BMC Health Services Research最新文献

{"title":"Virtual reality as a tool to promote healthcare providers wellbeing in pediatric palliative care.","authors":"Anna Marinetto, Valentina De Tommasi, Mariangela Rosa, Anna Santini, Caterina Carraro, Isabella Rosato, Pierina Lazzarin, Franca Benini, Anna Zanin","doi":"10.1186/s12913-025-13253-z","DOIUrl":"https://doi.org/10.1186/s12913-025-13253-z","url":null,"abstract":"<p><strong>Background: </strong>The pediatric palliative care (PPC) team's mission is to assist and promote the highest quality of life for children with life-threatening and life-limiting illnesses and their families. The whole care of these patients implies sometimes challenging clinical and emotional situations. PPC providers may be exposed to psychological distress.</p><p><strong>Aims: </strong>The study's objectives were to evaluate the psychological well-being of healthcare providers working in the Regional Center for Palliative Care and Pediatric Pain Therapy, including their stress levels, levels of depression, anxiety, and risk of burnout, and to determine whether practicing mindfulness through virtual reality can improve these items.</p><p><strong>Methods: </strong>The mindfulness intervention was delivered twice a week for four weeks in this prospective, non-randomized clinical study. Each participant received a 10-minute mindfulness-related session in 3-D virtual reality, for a total of eight exposures. Measures of emotional depression, anxiety, stress, and risk of burnout were assessed using the DASS-21 and Mini-Z questionnaires. Participants' respiratory and heart rate were also monitored throughout each session. The treatment was evaluated using the DASS-21 at each timepoint, the Mini-Z at T0 and T3, and vital parameters at T1, T2, and T3 (T0 before the treatment, T1 at the end of the first week, T2 at the end of the second week, and T3 after completion of the last week's treatment).</p><p><strong>Results: </strong>Pediatricians, nurses, allied healthcare professionals, and pediatric residents made up the 27 PPC healthcare practitioners enrolled. The median age was 47 years (IQR 36-50), and 85% of the participants were female. At the time of recruitment (T0), around 25% of individuals (n = 7; 25.93%) acknowledged a risk of burnout. Between T0 and T3, there was a significant shift in the DASS-21 scores for depression, anxiety, and stress (p <.05), indicating an improvement in the overall scores. The study of vital signs revealed that over the weeks, the heart and breathing rates had significantly decreased. It has also been demonstrated that the candidate's mood significantly improved at T3 compared to the study's beginning.</p><p><strong>Relevance to clinical practice: </strong>According to the current research, using virtual reality in a PPC team is a potential technology that may be helpful in lowering stress levels and the risk of burnout, resulting in significant improvements in the well-being of the healthcare personnel.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1295"},"PeriodicalIF":3.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224623","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":"Exploring barriers to help-seeking for sexual issues in Iranian postmenopausal women: a qualitative analysis.","authors":"Maryam Taherpour, Shahideh Jahanian Sadatmahalleh, Zainab Alimoradi","doi":"10.1186/s12913-025-13528-5","DOIUrl":"https://doi.org/10.1186/s12913-025-13528-5","url":null,"abstract":"","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1306"},"PeriodicalIF":3.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224772","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":"Racial/Ethnic variation in health insurance coverage and early midlife depressive symptoms in the U.S.","authors":"Xing Zhang, Leslie B Adams, Tiffany L Lemon","doi":"10.1186/s12913-025-13392-3","DOIUrl":"https://doi.org/10.1186/s12913-025-13392-3","url":null,"abstract":"<p><strong>Background: </strong>Health insurance access is a critical determinant of mental health, yet racial/ethnic disparities in coverage persist. Examining the relationship between health insurance access and depressive symptoms at early midlife can inform interventions addressing mental health inequities.</p><p><strong>Methods: </strong>To examine the association between health insurance coverage type (private, public, or uninsured) and depressive symptoms (CES-D-5 scale) at early midlife and variation across racial and ethnic groups. We used data from Waves I, IV, and V of the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative cohort study conducted from 1994 to 2018 in the U.S. The analytic sample included 7,302 respondents who completed Waves I, IV, and V, had valid sample weights, and were not missing key independent or dependent variables. We used ordinary least squares regression to evaluate the association between health insurance type and depressive symptoms.</p><p><strong>Results: </strong>The analytic sample was 49% women, 4% Asian, 14% Black, 9% Hispanic, and 73% White, and were 38 years old (n = 7,302). Among respondents, 75% had private insurance, 16% had public insurance, and 9% were uninsured. Relative to those with private insurance, adults with public insurance (B = 0.82; 95% CI = 0.53, 1.10; P = < 0.001) and those uninsured (B = 0.95; 95% CI = 0.60, 1.29; P = < 0.001) had significantly greater depressive symptoms. Racial and ethnic differences emerged: Hispanic and White adults with public insurance had greater depressive symptoms, while uninsured White adults reported significantly greater depressive symptoms.</p><p><strong>Conclusions: </strong>Disparities in health insurance access were associated with differences in depressive symptoms at early midlife, with variation across race and ethnicity. Addressing disparities in access to private health insurance may help improve mental health outcomes.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1299"},"PeriodicalIF":3.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224928","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":"Healthcare provider perspectives on their role in perpetrating and perpetuating reproductive coercion: a qualitative study.","authors":"Susan Saldanha, Jessica R Botfield, Danielle Mazza","doi":"10.1186/s12913-025-13240-4","DOIUrl":"https://doi.org/10.1186/s12913-025-13240-4","url":null,"abstract":"<p><strong>Background: </strong>Reproductive coercion (RC) refers to behaviours that interfere with an individual's autonomy over their reproductive health and decision-making. While traditionally attributed to partners or families, emerging research has highlighted the potential role healthcare providers may play in perpetrating and perpetuating RC. This study aims to explore the perspectives of Australian healthcare providers who deliver reproductive healthcare, focusing on their understanding of provider bias and coercion in the context of reproductive decision-making, both within their own practice and among their peers.</p><p><strong>Methods: </strong>This qualitative study used semi-structured interviews to gather insights from 18 healthcare providers, including general practitioners, nurses, and obstetricians/gynaecologists who deliver reproductive healthcare services in Australia. Participants were purposively sampled to capture a range of perspectives, selecting individuals from different healthcare roles with experience in reproductive healthcare provision. Interviews were analysed using reflexive thematic analysis and themes were constructed through an inductive approach.</p><p><strong>Results: </strong>Three key themes were identified: (1) Explicit refusals and their impact on reproductive autonomy, where participants described how refusal to provide or refer for services like abortion, sterilisation or long-acting contraception undermined patients' reproductive choices; (2) Implicit bias shaping reproductive decision-making, with participants reflecting on how unconscious biases influenced contraceptive counselling and other reproductive health decisions, often leading to coercive practices; and (3) Oversight and misinformation enabling coercion, where participants noted that a lack of awareness or incorrect assumptions about patient needs could unintentionally collude with coercive dynamics.</p><p><strong>Conclusions: </strong>This research highlights the complex ways healthcare providers may, often unintentionally, undermine reproductive autonomy through biased guidance, non-referral, or restrictive practices. Addressing both explicit and implicit provider biases is essential for fostering person-centred, non-coercive reproductive healthcare. Our findings underscore the need for healthcare systems to prioritise bias and reflective practice training, along with corresponding clinical guidance for providers. This must be supported by institutional safeguards, such as enforceable referral mechanisms and bias-aware education to ensure reproductive decisions are respected and supported in practice. By actively dismantling coercive practices, healthcare providers can ensure that the care they provide respects and upholds patients' reproductive intentions and autonomy.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1304"},"PeriodicalIF":3.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224767","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":"Racial disparities and trends in anticoagulant use among ambulatory care patients with atrial fibrillation and atrial flutter in the United States from 2007 to 2019.","authors":"Vincent Kan, Kate Lapane, David McManus, Jonggyu Baek, Chad Darling, Matthew Alcusky","doi":"10.1186/s12913-025-13397-y","DOIUrl":"https://doi.org/10.1186/s12913-025-13397-y","url":null,"abstract":"<p><strong>Introduction: </strong>Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, significantly increasing the risk of stroke. The introduction of direct oral anticoagulants (DOACs) since 2010 has transformed anticoagulation therapy, offering an alternative to warfarin with improved safety profiles. Despite the increased adoption of DOACs, disparities in their use among different racial and ethnic groups in the United States remain understudied.</p><p><strong>Methods: </strong>This study utilized a repeated cross-sectional design, analyzing data from the National Ambulatory Medical Care Survey (NAMCS) from 2007 to 2019. The study population included adults diagnosed with AF or atrial flutter (AFL). We analyzed the temporal trends of DOAC and warfarin use from 2007 to 2019. We examined the prevalence of DOAC versus warfarin use and assessed associations between race/ethnicity, patient characteristics, and DOAC utilization from 2011 to 2019. Multivariable modified Poisson regression models were used to calculate adjusted prevalence ratios (aPR) for the associations.</p><p><strong>Results: </strong>From 2011 to 2019, NAMCS recorded 3,224 visits involving AF or AFL, representing a weighted estimate of 103.6 million visits. DOAC use increased significantly, with apixaban becoming the predominant anticoagulant by 2016. The rate of DOAC adoption was slower for non-Hispanic Black compared to non-Hispanic White patients over time (aPR 0.75; 95% CI, 0.63-0.90). Patients with Medicaid insurance were also less likely to use DOACs (aPR 0.14; 95% CI: 0.04-0.46).</p><p><strong>Conclusion: </strong>Despite the shift from warfarin to DOACs for AF and AFL treatment, significant racial and socioeconomic disparities persist. Non-Hispanic Black patients adopted to DOAC use more slowly than non-Hispanic White patients, widening the treatment gap over time. Those with Medicaid insurance are less likely to use DOACs compared to those with private insurance. These findings highlight the need for targeted strategies to ensure equitable access to advanced anticoagulant therapies.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1300"},"PeriodicalIF":3.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224882","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":"Exploring health system resilience during the COVID-19 pandemic in Sweden: an interrupted time series analysis of service utilisation and sociodemographic differences.","authors":"Emily Maresch, My Fridell, Maxim Kan, Zangin Zeebari, Ulf O Gustafsson, Anna Mia Ekström, Helena Nordenstedt","doi":"10.1186/s12913-025-13551-6","DOIUrl":"10.1186/s12913-025-13551-6","url":null,"abstract":"","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1282"},"PeriodicalIF":3.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211537","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 sustainability of practice-based research networks across the globe - insights from a worldwide qualitative study.","authors":"Anna Dania, Zsolt Nagykaldi, Ari Haaranen, Jean W M Muris, Philip H Evans, Pekka Mäntyselkä, Chris van Weel","doi":"10.1186/s12913-025-13159-w","DOIUrl":"10.1186/s12913-025-13159-w","url":null,"abstract":"<p><strong>Background: </strong>PBRNs emerged from partnerships between academics and primary care practitioners and functioned as primary care \"laboratories\". In two previous scoping literature reviews, we presented the facilitators and barriers to building PBRNs linked to their internal and external environments. This article presents key insights from interviews with PBRN leaders worldwide about the sustainability of their networks.</p><p><strong>Methods: </strong>We used the consultation exercise component of the scoping review methodology to generate complementary/additional results to our previous studies. We conducted 56 semi-structured interviews with a purposive sample of PBRN leaders using the contact information included in our earlier scoping reviews. We then expanded the sample to achieve balance and saturation in terms of PBRN developmental stage maturity, structure, focus, governance and involvement of other stakeholders. We applied inductive thematic analysis to 55 interviews (one was inaudible) and derived key elements, subthemes, and main themes from the codes.</p><p><strong>Results: </strong>The overarching thematic framework yielded 4 main themes, 18 subthemes, and 72 key elements. Main themes were Internal Environment, Stakeholders at the Intersection between the Internal and External Environment, the Impact and Value of PBRNs, and the External Environment. We found that PBRN leaders associated network sustainability with sufficient infrastructural support, collaborative relationships, a learning team environment culture, and agile management. They also considered that support and advocacy from organisations with global influence was essential for their sustainability. They also indicated that PBRNs have a positive impact on academic faculty, clinician education, primary care practice, community health and healthcare policy.</p><p><strong>Conclusion: </strong>While PBRNs have found various ways to develop and thrive and have influenced the primary care field, there remains a strong need for strategic development of network relationships, research portfolios, stable infrastructure support and intensified advocacy to further consolidate their role within the broader healthcare landscape nationally and globally.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1287"},"PeriodicalIF":3.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211478","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":"Service experiences of hospitalized patients and family members with the \"one-stop\" smart admission and discharge service: a descriptive qualitative study.","authors":"Siyao Wang, Wenbin Jiang, Ruting Gu, Zhongjun Du, Shixiang Pan, Lili Wei","doi":"10.1186/s12913-025-13417-x","DOIUrl":"10.1186/s12913-025-13417-x","url":null,"abstract":"<p><strong>Background: </strong>To improve institutional healthcare quality and enhance the service delivery experiences of hospitalized patients and family members, it is essential to identify and address their core experiential needs at both the systemic and individual levels. Admission and discharge are critical points in the hospital service chain that significantly shape overall service experience. Traditional workflows are often fragmented and inefficient, resulting in reduced patient satisfaction and service efficiency. In response, a \"one-stop\" smart admission and discharge service was introduced in a tertiary hospital in Qingdao, China. It integrated digital functions, including registration, inpatient payment, insurance processing, and discharge settlement, into a streamlined, patient-centered system. This study aimed to identify the core experiential dimensions of this service from the perspectives of patients and family members. It offers practical insights for service optimization and digital health innovation.</p><p><strong>Methods: </strong>A descriptive qualitative study was conducted between February and April 2024. Semi-structured interviews were performed with 11 patients and 12 family members across four inpatient departments. Data were analyzed using Colaizzi's seven-step phenomenological method. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was applied to guide reporting and ensure methodological rigor.</p><p><strong>Results: </strong>Two overarching themes emerged: (1) perceived benefits of the service for patients and family members, including improved procedural efficiency, reduced non-medical waiting time, and enhanced convenience; and (2) perceived areas for improvement of the \"one-stop\" smart admission and discharge service, such as limited digital support for older adults, occasional system instability, and insufficient integration with insurance platforms.</p><p><strong>Conclusions: </strong>The service was generally perceived positively by patients and family members, who appreciated its efficiency and convenience. However, several practical challenges were identified. Enhancing user support, particularly for vulnerable groups, and strengthening system stability, financial security, and interoperability through stakeholder collaboration may further optimize patient-centered care delivery in digital health contexts.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1289"},"PeriodicalIF":3.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211528","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":"Perceptions of healthcare practitioners about NHI implementation in the public sector in Sedibeng district, Gauteng province.","authors":"Aluwani Delila Mudzweda, Thembi Violet Simbeni, Ntlogeleng Mabina Mogale","doi":"10.1186/s12913-025-13409-x","DOIUrl":"10.1186/s12913-025-13409-x","url":null,"abstract":"<p><strong>Background: </strong>South Africa's healthcare system is characterized by an overburdened public and well-resourced private sector, fuelling healthcare inequality. The National Health Insurance seeks to achieve universal health coverage but faces delays due to understaffing, resource shortages, and infrastructure gaps. Despite reforms like Primary Health Care re-engineering, healthcare practitioners fear National Health Insurance implementation may worsen workloads and care quality, yet their voices are overlooked. This study aimed to determine the perceptions of healthcare practitioners on the implementation of National Health Insurance in the public sector in the Sedibeng district.</p><p><strong>Materials and methods: </strong>A quantitative approach, with a cross-sectional descriptive design, was used among 352 healthcare practitioners in the public health sector in Sedibeng district, Gauteng Province. The researcher uses questionnaires with closed-ended questions to obtain information about the perceptions of healthcare practitioners on the implementation of National Health Insurance. The Microsoft Excel spreadsheet was imported to STATA 17 software for data analysis.</p><p><strong>Results: </strong>The level of confidence in the country's ability (24%), adequacy of resources (15%), and infrastructure (15%) to implement NHI, was very low among respondents and most of them (86%) felt that lack of adequate healthcare personnel is a challenge in NHI implementation.</p><p><strong>Conclusion: </strong>The study concluded that challenges related to the healthcare system and the success of National Health Insurance amongst others are poor infrastructure, shortage of the health workforce, medical products, and vaccines. Most respondents (74%) indicated that poor implementation of policies is the biggest challenge in the implementation of NHI. The successful implementation of National Health Insurance will depend on addressing these varied challenges.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1286"},"PeriodicalIF":3.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211493","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":"Barriers to primary health care: perspectives of marginalized Roma women and healthcare professionals.","authors":"Jana Marosnikova Plavnicka, Zuzana Dankulincova Veselska, Daniela Filakovska Bobakova","doi":"10.1186/s12913-025-13482-2","DOIUrl":"10.1186/s12913-025-13482-2","url":null,"abstract":"","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1284"},"PeriodicalIF":3.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211495","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}