Healthcare Provider Perspective Research Articles

Deprescribing of proton pump inhibitors in older patients: A cost-effectiveness analysis.

Over-prescribing of proton-pump inhibitors (PPIs) is widely observed in older patients. Clinical findings have showed that deprescribing service significantly decreased inappropriate PPIs utilization. We aimed to examine the cost-effectiveness of PPI deprescribing service from the perspective of Hong Kong public healthcare provider. A decision-analytic model was constructed to examine the clinical and economic outcomes of PPI deprescribing service (deprescribing group) and usual care (UC group) in a hypothetical cohort of older PPI-users aged ≥65 years in the ambulatory care setting. The model inputs were retrieved from literature and public data. The model time-frame was one-year. Base-case analysis and sensitivity analysis were performed. Primary model outcomes were direct medical cost and quality-adjusted life-years (QALYs) loss. In base-case analysis, the deprescribing service (versus UC) reduced total direct medical cost by USD235 and saved 0.0249 QALY per PPI user evaluated. The base-case results were robust to variation of all model inputs in one-way sensitivity analysis. In probabilistic sensitivity analysis, the deprescribing group was accepted as cost-effective (versus the UC group) in 100% of the 10,000 Monte Carlo simulations. In conclusion, the PPI deprescribing service saved QALYs and reduced total direct medical cost in older PPIs users, and showed a high probability to be accepted as the cost-effective option from the perspective of public healthcare provider in Hong Kong.

Why do new-borns die? Perspectives of community members and health care providers in the Lawra municipality of the Upper West Region, Ghana

BackgroundNeonatal deaths contribute significantly to under-five mortality and serve as a crucial indicator of a country’s socioeconomic development, quality of life, and health status. These deaths occur both at home and in health facilities. Therefore, the perspectives of community members and healthcare providers are essential in defining neonatal survival.AimThis study explored the perceived causes of neonatal deaths among healthcare professionals and community members at the Lawra Municipality in the Upper West Region, Ghana.MethodThis study employed a qualitative descriptive approach. A purposive sample of 30 participants including 18 community members and 12 healthcare providers, was selected. Data were gathered using Focus Group Discussion (FGD), transcribed verbatim, coded and analysed using thematic-content analysis.ResultsThree themes were constructed to describe the factors leading to newborn deaths both at health facilities and in the community. These factors included: (1) personal factors related to newborns, mothers/families and health staff; (2) physical factors related to hospital facilities and equipment; and (3) logistical factors related to transport, referral and presentation delays.ConclusionThe study identified differences in perspectives between healthcare providers and community members, which can affect interventions in neonatal care. Health authorities are encouraged to develop a shared vision to engage communities by addressing geographic-specific factors causing neonatal deaths. This approach can help in understanding how collective actions can contribute to reducing neonatal deaths.

A Nationwide Physical Activity Intervention for 654,500 Adults in Singapore: Cost-Utility Analysis.

Increasing physical inactivity is a primary risk factor for diabetes and hypertension, contributing to rising health care expenditure and productivity losses. As Singapore's aging population grows, there is an increased disease burden on Singapore's health systems. Large-scale physical activity interventions could potentially reduce the disease burden but face challenges with the uncertainty of long-term health impact and high implementation costs, hindering their adoption. We examined the cost-effectiveness of the Singapore National Steps Challenge (NSC), an annual nationwide mobile health (mHealth) intervention to increase physical activity, from both the health care provider perspective, which only considers the direct costs, and the societal perspective, which considers both the direct and indirect costs. We used a Markov model to assess the long-term impact of increased physical activity from the NSC on adults aged 17 years and older. A Monte Carlo simulation with 1000 samples was conducted to compare two situations: the NSC conducted yearly for 10 years against a no-intervention situation with no NSC. The model projected inpatient and outpatient costs and mortality arising from diabetes and hypertension, as well as their complications. Health outcomes were expressed in terms of the quality-adjusted life-years (QALYs) gained. All future costs and QALYs were discounted at 3% per annum. Sensitivity analyses were done to test the robustness of our model results. We estimated that conducting the NSC yearly for 10 years with a mean cohort size of 654,500 participants was projected to prevent 6200 diabetes cases (95% credible interval 3700 to 9100), 10,500 hypertension cases (95% credible interval 6550 to 15,200), and 4930 deaths (95% credible interval 3260 to 6930). This led to a reduction in health care costs of SGD (Singapore dollar) 448 million (95% credible interval SGD 132 million to SGD 1.09 billion; SGD 1=US $0.73 for the year 2019). There would be 78,800 (95% credible interval 55,700 to 102,000) QALYs gained. Using a willingness-to-pay threshold of SGD 10,000 per QALY gained, the NSC would be cost-saving. When indirect costs were included, the NSC was estimated to reduce societal costs by SGD 1.41 billion (95% credible interval SGD 353 million to SGD 3.80 billion). The model was most sensitive to changes in the inpatient cost of treatment for diabetes complications, time horizon, and program compliance. In this modeling study, increasing physical activity by conducting a yearly nationwide physical activity intervention was cost-saving, preventing diabetes and hypertension and reducing mortality from these diseases. Our results provide important information for decision-making in countries that may consider introducing similar large-scale physical activity programs.

Analysis of direct costs of trans anal saline irrigation to pharmacological measures for bowel dysfunction

BackgroundManagement of bowel dysfunction in children is expensive. Pharmacological measures (PM) are the most commonly used treatment option which has shown to have varying outcomes. The next option after failed PM involves invasive surgical procedures like the Malone Antegrade Continence Enema (MACE). Trans Anal Irrigation (TAI) is an efficacious treatment modality between failed medical therapy and invasive surgeries. As no cost analysis of TAI in children has been conducted, this study evaluated the direct costs involved with TAI in comparison to PM from the health care provider perspective. MethodsChildren >4 years with persistent bowel dysfunction despite PM, were divided into three groups: Constipation, Pseudoincontinence and Incontinence group. The costs of existing PM and number of diapers used daily were noted for each patient. In all patients, PM was stopped and TAI was initiated. Improvement in symptoms and reduction in daily diaper usage over six months was recorded. The direct costs of TAI versus the costs that would be involved had PM been continued, were compared using paired ‘t’ test. Results34 patients (20 male, 14 female) with an average age of 76.7 months were divided into three groups: Constipation:12, Pseudoincontinence:15 and Incontinence:7. In all groups, there was a significant reduction in direct costs with TAI in comparison to PM. ConclusionIn children with bowel dysfunction, TAI is an effective and significantly economical treatment modality in comparison to PM and should be considered early on in the management therapy.

Barriers and facilitators for the adoption of peritoneal dialysis: protocol for a systematic review of qualitative studies

IntroductionPeritoneal dialysis (PD) is an effective home-based treatment for end-stage kidney disease (ESKD) that offers several advantages over in-centre haemodialysis, including better quality of life, increased autonomy and lower costs....

MA04.09 An International Qualitative Study of Healthcare Provider Perspectives of the Psychosocial Impacts and Barriers to Lung Cancer Screening

MA04.09 An International Qualitative Study of Healthcare Provider Perspectives of the Psychosocial Impacts and Barriers to Lung Cancer Screening

Cost-utility analysis and drug pricing of once-weekly insulin icodec versus once-daily insulin degludec for type 2 diabetes patients treated with basal insulin in China.

Insulin icodec is a first once-weekly administration basal insulin analogue for type 2 diabetes. This study aimed to investigate the price range of icodec for type 2 diabetes in the Chinese market, taking insulin degludec as reference. Long-term health outcomes and costs for icodec and degludec were simulated using the United Kingdom Prospective Diabetes Study Outcomes Model (version 2.1) over 40 years from the Chinese healthcare provider's perspective. The efficacy and safety data were obtained from the ONWARDS 2 trial (Switching to once-weekly insulin icodec versus once-daily insulin degludec in individuals with basal insulin-treated type 2 diabetes (ONWARDS 2): a phase 3a, randomised, open label, multicentre, treat-to-target trial). Cost-utility analysis and a binary search were used to investigate the price range of icodec. Sensitivity analyses were performed to verify the robustness of the base-case analysis results. After a 40-year simulation, the quality-adjusted life years (QALY) of icodec and degludec were 10.32 and 10.28 years, respectively. At the initial assumption of the same annual costs of icodec and degludec of $455.40, icodec was the dominant therapy compared with degludec, with higher QALYs and lower total cost. After the binary search, we observed that the annual cost range of icodec was $625.17-$855.25. This cost range was finally adjusted to be $597.66-$736.34 using one-way sensitivity analysis and confirmed using probabilistic sensitivity analysis and scenario analysis. The scenario analysis revealed that the annual cost range of icodec could be $506.70-$736.34 if the price of degludec decreased by 20% in the future. Insulin icodec appears to be more cost effective than degludec if the annual cost of icodec ranges from $597.66 to $736.34 for patients with type 2 diabetes in China.

Patient and Healthcare Provider Perspectives on the Pathway to Diagnosis of Seborrheic Dermatitis in the United States.

Seborrheic dermatitis (SD) is a common, chronic inflammatory skin condition associated with significant impact on quality of life, yet its etiology and pathophysiology are not well understood. With significant impact on patients' quality of life, understanding the diagnostic pathway from the perspectives of patient and healthcare providers (HCPs) is crucial. An online survey was developed and administered in conjunction with the Harris Poll to gain insight into patient and HCP perspectives about SD diagnosis and management from December 2021 to January 2022. Most patients were unaware of SD before their diagnosis (71%) and experienced difficulty finding information online (56%). Patients delayed seeking medical attention for SD by an average of 3.6years, with most patients feeling their symptoms did not require medical attention (63%), a perception that HCPs correctly anticipated. Additionally, most patients (58%) reported embarrassment discussing their SD symptoms with HCPs, a factor HCPs underestimated. HCPs also underestimated the percentage of patients self-reporting moderate-severity SD. Patients preferred dermatology HCPs for SD treatment (79%), and reported visiting an average of 2.3different HCPs, with 75% of patients seeing more than one provider. These insights highlight the complexities in the diagnostic and management pathways of SD and underscore the need for a more nuanced understanding and approach in addressing the condition. Infographic available for this article. INFOGRAPHIC.

Care-seeking pathways and treatment practices for snakebite in Odisha, India

PurposeSnakebites represent a pressing global public health concern, with India shouldering a disproportionate burden and often dubbed the "snakebite capital." Traditional and spiritual healing methods prevail in India, yet their efficacy and potential adverse health consequences warrant investigation. This study seeks to elucidate the perspectives of healthcare providers and caretakers regarding snakebite treatment practices, with a specific emphasis on traditional healing modalities.MethodsAn exploratory study was conducted among ten healthcare providers–five traditional and five modern treatment providers, two snake trappers/catchers and 120 snakebite victims or their caretakers across three districts of Odisha, India. Data were collected through in-depth interviews and analysed using content analysis.ResultsThe analysis revealed five main categories: various snakebite treatment practices, care-seeking pathways of victims, perspectives of patients and caretakers on treatment, traditional healers’ views on modern treatment, and allopathic doctors’ views on traditional treatment. Treatment practices observed included allopathic treatment, cold treatment, spiritual healing practices at temples, brass plate treatment, mantra enchanting, herbal treatment, and self-medication. Reasons for treatment delay included strong community beliefs in traditional healing, lack of control over irrational treatment by traditional healers, suboptimal care at primary and secondary healthcare facilities, and poor community literacy on snakebites.ConclusionsThe study emphasizes the need for improved snakebite preparedness strategies, community literacy, active involvement in prevention programs, and strong political commitment to control irrational treatment practices.

Perspectives of health care providers on obstetric point-of-care ultrasound in lower-level health facilities in Kenya

BackgroundUltrasound technology has become integral in antenatal care for its diagnostic effectiveness and potential to improve maternal and neonatal outcomes. Despite its proven benefits, challenges persist in its widespread adoption, particularly in low-resource settings like Kenya. Aim: The aim of this study was to explore the perspectives of healthcare providers regarding the integration of obstetric point-of-care ultrasound into routine maternal services in low-level facilities Kenya. MethodsUsing a descriptive qualitative study embedded in a large scale implementation study 76 healthcare providers who had undergone obstetric point-ofcare ultrasound training and were providing maternal services were purposively sampled from healthcare facilities across eight counties. Data was collected using structured audiotaped interviews, which were transcribed, and analyzed using thematic analysis. ResultsFive main themes with several subthemes emerged from the analysis: (1) Clinical Decision-Making (2) Quality of Services, (3) Training, (4)Technology Issues, and (5) Sustainability. DiscussionFindings from this study suggest that use of obstetric Point-of-Care Ultrasound in resource-limited primary care settings, can enhance clinical decision making and influence patient management, ultimately resulting in significant health outcomes. ConclusionEquipping health care providers with skills to conduct obstetric point of care ultrasound can lead to better-informed clinical decisions and ultimately contribute to improved health outcomes in underserved populations.

An exploratory cross-sectional study of awareness and barriers to adoption of telemedicine services among patients in Bangladesh

Objectives Telemedicine has emerged as a promising solution to address healthcare challenges, particularly in resource-constrained settings such as Bangladesh. Understanding patient perspectives on telemedicine adoption is vital for improving healthcare delivery in such contexts. Material and Methods This cross-sectional study surveyed 120 patients in Bangladesh to explore awareness, acceptance, and barriers to telemedicine adoption. Data were collected using structured surveys administered face-to-face in 2024. Descriptive statistical techniques were employed for data analysis. Results Most respondents demonstrated awareness of telemedicine services, primarily learning about them through friends or online sources. They viewed telemedicine positively, especially for follow-up appointments and mental health services, expressing satisfaction with the services used. However, concerns regarding its effectiveness for emergency consultations were noted. Barriers to adoption included limited internet connectivity, trust/security issues, lack of awareness, regulatory challenges, and cultural resistance. Conclusion Despite positive attitudes towards telemedicine, challenges such as internet connectivity, trust concerns, and cultural barriers persist in Bangladesh. Addressing these challenges is essential for the successful implementation and widespread adoption of telemedicine, ultimately improving access to quality healthcare services. Future research should explore the perspectives of healthcare providers and policymakers and employ longitudinal and qualitative methods to gain deeper insights.

Economic effects of next-generation sequencing diagnostics in unspecific sepsis patients - a budget impact analysis from the healthcare providers' perspective in Germany.

Next-generation sequencing (NGS) tools have clinical advantages over blood culture but are more expensive. This study assesses the budget impact and break-even point of NGS testing costs from a healthcare provider's perspective in Germany. The budget impact was calculated based on aggregated data of German post-operative surgery cases. Simulated cost savings were calculated based on a simulated reduction in hospital length of stay (LOS) of four or eight days with a positivity rate of 71% and compared to the costs of one (scenario A) or two tests (scenario B) per case. Furthermore, the break-even point of the cost of two tests compared to saved costs through shortened LOS was conducted. For 9,450 cases, an average budget impact for scenario A and scenario B of €1,290.41 [95% CI €1,119.64 - €1,461.19] and - €208.59 [95% CI - €379.36 - - €37.81] was identified for gastrointestinal and kidney surgery cases, and €1,355.58 [95% CI €1,049.62 - €1,661.55] and €18.72 [95% CI - €324.69 - €287.24] for vascular artery surgery cases, respectively. The break-even analysis showed that using two tests per case could achieve a minimum positive contribution margin with an average of 1.9 tests per case across the study population. The results revealed a positive budget impact for one NGS test and a slightly negative budget impact for two NGS tests per case. Findings suggest that largest cost savings are generated for more severe cases and are highly dependent on the patient population.

Experiences, acceptability and barriers to calcium supplementation during pregnancy in Dar es Salaam, Tanzania.

Calcium supplementation in pregnancy is recommended in contexts with low dietary calcium intake to reduce the risk of pre-eclampsia and its complications. The World Health Organisation suggested high-dose calcium supplementation (1500-2000 mg/day), divided into three doses and taken at different times from daily iron-folic supplements. We conducted a mixed methods evaluation study to assess experiences, acceptability and barriers to high-dose calcium supplementation from the perspectives of pregnant women and antenatal health care providers at two public health facilities in Dar es Salaam, Tanzania. Descriptive statistics and thematic analysis were used to characterise acceptability, barriers and overall experiences of using high-dose calcium supplementation. Pregnant women in the cohort were aged 19-41 years, with 32.4% being primiparous. The proportion of pregnant women who liked calcium supplements 'a lot' decreased from 50.2% at the first visit to 31.8% at the last antenatal follow-up visit. Adherence was 71.3% (interquartile range: 50.5%, 89.3%), with only 24.0% of the participants taking 90% or more of the required supplements. Although participants expressed positive attitudes towards using calcium supplements, they also voiced concerns about the large size, side effects, the potential to forget and the burden of taking calcium supplements three times per day. Antenatal health care providers also affirmed the high burden of taking calcium supplements in addition to iron-folic acid supplements. Participants expressed the acceptability of using calcium supplements during pregnancy, but adherence to three doses per day posed challenges to pregnant women. Reducing the number of calcium supplement doses per day may improve adherence.

Comparative effectiveness and cost‐effectiveness of endoscopic nasopharyngectomy versus intensity‐modulated radiotherapy in the treatment of recurrent nasopharyngeal carcinoma: A microsimulation analysis

AbstractBackgroundNasopharyngeal carcinoma (NPC) is a significant health concern in southern China, like Guangdong and Hong Kong. This study aims to predict the effectiveness and cost‐effectiveness of two prevalent NPC treatments, intensity‐modulated radiotherapy (IMRT) and endoscopic nasopharyngectomy (ENPG).MethodsA microsimulation model was developed to project the long‐term outcomes of IMRT and ENPG, simulating 5000 patients with hypothetical locally recurrent NPC for each treatment option. The tumors of patients confined to the nasopharyngeal cavity, the post‐naris or nasal septum, the superficial parapharyngeal space, or the base wall of the sphenoid sinus. Analyses were performed from the healthcare system perspectives of Mainland China and the healthcare provider perspective of Hong Kong, with input parameters sourced from the existing literature and databases. The robustness of findings was evaluated through one‐way and probabilistic sensitivity analyses.ResultsFor DFS, ENPG showed a 29% reduction in risk with an HR of 0.71 (95% CI: 0.64–0.77) compared to IMRT. ENPG demonstrated a significant survival benefit in OS with an HR of 0.59 (95% CI: 0.54–0.65), equating to a 41% reduction in mortality risk. In Hong Kong, IMRT and ENPG yielded QALY gains of 4.59 and 6.29, respectively, with ENPG exhibiting an incremental cost‐effectiveness ratio (ICUR) of USD 13 057 per QALY. For Mainland China, ENPG denominated the IMRT and the ICUR was USD −1450 QALY. Probabilistic sensitivity analysis showed a 100% probability of ENPG being cost‐effective at the willingness‐to‐pay thresholds of USD 130 490 per QALY in Hong Kong and USD 12 741 per QALY in Mainland China.ConclusionThe analysis confirms that ENPG is more effective and cost‐effective than IMRT for treating recurrent NPC in both Hong Kong and Mainland China.

Igniting Awareness: Assessing Healthcare Providers' Understanding of Firefighter Cancer Risks

Firefighters are at increased risk for skin cancer from exposure to fireground carcinogens, UV radiation, and other occupational hazards. Despite known risk factors, agencies such as the US Preventive Services Task Force (USPSTF) do not include recommendations for routine skin cancer screenings in their general guidelines. Moreover, limited provider understanding of the unique health challenges firefighters encounter has resulted in a lack of awareness in the healthcare community regarding these increased skin cancer threats. This raises concern as providers are crucial in conducting skin cancer screenings and advocating for preventive measures for patients, especially firefighters. To better understand healthcare provider perspectives, the San Antonio Fire Department (SAFD) administered a questionnaire assessing healthcare providers’ knowledge of firefighter cancer, including rates, risks, and policies, to healthcare providers attending the second annual SAFD “Firefighter Cancer Prevention and Wellness Fair” in January and February 2024, sharing de-identified results with the research team. The results indicate a majority of healthcare providers have limited knowledge about skin cancer in firefighters and are unaware of the major risks affecting members of this occupation. Approximately 70 healthcare providers participated in the questionnaire; of those, 4% passed the basic firefighter cancer knowledge quiz (>70% correct answers) and 18% scored higher than 50%. The mean score was 34%. While the SAFD skin cancer screenings revealed a smoldering knowledge gap among providers in understanding firefighter cancer risk, this study underscores the necessity of educating more healthcare professionals about the men and women who dedicate their lives to keeping ours safe.

Exploring Communication Needs and Challenges in the Intensive Care Unit: A Survey Study From Providers' and Patients' Perspectives.

Effective communication between nonspeaking patients and providers is critical for the quality of care in intensive care units (ICUs). This study aims to evaluate perspectives of health care providers and nonspeaking patients on effective communication and communication barriers in the ICU. Qualitative and quantitative survey methodologies were employed to evaluate providers' and patients' perspectives on effective communication. Rating scales were utilized to measure patients' frustration levels and communication effectiveness. Open-ended questions were employed to reflect on barriers to communication in the ICU, instances of ineffective communication, and recommendations for enhancing effective communication. The results of the study suggest that nonspeaking patients experienced high levels of frustration due to ineffective communication. However, the data reveal that access to appropriate augmentative and alternative communication (AAC) strategies and materials could help mitigate patients' frustration. Providers mainly communicated via asking yes/no questions, which largely limited the information patients conveyed, leading to frequent communication breakdowns. Providers expressed a desire to participate in training programs to utilize appropriate AAC strategies and promote effective communication. This study provides preliminary survey results on perspectives of patients and providers on effective communication in the ICU. Both providers and patients reported experiencing challenges and frustration during their communication, due to barriers such as providers' insufficient training experience and lack of access to AAC materials. Skill training is warranted to promote effective patient-provider communication in intensive care settings. https://doi.org/10.23641/asha.26339623.

Exploring medication self-management in polypharmacy: a qualitative systematic review of patients and healthcare providers perspectives.

Purpose: Polypharmacy presents many challenges to patient medication self-management. This study aims to explore the self-management processes of medication in polypharmacy from the perspectives of both patients and healthcare providers, which can help identify barriers and facilitators to effective management. Methods: A systematic review of qualitative studies was performed by searching seven databases: PubMed, Web of Science, Cochrane Library, Embase, CINAHL, PsycINFO, and MEDLINE, from their establishment until August 2024. The Critical Appraisal Skills Programme (CASP) tool was employed to evaluate the quality of the studies included. The extracted data were then analysed thematically and integrated into The Taxonomy of Everyday Self-management Strategies (TEDSS) framework. Results: A total of 16 studies were included, involving 403 patients and 119 healthcare providers. Patient management measures were mapped into TEDSS framework, including categories such as medical management, support-oriented domains, and emotional and role management. Conclusion: Enhancing patients' proactive health awareness, improving medication literacy, balancing lifestyle adjustments with medication therapy, dynamically reviewing and optimizing medications, strengthening patients' social support networks, and helping patients integrate medication management into their daily life are the key elements that can effectively assist patients in self-managing their medications. Future interventions to improve patient medication self-management ability should be designed for these issues. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024524742.

REPRODUCTIVE HEALTH IN TRANS AND GENDER DIVERSE PATIENTS: Mind the gap: a nationwide audit of LGBTQ+ inclusion in fertility care providers in the United Kingdom.

We describe a first-of-its-kind audit of LGBTQ+ inclusivity in fertility care providers across the United Kingdom. Despite efforts being made to improve LGBTQ+ inclusion in fertility care, our results paint a picture of widespread gaps in clinical and cultural expertise alongside significant barriers to LGBTQ+ inclusion. LGBTQ+ patients comprise one of the fastest-growing user demographics in fertility care, yet they remain under-represented in fertility research, practice, and discourse. Existing studies have revealed significant systemic barriers, including cisheteronormativity, discrimination, and gaps in clinical expertise. In this article, we present a checklist of measures that clinics can take to improve LGBTQ+ inclusion in fertility care, co-created with members of the LGBTQ+ community. This checklist focuses on three key areas: cultural competence, clinical considerations, and online presence. The cultural competence criteria encompass inclusive communication practices, a broad understanding of LGBTQ+ healthcare needs, and knowledge of treatment options suitable for LGBTQ+ individuals. Clinical considerations include awareness of alternative examination and gamete collection techniques for transgender and gender diverse patients, the existence of specific clinical pathways for LGBTQ+ patients, and sensitivity to the psychological aspects of fertility care unique to this demographic. The online presence criteria evaluate provider websites for the use of inclusive language and the availability of LGBTQ+-relevant information. The checklist was used as the foundation for an audit of fertility care providers across the UK in early 2024. Our audit identified a widespread lack of LGBTQ+ inclusion, particularly for transgender and gender diverse patients, highlighting deficiencies in clinical knowledge and cultural competence. Our work calls attention to the need for further efforts to understand the barriers to inclusive and competent LGBTQ+ fertility care from both healthcare provider and patient perspectives.

What does ‘safe care’ mean in the context of community-based mental health services? A qualitative exploration of the perspectives of service users, carers, and healthcare providers in England

BackgroundHaving traditionally received limited attention in empirical research and safety improvement agendas, issues of patient safety in mental healthcare increasingly feature in healthcare quality improvement discourses. Dominant approaches to safety stem from narrow clinical risk management perspectives, yet existing evidence points to the limitations of this characterisation. Although mental healthcare is increasingly delivered in community-based settings, narratives of safety pertain primarily to hospital-based mental healthcare. Therefore, through exploratory qualitative interviews and one focus group, we aimed to examine how service users, carers, and healthcare providers conceptualise ‘patient safety’ in community-based mental healthcare.MethodsSemi-structured interviews and a single focus group were conducted with users of UK community-based mental healthcare provision for adults (n = 13), their carers (n = 12), and providers (n = 18), who were diverse in characteristics and experiences. Study data were analysed in accordance with a reflexive approach to thematic analysis.FindingsFour key themes were developed, reflecting contrasting conceptualisations of safety in this care context, where participant thinking evolved throughout discussions. ‘Systemic inertia: threats to safety’ characterises the entrenched, systemic challenges which rendered participants powerless to advocate for or deliver safe care. ‘Managing the risks service users present’ equates ‘safe care’ to the mitigation of risks service users may pose to themselves or others when unwell, or risks from those around them. ‘More than responding to risks: everyone plays a role in creating safety’ recognises providers’ agency in causing or proactively preventing patient harm. Finally, ‘The goals of ‘safety’: our destination is not yet in sight’ positions safety as a work in progress, calling for ambitious safety agendas, giving primacy to goals which meaningfully improve service users’ lives.ConclusionsOur findings have implications for the understanding and improvement of patient safety in community-based mental healthcare settings, where improvement objectives should transcend beyond management of risks and preventing deterioration to address patient and carer-centred concerns, including practices that make people feel unsafe.

From Hands to Words-Physiotherapists Experience of Delivering Online Exercise and Education for Individuals With Knee Osteoarthritis.

Little is known about delivering telehealth from a healthcare provider's perspective. To investigate physiotherapists' (PTs) experiences in delivering live online exercise and education for people with knee osteoarthritis (OA). This was a qualitative individual interview study with a thematic analysis approach. The interviewees were six PTs delivering 8 weeks of supervised online exercise and education for people with knee OA in secondary public care in Denmark. The three main themes were (1) From hands to words-on the transition from on-site to on-line physiotherapy, (2) Online selection-on the perceived barriers to managing a telehealth service and (3) Therapeutic relation under pressure-on the contextual difficulties in building relationships and alliances in online classes. The PTs in this study seemed to gradually come to terms with delivering first-line OA care online, appreciating advantages and new possibilities. PTs' initial apprehension towards this new form of physiotherapy service may be rooted in the traditional conception of physiotherapy as a predominantly manual profession but also in a lack of formal training in physiotherapy telehealth services. This study underlines the growing need for better and more formalised training in physiotherapy telehealth services to meet growing demands.