BMC Health Services Research最新文献

{"title":"Medical dispatchers' experience with live video during emergency calls: a national questionnaire study.","authors":"Natascha H Bohnstedt-Pedersen, Gitte Linderoth, Barbara Helios, Helle C Christensen, Britta K Thomsen, Lisbeth Bekker, Jannie K B Gram, Ulla Vaeggemose, Tine B Gehrt","doi":"10.1186/s12913-024-11939-4","DOIUrl":"10.1186/s12913-024-11939-4","url":null,"abstract":"<p><strong>Background: </strong>Telehealth has become increasingly essential in healthcare provision, also in the Prehospital Emergency Medical Services (EMS), where live video is implemented as a supplemental tool to assess and triage medical emergency calls. So far, using video for emergency calls seems beneficial for patient assessment and dispatcher-assisted first aid. However, the EMS dispatchers' experiences with and perceptions of using video during emergency calls are largely unexplored.</p><p><strong>Methods: </strong>In 2023, a nationwide survey study was conducted in Denmark, which is covered by five Emergency Medical Dispatch Centers. All Danish EMS dispatchers were invited to participate in the study. The survey explored the dispatchers' experience with using video during emergency calls, the perception of their own video use, and the process of implementing video as a new tool in their working procedure. Main questions were answered on a scale from 1 to 7, where higher scores indicate more agreement.</p><p><strong>Results: </strong>Of the 183 EMS dispatchers employed during the study period, 78% completed the survey. They found video easy to use (median = 7) and found video supportive in guidance and dispatch when the patient's problem was unclear (median = 7), but did not find video suitable for all emergency calls and expressed that complications with the technology was a barrier for using video. The EMS dispatchers were least likely to agree that they choose not to use video due to the risk of being emotionally affected by what they might see (median = 1). When dividing the sample based on EMS dispatcher's gender, age, seniority, and educational background, generally few differences between groups were found.</p><p><strong>Conclusions: </strong>Live video during emergency calls is generally experienced as a useful supplemental tool by EMS dispatchers in Denmark, and the greatest self-perceived barriers for using video were not finding video suitable for all situations and the technology.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1442"},"PeriodicalIF":2.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680614","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":"Distribution and predictors of haemophilia-related costs in the United Kingdom: analysis of the CHESS I and CHESS II burden of illness studies.","authors":"Ione Woollacott, Amit Chhabra, Tom Burke, Jack Brownrigg, Lucy Richardson, Enrico Ferri Grazzi, Jamie O'Hara, Josie Godfrey, Michael Laffan","doi":"10.1186/s12913-024-11850-y","DOIUrl":"10.1186/s12913-024-11850-y","url":null,"abstract":"<p><strong>Background: </strong>Few studies have evaluated direct medical or societal costs of haemophilia in the United Kingdom (UK), and how patient characteristics impact future costs is uncertain. Cost predictors were identified and examined using cross-sectional data from the CHESS I and II studies.</p><p><strong>Methods: </strong>Patient- and physician-reported outcomes were analysed for UK adult males aged ≤ 65, with haemophilia A or B and no recent clinical trial participation. Demographics, haemophilia type and severity, inhibitors, annual bleed rate (ABR), problem joints (PJs), treatment type, and comorbidities, were utilised in regression analyses. Health-related quality of life was assessed using EQ-5D. Generalised linear models estimated expected non-drug haemophilia-related direct medical costs (DMC) and societal costs (non-drug DMC, direct non-medical and indirect costs). Average marginal effects (AMEs) determined predictors of cost.</p><p><strong>Results: </strong>Costs for 378 patients were analysed. Mean age was 33 years and 79% (299) had haemophilia A. Mean annual per-patient DMC were £165,001 (including factor treatment costs) and £4,091 when excluding factor replacement treatment costs (non-drug DMC). Mean annual per-patient non-treatment societal costs were £11,550 (standard deviation £20,171) among those with data available (n = 51). Number of PJs, ABR, and treatment regimen were significant determinants of haemophilia-related non-drug DMC (all P < 0.001). Non-drug DMC increased as ABR increased (AMEs were £2,018 for ABR 1-5, £3,101 for ABR 6-10 and £5,785 for ABR ≥ 11, vs. ABR 0) and by £1,869 per additional PJ. No significant predictors of non-drug haemophilia-related societal costs were identified. Mean EQ-5D score was 0.66, with lower scores observed for people with haemophilia B (0.48) compared with haemophilia A (0.71) and with increasing haemophilia severity.</p><p><strong>Conclusions: </strong>UK direct medical and societal costs of haemophilia are substantial. Non-drug DMC were particularly associated with ABR and number of PJs. These findings may be useful for real-world evaluations of the economic burden of haemophilia in the UK.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1437"},"PeriodicalIF":2.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674775","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":"Negotiating care in organizational borderlands: a grounded theory of inter-organizational collaboration in coordination of care.","authors":"Ann-Therese Hedqvist, Catharina Lindberg, Heidi Hagerman, Ann Svensson, Mirjam Ekstedt","doi":"10.1186/s12913-024-11947-4","DOIUrl":"10.1186/s12913-024-11947-4","url":null,"abstract":"<p><strong>Background: </strong>Although coordination of care and integrated care models aim to enhance patient satisfaction and perceived care quality, evidence regarding their practical implementation remains scarce. Understanding the nuances of collaboration across care providers to achieve effective coordination of care is imperative for seamless care integration. The aim of this study was to construct a grounded theory of how inter-organizational collaboration is performed to support coordination of care for patients with complex care needs.</p><p><strong>Methods: </strong>A qualitative design with a constructivist grounded theory approach was applied. In total, 86 participants with diverse backgrounds were recruited across multiple care settings, including hospitals, ambulance services, primary care centers, municipal home healthcare and home care services. The grounded theory was developed iteratively, based on a combination of observations and interviews, and using constant comparative analysis.</p><p><strong>Results: </strong>Coordination of care, a complex process that occurs across interconnected healthcare organizations, is manifested as \"Negotiating care in organizational borderlands.\" Care coordination evolves through a spectrum of inter-organizational collaboration, ranging from \"Dividing care by disease-specific expertise\" to \"Establishing paths for collaboration\" and ultimately \"Co-constructing a comprehensive whole.\" These categories highlight the challenges of coordinating care across both professional and organizational boundaries. In the multifaceted healthcare landscape, effective care coordination occurs when healthcare professionals actively bridge the divides, leveraging their collective expertise. Importantly, organizational boundaries may serve a purpose and should not be dissolved to facilitate effective care coordination.</p><p><strong>Conclusions: </strong>The key to effective care coordination lies in robust inter-organizational collaboration. Even when patients receive integrated care, healthcare professionals may have fragmented roles. This research emphasizes the importance of clearly defined lines of accountability, reinforcing mutual responsibility and facilitating bridging of professional and organizational boundaries. Healthcare professionals and policymakers can use these insights to effectively utilize inter-organizational collaboration in supporting care coordination for patients with complex care needs.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1438"},"PeriodicalIF":2.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674966","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":"How to assess doctor managers' managerial attitude: results from an e-Delphi process.","authors":"Americo Cicchetti, Federica Morandi, Ilaria Valentini, Fausto di Vincenzo","doi":"10.1186/s12913-024-11938-5","DOIUrl":"10.1186/s12913-024-11938-5","url":null,"abstract":"<p><strong>Background: </strong>Since the 1990s, healthcare systems in many Western countries, including Italy, have undergone significant reforms, transforming organizational models and structures to meet the growing demand for healthcare services efficiently. This transformation has introduced new managerial roles for doctors-managers, particularly at the midlevel, creating \"doctor-manager\" positions that involve both clinical and managerial responsibilities. However, doctor-managers often struggle to balance these dual roles due to a lack of formal managerial training and the inherent conflict between clinical and economic objectives. This study aims to define new evaluation dimensions that can enhance the existing scale and develop a new tool to assess the necessary components of the managerial attitude dimension required by doctor-managers in the current Italian healthcare system.</p><p><strong>Methods: </strong>This study updated Cicchetti's 2005 scale to reflect the changes that have occurred in healthcare organizations over the past 20 years, focusing on the evolving roles and challenges of middle healthcare managers. A scoping review was conducted to explore the existing literature, resulting in the identification and analysis of 24 key articles. Thematic analysis, facilitated by NVivo software, identified 171 items related to managerial attitude. These items were further refined, resulting in a 61-item Health Middle Manager Competencies Scale. The scale was evaluated by a Delphi panel through an e-survey, and Cronbach's alpha was used to assess reliability.</p><p><strong>Results: </strong>The final Competencies Scale for Middle Managers of Health consists of 61 items, validated by the Delphi panel of experts. The panel reached consensus on the relevance and significance of each item, confirming the scale's reliability with an acceptable Cronbach alpha. The new scale captures various dimensions of the competencies essential for middle managers in healthcare settings.</p><p><strong>Conclusion: </strong>The study provides insights into the dimensions of doctor managerial attitude and contributes to the update of Cicchetti's Scale to develop a new tool that assesses all the necessary components now required within the managerial attitude dimension.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1440"},"PeriodicalIF":2.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680607","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":"Integrating dermatologists in primary care: impact on delays, patient and professional experiences.","authors":"Maria Lovén, Amanda Eklund, Laura Huilaja, Markus Paananen, Paulus Torkki","doi":"10.1186/s12913-024-11923-y","DOIUrl":"10.1186/s12913-024-11923-y","url":null,"abstract":"<p><strong>Background: </strong>Primary healthcare centres are burdened by the management of patients with skin conditions, while general practitioners might lack the expertise to assess skin changes accurately. The traditional care chain for skin findings is a multistage process that can cause delayed diagnosis and treatment, distressing the patient. This study aimed to determine whether adding a dermatologist to the primary care team would streamline the care pathway of patients with skin conditions, while examining levels of satisfaction among patients and healthcare professionals.</p><p><strong>Methods: </strong>A quasi-experimental multicentre study was conducted in three primary health centres in Finland. A dermatologist was integrated into two of the centres (intervention) but not the third (control). Data on timing of diagnosis and treatment and number of contacts were collected from records and analysed per care path. The Patient Enablement Instrument (PEI) and Net Promoter Score (NPS) were used to measure the patient's experience of the appointment. NPS and professional satisfaction queries were used to measure professional satisfaction.</p><p><strong>Results: </strong>In total 186 intervention and 176 control patients were included, with 38 primary care professionals. Compared with the control group, the intervention group showed a significantly shorter time to confirmed diagnosis and to treatment start (25 vs. 49 days, p < 0.001), with a higher proportion (49% vs. 27%, p < 0.001) receiving immediate treatment in the primary care setting. Patients in the intervention group required fewer visits. Patient experience by PEI and NPS scores were higher in the intervention group (p ≤ 0.022 for each). Satisfaction levels among professionals in both groups were higher after the intervention than before, although the NPS score did not improve significantly in the control group. Almost all professionals advocated for the continuation of the integrated care pathway.</p><p><strong>Conclusions: </strong>The integration of dermatologists into the primary care streamlined the management of skin conditions from diagnosis to treatment, while improving the experiences of both patients and healthcare professionals. This integrated care path is beneficial for the management of patients with skin findings in primary care.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1441"},"PeriodicalIF":2.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680613","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":"Access to medicines for the treatment of chronic diseases in Chile: qualitative analysis of perceived patient barriers and facilitators in five regions of the country.","authors":"Carla Castillo-Laborde, Isabel Matute, Ximena Sgombich, Daniel Jofré","doi":"10.1186/s12913-024-11900-5","DOIUrl":"10.1186/s12913-024-11900-5","url":null,"abstract":"<p><strong>Background: </strong>Access to medicines is one of the most serious public health problems globally, and Chile is not an exception. The aim of this study was to explore patients' perceptions, beneficiaries of both public and private health sectors, of barriers and facilitators in access to medicines in general, and those associated with the treatment of diabetes, dyslipidemia and hypertension.</p><p><strong>Methods: </strong>Ten focus groups of patients with these diseases, diagnosed for at least six months and with prescribed medication, were carried out in five regions of Chile: Arica (north), Aysén (south), and Valparaíso, Metropolitan, and Maule (center).</p><p><strong>Results: </strong>The experience of access to medicines is determined by the insurance system, the experience of care with public or private providers, and geographical-administrative difference between capital and other regions. Beneficiaries of public sector value territorial coverage of primary care, which guarantees access in isolated areas and, despite their greater socioeconomic vulnerability, perceive greater protection in access (access conditions, delivery reliability and adherence to pharmacological treatment). The main problem observed is the financing of treatments not covered by the system. Beneficiaries of private sector perceive that they have access to medicines of better quality than those provided free of charge by public sector, but raise fears associated with the inability to afford them and distrust in the market process. Regarding the type of provider, public sector shows greater capacity for user loyalty, which is expressed in regular visits and follow-up, unlike discontinuous examinations among private sector beneficiaries.</p><p><strong>Conclusions: </strong>Different access conditions both at the territorial level and in the health subsystems are evident. It is necessary to make progress in addressing the problem of access to medicines in a comprehensive manner.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1436"},"PeriodicalIF":2.7,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674494","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 relation between resident-related factors and care problems in nursing homes: a multi-level analysis.","authors":"Suleyman Bouchmal, Yvonne M J Goërtz, Coen Hacking, Bjorn Winkens, Sil Aarts","doi":"10.1186/s12913-024-11915-y","DOIUrl":"10.1186/s12913-024-11915-y","url":null,"abstract":"<p><strong>Background: </strong>Care problems such as decubitus and fall incidents are prevalent in nursing homes. Yet, research regarding explanatory factors on these care problems is scarce. The aim of this study is twofold: (1) to identify the degree to which a diverse set of resident-related factors (e.g., care dependency levels) are associated with the sum of six care problems (pressure ulcers, incontinence, malnutrition, falls, freedom restriction, and pain), and (2) to investigate which resident-related factors are associated with each of these six care problems individually.</p><p><strong>Methods: </strong>Data were collected (2016-2023) using the International Prevalence Measurements of Care Quality (LPZ). Factors such as age, number of diagnoses, and length of stay were included. While respecting nested data within eight organizations, the associations between thirteen resident-related factors and the six care problems were determined using multilevel analyses.</p><p><strong>Results: </strong>A total of 3043 residents were included (mean age 81.9; SD: 10.5). The most prevalent care problem was incontinence (n = 1834; 60.3%). Nurse proxy-rated confusion (r = 0.227; p < 0.001) and aggression (r = 0.285; p = 0.001) were associated strongest with the sum of the six care problems; and higher after correcting for the residents' care dependency levels (respectively r = 0.504; 0.584 - both p < 0.001). Pre-admission risk assessments for pressure ulcers (OR 7.03), malnutrition (OR 3.57), and falls (OR 3.93) were strongest associated with individual care problems such as pressure ulcers, and falls.</p><p><strong>Conclusions: </strong>This study shows the association between several resident-related factors and care problems such as gender, years since admission, and care dependency level. Factors such as proxy-rated aggression and confusion were strongest associated with the presence of care problems, while pre-admission risk assessments were strongest associated with several individual care problems. The findings underscore the importance of prioritizing early pre-assessments, as they empower care professionals to take into account resident-specific factors and their influence on the emergence of care problems.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1435"},"PeriodicalIF":2.7,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674991","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":"Availability, price, and affordability of diabetes mellitus and thyroid dysfunction medicines in South Wollo zone, Northeast Ethiopia.","authors":"Solomon Ahmed Mohammed, Haile Yirga Mengesha, Abel Andualem, Elham Seid, Getnet Mengistu Assefa","doi":"10.1186/s12913-024-11935-8","DOIUrl":"10.1186/s12913-024-11935-8","url":null,"abstract":"<p><strong>Background: </strong>Diabetes mellitus and thyroid dysfunction are prevalent endocrine disorders that impose enormous burdens on patients and countries. However, access to essential medicines remains inadequate in many low-income countries. This study evaluated medications' availability, price, and affordability for these conditions.</p><p><strong>Methods: </strong>A cross-sectional study was conducted at health facilities in the South Wollo zone in 2022. Following World Health Organization (WHO)/Health Action International (HAI) guidelines, 34 medicines were evaluated across 60 medicine outlets. Data were collected using a standardized tool adapted from WHO/HAI. Availability was measured by the percentage of facilities where the medicines were in stock. Prices were reported as median prices and median price ratios (MPR). Affordability was assessed based on the number of days' wages required for the lowest-paid government workers to cover the full course of therapy.</p><p><strong>Results: </strong>The availability of lowest-priced generic (LPG) diabetes and thyroid dysfunction medicines in the public sector was 24.4% and 28.7%, respectively. In private pharmacies, availability was 26.3% for diabetes and 21% for thyroid dysfunction medicines. Median prices for LPG medicines were higher in private pharmacies than in public health facilities, with 81.81% showing a statistically significant difference (p < 0.05). In private pharmacies, the prices of LPG diabetes (5, 71.43%) and thyroid dysfunction medicines (5, 83.33%) exceeded the reference price. None of the LPG diabetes and thyroid dysfunction medicines were affordable in either setting.</p><p><strong>Conclusions: </strong>The study revealed a very low availability of medicines and a financial burden on patients. Therefore, the government should improve the availability of these essential medicines and regulate their prices.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1434"},"PeriodicalIF":2.7,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674496","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 of HIV pre-exposure prophylaxis use among four key populations in Iran.","authors":"Hossein Moameri, Parvin Mangolian Shahrbabaki, Fatemeh Tavakoli, Parya Saberi, Ali Mirzazadeh, Reza Goudarzi, Hamid Sharifi","doi":"10.1186/s12913-024-11933-w","DOIUrl":"10.1186/s12913-024-11933-w","url":null,"abstract":"<p><strong>Background: </strong>Pre-exposure prophylaxis (PrEP) significantly reduces HIV transmission, but it is not commonly prescribed in Iran. Therefore, this study aimed to identify facilitators and barriers to PrEP use among four key populations (KPs) in Iran.</p><p><strong>Methods: </strong>We conducted in-depth qualitative interviews with female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and sexual partners of people living with HIV (PLHIV) to obtain deep insights into the participants' experiences, beliefs, and viewpoints. We included HIV experts, including staff from the HIV control department, healthcare providers with HIV experience, health policymakers, infectious disease specialists, and university professors. We performed a content analysis to identify facilitators and barriers to PrEP implementation among KPs.</p><p><strong>Results: </strong>We interviewed seven FSW, seven MSM, four PWID, four sexual partners of PLHIV, and 18 HIV experts. The facilitator's theme emerged in four main categories, including eight different factors: 1) Individual and interpersonal factors (motivations, fear of testing positive for HIV, and safety nets and financial support), 2) Age and sex differences, 3) Organizational factors (appropriate PrEP distribution, information sharing, and receipt of high-quality services, 4) Efficacy of PrEP. The barrier's theme emerged in three main categories, including four factors: 1) Individual factors (insufficient knowledge and awareness, and fragile trust), 2) Cultural barriers, and 3) Organizational factors (inadequate infrastructure and organizational barriers).</p><p><strong>Conclusions: </strong>We identified key facilitators and barriers to successful PrEP implementation among KPs in Iran. By addressing these barriers, Iran has an opportunity to include PrEP programs in its HIV prevention efforts for KPs.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1433"},"PeriodicalIF":2.7,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674719","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":"Clinician attitudes towards adoption of evidence-based practice: a nationwide multiprofessional cross-sectional study of child and adolescent mental health services in Sweden.","authors":"Anna Helena Elisabeth Santesson, Robert Holmberg, Martin Bäckström, Peik Gustafsson, Håkan Jarbin, Sean Perrin","doi":"10.1186/s12913-024-11934-9","DOIUrl":"10.1186/s12913-024-11934-9","url":null,"abstract":"<p><strong>Background: </strong>Implementation of evidence-based practice (EBP) in child and adolescent mental health services (CAMHS) is a priority to improve service delivery and outcomes. Clinicians' EBP attitudes are likely to play a crucial role in implementation but are poorly understood. This study aimed to assess variation in EBP attitudes in a large national sample of CAMHS clinicians in Sweden, and to compare these findings to findings from the United States of America (USA).</p><p><strong>Methods: </strong>CAMHS clinicians (n = 799; 60% response rate) completed the Evidence-Based Practice Attitude Scale (EBPAS) and items from the Organizational Readiness for Change Scale (ORC) ahead of an EBP for depression implementation effort across Sweden. EBPAS scores were compared with the USA study. Predictors of global and specific attitudes (gender, age, working years, education, profession, perceived benefit of diagnosis and organizational readiness and type of service) were examined using simple and multiple linear regressions.</p><p><strong>Results: </strong>Clinicians had positive attitudes towards EBP on the four-dimensional subscales of the EBPAS, somewhat more so than their American counterparts. Clinician and organizational characteristics were related to at least one attitudinal dimension in both models, with perceived utility of diagnosis being the strongest and most consistent predictor across dimensions and models.</p><p><strong>Conclusions: </strong>Results from this large-scale national study underscore the need to consider cultural, contextual, and individual variations in attitudes towards EBP when planning implementation efforts. Such efforts may need to be tailored to the working contexts, needs, and values of CAMHS clinicians, particularly their views on the utility of diagnosis.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1432"},"PeriodicalIF":2.7,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667410","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}