p><strong>Conclusion: </strong>Our findings indicate that while implementing a NRT is crucial for improving the overall health outcomes among patients with mental illnesses, substantial investment would be required. The budgetary allocation for NRT smoking cessation interventions would vary by treatment settings and program duration. Consequently, careful consideration of budget allocation and resource distribution is necessary to ensure the program's sustainability within the broader healthcare framework in South Africa.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"417"},"PeriodicalIF":2.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676801","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":"Integrated specialty care for amyloidosis: a scoping review using the Consolidated Framework for Implementation Research.","authors":"Mary O'Sullivan, Wahab Osman, Archanaa Krisnagopal, Monica Parry, Margot Davis, Charlene H Chu","doi":"10.1186/s12913-025-12520-3","DOIUrl":"10.1186/s12913-025-12520-3","url":null,"abstract":"<p><strong>Background: </strong>Amyloidosis is a complex and rare disease requiring specialized, multidisciplinary care to effectively manage its diverse manifestations. Existing evidence underscores the benefits of such care, linked to improved patient outcomes and clinician satisfaction. With the rising incidence of amyloidosis diagnoses and rapid advancements in treatment, the need for coordinated, expert-led care is increasing. However, implementing these centers is challenging due to resource allocation and inter-specialty collaboration. While resource allocation is a known hurdle, there has not been a comprehensive review of all the barriers and facilitators to establishing these clinics. This scoping review aims to identify the barriers and facilitators related to the implementation of coordinated, multidisciplinary specialty care clinics in amyloidosis management.</p><p><strong>Methods: </strong>An electronic search was conducted in Medline, Embase, and CINAHL for studies published in English from 2013 to 2023, supplemented by a grey literature search. The inclusion criteria focused on studies discussing multidisciplinary clinical environments for amyloidosis care, particularly light-chain (AL) and transthyretin amyloidosis (TTR). Exclusion criteria included books, opinion pieces, dissertations, and conference abstracts. Data were analyzed and synthesized using a narrative synthesis approach, guided by the Consolidated Framework for Implementation Research (CFIR), and reported according to PRISMA-ScR guidelines.</p><p><strong>Results: </strong>The search resulted in 1547 findings. After screening with Covidence, 7 papers were included in the final review. Independent reviewers screened and extracted the papers. Key facilitators identified include access to experts, adequate staffing, secure funding, partnerships with patient advocacy groups, and robust processes for multidisciplinary communication. Barriers primarily relate to the complexity of care, a lack of standardized protocols, difficulties in communication and coordination between providers, and challenges in training and maintaining knowledgeable care providers. The review also revealed significant gaps in existing research.</p><p><strong>Conclusions: </strong>This review enhances understanding of the barriers and facilitators in establishing amyloidosis specialty clinics. Addressing these barriers and leveraging facilitators are crucial for shaping the future of amyloidosis care. These insights support a model for implementing integrated care for this growing patient population and highlight the need for further research to support policy development and effective implementation of these specialized clinics.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"415"},"PeriodicalIF":2.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668776","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}