Healthcare Provider Perspective Research Articles

“Honoring their stories”: care providers’ understanding of psychosocial concerns among Bhutanese American older adults with refugee life experience

Purpose This paper aims to explore the barriers and facilitators to psychosocial well-being among ethnic Nepali Bhutanese American older adults from the perspective of health care and service providers working with this population. Specifically, the authors aimed to understand health-care and service providers’ perceptions of the psychosocial well-being in this community and appropriate interventions. Design/methodology/approach Qualitative research methods were used to collect and analyze data in collaboration with a community-based organization. A total of ten participants were interviewed. Interviews were conducted in either English or Nepali, based on participant preference. An inductive thematic analysis approach was used to analyze the data. Findings Three major themes were generated from the analysis. The first two were in reference to perceived barriers to mental well-being among Bhutanese American older adults: isolation that older adults faced in the USA and shifting responsibilities and lifestyles that arose from the cultural and structural barriers in the USA. Throughout these themes, there was an understanding that acculturation threatened families’ connections to each other and impacted older adults’ connections with younger generations. The third theme, a perceived facilitator of well-being, was the power of storytelling to counteract feelings of isolation and disempowerment caused by shifting lifestyles felt by older adults, especially amid community events. Originality/value Bhutanese American older adults, many of whom have limited English proficiency, face numerous challenges, psychosocial stressors and factors contributing to well-being. Care for this population should prioritize dignity, empowerment and the incorporation of strengths within their narratives. Interventions and services tailored for older Bhutanese American adults need to be adapted to integrate multiple care systems.

Exploring genetic counselors' interest and role in transitional care discussions for pediatric patients with neurodevelopmental conditions.

Previous studies have examined the perspectives of healthcare providers regarding their role in the transition process of pediatric patients with neurodevelopmental conditions (NDCs), but the perspective of a genetic counselor has yet to be considered. This study explored genetic counselors' current practices and attitudes regarding care for pediatric patients with NDCs as they transition into adult care. Genetic counselors (GCs) currently seeing patients with NDCs were recruited through a cross-sectional online survey. Questions included demographics, current practices with patients aged 0-15 years vs. patients 16-22 years, self-confidence, attitudes, and barriers regarding a genetic counselor's role in medical transition. A total of 51 surveys were included in the analysis. The majority (76.7%) of GCs were interested in playing a role in the transition process. Furthermore, all participants perceived transition planning for pediatric genetic patients with NDCs as somewhat important or important. Most GCs (70.0%) discussed topics of transition with patients over 18 years of age. These results demonstrate GCs' interest in assisting patients and families with the transition of individuals. Incorporating a genetic counselor skill set into transition discussions with patients with NDCs could improve the transition process and help to meet the standards of care called for by the American Academy of Pediatrics.

Parental experiences and perspectives of healthcare providers' genetic testing recommendations for their children diagnosed with autism spectrum disorder in the United States.

Although genetic testing is recommended for all children diagnosed with autism spectrum disorder (ASD) in the United States, it remains unclear how many parents have received and followed these recommendations. This study aimed to assess parental experiences and perspectives of healthcare providers' genetic testing recommendations. A total of 1043 parents of children with ASD from Simons Foundation Powering Autism Research for Knowledge completed an online survey. Only about one-third of the parents (34.2%) reported that their children's providers had recommended genetic testing. Factors associated with whether parents received these recommendations included the type of healthcare providers diagnosing ASD, parents' knowledge of genetic testing, the age of their children's diagnosis, and the presence of certain co-occurring medical conditions in their children. Our study also revealed that most parents (76.9%) who received recommendations had pursued genetic testing for their children. Adherence to the recommendations was associated with the characteristics of the parents (i.e., age and employment status) and children (i.e., gender), and their trust in the information from providers. The findings highlight the critical role of healthcare providers in facilitating genetic testing among families of children with ASD. Healthcare providers are recommended to increase their competencies and practice in providing genetic testing recommendations for ASD, assist parents in navigating testing challenges, and support parents through the testing process.

Perinatal Care Provider Perspectives on Integrating Clinical Research Into the Clinical Infrastructure.

This study explored perinatal health care providers' perspectives on the recruitment of pregnant participants and integrating clinical research into their practice, with a particular emphasis on the complexities introduced by the COVID-19 pandemic. From May to September 2021, semistructured interviews were conducted with 10 perinatal health care providers from an urban US health center. The interview transcripts were analyzed using Braun and Clarke's thematic analysis framework, a rigorous method for analyzing qualitative data by identifying, coding, and reporting themes. This approach allowed us to systematically code the data and identify key themes related to recruitment strategies and integration of clinical trials during prenatal care. Barriers to integrating clinical trials into the perinatal infrastructure included pandemic-related restrictions, heavy workloads, time constraints, ineffective communication and coordination, and maintaining the relevance of the research among providers. Facilitators included the use of communication tools, collaboration with multidisciplinary teams and stakeholders, creation of detailed study information for clinic staff, and fostering commitment to supporting research among providers. The perspectives of perinatal health care providers uncover barriers and facilitators regarding the recruitment of pregnant individuals for clinical trials and shed light on the unprecedented challenges of research in this population during the COVID-19 pandemic and lessons learned postpandemic. This information can support the development of evidence-based solutions and strategies to improve the recruitment of pregnant individuals, as well as enhance clinical research integration into infrastructure in perinatal health clinics.

The implementation process of decentralization of health services: a qualitative perspective from Sudan

BackgroundHealth system reform initiatives have increasingly embraced decentralization as a key trend. The implementation process and its outcomes are influenced by a myriad of factors, including economic forces, political dynamics, and ideological factors. Comprehending and carefully examining the implementation phase of decentralization and its consequences to achieve desired outcomes is crucial. Notably, this phase is often considered the weakest aspect of policy reforms, especially in developing countries. Therefore, this study aimed to explore and analyze the implementation phase of decentralization and its implications as essentials for achieving intended goals. The study objectives evolved around examining the entire decentralization as a multifaceted social and political process in Khartoum State, Sudan, from its early stages of decision-making, policy formulation, and implementation process and the influencing contextual factors.MethodsThis study was an exploratory qualitative study that employed in-depth interviews to gather perspectives of healthcare providers and policymakers, semi-structured observations, and thematic analysis. The study utilized Grindle’s framework for analysis.FindingsThis study revealed a political nature of decision-making, with a top–down approach to the implementation, which also lacked stakeholder involvement. It showed a lack of transparency, official documentation, and proper handover procedures from the Ministry of Health to the devolved hospitals during the implementation process. A conflict of interest between the federal and the state level was also reported. It is important to note that this process occurred within the context of structural adjustment program (SAP) schemes, which had already empowered the private sector in Sudan.ConclusionThis study documented the implementation process of decentralization of health services and its influencing factors. The study recommended reforming the decentralization policy through consultative stakeholder involvement and by implementing a concurrent responsibility paradigm that divides authority between the federal and state levels.

"Pushed to Their Limits": Health Care Provider Perspectives on Barriers and Facilitators to Implementing a Mind-Body and Activity Program for Older Adults With Chronic Pain in a Community Clinic for the Underserved.

Older adults from underserved backgrounds experience chronic pain at a rate of 60% to 75%. Pharmacological treatments have limited efficacy and involve considerable risks. Mind-body interventions hold promise to improve pain outcomes but are typically not implemented in community clinics in which they are needed most, thus contributing to health disparities in chronic pain treatment. We conducted qualitative focus groups and interviews with 20 providers (eg, primary care doctors, nurses, administrators). We sought their perspectives on barriers and facilitators to implementing an evidence based mind-body activity program for older adults with chronic pain at an underserved community health clinic in Massachusetts. Subthemes were identified within 2 superordinate domains (barriers and facilitators) using a hybrid inductive-deductive thematic analysis approach following the Framework Method. Providers discussed facilitators (partner with clinic staff to facilitate referrals and buy-in, integrate referrals through the electronic medical record, offer groups in different languages, post and tailor advertisements) and barriers (limited staff bandwidth, scheduling challenges, inconsistent patient participation). These results will directly inform tailoring and subsequent effectiveness testing and implementation of the pain management program for older underserved adults with chronic pain in this community health care setting.

Pediatric Resuscitation, Parental Presence, and Provider Perspective

Background Varying opinions and practices exist about parental presence during a pediatric resuscitation. In addition, there is a paucity of literature that investigates the perspectives of health care providers about the efficacy of parental presence in these situations. Objectives The aim of this study was to gain an understanding of the perspectives of emergency health care providers about parental presence during pediatric resuscitation. Methods This pilot study surveyed emergency health care providers about their opinions of parental presence during pediatric resuscitation. All participants were given a survey with closed- and open-ended questions. Data analysis included descriptive statistics for the demographic data and qualitative analysis for the open-ended responses. Results A total of 52 emergency services personnel completed the survey. Of the physician respondents, 78.2% (n = 18) were opposed to parental presence during pediatric resuscitation. Common reasons for opposition included the lack of education, interpersonal team communication skills or experience, and discussion concerning end-of-life issues. Discussion Utilization of formal education and simulation for parental presence during resuscitation could be helpful for increasing providers’ comfort levels with parental presence.

Cost–benefit analysis of mammography screening: the perspective of Nigerian healthcare providers

IntroductionThere is no national breast cancer screening implemented in Nigeria. The National Cancer Control Plan (NCCP) has a goal of making screening services and early detection of cancer available for...

"Another tool for the sexual health toolkit": U.S. health care provider knowledge and attitudes about doxycycline post-exposure prophylaxis (doxy-PEP) to prevent bacterial sexually transmitted infections among men who have sex with men.

Doxycycline post-exposure prophylaxis (doxy-PEP) reduces chlamydia, gonorrhea, and syphilis infections among men who have sex with men (MSM) and transwomen (TW). Perspectives of health care providers (HCPs) regarding doxy-PEP can inform implementation efforts. From August 2022 to January 2023, HCPs were recruited from 13 cities with high sexually transmitted infection (STI) rates for semi-structured, in-depth interviews about their awareness of and attitudes towards doxy-PEP for STI prevention. HCPs were purposively sampled to include people with experience prescribing PrEP and provision of care to MSM. Interviews were conducted virtually via Zoom. Transcripts and debrief reports were analyzed using a directed content analysis approach to explore knowledge, attitudes, and beliefs about doxy-PEP. Among 30 HCPs, almost half (47%) were between 31-40 years of age, 53% identified as male, and 47% reported their sexual orientation as gay or queer. Half (53%) of participants practiced in the South, 43% had >100 MSM in their clinic panel, and 17% had previously prescribed doxy-PEP. We identified four overarching themes: 1) HCPs expressed positive attitudes towards doxy-PEP; 2) antimicrobial resistance concerns limit enthusiasm for some HCPs; 3) additional data about the long-term safety of doxy-PEP would improve their confidence; and 4) development of guidelines would facilitate the prescription of doxy-PEP, including eligibility, dosing instructions, and treatment management. HCPs were motivated to prescribe doxy-PEP with almost 20% already having prescribed it. Guidelines and data about long-term safety, especially antimicrobial resistance, would facilitate introduction of doxy-PEP into clinical practice.

Perspectives on barriers to traditional sources of sexual and reproductive health information and services: Are mHealth technologies the answer?

Background: In Ghana, several qualitative studies have explored users’ perspectives on conventional sources of sexual and reproductive health (SRH) information and factors which influence provision of and access in rural settings. However, there is a dearth of qualitative studies on healthcare provider (HCP) perspectives on factors that deter access to conventional sources of SRH information among young people in rural Ghana and innovative ways for addressing barriers. This study explored perspectives on barriers to traditional sources of SRH information and services and innovative ways of using mHealth technologies for addressing provision and access challenges among young people in rural Ghana. Methods: This study used a qualitative approach using in-depth interviews. Semi-structured in-depth interviews were conducted with HCPs in rural areas in three regions of Ghana between May and August 2021. Participants were selected from rural communities using the convenience snowball sampling and were interviewed via Zoom. The interviews explored the experiences and perceptions of HCPs on conventional SRH information and services and young people’s access to this information and services. The interviews were audio recorded and transcribed verbatim. Data were analysed thematically using NVivo software version 12, following the approach outlined by Braun and Clarke. Results: Twenty HCPs were interviewed for this study. The participants identified different sources of SRH information and services used by rural young people. Peers or friends, health facilities, health providers, and community settings were reported as the main services and sources of SRH information. Participants reported several barriers and challenges to the provision of and access to SRH information to young people, including socio-cultural norms, religious beliefs, unfriendly health facility environments, negative health providers’ attitudes, lack of privacy and confidentiality resulting in unfriendly youth SRH services, distance, and financial challenges due to costs of transportation which limits rural young people’s access to, and use of, SRH services. All the participants indicated that in addressing provision and access barriers, the use of mobile phones could be beneficial. Conclusion: This study highlights several barriers and challenges that deter provision of, and access to, SRH information and services for young people in rural Ghana. The findings indicate the use of innovative mobile health (mHealth) technologies may be one solution to some of the barriers and challenges.

Reported roles of care partners in a specialized weaning centre-perspectives of patients, care partners, and health care providers.

Care partners are individuals chosen by a person with an illness to support their care during hospitalization. Patients with persistent critical illness have longer than average critical care admission and often other conditions including dysphagia, communication vulnerability, severe physical deconditioning, the need for an artificial airway, and difficulty weaning from invasive mechanical ventilation. Family presence has been identified as important for patients experiencing persistent critical illness in specialized weaning centers. Despite this, the role of care partners in clinical settings for patients with persistent critical illness has not been fully characterized, particularly from the perspectives of patients, care partners, and health care providers. The aim of this study was to gain insights into the roles of care partners during persistent critical illness from the perspectives of patients, care partners, and health care providers. We used qualitative descriptive methodology including semi-structured interviews and content analysis. Interviews were audio recorded and transcribed verbatim. Included participants (n = 30) were patient survivors (n = 7), care partners of patient survivors (n = 9), and professionally diverse health care providers (n = 14) of adult patients with persistent critical illness from two specialized units in one community academic hospital in Toronto, Canada. Participants across all groups described care partner roles that included physical, mental health, cognitive, social, and spiritual support of the patient, including the perceived role of safeguarding the multiple dimensions of care for the patient who is experiencing persistent critical care in specialized care settings. The results of this study are being used to co-design, implement, and evaluate a sustainable care partner program that is acceptable, appropriate, and feasible to implement in clinical settings where the care of patients with persistent critical illness occurs. Consolidated criteria for reporting qualitative studies (COREQ).

Knowledge, attitudes, and referral practices for smokers to a state tobacco quitline in a federally qualified healthcare center: Healthcare provider perspectives.

Federally qualified healthcare centers (FQHC) treat a large population of low-income patients disproportionately burdened by tobacco use. This study investigated healthcare providers' knowledge, attitudes, and referral patterns of patients who smoke to a state tobacco quitline. The study used a descriptive-qualitative design. In-depth interviews were conducted in 2021 with a sample of healthcare providers recruited from a federally qualified healthcare center (FQHC) in a large city in the Midwest. The interviews were guided by a standardized moderator's guide and lasted 30-45 minutes. Written informed consent was obtained before each interview, and participants completed a brief self-administered survey. Among the 25 participants, 92% were female and 44% were Black. Participants included medical providers (52%), behavioral health providers (16%), and other types of providers (32%). Participants' age and work experience averaged 41.5 and 5.25 years, respectively. Only 32% of providers reported having specialty training in smoking cessation or addiction counseling. Over half (52%) of the participants never or rarely referred patients to the Illinois Tobacco Quitline (ITQL). Providers reported several barriers to referring patients to the ITQL, including limited knowledge about services offered, time constraints, difficulties with the referral process, and lack of feedback between providers and the ITQL. Further, providers described patient-related barriers, including low motivation to quit smoking, language barriers, and failure of patients to respond to calls from the quitline. Recommendations were described for improving patient and provider education, referral processes, and increasing bi-directional communication between providers and the quitline. Providers identified numerous barriers to referring patients for smoking cessation treatment. Addressing the identified barriers requires a multi-faceted approach involving education, streamlined processes, supportive infrastructure, and patient-centered interventions to strengthen provider use and satisfaction with the available resources.

“The stay here is, of course, not appropriate for an old person”: the perspective of healthcare providers on older patients in the emergency department

BackgroundIn aging societies, emergency departments (ED) face an increasing number of older, geriatric patients. Research shows that older emergency patients have a greater burden of comorbidities and a higher risk of adverse events. It has been questioned whether contemporary ED structures can meet the specific needs and characteristics of older patients. Little is known about how professional health care providers perceive and experience ED care for older patients. This study aimed to get insight into the perspective of healthcare providers working with older ED patients and to explore the challenges they experience in their daily work.MethodsThe study used a qualitative research design with a social-constructivist perspective and a Grounded Theory based methodology. Data were collected through qualitative interviews with N = 25 healthcare providers from different urban EDs in Berlin, Germany, and adjacent healthcare institutions. Following the Ground Theory approach, categories and central themes were identified, analyzed, and interpreted to gain a comprehensive understanding of the healthcare provider perspective.ResultsThe interviews revealed a significant and increasing relevance of geriatric ED patients for healthcare providers. However, there was no shared definition of ‘the geriatric patient’. Most interviewees found ED structures to be inadequate for older patients. They described specific challenges, such as information gathering and safety risks in the ED, as well as an increased use of resources (both time and personnel) when caring for older patients. In addition, specific problems in the collaboration with other professions and institutions were addressed, namely nursing homes, hospital wards, consultations, and the hospital social service.ConclusionHealthcare providers experience a structural mismatch between contemporary EDs and the specific needs of geriatric patients. They are aware of the vulnerabilities of geriatric patients and try to compensate for inherent structural shortcomings. Such structures and limited resources often cause practical, organizational, and ethical problems. There is a great need to develop, implement, and evaluate systematic approaches and care concepts that address the specifics of ED care for geriatric patients.

Patient and healthcare provider perspectives on a digital first general practice: mixed-method study

Abstract Background General practitioners (GPs) are facing an increased workload as a result of an aging population and a growing prevalence of chronic diseases. Utilizing eHealth may help to enhance healthcare accessibility and reduce costs. A digital platform was developed that integrates eHealth into the organizational aspects of general practices. This study aims to provide insight into the experiences of patients and healthcare professionals with this new, digital way of working. Methods A mixed-method study was conducted in three Dutch general practices working with the digital platform. The digital platform focuses on digital communication and remote healthcare delivery in primary care. Primary outcomes included acceptability, the implementation process, suggestions for improvement, and facilitators and barriers for future implementation. Patient perspectives were identified through online questionnaires and focus groups, and healthcare professionals’ experiences were explored through in-depth interviews. Results Five focus groups and ten in-depth interviews were held. The questionnaires were completed by 616 patients. Patient acceptability of the care concept was high (M = 3.9, SD = 1.0; on a scale from 1-5) and they were satisfied with received care (M = 30.1, SD = 3.4; on a scale from 8-32). Regarding the perceived quality of consults, patients were positive about the longer duration of physical consults (i.e., 20 instead of 10 minutes). Some participants indicated a less personal doctor-patient relationship, because care was provided by various GPs. Conclusions Overall, patients and healthcare professionals were positive about the digital platform. The study gives insights into how to improve the care concept, e.g., how to enhance the doctor-patient relationship. Key messages • Digital first general practices that integrate eHealth into the practice’s organizational aspects of are considered acceptable by patients and healthcare professionals. • Digital first general practices can help to improve healthcare accessibility for both patients and healthcare professionals.

Patient and Healthcare Provider Perspectives on Disease Burden of Seborrheic Dermatitis in the United States: Results from a National Survey.

Seborrheic dermatitis (SD) is a common, chronic inflammatory skin disease, but the physical and emotional burden of patients with SD experience has not been well characterized. The Harris Poll conducted online surveys of US patients and healthcare providers (HCPs) from December 2021 to January 2022. Almost half of patients reported that SD negatively impacts their emotional and physical well-being "a lot/a great deal"; HCPs underestimate the level of impact on patients. Most patients with SD reported a significant mental health impact, including anxiety, depression, anxiety about interacting with other people, and isolation. Two-thirds of patients said they did not know anyone else who had been diagnosed with SD, and even after diagnosis, less than half of patients still said they did not know anyone else with SD. Nearly all patients and HCPs agreed that it was challenging to hide SD symptoms, and most patients felt embarrassed when people commented on their SD symptoms. Most patients agreed that they would be further along in their career if they did not have SD, and SD symptoms made them less confident at work and less likely to want to interact with people at work. Almost half of patients reported ever missing work as a result of SD symptoms. These insights emphasize the physical and emotional patient burden associated with SD, impacting all aspects of patients' lives. Graphical abstract available for this article.

Stakeholder perspectives on supplemental milk for infants under six months with growth faltering

Abstract Background Growth faltering is a significant public health issue among infants aged <6 months (m). Supplemental milk is commonly used for infants with growth faltering, with variations in type and duration. We synthesized qualitative evidence on stakeholder perspectives about equity, feasibility, and acceptability of the type and duration of supplemental milk for infants aged <6m with growth faltering. Methods We conducted a comprehensive search of six electronic databases in addition to manual searches to identify all qualitative studies published during January 2000-June 2022. Identified articles were screened in two stages against an inclusion criteria with titles and abstract screened first followed by full-text screening. Included studies were quality appraised using the Critical Appraisal Skills Programme checklist. The primary outcome was equity, feasibility, and acceptability of various supplemental milk for infants <6mwith growth faltering. Results Eighteen studies, reporting perspectives of mothers, fathers, grandmothers and healthcare providers were included. Studies were conducted in North America (9), Africa (5) and Asia (3) and South Australia (1). Donor human milk (DHM) (13) and infant formula(9) were the main supplementary milk reported followed by cow/goat milk (2). Key sub-themes derived were: education/awareness, socio-economic status (SES), race and religion, practicality, availability of resources, sustainability, cost, affective attitude, perceived effectiveness and ethicality. Maternal/caregiver SES was a key sub-theme across all three supplemental milk feeds, acting either as a barrier or facilitator for uptake. Conclusions DHM and infant formula were the most commonly reported supplemental feed for infants aged <6m with growth faltering. Maternal/care giver factors were perceived as key to ensure equity, feasibility, and acceptability with respect to type and duration of supplemental milk for infants aged <6m with growth faltering. Key messages • Stakeholders perceived donor human milk and infant formula as main supplemental milk for infants aged <6 months with growth faltering. • Maternal/care giver factors are key to ensure equity, feasibility, and acceptability of supplemental milk for infants aged <6 months with growth faltering.

Healthcare Provider Narratives of the Impacts of the COVID-19 Pandemic on Pregnant and Parenting Youth in Canada: A Qualitative Study

The COVID-19 pandemic led to significant challenges for healthcare providers working with pregnant and parenting youth. However, the impacts of the pandemic on this population and healthcare services from the perspective of healthcare providers are not well documented in Canada. We examined the narratives and experiences of healthcare providers regarding these impacts and explored the challenges to service provision. Using a qualitative interpretative description (ID) approach, we recruited 25 health and service providers from Alberta, Ontario, and British Columbia for individual qualitative interviews. Our analysis resulted in three themes: complexities of health service provision during COVID-19, healthcare providers’ accounts of impacts on pregnant and parenting youth, and leveraging challenges into opportunities for service provision. Participants described the influence of pandemic policies and distancing measures on accessibility of health services, availability of healthcare resources and personnel, and well-being of their clients. They also reported increased mental health issues, isolation, and exacerbation of inequities within this population. Providers highlighted the role of telemedicine in ensuring some degree of continuity of care. Additionally, they commented on service adaptations to address the evolving needs of their clients. Our findings underline the need for a resilient and adaptable healthcare system that can better support the needs of vulnerable populations during crises.

Caregiver Experiences, Healthcare Provider Perspectives and Child Outcomes with Virtual Care in a Neonatal Neurodevelopmental Follow-Up Clinic: A Mixed-Methods Study

Background: Caregiver and healthcare provider perspectives of virtual care have not been explored in depth in the literature for neonatal follow-up clinics. Our objective was to evaluate caregivers’ and healthcare providers’ perspectives and compare neurodevelopmental outcomes of preterm neonates before and after implementing virtual care during the SARS-CoV-2 pandemic. Methods: Semi-structured interviews were conducted with families and healthcare providers, designed and analyzed using phenomenological qualitative methods. A retrospective cohort study was conducted to evaluate and compare neurodevelopmental characteristics of two preterm cohorts, one before (“in-person”) and after (“virtual”) virtual care. Results: Three themes were identified: increased confidence in in-person assessments, adequate delivery of information using virtual platforms and a preference for specialized care through the neonatal follow-up clinic. A total of 252 infants born preterm, 104 infants in the in-person group and 148 infants in the virtual group, were included in the study. The adjusted odds ratio (aOR) of cerebral palsy was lower when virtual care was used compared to in-person assessments (aOR = 0.11, 95% CI 0.01–0.98) while the adjusted odds of cognitive delay measured by in-person standardized testing were higher (aOR = 2.78, 95% CI 1.25–6.19). Conclusions: Caregivers and healthcare providers prefer in-person assessments for comprehensive developmental support. It may be more challenging to detect subtle cognitive differences using caregiver-reported measures. Cerebral palsy may be missed when assessments are completed virtually.

Differences Between Intravenous and Subcutaneous Modes of Administration in Oncology from the Patient, Healthcare Provider, and Healthcare System Perspectives: A Systematic Review.

While patients with cancer have traditionally received oncology treatments through intravenous (IV) administration, some therapies are becoming available via alternative modes of administration, such as subcutaneous (SC). This study aimed to evaluate IV versus SC therapy administration from the perspectives of the patient, healthcare provider (HCP), and healthcare system. A systematic review was conducted, searching MEDLINE and Embase databases from 2000 to 2022. This was supplemented with grey literature searches of additional sources such as conference proceedings. Observational studies and clinical trials were included if they assessed adult patients with any cancer type who were treated with pharmacologic therapies administered via IV or SC and included patient- or HCP-reported outcomes or healthcare system perspectives on the mode of administration. Records identified by the literature search were screened by two independent reviewers. Included studies were data extracted by a single reviewer and validated by a second reviewer and synthesized using a narrative approach. After screening, 33 unique studies were included in the systematic review. Patients and HCPs reported substantially more favorable preference rates for SC over IV treatment. Additionally, from the patient perspective there were reductions in treatment time and economic burden for SC compared with IV therapy. From the HCP's perspective, treatment time was consistently reduced by SC compared with IV treatment administration. Although information on the impact of SC and IV treatments for oncology on healthcare systems was limited, the use of SC formulations showed consistent cost savings (direct costs) and time savings from this perspective considering various uptake scenarios compared with IV administration. Compared with IV administration, SC oncology treatment is a preferred option by patients and HCPs, increasing optionality and reducing treatment time while simultaneously increasing capacity and reducing the financial burden on healthcare systems.

Perspectives of healthcare providers around providing family planning services to women living with HIV attending six HIV treatment clinics in Lusaka, Zambia

ABSTRACT While international guidelines recommend integration of family planning (FP) and HIV services, limited research has been done to explore how healthcare providers perceive the feasibility and utility of integrated services. To address this gap, we administered a standardized questionnaire to 85 providers from 6 HIV clinics in Lusaka, Zambia, before (April–May 2018) and after (May–June 2019) implementing an enhanced model of FP/HIV service integration. We tested for differences in FP knowledge, attitudes and practices between the two time periods with tests appropriate for paired observations. The proportion of providers self-reporting direct provision of contraceptives increased significantly for several methods including oral contraceptives (14% vs. 26%, p = 0.03), injectables (9% vs. 25%, p < 0.001), implants (2% vs. 13%, p = 0.007) and intra-uterine devices (2% vs. 13%, p = 0.007). In-depth interviews were also conducted post-integration with 109 providers to solicit their feedback on the benefits and challenges of offering integrated services. While providers were highly supportive of integrated services, they identified several challenges including widespread belief in FP myths among female clients, the need to consult a male partner prior to starting FP, lack of trained staff and space, and frequent stockouts of contraceptives and equipment. Addressing these challenges will be critical in designing future services.