BMC Health Services Research最新文献

{"title":"No utilization without subjective need - a mixed-methods study on guideline-compliant mental health care for individuals with depressive symptoms.","authors":"Anna Katharina Reinhold, Elena Brushinski, Anna Levke Brütt","doi":"10.1186/s12913-026-15562-3","DOIUrl":"10.1186/s12913-026-15562-3","url":null,"abstract":"<p><strong>Background: </strong>The reasons why individuals with depressive disorders do not seek professional help are multifaceted and include illness-related, attitudinal, and structural barriers. While subjective need can facilitate help-seeking, its absence may act as a barrier. However, treatment guidelines primarily rely on objective need, defined by diagnosis, and do not address potential discrepancies between objective and subjective need. This study aimed to examine the frequency of congruent and incongruent mental health service use and to explore the conditions and reasons underlying incongruence between objective need, subjective need, and service use.</p><p><strong>Methods: </strong>This mixed-methods study used a sequential explanatory design based on a population-based sample of individuals with at least mild depressive symptoms (PHQ-9 ≥ 5). Quantitative data from telephone interviews conducted at baseline (T0) and 12 months later (T1) were used to assess objective need, subjective need, and mental health service use, and to determine whether service use was congruent or incongruent with guideline recommendations. Participants with different need-use patterns were then selected through theoretical sampling for subsequent qualitative interviews exploring the conditions and reasons underlying these patterns. Further cases were selected to refine, elaborate, or challenge categories developed through the Grounded Theory analysis according to Corbin and Strauss.</p><p><strong>Results: </strong>The analysis sample for descriptive analyses comprised 456 participants. Both the quantitative and qualitative data indicate that subjective need is a key predictor of help-seeking behavior. Seeking professional help in the absence of a perceived need is highly unlikely. Qualitative findings (n = 23) suggest that a dichotomous classification of subjective need (yes/no) is too simplistic and does not adequately reflect the reality of mental health care utilization. A typology of subjective need was therefore developed, identifying six types.</p><p><strong>Conclusions: </strong>This typology offers a framework for tailoring care more precisely to individuals' perceived need. Our findings highlight the importance of considering subjective and objective need in parallel when evaluating service utilization, particularly in cases of incongruence. This requires a shift from a predominantly objective need-based approach toward a more comprehensive perspective that considers both subjective and objective need alongside barriers, prior treatment experiences, social support, and coping strategies.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954880","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":"Process evaluation of a nurse-led transitional care model (Cardiolotse) within a randomized controlled trial aiming to improve care coordination for patients with cardiovascular diseases in Germany.","authors":"Saskia Kropp, Wiebke Schüttig, Marie Barzen Coors, Katrin C Reber, Harald Darius, Alfred Holzgreve, Sebastian Karmann, Anica Stürtz, Rebecca Zöller, Petra Riesner, Leonie Sundmacher","doi":"10.1186/s12913-026-15555-2","DOIUrl":"10.1186/s12913-026-15555-2","url":null,"abstract":"<p><strong>Background: </strong>Patients with higher age suffering from cardiovascular disease discharged from hospital are at greater risk of readmission within 30 days. We evaluated an innovative care program providing post-discharge support and helping patients to navigate through the healthcare system. This paper reports the findings of the process evaluation of the randomized controlled trial Cardiolotse, a nurse-led transitional care model improving care coordination for patients with cardiovascular diseases in Germany.</p><p><strong>Methods: </strong>A process evaluation, following the guidelines of the Medical Research Council (MRC) Framework, was performed. Semi-structured interviews with all relevant target groups were conducted to gain more insight about implementation processes. Questionnaires and medical records were used to explore mechanisms of impact and understand how change was produced in the intervention. Qualitative data were analysed using content analysis with deductive and inductive categories. Descriptive statistics and subgroup analyses were utilized to explore quantitative data.</p><p><strong>Results: </strong>Overall, the designed training programme was perceived positively by the study nurses, so called Cardiolotsen (CLs). Patients receiving support by the CLs reported positive satisfaction ratings. Interactions between CLs and patients were reported as trustworthy and reliable. A total of approximately 12,500 contacts were made over the course of the intervention. However, changes in satisfaction scores between intervention and control groups in terms of medical treatment or the interaction between medical health providers involved in the treatment could not be determined. Furthermore, data suggested reach issues with respect to office-based physicians, as regular CL contact could not be achieved with 90% of the participating general practitioners and cardiologists.</p><p><strong>Conclusions: </strong>The CLs served as an important source of support for the participating patients throughout the intervention. At regular intervals, they checked a patient's health status and their adherence to therapies after discharge. However, the process evaluation identified cross-sectoral communication and information exchange between CLs and office-based physicians as an implementation challenge.</p><p><strong>Trial registration: </strong>The study was retrospectively registered at German Clinical Trial Register, http://www.drks.de/DRKS00020424 (Trial Registration Number DRKS00020424) on 18 June 2020.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918195","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":"What do we know about medical invalidation and related concepts? - A scoping review and thematic analysis about the definitions, measurements, causes, consequences and potential solutions for medical invalidation.","authors":"Seraina Petra Lerch, Clara Stille","doi":"10.1186/s12913-026-14736-3","DOIUrl":"10.1186/s12913-026-14736-3","url":null,"abstract":"<p><strong>Background: </strong>Medical invalidation, medical gaslighting, and related constructs have gained visibility in public discourse but remain inconsistently defined in scientific literature. Despite growing research-often focused on specific diseases- to date, no single review has comprehensively synthesized their definitions, causes, consequences, or methods of measurement. This scoping review addresses this gap by examining medical invalidation and related constructs.</p><p><strong>Methods: </strong>Using a preregistered protocol, we systematically searched PubMed, CINAHL, Web of Science, Google Scholar, and ProQuest (dissertations) without year restrictions. Eligible sources included peer-reviewed empirical, theoretical, and conceptual work in English addressing invalidation, gaslighting, or closely related notions within healthcare. A total of 158 studies were identified through database searches and citation tracking. Data extraction followed a standardized schema, and findings were synthesized descriptively and through thematic analysis to clarify terminology, map determinants and outcomes, and identify existing measurement approaches.</p><p><strong>Results: </strong>The results showed substantial inconsistency in how \"invalidation,\" \"not being taken seriously,\" and \"gaslighting\" were defined. Medical invalidation emerged as a multifactorial phenomenon driven by diagnostic challenges, structural and societal factors, provider and patient characteristics, stigma, misattribution, interactional dynamics, academic knowledge gaps, and disease-related complexity. Invalidation was associated with wide-ranging behavioural, emotional, cognitive, physical, relational, and systemic harms, while validation had consistently beneficial effects. Proposed solutions in the summarized studies included communication improvements, clinician training, patient support, targeted research, and structural and systemic changes.</p><p><strong>Discussions: </strong>Medical invalidation represents a complex, systemic issue with significant implications for patient safety. The discussion highlights its multifactorial origins, its potential to cause both psychological and physical harm, and the need for clearer conceptualisation within the field. Advancing research requires validated instruments and longitudinal designs to examine underlying mechanisms and consequences. Addressing medical invalidation will demand multi-level interventions to improve communication, reduce structural barriers, and promote equitable, patient-centred care. OSF PREREGISTRATION: https://doi.org/10.17605/OSF.IO/MPE6U.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918201","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":"\"Then you are left on your own\": barriers to guideline-based speech and language therapy for aphasia along the patient journey in the German-speaking healthcare context.","authors":"Susann May, Felix Muehlensiepen, Laura Plotho, Helmut Ritschl, Robert Darkow","doi":"10.1186/s12913-026-15523-w","DOIUrl":"10.1186/s12913-026-15523-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Although evidence-based recommendations for aphasia rehabilitation exist, guideline-based speech and language therapy is still not consistently implemented in routine care. Previous studies have described barriers to therapy participation from the perspective of people with aphasia, but less is known about how these barriers develop along the patient journey, especially in outpatient care. This study explored systemic and individual barriers to the uptake of speech and language therapy in aphasia care and identified implications for improving services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An exploratory qualitative study was conducted in the German-speaking healthcare context using two online focus group discussions. A multiperspectival sample was recruited, including people with aphasia, relatives, speech and language therapists, and other healthcare stakeholders. Data were collected with a semi-structured topic guide addressing barriers to guideline-based therapy use, challenges along the patient journey, and possible solutions. Audio recordings were transcribed verbatim, anonymized, and analyzed in German using Kuckartz's structured qualitative content analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The analysis identified six main categories of factors influencing the provision of guideline-recommended speech and language therapy: societal and systemic conditions; access to care; the patient journey and continuity of care; relatives and the social environment; psychosocial factors; and therapy provision and interdisciplinary care; proposed solutions and areas for improvement are reported separately. Findings indicated that the provision of guideline-recommended speech and language therapy is strongly shaped by structural barriers within the healthcare system, particularly in the outpatient sector. Fragmented care pathways, limited coordination, bureaucratic and financial obstacles, and insufficiently accessible or specialized services hindered the implementation of guideline-based care. The transition from inpatient treatment to self-organized outpatient follow-up emerged as a particularly vulnerable stage. Relatives often compensated for deficits in formal care structures by taking on organizational, communicative, and emotional responsibilities. However, this informal compensation also created inequalities, as access to ongoing care partly depended on privately available support. Participants further highlighted shortcomings in interdisciplinary and psychosocial care and emphasized the need for earlier information, structured care pathways, improved coordination, and stronger implementation of evidence-based recommendations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The provision of guideline-recommended speech and language therapy in aphasia appears to be shaped largely by structural and organizational barriers rather than by individual factors alone. Improving aphasia care will require coordinated action across the healthca","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905197","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":"Nurses' perspectives on obtaining best possible medication histories in a virtual care setting: a qualitative study.","authors":"Vickie Zhiyan Zhang, Melissa Pham, Adrian Boscolo, Katrina Armour, Martina Francis","doi":"10.1186/s12913-026-15504-z","DOIUrl":"10.1186/s12913-026-15504-z","url":null,"abstract":"<p><strong>Background: </strong>Medication discrepancies during transitions of care are a major and preventable source of medication-related harm. A Best Possible Medication History (BPMH) is a critical first step in medication reconciliation and risk mitigation. While nurses are increasingly recognised as contributors to medication safety, limited evidence has explored their experiences obtaining BPMHs within a virtual care setting. This study aims to explore nurses' perspectives on obtaining BPMHs for patients in a virtual care setting, including perceived enablers, challenges, and implications for practice optimisation.</p><p><strong>Methods: </strong>A qualitative study was undertaken at a metropolitan virtual hospital in Sydney, Australia. Semi-structured interviews were conducted between March and July 2025 with accredited virtual care nurses and midwives who had independently performed BPMHs. Interview questions were informed by selected domains from the Theoretical Domains Framework, and data were analysed inductively using Braun and Clarke's six-phase thematic analysis.</p><p><strong>Results: </strong>Fifteen of twenty-one eligible nurses participated. Participants represented a highly experienced nursing workforce with a mean of 18 years of nursing experience and 4 years of virtual care experience. Three themes were identified: (1) Collaboration and workflow integration, (2) Education and feedback, and (3) Challenges. Nurses initially expressed uncertainty regarding role boundaries and accountability but progressively viewed BPMH as a valuable and relevant extension of nursing practice. Practical scenario-based learning and timely feedback were perceived as critical to skill development and sustainable workflow integration. Key challenges included patient acuity, digital literacy, limited visual assessment during consultations, fragmented communication, workload pressures, and limited protected time for comprehensive BPMH activities.</p><p><strong>Conclusions: </strong>Nurse-led BPMH is feasible in a virtual care setting when supported by multidisciplinary governance, structured education, and integrated support systems. This study provides novel insights into a scalable nurse-led BPMH workforce model within virtual care.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073339","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 a model to support safe medication use in the home for foreign-born-persons with language difficulties: a co-creation participatory action research study.","authors":"Katarina Hjelm, Ulrika Pöder, Anna Ekman, Lisa Hultin","doi":"10.1186/s12913-026-15510-1","DOIUrl":"10.1186/s12913-026-15510-1","url":null,"abstract":"<p><strong>Background: </strong>Migration has increased population diversity and created challenges for safe medication use. Evidence remains limited regarding factors influencing medication-related problems among migrants and the support needed to optimise medication use in the home. No studies have addressed support for medication use in the home among migrants or proposed models for such support. The aim was to identify the support needed and to develop a model for support to promote safe medication use in the home and prevent medication errors among foreign-born persons with language difficulties.</p><p><strong>Methods: </strong>A co-creation participatory action research design involved end-users-foreign-born persons and relatives, and staff in healthcare and pharmacies. Focus group discussions, based on previous studies, were analysed using qualitative content analysis and interpreted through Pawson's framework across four contextual dimensions: individual, interpersonal, institutional, and infrastructural.</p><p><strong>Results: </strong>The analysis identified seven areas where support was required: routines to support safe medication use; continuity and risk assessment; support for language understanding; resources; information for patients and relatives to understand medication treatment and the prescribing system; staff training; and national measures. Support was needed across all contexts, particularly at the institutional and infrastructural levels through organisational development and clearer guidelines and regulations, but also at the interpersonal level in everyday interactions with healthcare and pharmacy staff. The findings informed the development of a support model anchored in primary healthcare includingan extended interdisciplinary team involving relatives and pharmacists, coordinated by an accessible contact person.</p><p><strong>Conclusion: </strong>In conclusion, promoting safe medication use in the home for foreign-born persons with limited language proficiency requires placing a well-informed patient at the centre of care; care planning based on individual needs; and coordinated support across individual, interpersonal, institutional, and infrastructural levels. Everyday practice should be critically reviewed to organise teamwork, allow time for risk assessment, and improve patient and relative education. Strengthening continuity, communication, and shared responsibility across a seamless healthcare chain may reduce medication-related risks and support patients and relatives in managing medications safely in the home. Implementation of the developed model should be accompanied by organisational and policy-level changes to enable sustainable, person-centred medication safety.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910709","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":"Perceived benefits, barriers, and health system consequences of introducing new models of online sexually transmitted and blood-borne infection testing in Ontario, Canada.","authors":"Daniel Grace, Mackenzie Stewart, Heeho Ryu, Joshun Dulai, Catherine Worthington, Mark Gilbert","doi":"10.1186/s12913-026-15501-2","DOIUrl":"10.1186/s12913-026-15501-2","url":null,"abstract":"<p><strong>Background: </strong>Internet-based testing services for sexually transmitted and blood-borne infections have increased in prevalence and altered the testing landscape and testing behaviours in many jurisdictions. Our objective was to understand how system partners perceived the possible benefits and drawbacks of adapting and implementing an online testing program like GetCheckedOnline which was already operating in British Columbia, Canada, into a new provincial context where it did not exist.</p><p><strong>Methods: </strong>We conducted in-depth interviews and focus groups with sexual healthcare providers, program managers and developers, and other public health professionals with expertise in sexually transmitted infections testing (N = 41) in Ontario, Canada. Our interview questions were part of a larger study focused on improving equitable access to sexually transmitted infections testing. Transcripts were transcribed verbatim and analysed using NVivo software following grounded theory.</p><p><strong>Results: </strong>We created a conceptual figure to chart tensions from participant accounts onto a model of GetCheckedOnline. We describe five key tensions in the accounts of our participants to elucidate perspectives on the possible benefits and barriers/concerns of implementing a digital testing model like GetCheckedOnline in another province: (1) access, (2) privacy, (3) co-ordination/communication, (4) agency, and (5) health system impacts. We map these five tensions across the core elements of the online testing program (i.e., from creating an online account, completing an assessment, and submitting specimens to getting results and engaging in repeat testing).</p><p><strong>Conclusion: </strong>Our analysis elucidates the multiple advantages that online testing modalities may provide for service users as well as substantive barriers and concerns perceived by health system partners, including the potential (unintended) consequences and paradoxes of introducing digital sexually transmitted infections testing.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954981","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":"Applying system support mapping combined with the matrixed multiple case study approach to identify and analyse implementation determinants: lessons from a multi-site implementation study in German neonatal intensive care units.","authors":"Nicola Gabriela Dymek, Julia Jaschke, Sarah Meyer, Anna Katharina Stirner, Daniel Wiesen, Till Dresbach, Nadine Scholten, Juliane Köberlein-Neu","doi":"10.1186/s12913-026-15507-w","DOIUrl":"10.1186/s12913-026-15507-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Identifying and understanding implementation determinants is a critical step in the process of tailoring implementation strategies to local contexts. System Support Mapping (SSM) is a method rooted in systems thinking that offers a structured approach to exploring the responsibilities, needs, resources, and wishes of individuals within an implementation context. However, SSM has not yet been systematically described and applied as a methodology for identifying implementation determinants within multi-site implementation studies. This article introduces and illustrates the combined application of SSM and the Matrixed Multiple Case Study (MMCS) approach as a structured six-step methodology for identifying and analysing implementation determinants within and across sites, using data from the Neo-MILK project as an illustrative example. The project aimed to implement a structured lactation support programme for mothers of very low birth weight infants and establish human donor milk banks in German neonatal intensive care units (NICUs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;To illustrate the six-step methodology, semi-structured interviews with key persons from five German NICUs, which were conducted during the early intervention phase, served as the empirical basis for demonstrating each methodological step. Transcripts were analysed using directed content analysis, with SSM elements serving as deductive categories and context-specific codes developed inductively. The MMCS approach was used to organise, compare, and synthesise findings within and across sites.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Applying the six-step methodology, we demonstrate the type of output each step produces, ranging from individual System Support Maps per key person and NICU (steps 1-3) to a sortable cross-site matrix (steps 4-6). The within-site analysis (step 5) illustrates how the methodology surfaces context-dependent perceptions of the same determinant, showing that a given resource category could be perceived as facilitating, inhibiting, or both, depending on individual responsibilities, needs, and local context. The cross-site analysis (step 6) demonstrates how the matrix structure makes homogeneous and heterogeneous determinant patterns visible across sites, indicating different contextual manifestations of the same determinant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The combined application of SSM and the MMCS approach provides a structured methodology for identifying and analysing implementation determinants that accounts for the perspectives of individual interest-holders and enables systematic within-site and cross-site comparison. The distinction between homogeneous and heterogeneous determinant patterns offers a basis for differentiating between cross-site and site-specific implementation strategies. Further research is needed to evaluate the use of SSM across multiple evaluation timepoints and its integration into initial and ongoing tailoring","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905203","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":"Cancer care in Pakistan: a national survey of infrastructure, diagnostic capacity, therapeutic access, and workforce perspectives.","authors":"Asim Jamal Shaikh, Fatima Shaukat, Asif Sarwar, Abdul Salam, Saif Ur Rab, Ahmad Nadeem Abbasi, Mohammad Faheem, Nadeem Parvez, Ikram A Burney","doi":"10.1186/s12913-026-15519-6","DOIUrl":"10.1186/s12913-026-15519-6","url":null,"abstract":"<p><strong>Background: </strong>Pakistan, a lower-middle-income country of some 241 million people, faces a rising cancer burden - an estimated 185,748 new cancer cases and 118,631 cancer deaths in 2022 - that is served by a heterogeneous and largely uncoordinated mix of public, private for-profit, philanthropic, and Atomic Energy Commission cancer facilities. Nationally representative data on oncology infrastructure, diagnostic capacity, therapeutic access, and workforce conditions remain limited. We surveyed oncology professionals to describe, from their perspective, the capabilities of their institutions and their own working conditions.</p><p><strong>Methods: </strong>A cross-sectional survey was completed by 111 oncology professionals practising across ten cities in four provinces between July and September 2025. A structured questionnaire captured institutional infrastructure, diagnostic and molecular testing, multidisciplinary practice, therapeutic availability, supportive services, research activity, financial constraints, and workforce perspectives. Data were analysed descriptively with the individual respondent as the unit of analysis. Institutional sector (private, government, or Atomic Energy Cancer Hospital) was assigned post hoc from each respondent's known institutional affiliation and compared using the χ² test with Freeman-Halton exact confirmation.</p><p><strong>Results: </strong>Respondents comprised radiation/clinical (55.9%), medical (25.2%), and surgical (18.9%) oncologists; 81.1% practised in academic teaching hospitals, and two cities (Karachi and Lahore) accounted for 66.6% of respondents. Computed tomography was reported by 99.1% and positron-emission tomography by 57.7%; next-generation sequencing was reported by 61.3%, although most of these respondents indicated that fewer than half of their patients could afford it. Immunotherapy was reported at 76.6% of settings and dedicated palliative care at 39.6%. Financial barriers were reported by 94.6% of respondents, and only 27.9% were satisfied with their compensation. In exploratory sector comparisons, radiotherapy infrastructure was concentrated in Atomic Energy hospitals, whereas reported resource shortages rose from private (47%) through Atomic Energy (73%) to government (92%) settings.</p><p><strong>Conclusions: </strong>Respondents described an oncology system with foundational strengths concentrated in a few urban academic centres, alongside limited advanced diagnostics, sparse supportive care, and pervasive financial barriers. As what is, to our knowledge, the first structured national survey of its kind, and a descriptive, self-reported one, these findings map perceived gaps rather than verified service levels or patient outcomes, and are intended to provide a baseline that informs - not substitutes for - formal national cancer-capacity assessment and planning.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905130","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":"Exposure to tobacco smoke, concurrent short-term symptoms of respiratory, allergic, cardiovascular morbidities and health-services use among young adults in Kuwait.","authors":"Saeed Akhtar, Sarah Almutairi, Wadhah Alhajri, Sarah Alrashidi, Nouf Almutairi, Ghadeer Almutairi, Manar Aladwani, Lulowa Al-Sanafi","doi":"10.1186/s12913-026-15530-x","DOIUrl":"10.1186/s12913-026-15530-x","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Exposure to tobacco smoke remain major public health concerns due to its' association with multiple morbidities and increased health-services use. This cross-sectional study aimed to, (i) assess the prevalence of exposure to tobacco smoke (first-hand and second-hand) among students at a public university; (ii) assess the prevalence of tobacco smoke-related concurrent morbidities; (iii) assess the prevalence of health-services use (≥ 1 vs. none) during the past one-year; and (iv) evaluate the association between demographics, tobacco smoking, concurrent morbidities, and health-services use during the past year.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cross-sectional study was conducted in October 2022 among undergraduate students at Kuwait University using a structured electronic questionnaire. Participants were recruited as a sample of convenience. The prevalences (%) of exposure to tobacco smoke (1st hand and 2nd hand at home) were estimated. Self-reported respiratory symptoms, physician-diagnosed morbidities, and health-services use (≥ 1 visit vs. none) during the past year were assessed. Multivariable logistic regression analysis was conducted to examine the association between sociodemographics, lifestyle factors, concurrent morbidities, and health-services use during the past year. The adjusted odds ratios (OR) and 95% confidence intervals (CI) were used to interpret the final model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 1,323 participants, the majority were Kuwaiti (87.5%) and female (75.8%). The prevalence of exposure to first-hand tobacco smoke was 13.4% (177/1,323), while 50.8% (672/1,323) reported exposure to second-hand tobacco smoke at home. Overall, the prevalence of exposure to tobacco smoke was 55.9% (740/1323). The reported respiratory symptoms were shortness of breath (59.1%), cough (46.3%), chest pain (26.9%), and difficulty during exercise (21.6%). Physician-diagnosed conditions included asthma (16.8%), eczema (11.2%), and chronic obstructive pulmonary disease (1.4%). Of the participants, 44.6% (590/1323) used the health-services at least once during the past year. In the multivariable model, after adjusting for effects of age and sex, participants were significantly more likely to report at least one instance of health-services use during the past year if they reported cough (adjusted OR = 2.10; 95% CI: 1.66-2.64; p &lt; 0.001), shortness of breath (adjusted OR = 1.30; 95% CI: 1.01-1.67; p = 0.044), nausea/vomiting (adjusted OR = 2.52; 95% CI: 1.79-3.54; p &lt; 0.001), or asthma (adjusted OR = 1.95; 95% CI: 1.43-2.65; p &lt; 0.001). However, tobacco smoking (active and/ or secondhand) was not significantly associated with health services use at least once during the past year in this evaluation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study reports high prevalence of second-hand tobacco smoke exposure at home among young adults, along with high levels of respiratory and allergic morbidities. Although tobacco exp","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918138","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}