BMC Health Services Research最新文献

{"title":"Greener active pharmaceutical ingredients: perspectives of European healthcare professionals.","authors":"Neele Puhlmann, Yannick Heni, Rodrigo Vidaurre, Caroline T A Moermond, Klaus Kümmerer, Tiina M Sikanen, Oliver Olsson","doi":"10.1186/s12913-026-15145-2","DOIUrl":"10.1186/s12913-026-15145-2","url":null,"abstract":"<p><p>Pharmaceutical residues resulting from patient excretion, incorrect disposal and manufacturing of medicines contribute to environmental pollution and related risks. Designing active pharmaceutical ingredients of inherently lower environmental risk ('greener APIs') is one potential solution to this issue. To assess the current level of preparedness to adopt potentially greener APIs as a part of more sustainable medical care, the perspectives of healthcare professionals on greener APIs were evaluated by investigating related opportunities, barriers and the needs to overcome these barriers. Semi-structured interviews were conducted with professionals working in the healthcare sector in European countries between February and April 2024 (n = 16). The interviewees included doctors (3), pharmacists (3), experts in procurement (3), reimbursement (1), market authorisation (2), healthcare provision (2) and industry's sustainability reporting (1), as well as a professional working for an environmental NGO (1). Data was evaluated using qualitative content analysis. Interviewees' answers showed that some strategies already exist to account for environmental aspects in decision-making, e.g. by adding environmental criteria to the tenders of procurement agencies. Criteria on environmental properties of APIs can be expected to play a more significant role in the decision-making of HC professionals in future. Balancing molecular properties related to patient benefit and risk against environmental properties could be product specific. Frequently expressed needs to enable this include: access to reliable scientific data and evidence of environmental impacts of APIs, legislative and regulatory frameworks and guidance to ensure environmental properties are assessed and weighed in a centralised and harmonised manner. The evident interest among HC professionals to consider environmental properties in their decision-making may stimulate data sharing by pharmaceutical companies in the short-term and efforts to design greener APIs in the long-term. The marketing authorisation process is viewed as the main intervention point in the life cycle of pharmaceuticals to strengthen considerations of environmental risks. The authors conclude that future research should target the identified barriers and their solutions.</p>","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/PMC13551862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905188","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 center staff perceptions of gender and equity in the Conakry health region, Guinea (2025): a cross-sectional survey.","authors":"Houssainatou Bah, Abdoulaye Fode Touré, Amadou Wann, Almamy Amara Touré, Jean Séllé Bavogui, Mohamed Prince Kaba, Zainoul Traoré, Mimtiri Philippe Compaoré","doi":"10.1186/s12913-026-15497-9","DOIUrl":"10.1186/s12913-026-15497-9","url":null,"abstract":"<p><strong>Background: </strong>Gender and equity are critical determinants of health and healthcare access. The perceptions of health workers can shape how gender and equity are integrated into primary care services, influencing both the quality and fairness of care delivery.</p><p><strong>Objective: </strong>To assess health center staff perceptions of gender and equity in the Conakry health region, Guinea.</p><p><strong>Methods: </strong>A descriptive cross-sectional survey was conducted in 19 health centers across the five communes of Conakry. The study included 412 health workers: physicians, nurses, midwives, technicians, and other patient-facing staff. Perceptions of gender and equity were measured using a structured questionnaire, and data were analyzed with descriptive statistics.</p><p><strong>Results: </strong>Health workers predominantly held a biological view of gender, with most agreeing that biological characteristics mainly determine gender and that men's and women's roles are naturally different. A large proportion did not perceive gender as influencing daily work, career progression, or patient treatment. Despite generally positive views on organizational equity, the visibility of formal gender-related policies and structures was limited. More than half of the participants reported the absence of a gender-equity policy or focal point, while a strong majority supported training and sensitization on gender and equity.</p><p><strong>Conclusions: </strong>Primary health care staff in Conakry report limited recognition of gender's influence in their professional setting, alongside weak institutionalization of gender-responsive mechanisms, yet express a strong demand for targeted capacity-building. Strengthening policies, establishing clear focal points, and linking training to practical implementation tools are key opportunities for reinforcing gender and equity in Guinea's primary health care system.</p>","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/PMC13615583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058182","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":"Implementing the Primary Care Behavioral Health model into routine practice in Swedish primary care: a pilot trial.","authors":"Lise Bergman Nordgren, Kristin Thomas, Erica Skagius Ruiz, Kocher Koshnaw, Mats Fredriksson, Per Nilsen, Hanna Israelsson Larsen","doi":"10.1186/s12913-026-15452-8","DOIUrl":"10.1186/s12913-026-15452-8","url":null,"abstract":"<p><strong>Background: </strong>Mental health problems are an increasing public health concern, and demand for care is exceeding available resources. The Primary Care Behavioral Health (PCBH) service delivery model shows promise for managing mental health problems in primary care, but its effects require further evaluation. This study examined how the implementation of PCBH in standard Swedish primary care was associated with accessibility of behavioral and mental health care and psychotropic prescription patterns.</p><p><strong>Methods: </strong>This pragmatic multicenter stepped-wedge clinical trial reports results from the first four pilot centers implementing PCBH in southeast Sweden. These centers had 37,100 listed patients. Study participants included all individuals receiving mental health care during the study period (n = 6413, mean age 50 years, 60% women). Data from electronic medical records were analyzed regarding behavioral health consultant (BHC) accessibility (number of appointments and individual patients) and prescriptions of psychotropic drugs (ATC codes: N05A, N05B, N05C, and N06A). Three time periods were compared: baseline (period 1), implementation (period 2), and the year after implementation (period 3).</p><p><strong>Results: </strong>After the implementation of PCBH, mean waiting times for a first BHC appointment decreased between 30% and 39%: from 16 days in period 1 to 10 (period 2) respectively 11 days (period 3), p < 0.001 both comparisons. Waiting times for all BHC appointments decreased between 21% and 24%; from 18 days (period 1) to 13.7 (period 2) respectively 14.2 days (after implementation), p < 0.001 both comparisons. The total number of appointments with a BHC increased between 21% and 34%; from 1762 (period 1) to 2359 (period 2) and then 2127 (period 3), p < 0.001 both comparisons. Individuals receiving care from a BHC increased between 16% and 42%; from 702 (period 1) to 995 (period 2) and 815 (period 3), p < 0.005 both comparisons. The total prescription of psychotropic drugs decreased between 14% and 18%; from 8025 (period 1) to 6570 (period 2) and 6927 (period 3) p < 0.001 both comparisons.</p><p><strong>Conclusions: </strong>These findings suggest that implementation of PCBH improves access to mental health care and reduces psychotropic prescriptions. However, the improved access to care and reduction in psychotropic medication declined somewhat the year after implementation. Future research should focus on longitudinal outcomes with the use of comparison groups and systematically include patient-reported outcomes, experience measures, and staff perspectives to assess effectiveness and implementation experiences.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT05633940), registered 2021-04-21.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905123","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 characterizes first-time use of eldercare? A SNAC Stockholm Eldercare registry-based study of older people's health and care needs in Sweden.","authors":"Pernilla Alencar Siljehag, Åsa von Berens, Bettina Meinow, Carin Lennartsson, Janne Agerholm","doi":"10.1186/s12913-026-15500-3","DOIUrl":"10.1186/s12913-026-15500-3","url":null,"abstract":"<p><strong>Background: </strong>As populations age, it is becoming more important than ever to understand how older people's care needs can be met and to ensure that local care providers are coordinated effectively. Describing older adults' demographic characteristics, functional status, health status, and patterns of healthcare use leading up to their first-time use of eldercare provides valuable knowledge. This can facilitate the mobilization of expertise and methods in eldercare and healthcare and contribute to the joint planning of proactive and more targeted interventions for older adults.</p><p><strong>Methods: </strong>Data on demographics and functional status of people ≥ 65 years in first-time eldercare (July 2021 to June 2022; n = 3649) were obtained from the SNAC Stockholm Eldercare study and combined with registry data on medical diagnoses and use of inpatient and outpatient care six months preceding eldercare entry. Data were summarized using descriptive analyses. The RECORD checklist was used as a reporting guide.</p><p><strong>Results: </strong>The average age was 80 years. More than half were women and lived alone. One in four people had developed extensive functional limitations. Multimorbidity was common (92%) and almost half had as many as seven or more chronic conditions. Psychiatric comorbidity was prevalent in 15% of cases. Most people received informal care on a weekly or daily basis. Primary care was the predominant form of outpatient care, used by 80% of individuals before entering eldercare. The vast majority (95%) received home care. Every second person entered eldercare immediately following inpatient care. Many individuals in this group had experienced serious injuries, deterioration of existing chronic diseases or temporary infections.</p><p><strong>Conclusions: </strong>Many older people enter eldercare with extensive and complex care needs and receive support and care from several providers. These findings highlight which needs and care contexts during the period preceding the first use of publicly funded eldercare services are particularly important to consider when developing timely and well-coordinated support. They are useful to guide collaborative strategies, facilitating the use of expertise and methods of both municipal and primary care actors.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886023","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":"Medical mistrust, health system distrust, and their associations with healthcare delay and cancer screening attitudes in primary care.","authors":"Mehmet Uçar, Muhammet Faruk Yi̇ği̇t, Mehmet Kaplan","doi":"10.1186/s12913-026-15484-0","DOIUrl":"10.1186/s12913-026-15484-0","url":null,"abstract":"<p><strong>Aim: </strong>To examine the associations of medical mistrust and health system distrust with healthcare delay behavior and cancer screening attitudes among adults attending primary care services.</p><p><strong>Method: </strong>This descriptive and cross-sectional study was conducted with 568 adults who attended a family health center in eastern Türkiye. Data were collected using a Personal Information Form, the Medical Mistrust Scale, the Health System Distrust Scale, the Healthcare Demand Procrastination Scale, and the Attitude Scale for Cancer Screening. Data were analyzed using Pearson correlation and multiple linear regression analyses.</p><p><strong>Results: </strong>Medical mistrust and health system distrust were positively associated with healthcare delay behavior and negatively associated with cancer screening attitudes (p < 0.001). Medical mistrust showed the strongest independent association with both healthcare delay behavior (β = 0.59) and cancer screening attitudes (β = -0.79).</p><p><strong>Conclusion: </strong>The findings indicate that trust in healthcare is closely associated with healthcare utilization and preventive health attitudes. These associations highlight the potential relevance of trust-centered strategies, improved access, and patient-centered health service delivery in primary care.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036328","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":"Translation, cultural adaptation, and descriptive psychometric pilot evaluation of the Swedish Cancer Support Source-caregiver.","authors":"Maria Samuelsson, Jenny Jakobsson, Benjamin Maus, Carl Magnus Olsson, Marie Louise Möllerberg","doi":"10.1186/s12913-026-15491-1","DOIUrl":"10.1186/s12913-026-15491-1","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to translate the CancerSupportSource-Caregiver (CSS-C), culturally adapt it, and conduct a descriptive pilot evaluation of the psychometric properties of the Swedish version in a sample of Swedish family members of persons diagnosed with cancer.</p><p><strong>Method: </strong>Translation and cultural adaptation involved forward-backward translation by professional translators in collaboration with the research team and assessments of comprehensibility and face and content validity by two expert panels comprising family members of persons diagnosed with cancer and healthcare professionals, respectively. The psychometric properties, validity, and reliability of the Swedish version were pilot evaluated using classical test theory among a sample of 30 adult Swedish family members of persons diagnosed with cancer.</p><p><strong>Results: </strong>Based on requests from the expert panels, and supported by empiricism, the CancerSupportSource-Caregiver was adapted to the Swedish context, and five items were added. Thus, the Swedish version comprises 24 items. The face and content validity of the Swedish CancerSupportSource-Caregiver were satisfactory, and the convergent validity was promising. Moreover, the psychometric pilot evaluations indicated high data quality, overall satisfactory targeting, and internal consistency. However, two items were right-skewed, and there were indices of redundancy.</p><p><strong>Conclusion: </strong>The Swedish CancerSupportSource-Caregiver appears to have the potential to identify unmet needs and symptoms of anxiety and depression among Swedish family members of persons diagnosed with cancer. Since the focus of this study was on translating and adapting the tool, further studies in larger samples are warranted to determine the psychometric properties, factor structure, validity, and reliability.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872639","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 and facilitators to population-based lung cancer screening in Belgium: a qualitative stakeholder analysis in a pre-implementation context.","authors":"Lauren Michiels, Jana Duchateau, Amelie Vangilbergen, Caro Verlies, Christophe Dooms, Guido Van Hal, Isabelle Huys","doi":"10.1186/s12913-026-15349-6","DOIUrl":"10.1186/s12913-026-15349-6","url":null,"abstract":"<p><strong>Background: </strong>Low-dose computed tomography screening has demonstrated effectiveness in reducing lung cancer mortality among high-risk populations. Despite growing international momentum and supportive evidence, population-based lung cancer screening has not yet been implemented in Flanders, Belgium. Successful implementation requires insight into context-specific barriers and facilitators from both healthcare professionals (HCPs) and potential screening participants (PSPs). This study aimed to explore stakeholders' perspectives on the implementation and uptake of lung cancer screening in Flanders.</p><p><strong>Methods: </strong>A qualitative exploratory study was conducted using semi-structured interviews with two stakeholder groups: HCPs involved in lung cancer prevention, detection, or care, and PSPs who would likely be eligible for lung cancer screening if such a programme were implemented. Interviews were conducted between October 2024 and February 2025 and analysed using the Qualitative Analysis Guide of Leuven (QuAGOL). Identified themes were subsequently organised according to the Consolidated Framework for Implementation Research (CFIR) domains and constructs.</p><p><strong>Results: </strong>Interviews were conducted with 22 HCPs and 13 PSPs. Overall, attitudes towards lung cancer screening were positive, driven by perceived benefits of early detection and reassurance. Key barriers to implementation and participation included smoking-related stigma, limited health literacy, indirect financial and logistical constraints, competing life priorities, and fear or anxiety related to screening and waiting for results. HCPs additionally highlighted concerns regarding workload, limited capacity, and the need for professional training and coordinated communication pathways. Important facilitators included clear and standardised screening guidelines, governmental coordination and funding, integration within existing healthcare workflows, accessible and flexible screening organisation, public awareness campaigns, and timely, transparent communication. Across stakeholder groups, trust-based, non-judgemental communication and endorsement by trusted HCPs were considered essential to support equitable participation and sustained engagement.</p><p><strong>Conclusions: </strong>Stakeholders in Flanders are broadly supportive of population-based lung cancer screening, but successful implementation will depend on addressing organisational complexity, stigma, equity, and accessibility. Beyond clinical efficacy, careful programme design, interprofessional collaboration, and person-centred communication will be key to equitable and sustainable uptake. These findings offer actionable guidance for policymakers and may inform implementation in comparable healthcare settings and systems.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975624","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":"Development of a patient journey map for diabetic retinopathy: exploring evidence from qualitative research.","authors":"Nan Wang, Rong Wei, Guangcun Liu, Jianxin Li, Paulo Moreira","doi":"10.1186/s12913-026-15325-0","DOIUrl":"10.1186/s12913-026-15325-0","url":null,"abstract":"<p><strong>Background: </strong>The World Health Organization has emphasized people-centered health, shifting focus from disease to patient needs. Patient Journey Mapping has emerged as a valuable methodological approach to support healthcare and nursing management by visualizing patient experiences and identifying service improvement opportunities. Despite extensive clinical research on diabetic retinopathy (DR), the phases and dimensions of its healthcare management process remain poorly understood. This study aimed to: (a) synthesize existing qualitative evidence on the experiences, emotions, and healthcare needs of persons with DR across screening, perioperative, and extended treatment stages; (b) conduct semi-structured interviews to contextualize and enrich the synthesized evidence; and (c) develop an integrated Patient Journey Map to inform tailored healthcare interventions.</p><p><strong>Methods: </strong>This study employed a two-phase qualitative evidence mapping and interview design. Phase 1 comprised a narrative literature review with systematic search to map existing qualitative evidence, with data analyzed using thematic synthesis. Phase 2 involved semi-structured interviews with 13 persons with DR at a Chinese university hospital, with data analyzed using qualitative content analysis. Literature and interview findings were integrated through triangulation to construct a comprehensive Patient Journey Map. Quality was assessed using CASP and GRADE-CERQual; reporting followed ENTREQ guidelines.</p><p><strong>Results: </strong>Twenty-five studies were included, describing patient experiences across screening, perioperative, and post-acute care phases, forming a preliminary framework. Interviews with 13 persons with DR enriched these findings and established a complete journey trajectory.</p><p><strong>Conclusions: </strong>The proposed Patient Journey Map visually illustrates patient experiences and behaviors across the care continuum. This evidence provides a theoretical foundation for developing tailored diabetes care recommendations based on individual needs. Patient Journey Mapping contributes to improving healthcare management processes and supports healthcare managers in optimizing service delivery.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863476","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":"Retention and attrition of Chinese medicine practitioners in Australia: survey and registration analysis from the workforce retention and attrition project.","authors":"Timothy Lathlean, Johannah Shergis, Kirsten Hibberd, Chi Eung Danforn Lim, Craig Bennett Am, Rechu Divakar, Lee Barclay, Eva Saar, Jade Tan","doi":"10.1186/s12913-026-15415-z","DOIUrl":"10.1186/s12913-026-15415-z","url":null,"abstract":"<p><strong>Background: </strong>National shortages exist in relation to the Chinese Medicine (CM) profession. This project aimed to identify factors associated with the retention and attrition of CM practitioners in Australia.</p><p><strong>Methods: </strong>An online survey of CM practitioners in 2024 and a retrospective analysis of 10 years of Australian Health Practitioner Regulation Agency (Ahpra) CM registration data.</p><p><strong>Results: </strong>Of 1,366 surveyed CM practitioners, 79.4% intended to stay, 3.8% intended to leave, and 8.5% were unsure and 73 (5.3%) intended to retire. Most intending to leave planned to do so within five years (76.9%). Top reasons for leaving included unsatisfactory remuneration (n = 16, 40.0%), lack of job security (n = 14, 35.0%), retirement (n = 14, 35.0%), lack of opportunities for career advancement (n = 11, 27.5%), and lack of opportunities for personal growth and/or development (n = 7, 17.5%). Those with limited registration or acupuncturists were more likely to consider not renewing their registration or be unsure about it. Ahpra registration data from 2014 to 2023 showed that the overall numbers of CM practitioners (per 100,000 population) decreased by 5.1%, and the replacement rates decreased by 52.9%, with more males than females leaving the profession. The highest number of exits occurred in the 35-60 age group.</p><p><strong>Conclusions: </strong>The decline in the number of CM practitioners per 100,000 population, alongside a significant drop in the replacement rate raises concerns around workforce stability and sustainability. Addressing intrinsic and workplace factors, such as remuneration, job security, and opportunities for career advancement and personal development may improve retention.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872978","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 replica dilemma: older patients' views on virtual models made from their health data-a qualitative study.","authors":"Weimei Zhang, Xuemeng Zhu, Weizhen Hu","doi":"10.1186/s12913-026-15168-9","DOIUrl":"10.1186/s12913-026-15168-9","url":null,"abstract":"<p><strong>Background: </strong>Virtual models (digital twins, AI-simulated cohorts) built from patient data are transforming medical research, including applications in Transcatheter Edge-to-Edge Repair, yet the ethical perspectives of older patients, who are disproportionately represented in these datasets, remain critically unexplored. This study investigated how older adults with chronic conditions understand the use of their data for virtual model construction, what concerns emerge regarding digital replicas, and what rights they believe should accompany such data use.</p><p><strong>Methods: </strong>A descriptive qualitative study employing in-depth, semi-structured interviews with 22 chronically ill patients aged ≥ 65, using a standardized plain-language explanation of virtual models, purposively sampled for diversity in diagnosis and digital literacy. Data were analyzed inductively using reflexive thematic analysis.</p><p><strong>Results: </strong>Five major themes emerged: (1) Conceptual opacity, limited understanding of virtual models, often conflated with clinical data use; (2) The \"uncanny self\", existential discomfort with an independently manipulable digital replica; (3) Consent inadequacy, recognition that past agreements cannot authorize unforeseen virtual applications; (4) The \"trapped self\", frustration over irreversible data integration nullifying withdrawal rights; (5) Rights reclamation, demands for notification, ongoing assent, digital deletion, use restrictions, and transparency.</p><p><strong>Conclusion: </strong>Older patients perceive virtual model construction as a fundamental ethical shift beyond traditional data sharing that current one-time consent frameworks cannot address. Findings provide a patient-derived rights framework to guide health policy and governance reform for the integration of AI-driven tools, including large language models, into health services involving this population.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179252","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}