Bmc Health Serv Res
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Bmc Health Serv Res · Sep 2018
Multicenter StudyPhysiotherapy for injured workers in Canada: are insurers' and clinics' policies threatening good quality and equity of care? Results of a qualitative study.
In recent years, significant efforts have been made to improve the provision of care for compensated injured workers internationally. However, despite increasing efforts at implementing best practices in this field, some studies show that policies overseeing the organisation of care for injured workers can have perverse influences on healthcare providers' practices and can prevent workers from receiving the best care possible. The influence of these policies on physiotherapists' practices has yet to be investigated. Our objectives were thus to explore the influence of 1) workers' compensation boards' and 2) physiotherapy clinics' policies on the care physiotherapists provide to workers with musculoskeletal injuries in three large Canadian provinces. ⋯ In Canada, workers' compensation play a significant role in financing physiotherapy care for people injured at work. Despite the best intentions in promoting evidence-based guidelines and procedures regarding rehabilitation care for injured workers, complex policy factors currently limit the application of these recommendations in practice. Research that targets these policies could contribute to significant changes in clinical settings.
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Bmc Health Serv Res · Jul 2018
Multicenter StudyAssessment of facility readiness for implementing the WHO/UNICEF standards for improving quality of maternal and newborn care in health facilities - experiences from UNICEF's implementation in three countries of South Asia and sub-Saharan Africa.
There is a global drive to promote facility deliveries but unless coupled with concurrent improvement in care quality, it might not translate into mortality reduction for mothers and babies. The World Health Organization published the new "Standards for improving quality of care for mothers and newborns in health facilities" but these have not been tested in low- and middle-income settings. UNICEF and its partners are taking the advantage provided by the Mother and Baby Friendly Hospital Initiative in Bangladesh, Ghana and Tanzania to test these standards to inform country adaptation. This manuscript presents a framework used for assessment of facility quality of care to inform the effect of quality improvement interventions. ⋯ This strategy and framework provides a very useful model for supporting country implementation of the new WHO standards. It will serve as a template around which countries can build quality of care assessment strategies and metrics to inform their health systems on the effect of QI interventions on care processes and outcomes.
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Bmc Health Serv Res · May 2018
Multicenter StudyPolicies and clinical practices relating to the management of gestational diabetes mellitus in the public health sector, South Africa - a qualitative study.
Women with a prior gestational diabetes have an increased lifetime risk of developing type 2 diabetes. Although post-partum follow-up for GDM women is essential to prevent progression to type 2 diabetes, it is poorly attended. The need for health systems interventions to support postpartum follow-up for GDM women is evident, but there is little knowledge of actual current practice. The aim of this study was to explore current policies and clinical practices relating to antenatal and post-natal care for women with GDM in South Africa, as well as health sector stakeholders' perspectives on the barriers to -- and opportunities for -- delivering an integrated mother - baby health service that extends beyond the first week post-partum, to the infant's first year of life. ⋯ Although there is alignment between international guidelines, local policy and reported clinical practice in the management of GDM, there is a gap in continuation of care in the postpartum period. Health systems interventions that support and facilitate active follow-up for women with prior GDM are needed if high rates of progression to type 2 diabetes are to be avoided.
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Bmc Health Serv Res · Apr 2018
Multicenter StudyManagers' experience of success criteria and barriers to implementing mobile radiography services in nursing homes in Norway: a qualitative study.
In order to meet the future challenges posed by ageing populations, new technology, telemedicine and a more personalized healthcare system are needed. Earlier research has shown mobile radiography services to be highly beneficial for nursing home residents in addition to being cost-effective. Despite the benefits, mobile radiography services are uncommon in Europe and Norway. The purpose of this study was to explore success criteria and barriers in the process of implementing mobile radiography services, from the point of view of the hospital and municipal managers. ⋯ The managers experienced financial, structural and procedural barriers. The main success criteria in the process were external funding, and the support and engagement from the individuals in the organizations. This commitment was mainly facilitated by the intuitive appeal of mobile radiography. Changes in healthcare management and in the financial system might facilitate services across healthcare levels. In addition, compatible information systems across healthcare levels are needed in order to facilitate the use of new technology and mobile services.
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Bmc Health Serv Res · Apr 2018
Multicenter StudyPharmacists in general practice: a qualitative interview case study of stakeholders' experiences in a West London GP federation.
Increased patient demand for healthcare services coupled with a shortage of general practitioners necessitates changes in professional roles and service delivery. In 2016, NHS England began a 3-year- pilot study of pharmacists in general practice, however, this is not an entirely new initiative. There is limited, current, evidence-based, UK research to inform the pilot so studies of pre-existing services must suffice until findings from a formal national evaluation are available. ⋯ Recommendations are made for the development of clear role definitions, identification of training needs, dedication of time for team building, production of educational materials for practice staff members and patients, and provision of on-site, full-time pharmacy services. Future work should focus on evaluation of various models of employing pharmacy teams in general practice; integration of pharmacists and pharmacy technicians into multidisciplinary general practice teams; relationships between local community pharmacy and general practice personnel; and patients' service and information needs. A formal national evaluation of the pilot scheme is overdue.