BMC Health Services Research最新文献

{"title":"Evidence of tuberculosis treatment outcomes among people experiencing homelessness: a scoping review.","authors":"Claudia Susana Pérez Guerrero, Tiago Augusto Cavalcante Oliveira, Willie Otávio Bueno Bernardi, Stephanie Ribeiro, Jeanne-Marie Stacciarini, Aline Aparecida Monroe, Hugo Fernandes, Paula Hino","doi":"10.1186/s12913-025-12230-w","DOIUrl":"10.1186/s12913-025-12230-w","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis is an infectious, preventable and treatable disease that is socially determined. People experiencing homelessness represent a group that is highly vulnerable to this disease, presenting a challenge for its control and elimination. The aim of this review was to synthesize the existing scientific evidence on the outcomes of tuberculosis treatment in the context of the population experiencing homelessness.</p><p><strong>Methods: </strong>This scoping review was conducted following JBI guidelines. Six databases were consulted: MEDLINE, Web of Science, Scopus, LILACS, CINAHL and EMBASE. Scientific literature with quantitative or mixed-method approaches may be included, published from 2015 onward, in English, Portuguese and Spanish, involving participants aged 15 years or older. The Rayyan application was used to facilitate the selection process, and a descriptive analysis of the findings was performed.</p><p><strong>Results: </strong>Fourteen articles were included, comprising primarily cohort studies (n= 6) and cross-sectional studies (n= 5), along with two ecological studies and a systematic review. Eight articles were from South America (seven from Brazil), three from Europe and three from Asia. The rates of treatment success outcomes ranged from 89.7% to less than 30%, with nine studies reporting rates under 45%. The highest proportion of accumulated unsuccessful treatment outcomes was nearly 70%, with four studies indicating rates between 60% and 66%. Loss to follow-up was the most frequently reported negative outcome (n= 9), reaching rates of 53.6%. The \"failed\" treatment outcome was reported in low proportions, often less than 1% (n= 5) and \"not evaluated\" outcome was reported in half of the studies (n= 7). The proportions observed in the systematic review were consistent with these findings. Furthermore, the results revealed significant differences compared with those of the global general population. While both groups exhibited low proportions of treatment failures, other outcomes for the homeless population were markedly poorer.</p><p><strong>Conclusions: </strong>The homeless population experiences low success rates in tuberculosis treatment, with no study in this review meeting the international treatment success rate target. A comprehensive, collaborative and patient-centered care approach that addresses social determination of health is essential to improve outcomes and enhance health, social care, and educational services tailored to the needs of this population.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"497"},"PeriodicalIF":2.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770951","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":"Holistic framing for improving care provision for older people with chronic diseases in Jordan: a phenomenological study.","authors":"Anas Shehadeh, Malakeh Z Malak, Ahmad Ayed","doi":"10.1186/s12913-025-12658-0","DOIUrl":"10.1186/s12913-025-12658-0","url":null,"abstract":"<p><p>There is a sharp increase in the number of older people globally. Thus, it is important to adopt strategies to improve the care provided for older people, especially due to the increased prevalence of chronic conditions. However, very little evidence is available on what should be done, especially from the perspective of healthcare professionals responsible for providing care for older people in nursing homes. Thus, this study aimed to explore the opinions of healthcare professionals including nurses and physicians in nursing homes on adopting holistic framing for improving care provision for older people with chronic conditions in Jordan. The study employed a descriptive phenomenological design using semi-structured interviews with 13 nurses and two physicians in Amman governorate in Jordan during the period from June to September 2024. Inductive content analysis was used to analyze data. The findings revealed three overarching themes including: (1) offering dedicated courses and postgraduate programs; (2) improving facilities and resources; and (3) raising awareness and enhancing collaborations. The findings provide a holistic framing for improving healthcare provision for older people with chronic diseases in Jordan.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"492"},"PeriodicalIF":2.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770960","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":"User journey method: a case study for improving digital intervention use measurement.","authors":"Lauri Lukka, Maria Vesterinen, Antti Salonen, Vilma-Reetta Bergman, Paulus Torkki, Satu Palva, J Matias Palva","doi":"10.1186/s12913-025-12641-9","DOIUrl":"10.1186/s12913-025-12641-9","url":null,"abstract":"<p><strong>Background: </strong>Many digital mental health interventions meet low levels of use. However, current use measurement methods do not necessarily help identify which intervention elements are associated with dropout, despite this information potentially facilitating iterative intervention development. Here, we suggest improving the comprehensiveness of intervention use measurement with the user journey method, which evaluates every intervention element to identify intervention-specific use barriers.</p><p><strong>Methods: </strong>We applied user journey method in a clinical trial that investigated the efficacy of a novel game-based intervention, Meliora, for adult Major Depressive Disorder. We modelled the intervention for its four technological (Recruitment, Website, Questionnaires, Intervention Software) and two interpersonal elements (Assessment, Support). We then applied the user journey method to measure how many users proceeded from one element to the next combining social media analytics, website use data, signup data, clinical subject coordinator interview data, symptom questionnaire data, and behavioral intervention use data. These measurements were complemented with the qualitative analysis of the study discovery sources and email support contacts.</p><p><strong>Results: </strong>Recruitment: The intervention recruitment reached at least 145,000 Finns, with social media, word-of-mouth, and news and web sources being the most effective recruitment channels. Website: The study website received 16,243 visitors, which led to 1,007 sign-ups.</p><p><strong>Assessment: </strong>895 participants were assessed and 735 were accepted. Intervention Software: 498 participants were assigned to the active intervention or comparator, of whom 457 used them at least once: on average, for 17.3 h (SD = 20.4 h) on 19.7 days (SD = 20.7 d) over a period of 38.9 days (SD = 31.2 d). The 28 intervention levels were associated with an average dropout rate of 2.6%, with two sections exhibiting an increase against this baseline. 150 participants met the minimum adherence goal of 24 h use. Questionnaires: 116 participants completed the post-intervention questionnaire.</p><p><strong>Support: </strong>313 signed-up participants contacted the researchers via email.</p><p><strong>Conclusion: </strong>The user journey method allowed for the comprehensive evaluation of the six intervention elements, and enabled identifying use barriers expediting iterative intervention development and implementation.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT05426265. Registered 28 June 2022, https://clinicaltrials.gov/ct2/show/NCT05426265 .</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"479"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11959768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750818","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":"Exploring challenges in accessing primary healthcare for pregnant women in Pakistan: a qualitative descriptive study.","authors":"Bushra Asif Ali Khan, Humaira Mahmood, Jawaria Mukhtar Ahmed, Bushra Anwar, Ameer Muhammad, Rawshan Jabeen","doi":"10.1186/s12913-024-11637-1","DOIUrl":"10.1186/s12913-024-11637-1","url":null,"abstract":"<p><strong>Introduction: </strong>Maternal and newborn mortality are critical global health concerns. Achieving Sustainable Development Goal 3.8 (SDGs), which aims to improve these outcomes, is hindered by the poor quality of care in health facilities, a significant barrier to the utilization of antenatal care (ANC) services in Pakistan. This study aimed to explore the barriers to the underutilization of ANC services in Tehsil (sub-division of a district) Hazro, Punjab, Pakistan, from the perspective of pregnant women.</p><p><strong>Method: </strong>The study employed four focus group discussions (FGDs) with 36 pregnant women who had attended at least three ANC visits. Data were collected through purposive sampling and analyzed using NVivo 12, ensuring rigor through Lincoln and Guba's guiding principles.</p><p><strong>Result: </strong>The findings revealed three key themes, following the three delays model: 1. Decision to Seek Care, 2. Delay in Reaching Healthcare Facilities, and 3. Delay in Acquiring Satisfactory and Appropriate Health Care. Women often made the decision to seek care with the support of their spouse, family, and lady health workers, highlighting the importance of their decision-making autonomy. Financial constraints did not significantly hinder access to healthcare services. However, long distances, travel time, and associated costs were identified as major barriers. Most importantly, the majority of women lacked awareness of danger signs and the importance of seeking timely medical help. This issue was compounded by the unavailability of healthcare personnel, negative staff attitudes, insufficient medicines and equipment, and a lack of referral services.</p><p><strong>Conclusion: </strong>This descriptive study underscores the urgent need for affordable, accessible, and responsive maternal and child healthcare. To address these barriers, stakeholders - including policymakers, public health experts, and maternal, neonatal, and child health (MNCH) providers - must prioritize MNCH initiatives and reforms. Collaborative efforts are crucial to translating MNCH policies into effective strategies at the community level.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"482"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11959712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762969","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":"Climate risks, multi-tier medical insurance systems, and health inequality: evidence from China's middle-aged and elderly populations.","authors":"Hongyan Yang, Yang Yang, Dequan Li","doi":"10.1186/s12913-025-12648-2","DOIUrl":"10.1186/s12913-025-12648-2","url":null,"abstract":"<p><strong>Background: </strong>Against the backdrop of increasing population aging, the uncertainty and irreversibility of climate change have a significant impact on the health and healthcare burden of the elderly. However, it remains uncertain whether the multi-tiered medical insurance system disproportionately influences the health impacts of climate risks.</p><p><strong>Methods: </strong>Using data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020, matched with urban climate risk variables, we employ a multi-dimensional panel fixed effects model and an instrumental variable model to examine the impact of climate risks on the health of the middle-aged and elderly, while also investigating the unequal effects of the multi-tiered medical insurance system.</p><p><strong>Results: </strong>Climate risks significantly worsened the self-reported health of the middle-aged and elderly (β = 0.073, P = 0.089), and increased both total medical costs (β = 2.570, P = 0.012) and out-of-pocket expenses (β = 2.652, P = 0.003). Notably, the increases in hospitalization costs (β = 0.721, P = 0.004) and out-of-pocket hospitalization expenses (β = 0.706, P = 0.036) are particularly prominent. The current multi-tiered medical insurance system results in unequal impacts of climate risks on health and medical costs. Specifically, urban employee medical insurance and commercial medical insurance effectively improve the health outcomes of elderly individuals affected by climate risks. Urban residents' medical insurance significantly reduces both total medical costs and out-of-pocket expenses for the elderly, whereas the new rural cooperative medical insurance shows no significant mitigating effect. Additionally, there is no evidence to suggest that the integration of urban and rural resident medical insurance can reduce the medical burden on rural elderly populations caused by climate risks. Our long-term projections indicate that, under both the SSP245 and SSP585 scenarios, the increase in elderly healthcare costs due to climate risks is irreversible. However, restrictive climate policies would yield significant health benefits, potentially reducing per capita medical costs for the elderly by nearly 50%.</p><p><strong>Conclusions: </strong>The decentralized multi-tier medical insurance system leads to significant inequality in the health impacts of climate risks. Our study emphasizes the critical role of reforming the existing social medical insurance system and implementing climate policies to protect the health of elderly populations.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"481"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762967","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":"Study on the efficiency of health resource allocation in the western region of China-based on three-stage DEA and Tobit regression analysis.","authors":"Dongxue Zhao, Hua Huang, Yu Zhang, Shuanghang Li","doi":"10.1186/s12913-025-12630-y","DOIUrl":"10.1186/s12913-025-12630-y","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the allocation efficiency of health resources in the western region of China, and to explore the influence of external environmental factors on the allocation efficiency, to provide reference for optimizing the allocation of resources.</p><p><strong>Methods: </strong>In this study, we employed a three-stage Data Envelopment Analysis (DEA) model alongside Tobit regression analysis to evaluate the efficiency of health resource allocation and explore the factors that influence it across western China. This analysis focused on data from 2021, covering ten provinces. Through this combined approach, the study aimed to uncover key insights into the determinants and variations in resource allocation efficiency within western China.</p><p><strong>Results: </strong>Following the three-stage DEA analysis, the results showed that health resource allocation in western China achieved a comprehensive efficiency of 0.979, a pure technical efficiency of 0.980, and scale efficiency of 0.999. Notably, six provinces, specifically Chongqing, Guizhou, Yunnan, Tibet, Qinghai, and Ningxia, maintained efficient performance both before and after adjustment. The extensive efficiency of 3 provinces, including Sichuan, Shaanxi, and Gansu decreased. Xinjiang's comprehensive efficiency improved. The comprehensive efficiency of the southwest area was higher than that of the northwest area. The Tobit regression analysis revealed that factors such as per capita disposable income, the share of government spending in total healthcare expenditure, and the medical service price index significantly influenced the efficiency of health resource allocation in Western China.</p><p><strong>Conclusion: </strong>Environmental factors appeared to inflate the efficiency estimates of health resource allocation in China's western region, with considerable disparities across different areas. To address these issues, the government should advance reforms in medical resource distribution, enhance management practices and technology, optimize resource allocation structures, and minimize resource wastage. At the same time, strategies should be formulated according to provincial characteristics, and interregional cooperation and resource sharing should be strengthened to achieve complementary advantages and common development.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"480"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11959864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750755","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":"Facilitators and barriers to smoking cessation: a qualitative study among health professionals in Germany.","authors":"Frederike Bokemeyer, Paulina Kiefer, Lea Schmidt, Kathleen Gali","doi":"10.1186/s12913-025-12646-4","DOIUrl":"10.1186/s12913-025-12646-4","url":null,"abstract":"<p><strong>Background: </strong>Tobacco consumption remains a leading cause of global morbidity and mortality and is a significant preventable health concern. Despite the known benefits of smoking cessation, many smokers face difficulties in maintaining abstinence and preventing relapse. In Germany, approximately 30% of individuals aged 14 and older are smokers, which reflects low smoking cessation rates and limited use of evidence-based smoking cessation interventions.</p><p><strong>Purpose: </strong>This qualitative study aimed to explore experts' views on smoking cessation through interviews with health practitioners.</p><p><strong>Methods: </strong>Fifteen semi-structured in-depth interviews were conducted with professionals from diverse fields, including medical doctors, psychologists, and addiction therapists, from July to November 2022. The data were analyzed using qualitative content analysis. A deductively developed categorization system was applied to identify sub-themes within categories and to systematically code the data. All data were thencategorized under two main categories: facilitators and barriers to smoking cessation.</p><p><strong>Results: </strong>Key facilitators included the self-motivation of participants, the communication skills of the intervention leader, and the provision of knowledge about addiction mechanisms. Important barriers were smokers' fears of quitting, external environmental pressures, and inadequate counseling structures.</p><p><strong>Conclusion: </strong>The findings suggest that improving smoking cessation interventions in Germany require comprehensive strategies involving both structural adjustments in health care settings and enhanced training for tobacco treatment specialists.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"483"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11959832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing user experience with the Bioline™ HCV point-of-care test in primary healthcare settings: a mixed-methods study.","authors":"Evans Duah, Evans Mantiri Mathebula, Kuhlula Maluleke, Tinyiko Violet Baloyi, Richard Kobina Dadzie Ephraim, Tivani Mashamba-Thompson","doi":"10.1186/s12913-025-12634-8","DOIUrl":"10.1186/s12913-025-12634-8","url":null,"abstract":"<p><strong>Background: </strong>Hepatitis C Virus (HCV) is a major public health challenge, particularly in resource-limited settings with inadequate diagnostic services. The Bioline™ HCV Point-of-Care (POC) test provides a promising solution for improving diagnosis in Primary Healthcare (PHC) clinics without laboratory infrastructure. This study evaluated the test's usability, acceptability, and deliverability in Ghana using user-oriented REASSURED criteria.</p><p><strong>Methods: </strong>A convergent parallel mixed-methods design was adopted. Quantitative data was collected through direct observation of Healthcare Workers (HCWs) using audit checklists and analyzed with Stata 16. The analysis included descriptive statistics, inter-rater concordance assessment, and the application of the System Usability Scale (SUS). Qualitative data, analyzed using Atlas.ti 24.2.0, explored user experiences, confidence, storage infrastructure, and suggestions for test design improvement through in-depth interviews.</p><p><strong>Results: </strong>The quantitative audit included 81 non-laboratory HCWs, with 22 participating in in-depth interviews. The test scored 88.7 on the SUS (95% CI: 86.40-90.88), with 88% of HCWs rating it as easy or very easy to use. Most HCWs (81.5%) successfully completed all testing steps independently, achieving 100% inter-rater concordance, but 83% made errors in at least one step, primarily during pre-testing. Qualitative findings revealed widespread acceptance, confidence, and adaptability despite challenges with storage infrastructure.</p><p><strong>Discussion: </strong>The Bioline™ HCV POC test demonstrated high usability and acceptance among HCWs in resource-limited settings. Enhancements such as improved packaging, simplified information sheets, refined droppers, and additional components like gloves could further optimize usability. These findings support the Sustainable Development Goal (SDG) 3 by enhancing access to timely HCV diagnosis, contributing to Universal Health Coverage, and strengthening health systems in underserved areas.</p><p><strong>Trial registration: </strong>This study is part of a diagnostic trial registered in the Pan African Clinical Trial Registry ( https://pactr.samrc.ac.za ) on 24th October 2024 with trial registration number: PACTR202410837698664.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"484"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762965","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":"Trauma team members' perceptions of the effectiveness of the current trauma care system in Addis Ababa, Ethiopia: a phenomenological study.","authors":"Eyayalem Melese Goshu, Zodwa Margaret Manyisa","doi":"10.1186/s12913-025-12611-1","DOIUrl":"10.1186/s12913-025-12611-1","url":null,"abstract":"<p><strong>Background: </strong>Trauma is a leading cause of mortality and disability in low- and middle-income countries (LMICs). Among African nations, Ethiopia has one of the highest trauma fatality rates at 26.7% per 100,000 population, significantly exceeding rates in many other LMICs. Most trauma cases occur in the capital, Addis Ababa. Despite this significant burden, the effectiveness and quality of trauma care in Addis Ababa vary widely across hospitals, driven by disparities in available resources and the knowledge levels of trauma team members.</p><p><strong>Objective: </strong>This qualitative study aimed to explore trauma team members' perceptions of the effectiveness of the current trauma care system in Addis Ababa, Ethiopia.</p><p><strong>Methods: </strong>This study used a qualitative phenomenological design to analyze trauma care team members' perceptions of the current trauma care system in Addis Ababa, Ethiopia. The population included trauma team members, healthcare personnel, hospital leaders and coordinators from nine hospitals. The data were collected through semi-structured interviews and focus group discussions. The study used the Colaizzi approach and ATLAS.ti 23 software for data analysis. An inductive-deductive strategy, alternating between data analysis and emergent concepts and theories to identify patterns. Memos and display matrices were generated for in-depth analysis.</p><p><strong>Results: </strong>This study identified several challenges with the trauma care system in Addis Ababa, Ethiopia, including a lack of effective leadership, coordination, and teamwork spirit; insufficient referral connections in the trauma care system; knowledge gaps among health-care professionals; and poor organization of the emergency room and trauma center. In addition, participants perceived that factors such as insufficient pharmaceutical and medical equipment and ineffective ambulance services may have contributed to the increased number of deaths and disabilities among trauma patients in the country.</p><p><strong>Conclusion: </strong>The qualitative report highlights the gaps in Ethiopia's emergency trauma care system and recommends strategies for improvement, including clear leadership, policies, resources, communication, and continuous training.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"472"},"PeriodicalIF":2.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750765","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":"Health economic evaluation of Autism Adapted Safety Plans: findings on feasibility of tools from a pilot randomised controlled trial.","authors":"Nawaraj Bhattarai, Jane Goodwin, Mirabel Pelton, Isabel Gordon, Jacqui Rodgers, Sarah Cassidy, Janelle Wagnild, Colin Wilson, Phil Heslop, Emmanuel Ogundimu, Rory C O'Connor, Sheena E Ramsay, Ellen Townsend, Luke Vale","doi":"10.1186/s12913-025-12642-8","DOIUrl":"10.1186/s12913-025-12642-8","url":null,"abstract":"<p><strong>Background: </strong>Autism Adapted Safety Plans (AASP) have been proposed to help prevent self-harm and suicidality among autistic adults. The introduction of such plans not only needs to be clinically effective but also cost-effective. The aim of this work was to establish how the cost-effectiveness of AASP could be assessed. Specifically, whether tools and techniques used to collect data for health economic evaluation of the intervention are feasible and acceptable to autistic people.</p><p><strong>Methods: </strong>A feasibility and external pilot randomised controlled trial of the AASP intervention was conducted. Autistic adults recruited from diverse locations in England and Wales were randomised to either: AASP and usual care, or usual care only. Health economics tools (bespoke and adapted) were developed and focus groups were undertaken with participants, including autistic adults (n = 15), their family members/carers (n = 5), and service providers (n = 10), to determine their acceptability and feasibility. Tools considered worth further exploration were interviewer administered to participants during the pilot trial at baseline and at 6 months. Interviewer notes were used to record any issues reported while completing the tools. Response rates on the questions and completeness of the tools, along with participant feedback in the interviewer notes was assessed.</p><p><strong>Results: </strong>Standard Gamble and Time-Trade Off approaches to measure health status were judged inappropriate to measure health outcomes with autistic adults experiencing suicidal ideation and with a history of self-harm. Contingent valuation and discrete choice experiments were also considered inappropriate, due to the heavy cognitive burden on respondents. The EQ-5D-5L/VAS, resource utilisation questionnaire and time-travel questionnaire were considered acceptable by participants. Response and completion rates (as a percentage of all returned questionnaires) for resource utilisation questionnaire (> 85%), time-travel questionnaire (> 79%), EQ-5D-5L (> 96%) and EQ-5D-VAS (> 87%) were good in general. Participants needed clear guidance and interviewer support to enable questionnaire completion.</p><p><strong>Conclusions: </strong>It is feasible and acceptable to collect relevant data on resource utilisation, and costs of accessing care and the EQ-5D-5L in a future definitive trial. Clear guidance and interviewer support on how to complete the questionnaires and explanations of the importance of questions to the research would help autistic participants completing the health economic tools.</p><p><strong>Trial registration: </strong>ISRCTN70594445; Trial Registration Date: 06/07/2020.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"473"},"PeriodicalIF":2.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750532","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}