BMC Health Services Research最新文献

{"title":"The impact of the COVID-19 pandemic on governmental hospitals performance indicators in city of Yazd, Iran: an interrupted time-series analysis.","authors":"Mohammad Ranjbar, Mohammad Bazyar, Ommolbanin Sarkari, Hossein Ameri, Blake Angell, Yibeltal Assefa","doi":"10.1186/s12913-025-12587-y","DOIUrl":"10.1186/s12913-025-12587-y","url":null,"abstract":"<p><strong>Background: </strong>The Covid-19 pandemic stretched health systems globally including in Iran. Hospital demand and performance was affected both directly and indirectly as a result of the pandemic. Analyzing hospital indicators can provide insights to deal with the consequences and challenges related to various aspects of future pandemics.</p><p><strong>Objective: </strong>This study aimed to investigate the impact of the Covid-19 pandemic on key performance indicators of public hospitals in Iran.</p><p><strong>Methods: </strong>In this quasi-experimental study, we used time-series analysis to examine eight key indicators of hospital performance: number of outpatient visits, number of elective hospitalization, average length of stay, hospital mortality rate, number of surgeries, hospitalization rate, emergency visits, bed occupancy rate, and hospitals' revenue. Data were extracted from four public hospitals in Yazd at two time intervals, 15 months before and after the outbreak of COVID-19. Data were analysed using interrupted time series analysis models with STATA₁₇.</p><p><strong>Results: </strong>Average length of stay (p = 0.02) and hospital mortality rate (p < 0.01) increased significantly following the outbreak of COVID-19, while the mean of other indicators such as number of outpatient visits (p < 0.01), number of elective hospitalization (p < 0.01), number of surgeries (p = 0.01), hospitalization rate (p < 0.01), emergency visits (p < 0.01) and bed occupancy rate (p < 0.01) decreased significantly. The Covid-19 pandemic had an immediately reverse significant impact on the level changes of \"outpatient visits\", \"elective hospitalization\", \"hospitalization rate\", \"emergency visits\" and \"bed occupancy rate\" indicators (p < 0.05). Although the trend of surgeries indicator was affected significantly (p = 0.01) after the covid-19 outbreak.</p><p><strong>Conclusion: </strong>We showed significant changes in most hospital indicators after the Covid-19 pandemic, reflecting the effect of this pandemic on the performance of hospitals. Understanding the impact of a pandemic on hospital indicators is necessary for decision-makers to effectively plan an effective pandemic response and to inform resource allocation decisions.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"438"},"PeriodicalIF":2.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717757","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":"\"We really need to surround people with care:\" a qualitative examination of service providers' perspectives on barriers to HIV care in Manitoba, Canada.","authors":"Cheryl Sobie, Katharina Maier, Margaret Haworth-Brockman, Enrique Villacis-Alvarez, Yoav Keynan, Zulma Vanessa Rueda","doi":"10.1186/s12913-025-12514-1","DOIUrl":"10.1186/s12913-025-12514-1","url":null,"abstract":"<p><strong>Objective: </strong>To identify barriers to HIV care from the perspectives of HIV service providers in Manitoba (MB), Canada during the 2020-2022 period of the COVID-19 pandemic.</p><p><strong>Methods: </strong>In this qualitative study, we conducted semi-structured interviews with HIV service providers between October 2022 and January 2023. Purposive sampling was used to include a cross-section of 27 providers (clinicians, nurses, social workers, pharmacists, program managers, and health education facilitators). The main themes explored in the interviews included: (1) provider roles and organization; (2) facilitators and barriers to HIV care; (3) harm reduction and sexually transmitted and blood-borne infections prevention practices; (4) impacts of the COVID-19 pandemic on HIV care and providers and (5) policies related to HIV care in Manitoba.</p><p><strong>Results: </strong>Using a Social Ecological Model of Health framework, our analysis of service provider interviews identified barriers at four different levels: (1) structural level barriers, including limitations to public health and social support systems, geographic barriers, and policy inefficiencies; (2) socio-cultural/community level barriers, such as experiences of racism, stigma and discrimination leading to people living with HIV's (PLHIV) reduced trust in the health care system; (3) institutional level barriers, which describe how lack of primary care for PLHIV, limitations to the HIV care delivery model in Manitoba, and system capacity limitations have created missed opportunities for linkage to HIV care; and (4) intrapersonal barriers that reflect how the interaction of structural, socio-cultural, and institutional level barriers challenge providers' role performance and exacerbate risk of burnout and moral distress.</p><p><strong>Conclusions: </strong>Our findings demonstrate how multi-level barriers intersect to create challenges for both PLHIV and providers, limiting where and how people receive HIV care and impeding providers' ability to perform their roles and provide effective, consistent HIV care. Given the key role of HIV providers in facilitating care, structural, social/community, and institutional changes are needed, as is further research to examine structural causes of burnout to develop meaningful interventions that support service providers' mental health and well-being.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"436"},"PeriodicalIF":2.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717837","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":"Navigating the completing cancer treatment incentive in Malaysia: patient insights and implementation challenges.","authors":"Nur Hidayati Abdul Halim, Nur Azmiah Zainuddin, Farhana Aminuddin, Nurul Athirah Naserrudin, Nor Zam Azihan Mohd Hassan","doi":"10.1186/s12913-025-12544-9","DOIUrl":"10.1186/s12913-025-12544-9","url":null,"abstract":"<p><strong>Background: </strong>Cancer diagnosis imposes a significant economic burden on healthcare systems, patients, and their families particularly those from low-income households. To mitigate these challenges, Malaysia introduced the completing cancer treatment incentive (CCTI) under the PeKa B40 healthcare scheme to support cancer patients in completing their treatment. This study explores patients' experiences with the CCTI program to provide insights for refining policy interventions and enhancing the program's effectiveness in meeting the needs of its beneficiaries.</p><p><strong>Methods: </strong>This qualitative study examined the experiences of cancer patients with the CCTI program in Malaysia. Semi-structured interviews were conducted with 23 respondents, both CCTI recipients and non-applicants, from eight public hospitals. Data were anlaysed using the RE-AIM framework, focusing on the dimensions of reach, adoption, and implementation.</p><p><strong>Results: </strong>Patients' awareness of the CCTI varied, with recipients mostly informed through acquaintances, media, or healthcare providers. Non-recipients lacked awareness, with limited information provided by healthcare personnel. While the CCTI was perceived as valuable for alleviating financial burdens, particularly transportation costs, it did not appear to significantly influence treatment-seeking behaviours, as most patients expressed willingness to continue treatment even without financial aid. Implementation challenges included a burdensome application process requiring mandatory health screening, lack of clarity regarding procedures, and inadequate communication about claim approvals. Patients frequently encountered delays and confusion, exacerbated by insufficient support from healthcare providers. Additionally, many were unaware that transport incentives could be claimed for every hospital visit, further limiting the program's usefulness.</p><p><strong>Conclusions: </strong>The study highlights critical gaps in the CCTI program's design and delivery, including inadequate communication strategies, complex administrative processes, and a lack of transparency. Addressing these challenges are essential to improve program reach and ensuring equitable access to CCTI. Policymakers should prioritise streamlining application process, enhancing information dissemination, and leveraging digital tools to improve patient experiences. Future studies should assess the program's long-term sustainability and impact on treatment adherence and outcomes. The findings underscore the importance of adopting patient-centred approaches in designing financial aid programs to enhance healthcare equity and access.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"435"},"PeriodicalIF":2.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717792","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":"An analysis of factors influencing dropout in methadone maintenance treatment program in Dehong Prefecture of China based on Cox regression and decision tree modelling.","authors":"Qunbo Zhou, Renhai Tang, Yuecheng Yang, Runhua Ye, Jie Gao, Lin Li, Lifen Xiang, Song Duan, Duo Shan","doi":"10.1186/s12913-025-12538-7","DOIUrl":"10.1186/s12913-025-12538-7","url":null,"abstract":"<p><strong>Background: </strong>The high dropout rate among Methadone Maintenance Treatment (MMT) patients poses a significant challenge to drug dependence treatment programs, especially in regions with prevalent drug use and HIV transmission risks. This study aimed to analyze factors of dropout in MMT clinics over an 18-year period in Dehong Prefecture, Yunnan Province, China.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using data from China's HIV/AIDS Comprehensive Response Information Management System (CRIMS). Participants included individuals who enrolled in MMT between June 2005 and December 2023 and completed baseline surveys. Cox proportional hazards regression identified independent predictors, while decision tree modeling (CART algorithm) captured variable interactions. The decision tree employed Gini impurity minimization, a 70:30 training-test split, and pruning to prioritize factors like treatment duration and urine test results.</p><p><strong>Results: </strong>The study included 9,435 MMT participants, with a male-to-female ratio of 26:1 (9,086 males and 349 females). The median duration of treatment was 12.2 months (ranging from 2.7 to 43.9 months), with a minimum of 1 day and a maximum of 217 months. From 2005 to 2023, the cumulative dropout rate among MMT patients in Dehong Prefecture reached 89.6% (8,458/9,435), with an incidence rate of 34.75 dropouts per 100 person-years over 24,354.98 person-years of follow-up. The Cox proportional hazards regression identified that participants with occupations as farmers (AHR = 1.52, 95% CI: 1.41-1.62) or positive urine test results (AHR = 2.47, 95% CI: 2.35-2.59) exhibited significantly higher dropout risks. Protective factors included enrollment age > 35 years (AHR = 0.86), being married (AHR = 0.81), higher education levels (AHR = 0.94), good family relationships (AHR = 0.30), and methadone doses > 60 ml/day (AHR = 0.60). The decision tree model prioritized treatment duration as the root node, followed by urine test results, family relationships, education level, and methadone dosage. Patients with ≤ 12 months of treatment and positive urine tests faced the highest dropout probability (98.9%), while those with > 12 months of treatment but poor family relationships and doses ≤ 60 ml showed intermediate risks (82.3%).</p><p><strong>Conclusion: </strong>Between 2005 and 2023, the dropout rate among MMT patients in Dehong Prefecture was relatively high, driven by modifiable factors (low methadone doses, positive urine tests) and contextual hierarchies (early-phase treatment duration). By integrating Cox regression and decision trees, we advance both epidemiological risk assessment and precision intervention design. Policymakers should prioritize dose optimization and targeted monitoring for high-risk subgroups (e.g., patients ≤ 12 months with concurrent drug use) to improve retention in resource-limited settings.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"439"},"PeriodicalIF":2.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717839","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 systematic literature review on initiatives to involve children and adolescents in evaluating their hospitalization experience.","authors":"Veronica Spataro, Ilaria Corazza, Jan A Hazelzet, Manila Bonciani, Sabina De Rosis","doi":"10.1186/s12913-025-12486-2","DOIUrl":"10.1186/s12913-025-12486-2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Despite patient experience being an important topic in healthcare management, most research does not concentrate on initiatives targeted to patients experiencing vulnerabilities, for whom it is challenging to contribute to the processes of feedback collection. In healthcare, children and adolescents can be considered a group of patients experiencing vulnerability, particularly during a sensitive time such as hospitalization. The aim is to provide an overview of the research on patient experience collection initiatives used by healthcare service providers to facilitate children and adolescents' involvement in the evaluation of their hospitalisation experience. The study attempts to determine if these approaches exist, how they are structured, and what impact they have on services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This research is based on a systematic literature review. We identified 1498 articles through Scopus, ISI Web of Science, and PubMed. To guarantee transparency and replicability, we adhered to the PRISMA guidelines. The analysis focused on the main elements of the approaches used by the different providers to involve children and adolescents in the evaluation of their hospitalization experience, including the characteristics of patients targeted by the feedback collection initiatives, the methods and tools implemented by healthcare providers, the different dimensions of patient experience on which feedback is requested, the co-design of the initiative, quality and performance implications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Fifty-eight articles were included in the final review. Patient feedback was mostly collected using qualitative tools, which seem more likely to be child-friendly. Quantitative methodologies were shown to be more suitable for standardised and systematic patient experience feedback collection initiatives. The findings indicate a scarcity of innovative tools and gamified techniques, which in turn suggests new potential areas of research by combining qualitative and quantitative methods. Feedback from paediatric patients was collected regarding different aspects of the patient experience. Physical environment and pain management emerge as crucial aspects of the patient experience with hospitalisation, despite the intensive relational service. There is a germinal trend for co-design. Most of the analysed papers only discuss future and potential quality and performance implications of the patient experience feedback collection initiative, opening to questions on its actual impact on outcomes. Mostly sporadic experiences are reported, rather than systematic initiatives of feedback collection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study contributes to systematising the topic of children and adolescents' involvement in evaluating their hospitalisation experience. The findings provide insights regarding the approaches service providers can take to encourage vulnerable patients' direct participatio","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"429"},"PeriodicalIF":2.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708299","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":"IM4Equity: an implementation science meta-framework for community-engaged partnerships to advance health equity.","authors":"Lilian G Perez, James L Merle, Justin D Smith, Alex R Dopp, Amy G Huebschmann","doi":"10.1186/s12913-025-12537-8","DOIUrl":"10.1186/s12913-025-12537-8","url":null,"abstract":"<p><strong>Background: </strong>Implementation determinant frameworks identify factors that may impede or facilitate implementation of evidence-based innovations (EBI) in new contexts, including diverse community settings. For health equity initiatives, variations in which frameworks are used make synthesis and identification of shared determinants difficult, including equity constructs. Further, such frameworks are rarely informed by community partner input. We describe the development of an equity-centered meta-framework that centers community-engagement called IM4Equity (Crosswalk of 4 IMplementation Frameworks to advance health Equity) as part of the Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk (DECIPHeR) Alliance, comprised of seven research-community partnerships across the U.S.</p><p><strong>Methods: </strong>We conducted a crosswalk of determinants (domains and constructs within domains) from the Exploration, Preparation, Implementation, and Sustainment framework; Practical, Robust Implementation and Sustainability Model; updated Consolidated Framework for Implementation Research; and Health Equity Implementation Framework. We reviewed original source publications and resources to identify determinants from each framework, which informed a prototype figure. We obtained feedback on the figure with a user-centered design approach with DECIPHeR research teams and community partners, plus framework developers. We used thematic analysis to summarize the feedback and inform iterative development of supporting materials to guide community partner engagement in informing and applying IM4Equity (e.g., blank framework template, guidance for completing the template).</p><p><strong>Results: </strong>IM4Equity identifies shared and unique domains: intra- and extra-organizational contexts, characteristics of individuals involved in implementation, innovation characteristics, bridging factors, implementation process, and implementation phases. We identified examples of shared constructs for each domain and example factors that may improve health equity or maintain systems of oppression (e.g., structural racism). Feedback sessions identified two areas for improving the usability of IM4Equity, which we addressed in the final figure and supporting materials: 1) design and appropriateness (e.g., language) and 2) approach for integrating community partner perspectives.</p><p><strong>Conclusions: </strong>IM4Equity highlights key overlapping determinants across existing frameworks, which can promote shared learning across health equity initiatives. IM4Equity is one of the first meta-frameworks to promote co-creation and application of an implementation framework with community partners, which may help inform more equitable implementation measures and strategies to advance health equity.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"437"},"PeriodicalIF":2.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717788","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 renewed Development Model for Integrated Care: a systematic review and model update.","authors":"Mirella M N Minkman, Nick Zonneveld, Kirsten Hulsebos, Marloes van der Spoel, Roelof Ettema","doi":"10.1186/s12913-025-12610-2","DOIUrl":"10.1186/s12913-025-12610-2","url":null,"abstract":"<p><strong>Background: </strong>Organising integrated health services beyond domains in interorganizational networks, can be supported by conceptual models to overview the complexity. The Development Model for Integrated Care (DMIC) is a systematically developed generic model that has been applied to innovate and implement integrated care services in a large range of (international) healthcare settings. After a decade, it is important to incorporate new available literature in the model. Therefore, our aim was to update and further develop the DMIC by incorporating the current body of knowledge.</p><p><strong>Methods: </strong>A systematic literature review and subsequent stepwise systematic update of the DMIC.</p><p><strong>Results: </strong>The review of the literature resulted in 179 included studies and eventually 20 new elements for the development model, which could be positioned in the nine clusters. New elements address the importance of the social system and community of the client, proactive care during the life span, digital (care) services and ethical and value driven collaboration in interorganizational networks that cross domains. The added elements for integrated care build further on the nine thematic clusters and the model as a whole, expanded with new accents.</p><p><strong>Conclusion: </strong>The renewed model emphasizes the connectedness of care within a larger eco-system approach and inter-organizational networks. The model captures current knowledge which can be supportive as a generic conceptual model to develop, implement or innovate integrated services towards health value in societies. Further, it can serve for healthcare services research purposes to reflect on an monitor developments in integrated care settings over time on multiple levels.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"434"},"PeriodicalIF":2.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717902","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":"Putting people at the center: methods for patient journey mapping of viral hepatitis services across two LMICs in the Asia Pacific.","authors":"Bethany Holt, Jhaki Mendoza, Hoang Nguyen, Duong Doan, Thu Huyen Nguyen, Timothy Bill Mercado, Lam Dam Duy, Martin Fernandez, Manu Gaspar, Geohari Hamoy, Bao Ngoc Le, Boon-Leong Neo, Vy Nguyen, Thuy Pham, Janus Ong, Todd M Pollack, Jae-Ann Sumalo, Pham Thai, David B Duong","doi":"10.1186/s12913-025-12543-w","DOIUrl":"10.1186/s12913-025-12543-w","url":null,"abstract":"<p><strong>Background: </strong>To ensure that health services are high-quality, trusted and used by the population, their design and improvement should start from the perspective of what matters to people. Patient journey mapping (PJM) is one research method that centers the experiences of individuals living with health conditions and follows their pathways through care and recovery. This paper describes a novel, qualitative PJM methodology used in Vietnam and the Philippines to inform the co-design of a people-centered viral hepatitis screening, care and treatment pathway for individuals living with chronic hepatitis, which is a significant public health concern in the Asia-Pacific region.</p><p><strong>Methods: </strong>Data collection involved in-depth interviews with a purposive sample of 63 people living with hepatitis (demand-side) and focus group discussions with healthcare providers working in the same geographical areas (supply-side). Rapid deductive qualitative analysis was used to identify typical journeys, and related barriers and enablers. The methodology was implemented over 8 weeks, adapting the Consolidated Criteria for Reporting Qualitative Research (COREQ).</p><p><strong>Results: </strong>This paper demonstrates how a PJM methodology that incorporates patient and HCP perspectives can be feasibly implemented in two LMIC contexts, while fulfilling many of the criteria identified by the COREQ guidelines. Sharing such methods and associated instruments may help to enable broader uptake and application in other LMIC settings, providing health systems practitioners with a critical tool to identify and overcome barriers in and promote the delivery of people-centered health services globally.</p><p><strong>Conclusion: </strong>Despite limited uptake, especially in resource-limited contexts and at the primary healthcare level, PJM is a novel research method with the potential to make promising contributions to people-centered health service design.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"427"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699509","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 community-focused cervical and breast cancer screening program using a sustainable funding model in a training center in Ghana.","authors":"Kofi Effah, Ethel Tekpor, Comfort Mawusi Wormenor, Gifty Enyonam Abiti, Theodore Wordui, David Akanvarewon Dan-Braimah, Pikus Enu-Kwasi, Gifty Belinda Klutsey, Edna Sesenu, Elagbe Goka, George Griffith Legbedze, Seyram Kemawor, Stephen Danyo, Nana Owusu Mensah Essel","doi":"10.1186/s12913-025-12466-6","DOIUrl":"10.1186/s12913-025-12466-6","url":null,"abstract":"<p><strong>Background: </strong>While Ghana prepares to roll out a nationwide breast and cervical (pre)cancer screening policy, it is necessary to continuously document high-impact and scalable models. Over the years, the Cervical Cancer Prevention and Training Centre (CCPTC), Battor, has utilized a sustainable funding model in which each trainee pays for 15 women to be screened with visual inspection with acetic acid. This paper details the framework of community-focused trainer-led coordinated cervical and breast screening outreaches carried out under this model. The paper further reports the outcomes of screening over a 5-year period and discusses the advantages and shortcomings of the model in an effort to make recommendations for the development and scale-up of combined cervical and breast screening in a largely opportunistic setting.</p><p><strong>Methods: </strong>This descriptive retrospective cross-sectional study investigated women who underwent cervical precancer screening using visual inspection with acetic acid or mobile colposcopy and/or high-risk human papillomavirus (hr-HPV) DNA testing between September 2017 and July 2022 (n = 2,273) and clinical breast examination between June 2021 and March 2023 (n = 622) by trainees of the CCPTC on outreaches conducted primarily to solidify their practical skills. For women screened using HPV DNA testing and visual inspection, respectively, the study explored factors associated with HPV infection or visual inspection 'positivity' using nominal logistic regression.</p><p><strong>Results: </strong>The overall prevalence of hr-HPV infection was 14.3% (95% CI, 10.0-19.6) among women with valid results for hr-HPV DNA testing, while the overall visual inspection 'positivity' rate was 2.8% (95% CI, 2.2-3.6). After controlling for age, earning an income was the only factor associated with hr-HPV infection (aOR = 3.00; 95% CI, 1.35 - 6.64; p-value = 0.007). Factors associated with visual inspection 'positivity' after adjusting for age were: number of births (aOR = 0.71; 95% CI, 0.52 - 0.97; p-value = 0.029), number of lifetime pregnancies (aOR = 0.79; 95% CI, 0.67 - 0.93; p-value = 0.004), being single (aOR = 2.42; 95% CI, 1.19 - 4.90; p-value = 0.014), and earning an income (aOR = 0.44; 95% CI, 0.26 - 0.74; p-value = 0.002). Breast examination showed clinically significant masses in 20 women (3.2%), lymphadenopathy in 13 (2.1%), and nipple discharge in 37 women (6.0%) and only n = 3/67 women (4.5%) requiring referral followed up for further management.</p><p><strong>Conclusion: </strong>While the outreach approach adopted by the CCPTC has myriad benefits, further evidence-based studies and structured program evaluations are needed to assess if this approach can be adopted on a large scale, especially without the backing of a training institution with the needed resources and capacity to investigate and manage screen positives.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"428"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708296","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":"Functionality and performance of COVID-19 taskforces in response to the pandemic in Uganda.","authors":"David Musoke, Micheal Jonga, Gloria Kisakye Ndagire, Benon Musasizi, Amanuel Gidebo, Asrat Tolossa, Maya Thomas, Peter Waiswa, Richard Rumsey","doi":"10.1186/s12913-025-12585-0","DOIUrl":"10.1186/s12913-025-12585-0","url":null,"abstract":"<p><strong>Background: </strong>In response to increasing COVID-19 community transmission in 2020, the Government of Uganda established the National Community Engagement Strategy. As part of this strategy, COVID-19 taskforces were recommended in response to the pandemic. However, the extent to which these taskforces supported their communities during the pandemic is not clear. This study assessed the functionality, performance and contribution of the COVID-19 taskforces to response to the pandemic in Uganda.</p><p><strong>Methods: </strong>A qualitative study was carried out that also involved functionality assessment of COVID-19 taskforces in 5 districts of Amuria, Karenga, Kamwenge, Bugiri and Pader. Twenty key informant interviews were conducted at national, district and community levels to gain insights on the COVID-19 taskforces. The data were analyzed by thematic analysis using the inductive approach with the support of NVivo version 12 pro (QSR International).</p><p><strong>Results: </strong>COVID-19 taskforces were created at national, district and village levels. Composition, surveillance and communication functions of COVID-19 village taskforce were best scored. A key feature of the COVID-19 taskforces was their multi-disciplinary and inter-sectoral composition. Coordination between the different taskforce levels particularly village, sub-county and district had gaps in communication and sharing of information. Parish level COVID-19 taskforces were either not functional or nonexistent. COVID-19 taskforces played different roles in response to the pandemic. At district level, the taskforces performed a more coordination role, mainly supporting planning and resource mobilization. However, the village taskforces were primarily engaged in interpersonal communication, awareness creation, and community mobilization for interventions including observing the standard operating procedures for controlling the pandemic.</p><p><strong>Conclusion: </strong>The COVID-19 taskforces at decentralized government levels supported the response to the pandemic. These taskforces could be strengthened and utilized during response to future outbreaks across the country.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"424"},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699488","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}