BMC Health Services Research最新文献

{"title":"Variation in healthcare services utilization and continuity of care in long-term care facilities: a cross-sectional study.","authors":"Johannes Schwabe, Brian W Pulling, Gillian E Caughey, Maria Crotty, Helena Williams, Andrew Kellie, David Roder, Krystal-Lee Nixon, Gillian Harvey, Janet K Sluggett, Monica Cations, Tiffany K Gill, Jyoti Khadka, Megan Corlis, Marilyn von Thien, Maria C Inacio","doi":"10.1186/s12913-025-13321-4","DOIUrl":"10.1186/s12913-025-13321-4","url":null,"abstract":"<p><strong>Background: </strong>Primary and specialist healthcare services are critical to ensuring high-quality care for people living in long-term residential aged care facilities (LTCFs). In Australia, these government-subsidized services include general practitioner attendances, health assessments, management plans, allied health services, pain medicine specialists, and mental healthcare, among others. Although the utilization of these services is known to be suboptimal, the extent and nature of variation in their use across LTCFs nationally remain unknown. Importantly, variation that is not attributable to resident needs or planned system design-termed unwarranted variation-has been shown to negatively impact health outcomes and warrants investigation. To address this gap, this population-based study aims to examine the national variation in primary and selected specialist healthcare services utilization and continuity of care in residential aged care facilities and characteristics of facility utilization outliers.</p><p><strong>Methods: </strong>A national cross-sectional study of 173,275 non-Indigenous residents aged ≥65 years from 2,744 Australian facilities in 2019 was conducted. To evaluate continuity of care, the cohort was restricted to LTCF residents who entered care in 2019 and were alive for at least six months (N = 41,654 individuals in 2,680 LTCFs). Adjusted median service and continuity of care utilization per 100 residents were calculated. National variation in the rate of healthcare service utilization was quantified using inlier-ranges, categorized as minimal = 0, low < 20, moderate = 20-79, high = 80-99, and maximal = 100.</p><p><strong>Results: </strong>Maximal variation for services with moderate utilization (median = 22.1-60.6/100 residents) was observed for after-hours attendances, urgent after-hours attendances, health assessments, management plans, podiatry, and optometric services. Continuity of care had low-to-moderate utilization (median = 13.4-26.6/100) and moderate-to-high variation (inlier-range = 68-95.5). Some services had high (median = 99.9/100, general attendances) or low (median < 8.2/100, specialist attendances) utilization and low-to-moderate variation. A small number of mostly high-utilization outliers were identified.</p><p><strong>Conclusions: </strong>There is substantial variation in utilization of healthcare services and continuity of care amongst residential aged care facilities nationally. While some facilities deliver high levels of preventive and disease management healthcare services supporting residents to have high continuity of care, many facilities face challenges facilitating access to adequate healthcare for their residents.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1216"},"PeriodicalIF":3.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190806","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":"Electronic data sources for drug utilization research and healthcare decision-making in Mexico.","authors":"Yared Santa-Ana-Tellez, Anahí Dreser Mansilla, Lucila Isabel Castro Pastrana, Maribel Salas, Juan Carlos Sánchez Salgado, Diana Gómez-Galicia, Lisiane Freitas Leal, Luciane Cruz Lopes","doi":"10.1186/s12913-025-13216-4","DOIUrl":"10.1186/s12913-025-13216-4","url":null,"abstract":"<p><strong>Background: </strong>Understanding drug utilization is essential for informed decision-making in national healthcare and for enabling comparisons across countries. In Mexico, the limited research in this field may be attributed to the lack of awareness and accessibility of existing data sources. Addressing this gap requires a comprehensive inventory of data sources for Drug Utilization Research (DUR). The purpose of this study was to develop an inventory of electronic data sources available in Mexico for DUR, outlining their characteristics, strengths, and limitations.</p><p><strong>Methods: </strong>From 2019 to 2024, specialists in pharmacoepidemiology and healthcare systems research conducted online searches for DUR data sources, including official websites of the Mexican government and public health institutions. A literature review was also performed for country-specific data sources in articles published between 2000 and 2023. Data sources were independently searched, screened, and selected by independent reviewers, with disagreements resolved through consensus. A descriptive analysis of selected databases was conducted, focusing on accessibility, geographical coverage, data aggregation level, health sector type, data source type, and setting.</p><p><strong>Results: </strong>The analysis included twenty data sources, of which only four were publicly available. These databases offer insights into various aspects of drug utilization, primarily owned by social security institutions (twelve). Only four contain data from the private healthcare sector. Regarding data source type, five focused on procurement, twelve on prescription, two on pharmacovigilance, and one on drug disposal.</p><p><strong>Conclusions: </strong>Mexico faces notable challenges in accessible data for DUR especially in non-social security institutions and the private sector. This study underscores the urgent need to improve healthcare data accessibility and research in Mexico, to drive evidence-informed decision-making regarding medicines utilization.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1214"},"PeriodicalIF":3.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12466055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173452","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 development of the sustainability measure for healthcare using a modified Delphi process.","authors":"Deonni P Stolldorf, Abigail C Jones, Mary S Dietrich","doi":"10.1186/s12913-025-13291-7","DOIUrl":"10.1186/s12913-025-13291-7","url":null,"abstract":"<p><strong>Background: </strong>Valid and reliable measures for assessing the sustainability of complex, multicomponent, and interdisciplinary healthcare interventions are lacking. The study objective was to develop a multidimensional instrument for use to assess the sustainability of complex, interdisciplinary, healthcare interventions implemented in acute care settings.</p><p><strong>Methods: </strong>Content experts participated in a modified Delphi study of electronic REDCap^® measures. Round 1, composed of 49 structured and unstructured questions, was analyzed using descriptive statistics and content analysis. In rounds 2 and 3, experts rated items derived from round 1 to provide evidence of sustainability on a 5-point Likert-type scale. Questions rated by > 75% of the experts as important were retained for the final measure.</p><p><strong>Results: </strong>Ten experts representing areas of quality improvement, sustainability, and implementation science participated in rounds 1 and 8 experts in rounds 2 and 3, respectively. Round 1 statements with a median value of < = 6 on the 10-point Likert scale or < = 3 on the 4- or 5-point Likert scale were retained. The items retained, modified, and added in Round 2 included 53 items. Questions rated by > 75% of the experts as important were retained for the final measurement; conversely, questions rated by ≤ 25% of the experts as important were discarded. Twenty-five items with associated %s expert ratings of \"important\" (between 25% and 75% from Round 2) were included in Round 3. The modified Delphi process resulted in a final 37-item scale.</p><p><strong>Conclusions: </strong>Using a modified Delphi technique, experts reported varying perceptions of sustainability. However, commonalities in key areas were successfully translated into the Sustainability Measure for Healthcare for assessing the sustainability of complex, multicomponent interventions.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1215"},"PeriodicalIF":3.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173444","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 and solutions to effective stewardship of rehabilitation services: a scoping review.","authors":"Kianoush Abdi, Zeynab Foroughi, Zahra Najafi, Mahnaz Afshari","doi":"10.1186/s12913-025-13366-5","DOIUrl":"10.1186/s12913-025-13366-5","url":null,"abstract":"<p><strong>Background and aim: </strong>Strong and effective stewardship is a fundamental function of health systems. However, rehabilitation services often receive insufficient attention due to the limited priority assigned to them by governments and health systems. In many countries-particularly low- and middle-income nations-this neglect has resulted in fragmented and poorly coordinated rehabilitation services across various sectors, with inconsistent service delivery influenced by the internal policies of individual institutions. This study investigates the broader barriers to rehabilitation services, analyzes their implications for stewardship, and proposes solutions to improve governance and system coordination.</p><p><strong>Method: </strong>In this scoping review of studies conducted in Iran and globally, we identified factors and strategies for effective stewardship of rehabilitation services using Arksey and O'Malley's framework. Searches were performed in English databases (PubMed, Web of Science, and Scopus) and Persian databases (SID and Magiran), as well as the Google Scholar search engine, utilizing relevant English keywords and their Persian equivalents. Data were analyzed through a qualitative methodology employing directed content analysis. Additionally, Veillard et al.'s Health System Stewardship Framework was utilized to identify and analyze the challenges and solutions implemented in other countries.</p><p><strong>Findings: </strong>From a total of 38 published articles on rehabilitation services, six themes, eight sub-themes, 81 challenges, and 74 solutions were identified. The challenges included the ineffectiveness of the fragmented rehabilitation structure and stewardship, the absence of a comprehensive plan, and inadequate coordination and communication. Proposed solutions from these studies included establishing a central regulatory and governance body; developing rehabilitation services that recognize rehabilitation as a population-based strategy for health and well-being across a wide range of health conditions throughout the continuum of care and throughout life; and creating databases to track individuals with disabilities and the rehabilitation services provided to them.</p><p><strong>Conclusion: </strong>Effective stewardship of integrated rehabilitation services necessitates service continuity, coordinated policymaking, and active stakeholder engagement. A cohesive governance structure, bolstered by a robust information system, is crucial for evidence-based decision-making. Aligning policies with operational plans fosters collaboration and improves service efficiency.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1211"},"PeriodicalIF":3.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147718","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":"Developing an anxiety management application for healthcare providers: a qualitative study on improving well-being.","authors":"Mohammad Mahdi Askarizadeh, Leila Gholamhosseini, Reza Khajouei, Razieh Askarizade, Fatemeh Askarizadeh, Zahra Rahmani, Saeedeh Homaei, Mahdi Aminizadeh, Mehran Nakhaeizadeh, Leila Ahmadian","doi":"10.1186/s12913-025-13341-0","DOIUrl":"10.1186/s12913-025-13341-0","url":null,"abstract":"<p><strong>Background: </strong>Healthcare providers are at high risk of anxiety due to their responsibilities and workplace conditions. This issue may worsen over time, especially when the work duration is prolonged. One innovative approach to reducing healthcare providers anxiety, while enhancing the quality of care and improving patient safety, is the implementation of educational programs and the utilization of these resources through a mobile application. This study aimed to develop an anxiety management application to enhance the quality of care and improve patient safety.</p><p><strong>Methods: </strong>An application prototype was developed based on a systematic review and refined through semi-structured interviews with healthcare workers, psychologists, psychiatrists, and medical informatics specialists. The application was developed using the Flutter framework in both web-based and mobile formats for Android and iOS. Data were analyzed using descriptive statistics and content analysis.</p><p><strong>Results: </strong>A systematic review, along with interviews with treatment staff, psychologists, and psychiatrists, was conducted to develop the program. The application included strategies such as Acceptance and Commitment Therapy (ACT), meditation, yoga, mindfulness, breathing therapy, and nature therapy. Additional features included a user chat room and a 'My Medications' section. The validated Beck Anxiety Inventory was used to assess the anxiety level.</p><p><strong>Conclusions: </strong>This study led to the development of a specialized anxiety reduction application that provides evidence-based strategies to significantly reduce anxiety among healthcare providers. This application can greatly improve the mental health of healthcare staff, leading to enhanced patient care quality and safety. The findings of this research offer a valuable foundation for future studies and the development of similar applications to manage and reduce mental health disorders in diverse populations.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1212"},"PeriodicalIF":3.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147660","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 intervention mapping framework to develop knowledge translation program: a scoping review.","authors":"Hongzhan Jiang, Ziyan Wang, Dan Yang, Meiqi Meng, Xuejing Li, Yufang Hao","doi":"10.1186/s12913-025-13454-6","DOIUrl":"10.1186/s12913-025-13454-6","url":null,"abstract":"<p><strong>Objective: </strong>This scoping review systematically examines the application of Intervention Mapping (IM) in knowledge translation (KT) processes, focusing on its effectiveness, completeness, advantages and challenges.</p><p><strong>Methods: </strong>Following Joanna Briggs Institute (JBI) guidelines, we conducted a scoping review of 57 studies (1998-2024) from PubMed, Embase, Web of Science, and Chinese databases. The data extracted encompass the basic information of the studies, the objectives of the research, the part of the IM steps, as well as the main results and the methods used for evaluating.</p><p><strong>Results: </strong>IM demonstrated broad applicability across 18 healthcare domains, with the highest prevalence in maternal and child health (12.3%), geriatrics (12.3%), and endocrine/metabolic diseases (10.5%). While 64.9% of studies implemented all six IM steps, there were differences in the specific application of the steps, with lower implementation rates observed for step 5 (85.9%) and step 6 (78.9%). IM's strengths included systematic design and stakeholder engagement, yet reliance on funding (84.2%) and regional concentration (47% from China, the Netherlands, and the United Kingdom) limited global scalability.</p><p><strong>Conclusion: </strong>IM provides a robust, theory-driven framework for KT, enhancing intervention sustainability and adaptability. However, incomplete step adoption, resource intensity, and geographic bias limit the effective application of IM across diverse settings. In future, theoretical education should be strengthened to enhance IM application completeness and standardization, while promoting KT terminology unification and IM framework localization to optimize IM's role in bridging the evidence-practice gap and advancing health.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1213"},"PeriodicalIF":3.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147443","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":"Improving osteoporosis prevention and care for patients with HIV: insights from HIV care providers in China.","authors":"Leslie Yingzhijie Tseng, Wei Pan, Yafang Zhao, Leslie A Curry, Evelyn Hsieh, Taisheng Li","doi":"10.1186/s12913-025-13073-1","DOIUrl":"10.1186/s12913-025-13073-1","url":null,"abstract":"","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1210"},"PeriodicalIF":3.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12462348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136201","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":"Evaluation of Primary Care Behavioral Health (PCBH) with guided self-help CBT as a treatment option - a protocol of a single-blind randomized multicenter trial (KAIROS).","authors":"Anneli Farnsworth von Cederwald, Sigrid Salomonsson, Nils Hentati Isacsson, Viktor Kaldo","doi":"10.1186/s12913-025-13232-4","DOIUrl":"10.1186/s12913-025-13232-4","url":null,"abstract":"<p><strong>Background: </strong>While protocol-based psychological treatments have significantly advanced mental health care, real-world accessibility remains a challenge. Primary care, the main provider of mental health services, faces barriers such as limited resources and a diverse patient population with varying needs, making it difficult to rely solely on time-intensive, protocolized treatments. The Primary Care Behavioral Health (PCBH) model promotes brief, flexible interventions that may better accommodate these needs. However, limited research on these interventions raises concerns about potential undertreatment. To align with Universal Health Coverage principles, it is essential to identify which patient groups benefit most from resource-efficient protocol-based versus brief, flexible, and individualized treatments. Our main aim is to evaluate whether a integrating guided self-help into PCBH improves outcomes compared to the core PCBH model, as well as to assess whether patients identified as suitable for protocol-based interventions benefit more from the combined model.</p><p><strong>Methods: </strong>Patients seeking help for mental or behavioral health problems at PCBH primary care centers will be randomized to one of two arms: core PCBH, where patients receive a contextual assessment and brief interventions tailored to their needs, or an extended PCBH model, where a diagnostic assessment determines whether patients receive brief interventions or guided self-help. The primary outcome is functional impairment, assessed at baseline and followed up at 4, 8, and 12 weeks (primary endpoint), as well as at 1 year. Secondary outcomes include symptom change, cost-effectiveness, and care process factors.</p><p><strong>Discussion: </strong>The study design allows for comparisons of patient outcomes between the two care models, with a primary focus on evaluating superiority and a secondary focus on non-inferiority, cost-effectiveness, and care process factors. Overall, the project seeks to advance understanding of effective mental health interventions in primary care settings and inform decision-making regarding treatment approaches.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT04900064. Registered on May 25th, 2021. Registered with the Swedish Ethical Review Board (2020-04198) on October 12th, 2020. This protocol was submitted for publication on March 18th, 2025, prior to the inclusion of the final participant, and will shortly thereafter, without any changes, be made publicly available as a preprint in an open-access repository.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1208"},"PeriodicalIF":3.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12455819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129830","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":"Evaluation of health technology implementation in the Brazilian public health system: a systematic review.","authors":"Mariana Lourenço Freire, Beatriz Prado Noronha, Gláucia Cota, Sarah Nascimento Silva","doi":"10.1186/s12913-025-13117-6","DOIUrl":"10.1186/s12913-025-13117-6","url":null,"abstract":"","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1207"},"PeriodicalIF":3.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12455806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129855","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":"General hospital patients' satisfaction with a proactive automatized multiple health behavior change intervention.","authors":"Caroline Timm, Anika Tiede, Filipa Krolo-Wicovsky, Marie Spielmann, Gallus Bischof, Christian Meyer, Ulrich John, Jennis Freyer-Adam","doi":"10.1186/s12913-025-13425-x","DOIUrl":"10.1186/s12913-025-13425-x","url":null,"abstract":"","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1209"},"PeriodicalIF":3.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129776","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}