BMC Health Services Research最新文献

{"title":"Healthcare utilization among people with disabilities in Iran: what predictors are associated with medical visits?","authors":"Fardin Moradi, Badriyeh Karami, Moslem Soofi, Behzad Karamimatin, Faramarz Jalili, Shahram Akbari, Shahin Soltani","doi":"10.1186/s12913-024-12069-7","DOIUrl":"https://doi.org/10.1186/s12913-024-12069-7","url":null,"abstract":"<p><strong>Background: </strong>Ensuring equitable access to healthcare services for individuals with disabilities poses a significant challenge for healthcare systems. This research aimed to explore the factors affecting medical visits among this population.</p><p><strong>Method: </strong>This cross-sectional study in Iran involved data from 766 adults with disabilities aged 18 and older. Unadjusted and adjusted logistic regression analyses were used to calculate the odds ratios for medical visits.</p><p><strong>Results: </strong>The majority of participants were male (64.36%) and single (54.02%). In the adjusted model, participants with severe disabilities (OR: 1.901, p = 0.025) were more likely to utilize medical visits compared to those with less severe disabilities. Conversely, individuals in the second (OR: 0.420, p = 0.017), fourth (OR: 0.360, p = 0.004), and fifth (OR: 0.319, p = 0.001) wealth quintiles demonstrated a significantly lower likelihood of accessing medical visits in comparison to the reference group.</p><p><strong>Conclusions: </strong>This study reveals critical disparities in healthcare access for individuals with disabilities in Iran. While individuals with severe disabilities demonstrate a higher likelihood of utilizing medical services, those in lower wealth quintiles face significant barriers to accessing care. These findings emphasize the urgent need for targeted interventions to enhance healthcare equity, ensuring that financial constraints do not hinder medical visits for this vulnerable population.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1637"},"PeriodicalIF":2.7,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876148","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":"Pre-diagnosis and pre-treatment loss to follow-up and associated factors among patients with presumed tuberculosis and those diagnosed in Uganda.","authors":"Rebecca Nuwematsiko, Noah Kiwanuka, Solomon T Wafula, Mary Nakafeero, Lydia Nakanjako, Henry Luzze, Stavia Turyahabwe, Juliet N Sekandi, Lynn Atuyambe, Esther Buregyeya","doi":"10.1186/s12913-024-12115-4","DOIUrl":"https://doi.org/10.1186/s12913-024-12115-4","url":null,"abstract":"<p><strong>Background: </strong>Loss to follow-up (LTFU) of patients with presumed tuberculosis (TB) before completing the diagnostic process (pre-diagnosis LTFU) and before initiating treatment for those diagnosed (pre-treatment LTFU) is a challenge in the realization of the End TB Strategy. We assessed the proportion of pre-diagnosis and pre-treatment LTFU and associated factors among patients with presumed TB and those diagnosed in the selected health facilities.</p><p><strong>Methods: </strong>This was a retrospective cohort study involving a review of routinely collected data from presumptive, laboratory and TB treatment registers from January 2019 to December 2022. The study was conducted in three general hospitals and one lower-level health center IV in Central Uganda. We defined pre-diagnosis LTFU as failure to test for TB and obtain results within 30 days from the date of being presumed and pre-treatment LTFU as failure to initiate TB treatment within 14 days from the date of diagnosis. Modified Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) of factors associated with pre-diagnosis and pre-treatment LTFU.</p><p><strong>Results: </strong>Of the 13,064 patients with presumed TB, 39.9% were aged 25 to 44 years, and 57.1% were females. Almost a third, 28.3% (3,699/13.064) experienced pre-diagnosis LTFU and 13.7% (163/1187) did not initiate treatment within 14 days from being diagnosed. Pre-diagnosis LTFU was more likely to occur among patients aged 0-14 years (adj PR 1.1, 95% CI: 1.06,1.24), females (adj.PR=1.06, 95% CI: 1.01, 1.12) and those with no record of place of residence (adj. PR=2.7, 95% CI: 2.54, 2.93). In addition, patients with no record of phone contact were more likely to be LTFU, (adj. PR=1.1, 95% CI: 1.05, 1.17). Pre-treatment LTFU was also more likely among patients with no record of place of residence (adj PR 7.1, 95% CI: 5.13,9.85) and those with no record of phone contact (adj PR 2.2, 95% CI: 1.63,2.86). Patients presumed from the HIV clinics were 40% less likely to experience pre-treatment LTFU compared to those in the outpatient departments (adj PR 0.6, 95% CI: 0.41,0.88).</p><p><strong>Conclusion: </strong>High proportions of pre-diagnosis and pre-treatment LTFU were observed in this study. This calls for urgent interventions at these time points in the TB care cascade to be able to realise the End TB Strategy.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1638"},"PeriodicalIF":2.7,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876150","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":"A qualitative exploration of community knowledge, attitudes, and practices towards tuberculosis in the Karamoja subregion, northeastern Uganda.","authors":"William Kasozi, Stella Zawedde-Muyanja, Joseph Musaazi, Alfred Etwom, James Lemukol, Patrick Sagaki, Salome Tino, Cerino Achar, Mary G Nabukenya-Mudiope, Turyahabwe Stavia, Miriam Murungi, Edmund Rutta, Tadeo Nsubuga, Brenda Picho","doi":"10.1186/s12913-024-12136-z","DOIUrl":"https://doi.org/10.1186/s12913-024-12136-z","url":null,"abstract":"<p><strong>Background: </strong>The Karamoja subregion is a high TB burden pastoralist community that previously had limited access to public health services. We explored the community's perceptions towards TB to better understand how healthcare services should be structured to meet the needs of the persons with TB and their households.</p><p><strong>Methods: </strong>From September to October 2022, we conducted 12 focus group discussions (FGDs) and interviewed 95 persons (48 community members and 47 health workers). Research assistants trained in qualitative interviewing carried out the FGDs using an FGD guide that was developed iteratively following collection of quantitative data and initial interviews. We transcribed and analyzed data inductively and presented emerging themes about knowledge on, attitudes towards and practices associated with TB in the region.</p><p><strong>Results: </strong>Participants were aware that TB was a significant public health problem and accurately described the signs and symptoms of TB. However, knowledge on TB transmission was inaccurate. Respondents thought that in addition to being airborne, TB was a contagious disease transmitted through direct contact or sharing of utensils. This affected attitudes towards patients with TB, contributing to stigmatization and isolation of persons diagnosed with TB in several homesteads. Community members preferred to go to public health facilities for TB diagnosis except where these health facilities were too far in which case they resorted to alternative care providers e.g., traditional healers or private health providers. Community members were aware of and had experienced the benefits of TB preventive therapy.</p><p><strong>Conclusion: </strong>Knowledge about TB transmission is suboptimal and leads to stigmatization and isolation of infected individuals. Addressing this gap would contribute to reducing stigma and enhance care practices for patients diagnosed with TB. Development and distribution of communication messages with accurate information about TB transmission should be a priority. These messages should also include a strong component on the benefits of TB preventive therapy.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1639"},"PeriodicalIF":2.7,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881177","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":"Evolution and determinants of antenatal care services utilization among women of reproductive age in Rwanda: a scoping review.","authors":"Emile Twagirumukiza, Valens Bubanje, Revocathe Girimpundu, Emile Sebera","doi":"10.1186/s12913-024-12038-0","DOIUrl":"https://doi.org/10.1186/s12913-024-12038-0","url":null,"abstract":"<p><strong>Background: </strong>Maternal and child health remains a global priority, with antenatal care (ANC) recognized as essential for ensuring positive pregnancy outcomes. Despite significant improvements, in low- and middle-income countries, ANC service utilization remains low in Sub-Saharan Africa. This paper contributes to the understanding of the evolution and determinants of ANC service utilization among women of reproductive age in Rwanda.</p><p><strong>Methods: </strong>This review focused on studies published between 2010 and 2024 and examined the factors associated with ANC utilization in Rwanda. Two reviewers independently performed screening of the abstracts and full texts and conducted data extraction and synthesis. The aggregated odds ratios for various factors associated with ANC service utilization were presented in forest plots, created using GraphPad Prism version 10.</p><p><strong>Results: </strong>The review included 11 studies and 1 report on ANC service utilization in Rwanda. By 2019-2020, 47% of women had received ANC in the first trimester, and 59% had four or more visits. Higher education levels, better wealth status, health insurance coverage, and small household size are associated with adequate ANC service utilization. Conversely, a significant distance from health facilities and unwanted pregnancies were associated with lower odds of adequate ANC utilization. Delayed ANC was more likely among women with higher parity, those who lacked social support, and those with no or only primary education.</p><p><strong>Conclusion: </strong>Rwanda has made considerable strides in improving ANC services. Addressing barriers such as distance to healthcare facilities, education, and economic disparities is crucial for enhancing maternal and child health outcomes. This review underscores the need for targeted interventions to achieve the World Health Organization recommendations of 8 antenatal care visits and sustainable development goals related to maternal and child health in Rwanda.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1636"},"PeriodicalIF":2.7,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871150","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":"Patient cost analysis of a community-based teledermatology service versus conventional outpatient appointments in East Kent: a retrospective study through a societal lens to reduce health inequalities.","authors":"Nurul Ain Nizar, Roopa Farooki, Piyush Mahapatra, Saul Halpern, Tim C H Hoogenboom","doi":"10.1186/s12913-024-12112-7","DOIUrl":"https://doi.org/10.1186/s12913-024-12112-7","url":null,"abstract":"<p><strong>Background: </strong>The UK's National Health Service (NHS) is grappling with rising demand and limited dermatologists, leading to longer waiting times. This is particularly concerning for conditions like malignant melanoma, where early diagnosis is crucial. Teledermatology is being introduced to address these issues, but its impact on patients' monetary and time costs, especially in deprived areas, is under-researched. This study investigates the impact of a community-based teledermatology model in East Kent, a coastal region with high cross-regional health inequalities.</p><p><strong>Methods: </strong>We analysed the financial costs and time invested by patients undergoing community-based teledermatology versus if they were to attend traditional appointments. Data were gathered from 1368 referrals, from May 2022 to January 2024 at a secondary care provider in the region. We considered the diagnosis method, appointments, travel, monetary cost of time, parking costs and Index of Multiple Deprivation Deciles (IMDD).</p><p><strong>Results: </strong>Our study showed the community teledermatology model significantly reduced the active patient's time and cost to obtain a diagnosis. Average time was 38.1 min, compared to 96.7 min in traditional clinics, saving 58.4 min (95% CI -62.3 to -54.5, p < 0.001). Patients saved £17.9 per diagnosis with this model (95% CI -£19.2 to -£16.6, p < 0.001). Time savings were more substantial for patients from more deprived regions (IMDD 1-3).</p><p><strong>Conclusion: </strong>The community-based teledermatology model proves to be cheaper for patients, providing a convenient alternative to traditional clinics, particularly benefiting patients from deprived backgrounds by improving healthcare accessibility and offering flexible consultation options.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1632"},"PeriodicalIF":2.7,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871186","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 application of a tool for supporting shared decision making in primiparous women during early labour - a descriptive survey of obstetric health care professionals' opinion.","authors":"Antonia N Mueller, Susanne Grylka-Baeschlin","doi":"10.1186/s12913-024-12096-4","DOIUrl":"https://doi.org/10.1186/s12913-024-12096-4","url":null,"abstract":"<p><strong>Background: </strong>Interventions in maternity health care settings often need to be studied within everyday clinical work and with the contributions of the staff. Therefore, the health care workers on-site play an important role for research success. This explains why it is necessary not only to focus on the outcomes of the research project itself, but also to study the whole process.</p><p><strong>Objective: </strong>This study aimed to evaluate maternity care providers' satisfaction with the use of a preliminary long version of a standardised tool for supporting shared decision making in women during early labour.</p><p><strong>Methods: </strong>A cross-sectional survey was distributed to n = 607 maternity care professionals working in the study sites which applied a tool to support shared decision making in primiparous women in early labour. The data was collected using RedCap®. It was analysed descriptively, and logistic regression modelling was applied to find associations between the application of the tool and care as well as work organisation.</p><p><strong>Results: </strong>A total of 110 health care professionals answered the online survey including 95 (86.4%) midwives and 15 (15.3%) obstetricians. N = 36 (43.9%) midwives stated that they found the tool helpful in the provision of care, whereas 46 (56.1%) did not agree. There was great dissatisfaction with the length of the preliminary tool. The tool adversely impacted the timely management of early labour care. Midwives with greater work experience (OR 0.82, p = 0.02) and a higher workload (OR 0.97, 0.02) were less likely to agree that the tool facilitates their work organisation. Additionally, midwives with more work experience (OR 0.86) and a higher workload (OR 0.96) found the tool less likely to be useful for care provision. The implementation of the tool was challenging for many midwives (40.2%) and some feel their competencies are threatened by the tool (20.7%).</p><p><strong>Conclusions: </strong>The involvement of maternity care providers in research is crucial for the success of projects, but they face challenges. Implementing a preliminary tool in clinical practice led to dissatisfaction mainly due to lack of time and partial understanding of its purpose. Providing adequate training and supportive leadership can help improve their understanding and satisfaction.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1633"},"PeriodicalIF":2.7,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871208","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":"Ambivalent and heavy burdened wanderers on a road less travelled: a meta-ethnography on end-of-life care experiences among family caregivers in rural areas.","authors":"Elisabet Breivik, Bente Ervik, Gabriele Kitzmüller","doi":"10.1186/s12913-024-11875-3","DOIUrl":"10.1186/s12913-024-11875-3","url":null,"abstract":"<p><strong>Background: </strong>As the population ages, more people will be diagnosed with cancer, and they will live longer due to receiving better treatment and optimized palliative care. Family members will be expected to take on more responsibilities related to providing palliative care at home. Several countries have expressed their vision of making home death an option, but such a vision can be more challenging in rural areas. There is a lack of synthesized research providing an in-depth understanding of rural family caregiving for people with cancer at the end of life. Thus, the purpose of this study was to synthesize and reinterpret the findings from qualitative research on rural family caregivers of adult cancer patients at the end of life.</p><p><strong>Methods: </strong>We conducted a meta-ethnography following Noblit and Hare's approach. A systematic literature search of four databases and extensive manual searches were completed in April 2022. The final sample included twelve studies from six different countries published in 2011-2022.</p><p><strong>Results: </strong>Based on the translation and synthesis of the included studies, four themes were developed (1) providing family care at the end of life in rural areas-a challenging endeavour; (2) the heavy responsibility of rural caregiving-a lonesome experience; (3) working on and behind the scenes; and (4) the strong and weak spots of community connectedness in rural areas. An overarching metaphor, namely, \"ambivalent and heavy burdened wanderers on a road less travelled\", provides a deeper understanding of the meaning of rural family caregiving at the end of life.</p><p><strong>Conclusions: </strong>This study provides valuable insights into end-of-life cancer care for rural families on four continents. It is crucial to prepare family caregivers for the demanding role of palliative caregiving in rural areas. To address the long distances and poor access related to specialized health care services, outpatient palliative teams tailored to the families' individual needs should be provided. In addition, more telehealth services, palliative units, or beds in local nursing facilities may reduce the number of exhausting trips that need to be made by caregivers and patients. Healthcare workers in rural areas need further education in palliative care.</p><p><strong>Trial registration: </strong>The study was registered in PROSPERO.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1635"},"PeriodicalIF":2.7,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871139","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":"Enhanced recovery after surgery in Pakistan: a qualitative descriptive analysis of current practices and future directions.","authors":"Hamza Ahmad, Antonia Arnaert, Waqas Shedio, Omaid Tanoli, Dan Deckelbaum, Tayyab Pasha","doi":"10.1186/s12913-024-11569-w","DOIUrl":"https://doi.org/10.1186/s12913-024-11569-w","url":null,"abstract":"<p><p>Enhanced Recovery After Surgery (ERAS) is a cost-effective perioperative approach that has been shown to shorten patients' hospital length of stay, improve resource utilization, and reduce postoperative costs for both patients and hospitals. While ERAS has the potential to offer even greater benefits in low- and middle-income countries (LMICs) its successful long-term implementation remains incomplete in Pakistan. This study aimed to explore insights and identify opportunities for implementing ERAS within the local socio-environmental context. A qualitative descriptive approach was employed, using convenience sampling to recruit 11 surgical residents from a public tertiary care hospital in Lahore, Pakistan. Individual semi-structured interviews were conducted. The data collected was then thematically analyzed to capture the residents' experiences regarding the implementation of ERAS. Acknowledging the benefits of ERAS, participants faced several challenges when implementing ERAS in their respective wards. The participants identified several key opportunities for successful implementation, including enhanced teamwork and collaboration amongst medical teams, improved patient education and compliance towards ERAS, strengthening of peripheral healthcare services, and targeted resource allocation. Even though several challenges identified by the participants were like those highlighted in high-income countries (HICs), unique barriers specific to Pakistan's healthcare structure and culture also emerged. Further research exploring and highlighting these specific challenges is needed to overcome these core barriers and promote a shift towards a standardized healthcare system focused on improving patient outcomes.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1634"},"PeriodicalIF":2.7,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871143","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 Rhode Island transitions clinic: connections to social and healthcare services after release from incarceration.","authors":"Katherine LeMasters, Sara N Levintow, Justin Berk, Sarah Martino, Catherine Paquette, Rahul Vanjani, Lauren Brinkley-Rubinstein","doi":"10.1186/s12913-024-12110-9","DOIUrl":"https://doi.org/10.1186/s12913-024-12110-9","url":null,"abstract":"<p><strong>Background: </strong>After release from incarceration, individuals are rarely connected to primary care or to social services despite bearing a disproportionate burden of poor health (e.g., chronic illness) and structural determinants of health (e.g., housing instability). The Rhode Island Transitions Clinic (RITC) works to fill this gap, particularly for patients with complex needs, by linking individuals to primary care and social services. However, prior work has not formally assessed how successful the TCN is at connecting patients to social services. Our objective was to assess the relationship between RITC and connections to healthcare use and services addressing structural determinants of health.</p><p><strong>Methods: </strong>This retrospective cohort study utilizes data among those released from the Rhode Island Department of Corrections (RIDOC) from 2018-2020. These data were linked with state agency data (e.g., unemployment, Medicaid medical claims, housing and homelessness services). We estimated 6-month risk differences (RDs) of each outcome, using stabilized inverse probability weights to account for censoring and confounding.</p><p><strong>Results: </strong>Of 8,694 individuals, the 68 enrolled in RITC are, on average, older, more likely to be Black, and have had more incarcerations. The RITC was associated with higher likelihood of connection to housing and homelessness services (RD: 0.29; 95% CI: 0.17, 0.41), (re)instatement of Supplemental Security Income (RD: 0.17, 95% CI: 0.06, 0.28), Emergency Department (RD: 0.29; 95% CI: 0.17, 0.41), and primary care visits (RD: 0.32; 95% CI: 0.21, 0.43), and lower likelihood of receiving taxable wages (RD: -0.05; 95% CI: -0.14, 0.05) compared to not being in RITC within six-months of release.</p><p><strong>Conclusions: </strong>RITC patients have complex healthcare and social service needs. The RITC is an innovative approach that is successful at connecting its patients to primary care and social services.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1631"},"PeriodicalIF":2.7,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871232","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":"GP emigration from Ireland: an analysis of data from key destination countries.","authors":"Holly Rose Hanlon, Éidín Ní Shé, John-Paul Byrne, Susan M Smith, Andrew W Murphy, Aileen Barrett, Mike O'Callaghan, Niamh Humphries","doi":"10.1186/s12913-024-12117-2","DOIUrl":"https://doi.org/10.1186/s12913-024-12117-2","url":null,"abstract":"<p><strong>Background: </strong>Ireland is experiencing a general practitioner (GP) workforce crisis, facing an ageing workforce, a growing population with increased life expectancy, and increased complexity of patients. The GP crisis threatens access to primary care in Ireland, as well as Ireland's aim to transform into a primary-care centred system of universal healthcare via the proposed \"Sláintecare\" healthcare reforms. The challenges faced are common to many countries as health systems seek to expand their medical workforce post-pandemic. In addition Ireland has a legacy of austerity policies which impacted the health system, and triggered/generated largescale doctor emigration. However, little is known specifically about GP emigration and the role it potentially plays in the GP workforce crisis. This paper aims to address the gap in knowledge about the level of GP emigration from Ireland and consider the implications for the Irish health system and health systems internationally.</p><p><strong>Methods: </strong>As Ireland does not formally collect routine data on GP emigration, this paper presents routinely collected secondary data from four key destination countries; Australia, New Zealand, the United Kingdom, and Canada, in order to gain an initial picture of GP emigration from Ireland to these countries, from 2012-2021. The data were in the form of medical registration and immigration (visa) data and both stock (the total number of GPs registered in a country in a given year) and flow data (the number of GPs entering a country in a given year) were collated, where available.</p><p><strong>Results: </strong>The stock data shows a substantial cohort of Irish-trained doctors working in general practice in key destination countries. The flow data suggests a relatively small annual emigration flow of GPs from Ireland to individual countries. However when compared with the total numbers of GPs trained in Ireland each year, the numbers are notable.</p><p><strong>Conclusions: </strong>The available data suggests a mixed picture regarding GP emigration from Ireland. There is a significant stock of Irish-trained GPs abroad which perhaps represents a potential cohort of GPs who could be encouraged to return to practice in Ireland as part of Ireland's strategy for addressing the GP workforce crisis. The annual flow of GPs from Ireland to key destination countries, while small, should be monitored and factored into GP workforce planning. As global demand for GPs increases, countries will inevitably compete with each other to attract and retain GPs (see for example Australia's recent move to attract and recruit Irish trained GPs). The paper highlights the need for improved routine data on the GP workforce in Ireland, including the need for a national GP workforce dataset, in order to ensure that national workforce planning efforts are informed by the latest evidence on GP emigration.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1628"},"PeriodicalIF":2.7,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871182","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}