BMC Health Services Research最新文献

{"title":"Analysis of a theory of change to evaluate the Health Care-Associated Infection Prevention Program (HAI) in Colombia.","authors":"Lina Patricia Camacho Núñez, Gino Montenegro Martinez, Erika Giraldo Gallo","doi":"10.1186/s12913-024-12072-y","DOIUrl":"10.1186/s12913-024-12072-y","url":null,"abstract":"<p><strong>Background: </strong>Healthcare-associated infections affect the safety of patients, health personnel, and families and generate expenses for health systems. The Theory of Change allows us to evaluate the strengths and weaknesses of a program, hoping to achieve change and improve its design. The objective was to analyze the change theory underpinning the actions proposed by the Program for the Prevention of Healthcare-Associated Infections (HAI) in Colombia.</p><p><strong>Methods: </strong>The research used a case study. The case is the implementation of this program in the Colombian context. A documentary review of the Patient Safety Policy and the prevention, surveillance, and control of HAI events from 2006 to 2020 was conducted. Subsequently, semi-structured interviews were conducted with the actors who designed the patient safety policy and the HAI program. Of these, two had the role of national political and administrative authorities; one participated in the design of the guidelines for the implementation of the patient safety policy, and the other in the design of the IAAS program. Likewise, two academics and researchers, one who contributed to the design of the patient safety policy and the other who played a fundamental role in the development of the IAAS program, each of them contributing significantly to the advancement of their respective areas. Qualitative content analysis was used to analyze the data. Data processing, coding, grouping into categories, and network construction were performed in the Atlas Ti 23 program and represented as a theory of change diagram.</p><p><strong>Results: </strong>The results show that the desired impacts of the program are to reduce the incidence of HAI, improve the quality of life of patients, and their families, and improve the country's General Social Security Health System. Among the long-term results identified are the strengthening of the prevention and control of HAI, adjusting regulations, strengthening surveillance, implementing actions for the prevention and control of HAI, and improving the knowledge and skills of health personnel to contain these events. Five preconditions and 14 strategies were identified. Finally, four assumptions were identified that potentially influence the achievement of the program's results.</p><p><strong>Conclusions: </strong>The analyzed theory integrates the elements of a theory of change, explaining how this type of intervention works to generate changes and prevent these infections associated with health care, which is the expected impact. However, strategies and indicators were identified that were not incorporated, and that are needed to assess the impact of these interventions. The study allows us to advance in the development of the design and evaluation of HAI programs, supporting them in a theory of change as a guide to detect failures during their implementation for their improvement.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"442"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717844","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":"Continuous quality improvement across a South Australian health service and the role it plays in a learning health system: a qualitative study.","authors":"Mia Bierbaum, Susan Hillier, Louise A Ellis, Robyn Clay-Williams, Angie Goodrich, Robert Padbury, Peter Hibbert","doi":"10.1186/s12913-025-12557-4","DOIUrl":"10.1186/s12913-025-12557-4","url":null,"abstract":"<p><strong>Introduction: </strong>Continuous quality improvement (CQI) initiatives are commonly used to enhance patient safety and quality of care. A novel South Australian Local Health Network (SALHN) Continuous Improvement Program (CIP009) has integrated a top-down model of executive-directed change initiatives, with a bottom-up approach of clinician designed interventions to address an organisational-wide goal of improved patient flow. This study evaluated the strengths and challenges of CIP009 implementation from the perspective of participants and deliverers.</p><p><strong>Methods: </strong>A qualitative study was conducted in 2023/2024 to evaluate the implementation of CIP009 and 12 associated quality improvement projects. Semi-structured interviews and focus groups were conducted with key stakeholders (executives, coaches and CIP009 fellows) and guided by the Consolidated Framework for Implementation Research (CFIR). A document review and observations of CIP009 team meetings were also conducted. Data were analysed inductively using thematic analysis, then deductively mapped against the five CFIR domains.</p><p><strong>Results: </strong>Thirty-one participants were interviewed individually or in focus groups, two presentation days and six team meetings were observed, and 78 documents were reviewed. Seven key themes were identified highlighting key challenges and strengths of CIP009 implementation within the SALHN setting. These included four key strengths: the CIP framework and culture (the flexible framework, common language, training, and a culture of flattened hierarchy); the benefits of support from a dedicated, internal improvement Faculty (wrap around support from coaches); the advantages of an enthusiastic team member disposition and incentives (vested interests to enhance workflow and patient outcomes); and effective teams and team composition (teams comprised of senior clinician change agents). Three key challenges included: workforce and organisation-level challenges (individual workloads, workforce capacity, and data access); team cohesion, logistics and stakeholder engagement challenges (issues in the way teams worked together); and training and support shortcomings (the training course, and the top-down nature of CIP009).</p><p><strong>Conclusion: </strong>This evaluation identified that CIP009 was considered an effective multifaceted CQI program. The strengths of CIP009 support a learning health system (a data driven model, utilising systematic frameworks, with commitment from leadership, and a culture of continuous learning). Further integration of implementation science principles may support the program to overcome the key challenges identified. These findings will inform and guide improvement efforts within future iterations of CIP.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"457"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727970","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":"Knowledge-seeking and knowledge sharing of health services across social networks and communities: a scoping review.","authors":"Anamitra Bhowmick, Marieke M van der Zande, Rebecca Harris","doi":"10.1186/s12913-025-12525-y","DOIUrl":"10.1186/s12913-025-12525-y","url":null,"abstract":"<p><strong>Introduction: </strong>Lay people's knowledge influences healthcare service utilisation, but the literature on people's knowledge-seeking and sharing about different healthcare services across social networks is patchy and not well integrated. This scoping review was undertaken to map how different studies report healthcare service -related (healthcare) knowledge-seeking or sharing in social circles and to identify evidence gaps for further research.</p><p><strong>Method: </strong>Levac's enhanced scoping review framework was adapted to develop a comprehensive electronic search strategy. Four electronic databases-Medline, Web of Science, PsychINFO, and CINAHL were searched as well as Grey literature. Five per cent of all titles and abstracts screened were screened by a blinded second reviewer. After full-text screening, data were extracted and summarised.</p><p><strong>Results: </strong>The review included 14 quantitative, 23 qualitative, 2 mixed-method studies, one literature review and one report [N = 41]. Theories included within studies ranged from the socio-ecological model to bricolage. The concept of healthcare-related knowledge was generally ill defined and usually positioned within the concept of health literacy more generally. Lay people's healthcare knowledge was not generally considered as a distinct entity in a holistic sense, with only two studies identified which investigated healthcare knowledge exclusively at inter-personal (meso) levels. However, included studies showed that people's healthcare knowledge in everyday life is co-constructed when they engage in inter-personal interactions with informal social network ties. People tend to acquire healthcare knowledge from others who share similar lived experiences of using healthcare services, which binds the knowledge seekers through homophily. Due to the social responsibility to help others being ingrained within the community, people (predominantly women), support each other, providing emotional and instrumental support in addition to essential healthcare information. This then builds holistic healthcare literacy, which people conventionally do not gain solely from the knowledge transmitted by healthcare professionals.</p><p><strong>Conclusion: </strong>People in diverse community settings acquired, co-constructed, transmitted, or suppressed knowledge about various healthcare services with the support of informal networks, mostly family and friends, combined with mass media sources. Therefore, people's healthcare knowledge is not an individual asset but a shared resource among their social circles. It is multi-faceted and acquired from diverse sources available in the local and online communities and not limited only to individually held lay accounts of using healthcare services.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"443"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728315","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":"Evaluation of content validity and feasibility of the World Falls Guidelines' three key questions to identify falls among older adult users of home care services in Norway.","authors":"Rune Solli, Linda Aimée Hartford Kvæl, Nina Rydland Olsen, Therese Brovold","doi":"10.1186/s12913-025-12606-y","DOIUrl":"10.1186/s12913-025-12606-y","url":null,"abstract":"<p><strong>Background: </strong>Falls among older adults (65 + years) is an important issue in municipal home care. Screening using the World Falls Guidelines' three key questions (3KQ) is recommended to identify older adults at increased fall risk, but the 3KQ has not been formally tested by healthcare practitioners (HCPs) working in Norwegian municipal home care. The aim of this study was to evaluate the content validity and the feasibility of the 3KQ among HCPs in home care services.</p><p><strong>Methods: </strong>Participants were 10 multidisciplinary HCPs working in home care and in low-threshold services of Oslo, Norway. We evaluated the content validity of the 3KQ through individual think-aloud interviews. Next, feasibility was evaluated as follows: We trained HCPs in how to use the 3KQ. HCPs then screened older adults using the 3KQ during a six-week test period, and took pocket-notes of older adults' answers. We conducted two focus groups to explore HCPs' experiences with using the 3KQ. We analysed interview data using reflexive thematic analysis.</p><p><strong>Results: </strong>Content validity evaluation revealed that HCPs found the 3KQ easy to understand, and potentially timesaving. They experienced the tool as applicable among home care users, and it was particularly useful among new users. Still, HCPs emphasised the necessity of their training on how to best ask the questions and determine appropriate actions based on users' responses. We identified three main themes from the feasibility evaluation: (1) Promoting awareness and action: using the 3KQ helps put falls on the agenda in municipal home care, (2) Obtaining reliable answers: integrating the 3KQ into daily practice is important, and (3) Unlocking insights: the 3KQ as a gateway to supplementary information from users. Most older adults had increased fall risk according to the 3KQ.</p><p><strong>Conclusions: </strong>The 3KQ appears feasible for Norwegian municipal home care and may be of value for HCPs who screen new users and users of low-threshold services. Integrated use of the 3KQ may enhance awareness, promote reliable answers, and provide supplementary information useful for decision-making. The study findings may benefit HCPs and managers in home care services, and other stakeholders in implementing fall prevention guidelines in primary care.</p><p><strong>Trial registration: </strong>Open Science Framework Identifier https://doi.org/10.17605/OSF.IO/2JFHV . Registered: 11th January 2023.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"444"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728350","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":"A national survey of osteopaths' conceptions of practice in France: structural validity of the Osteo-TAQfr and the tendency toward technical rationality.","authors":"Oliver P Thomson, Loïc Treffel, Agathe Wagner, Erwann Jacquot, Jerry Draper-Rodi, Chantal Morin, Brett Vaughan","doi":"10.1186/s12913-025-12540-z","DOIUrl":"10.1186/s12913-025-12540-z","url":null,"abstract":"<p><strong>Background: </strong>Despite the growing popularity of osteopathy in France, little is known about how French osteopaths conceptualise key aspects of their practice, including skills, knowledge, and decision-making. This study aimed to adapt and validate the Osteopaths' Therapeutic Approaches Questionnaire (Osteo-TAQ) for use in a French osteopathic population (Osteo-TAQfr) and to examine the professional profile and core elements of clinical practice among French osteopaths. The first objective was to establish the psychometric properties of the Osteo-TAQfr within a French osteopathic population. The second aim was to explore French osteopaths' conceptions of practice and their approach to patient care, thereby contributing to a broader understanding of the profession in France and its relevance within the discourse on allied health professions (AHPs).</p><p><strong>Methods: </strong>A cross-sectional study was conducted to (1) adapt and validate the French version of the Osteopaths' Therapeutic Approaches Questionnaire (Osteo-TAQfr) and (2) explore osteopaths' conceptions of practice in France. The translation and cultural adaptation process was informed by cognitive interviews to ensure linguistic and contextual appropriateness. Exploratory Factor Analysis (EFA) was performed to assess the factor structure in the French osteopathic context and Confirmatory Factor Analysis (CFA) was used to test the validity of previously established constructs-Professional Artistry (PA) and Technical Rationality (TR). Internal consistency was evaluated using McDonald's omega (ω).</p><p><strong>Results: </strong>The survey yielded 1,703 complete responses. Analysis supported a two-factor model with PA andTR subscales, both showing strong reliability estimations (PA ω = 0.882; TR ω = 0.873). Minor theory-informed adjustments improved model fit. A moderate negative correlation was observed between the PA and TR subscales (r=-0.407). Respondents with additional health professions qualifications scored lower on the PA subscale and higher on the TR subscale.</p><p><strong>Conclusions: </strong>The Osteo-TAQfr is an original tool that assesses conceptions of osteopathic practice in France. Findings reveal a predominance of TR among French osteopaths, characterised by biomedical, technique-driven approaches. These results have significant implications for aligning osteopathic education and practice with contemporary AHP paradigms, including patient-centred care and interdisciplinary collaboration. Further research should explore the transferability of the Osteo-TAQ across other healthcare systems and its potential impact on clinical outcomes and professional development.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"451"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728316","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":"Evaluation of prescribing patterns of sodium valproate in neurological disease patients: a quasi-experimental pretest-posttest design study.","authors":"Rehab H Werida, Salima El-Sherif, Rania Shoshan, Naglaa F Khedr","doi":"10.1186/s12913-025-12483-5","DOIUrl":"10.1186/s12913-025-12483-5","url":null,"abstract":"<p><strong>Background: </strong>The well-known anti-seizure medication, sodium valproate, is used to treat epilepsy, bipolar disorder, and other mental health conditions.</p><p><strong>Objective: </strong>This study aimed to determine how pharmacist counseling intervention affected the prescribing patterns and usage of sodium valproate in patients with neurological diseases.</p><p><strong>Methods: </strong>Patient prescriptions were analyzed in a quasi-experimental pretest-posttest design research, at baseline and after three months of pharmacy educational intervention. Medical history, drug-drug interactions, antipsychotic combinations, medication errors, and dosages were among the information gathered.</p><p><strong>Results: </strong>The reviewed prescriptions observed trend towards antipsychotic combination, 15 (2.5%) prescriptions had five medications, while 18 (3%) contained four, 169 (28.2%) containing three, 329 (54.8%) containing two, and 69 (11.5%) containing one, antipsychotic. Of the reviewed prescriptions, 6% had possible drug-drug interactions. However, following a 3-month pharmacy educational intervention, the tendency toward antipsychotic combination decreased significantly to 262 (52%) with prescriptions for 2 antipsychotics and 163 (32.3%) with 3 antipsychotics. Likewise, the decreases in medication errors related to frequency and dosage were 8 (1.6%) vs. 29 (4.8%) and 6 (1.2%) vs. 35 (5.8%), compared to baseline respectively. Additionally, medication adherence was raised significantly (p < 0.000) from 50 (8.3%) to 338 (67.1%) after the intervention.</p><p><strong>Conclusion: </strong>More precise regulations should be placed on sodium valproate prescription patterns and usage, throughout implemented pharmacist initiative in patients counselling, provision of health education and therapeutic monitoring to improve health-related quality of life.</p><p><strong>Trial registration: </strong>This study was registered on clinicaltrial.gov with an identification code NCT05830981. https://classic.</p><p><strong>Clinicaltrials: </strong>gov/ct2/show/NCT05830981 (First Posted: April 26, 2023).</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"441"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717847","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":"Threshold effect of governance quality in the relationship between public health expenditure and life expectancy at birth in the West African Economic and Monetary Union.","authors":"Jacques Boundioa, Noël Thiombiano","doi":"10.1186/s12913-025-12603-1","DOIUrl":"10.1186/s12913-025-12603-1","url":null,"abstract":"<p><strong>Background: </strong>The population in the West African Economic and Monetary Union (WAEMU) suffers poor health, as manifested in low life expectancy at birth. Public health expenditure (PHE) has long been viewed as having the potential to improve health. However, the relationship between PHE and health outcomes is inconclusive. In view of the above, poor governance could be a factor inhibiting the effect of public health expenditure on certain health indicators. This article analyzes the threshold effect of governance quality on the relationship between public health spending and life expectancy at birth in WAEMU.</p><p><strong>Methods: </strong>The data used come from the Worldwide Governance Indicators (WGI) database and the World Bank's World Development Indicators and cover the period 1996-2018. Threshold-effect analysis for Hansen (1999) was performed to assess the relation between governance quality (using the six (06) indicators and index of governance quality for robustness) and public health expenditure with life expectancy at birth.</p><p><strong>Result: </strong>The results show that governance quality is a transition variable at which public health expenditure affects life expectancy. Indeed, the effect of public spending on life expectancy at birth varies according to the thresholds reached by the different levels of governance on a 0-1 scale.</p><p><strong>Conclusion: </strong>Public health expenditure affects life expectancy if the quality of governance is high. Improving governance quality must be a prerequisite for any allocation of public resources in the health sector in WAEMU.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"432"},"PeriodicalIF":2.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717906","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":"Misclassification of HIV infection status among serologically diverse populations in Nigeria: implications for test and treat program.","authors":"George I E Eluwa, Scott Geibel, Steven Callens, Lung Vu, Vincent J Wong, Isa Iyortim","doi":"10.1186/s12913-025-12617-9","DOIUrl":"10.1186/s12913-025-12617-9","url":null,"abstract":"<p><strong>Background: </strong>In 2015, the World Health Organization (WHO) launched the Test and Treat policy which supports antiretroviral treatment for all people with HIV, irrespective of CD4 count or clinical stage. This was adopted in 2016 in Nigeria. This policy resulted in scaleup of HIV testing strategies and differentiated models of care including community-based ART. This study evaluated the HIV testing algorithm and assessed the rates of misclassification of HIV status among newly diagnosed clients.</p><p><strong>Methods: </strong>Between February and August 2018, whole blood samples were collected from clients newly diagnosed with HIV in Lagos and Benue states. HIV status wasconfirmed with rapid tests using the serial algorithm during outreach sessions for both key populations and general populations. HIV positivity was confirmed using GenScreen™ HIV1/2.O Antibody only ELISA test (BioRad, USA). Optical density (OD) for each sample was measured with the use of Emax microplate reader set at endpoint 450 wavelength. Based on manufacturer's algorithm, sample OD and calculated cut-off value ratio, an OD < 1.0 was interpreted as negative and > 1.0, positive. Concordance between rapid test algorithm result and ELISA was used to estimate the proportion of samples that were misclassified.</p><p><strong>Results: </strong>A total of 788 samples were collected from newly diagnosed clients across 4 sites in Lagos and 3 sites in Benue. Samples were collected from 212 and 178 key populations (KPs) clients in Lagos and Benue, respectively, and from 206 and 192 general population (GPs) clients in Lagos and Benue, respectively. Mean OD was 3.75 (IQR:3.70-3.81) with a standard deviation of 0.13. There was a 100% concordance between rapid test and ELISA results and no misclassification identified.</p><p><strong>Conclusion: </strong>We identified no instances of misclassification of positive HIV status suggesting that all clients who have been placed on treatment truly had HIV infection. The 100% concordance rate recorded from all the sites may be attributable to the maturity of the HIV program in Nigerian with a concomitant standard quality assurance system for both clinical and outreach testing services. This finding supports the implementation of the Test and Treat policy that Nigeria has adopted. Scale up of Test and Treat and community ART is thus recommended to increase access to treatment.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"430"},"PeriodicalIF":2.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708333","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":"Real world initiation of newly funded empagliflozin and dulaglutide under special authority for patients with type 2 diabetes in New Zealand.","authors":"Lynne Chepulis, Mark Rodrigues, Han Gan, Rawiri Keenan, Tim Kenealy, Rinki Murphy, Leanne Te Karu, Jo Scott-Jones, Penny Clark, Allan Moffitt, Sara Mustafa, Ross Lawrenson, Ryan Paul","doi":"10.1186/s12913-025-12601-3","DOIUrl":"10.1186/s12913-025-12601-3","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes (T2D) is sub-optimally managed for many in Aotearoa New Zealand, and disproportionately affects Māori and Pacific peoples. In February 2021, SGLT2i/GLP1RA agents were funded for use for the first time with prioritisation for Māori, Pacific and those with cardiovascular and/or renal disease or risk (CVRD). This study evaluates the impact of health system factors on initiation of SGLT2i/GLP1RA therapy.</p><p><strong>Methods: </strong>Primary care data was collected for patients with T2D aged 18-75 years from four primary care organisations (302 general practices) in the Auckland / Waikato region of New Zealand (Feb 2021 - July 2022). Initiation of SGLT2i/GLP1RA therapy was reviewed by patient (age, gender, ethnicity, CVRD status) and health system variables (funding, provider type, staffing, patient numbers, rurality, after-hours access). Logistic regression was used to estimate the odds ratio of a patient being dispensed SGLT2i/GLP1RA.</p><p><strong>Results: </strong>Of 57,743 patients with T2D, 22,331 were eligible for funded SGLT2i/GLP1RA access and 10,272 of those (46.0%) were prescribed. Initiation of therapy was highest in Māori (50.8%) and Pacific (48.8%) patients (vs. 36·2-40·7% of other ethnic groups; P < 0.001), but was comparable in those with and without CVRD (47·1% vs. 48·9%; P = 0.2). Prescribing was highest in practices with higher doctor/patient numbers, low-cost fees, Māori health providers and clinics without after-hours access.</p><p><strong>Conclusion: </strong>Prioritised access for SGLT2i/GLP1RA appears to be associated with a reduced health equity gap for Māori and Pacific patients with T2D in NZ, but work is required to improve prescribing for patients with CVRD.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"433"},"PeriodicalIF":2.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717805","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":"Experiences of violence and abuse among transgender women in healthcare settings in Uganda: a community-engaged qualitative study.","authors":"Patience A Muwanguzi, Racheal Nabunya, Moses Sabila","doi":"10.1186/s12913-025-12591-2","DOIUrl":"10.1186/s12913-025-12591-2","url":null,"abstract":"<p><strong>Background: </strong>People who identify as transgender have a gender identity or expression that differs from the sex they were assigned at birth. Because of this, transgender people may encounter widespread stigma, discrimination, and violence, including in medical facilities. Understanding how these phenomena manifest during healthcare interactions is crucial for enhancing health equity for transgender individuals. Therefore, this study explored the experiences of transgender-related stigma and violence among transgender individuals in Uganda.</p><p><strong>Methods: </strong>The study used a community-based qualitative participatory approach, with transgender women actively co-generating the data. Six focus groups were held with 33 transgender women in southwestern and central Uganda. Data were thematically analysed using OpenCode software.</p><p><strong>Results: </strong>Four key themes emerged for the lived experiences of violence and abuse among transgender women in Uganda. These included: (i) Institutionalized physical violence and violation of bodily autonomy, (ii) Religious impositions and moral policing, (iii) Dehumanising treatment and objectification and (iv) Systemic discrimination and denial of care.</p><p><strong>Conclusions: </strong>In conclusion, this study highlights the pervasive violence, abuse, sexual assault and discrimination reported by transgender women in healthcare settings in Uganda. These experiences not only compromise access to quality healthcare but also perpetuate stigma and exacerbate health disparities. Addressing these issues requires comprehensive, trauma-informed care, alongside structural reforms and training for healthcare providers. Ensuring respectful, affirming, and inclusive healthcare environments is essential to safeguarding the rights and well-being of transgender individuals. Additionally, more studies should evaluate the effectiveness of interventions like healthcare provider training and addressing social determinants of health to determine the most impactful strategies for reducing violence.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"431"},"PeriodicalIF":2.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717852","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}