BMC Health Services Research

BackgroundHospital drug formularies function within Complex Adaptive Systems (CAS), where the alignment between drug supply and disease patterns is critical for patient care and cost-effectiveness. However, measuring this adaptability is challenging due to conflicting priorities among stakeholders and a lack of standardized assessment tools. ObjectivesThis study aims to analyze the perspectives of three key stakeholder groups-clinical providers, non-clinical service providers, and policymakers-...

PurposeAlthough numerous research studies have demonstrated the positive impact of clinical pharmacy services, these benefits do not translate into sustained practice changes without support from hospital pharmacy leaders. Factors influencing leadership decisions to expand pharmacy services remained unclear. This study aimed to identify barriers to implementing pharmacy practice model changes and gain insights on potential methods of overcoming these barriers from the hospital pharmacy leader pe...

Safety is a foundational concern in adolescent behavioral health crisis units (BHCUs), where therapeutic care must be delivered in complex, rapidly evolving environments. However, limited research has explored how key personnel involved in shaping the environment of care in such units, such as clinicians and healthcare designers, understand and prioritize safety. To address this gap, one-hour, online semi-structured interviews were conducted with a panel of experts (N = 13) at a national level i...

IntroductionNewfoundland and Labrador (NL) faces persistent difficulty attaching its residents to primary care. We undertook a stock and flow analysis to represent how inflows and outflows of family physicians (FPs) shape effective capacity and to provide a reconciled estimate of FP supply for 2024. This approach clarifies drivers of change, exposes intervention points, and supports timely planning. MethodsWe assembled a multi-year headcount series and linked it to CIHIs "entering/leaving direc...

IntroductionMedication errors (MEs) are common events in the hospital that compromises the patient safety. Despite high prevalence of MEs being reported, there is a limited information at the outpatient settings. MethodThis study assessed the prevalence and characteristics of MEs by analyzing the data of pharmacist-led interventions recorded between 1st November 2024 to 30th September 2025 at the outpatient department of pharmacy, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH). Resu...

PurposeAmbient Documentation Tools (ADT) are an emerging technology designed to help clinicians complete documentation better with less time and effort. This study aimed to understand the impact of ADT on the pharmacist care experience. MethodsData from Epic Signal, surveys, and interviews were collected between February 2024 and October 2025 from 41 medication therapy disease management (MTDM) pharmacists across 33 primary care and subspecialty clinics at a large integrated health system who w...

BackgroundPharmaceutical care is a patient-centered practice model in which pharmacists assume responsibility for identifying, preventing, and resolving medication-related problems to optimize therapeutic outcomes. In Nigeria, pharmaceutical care activities within hospital settings have expanded over time; however, evidence describing the frequency of specific pharmacist intervention activities and the structural barriers influencing their delivery at the facility level remains limited. Objecti...

BackgroundApproximately 33% of U.S. Veterans live in rural areas, often facing significant barriers to accessing healthcare due to staffing shortages at VA facilities. The Contract Buyout (CBO) program, authorized under the PACT Act of 2022, was designed to address rural healthcare staffing shortages by enabling Veterans Health Administration (VHA) facilities to buy out existing service contracts to work in rural VA facilities. Despite its potential, uptake of the program has been limited, with ...

BackgroundHealthcare quality is a key determinant of patient experience, satisfaction, and loyalty, yet the mechanisms linking quality to loyalty remain underexplored in Egypts Health Insurance Organization (HIO). This study examines the mediating role of patient satisfaction in the relationship between healthcare quality and patient loyalty among HIO beneficiaries. MethodsA cross-sectional study was conducted with 983 beneficiaries from four HIO hospitals in Alexandria. Data was collected usin...

BackgroundClinical audit is a vital quality improvement tool in healthcare that enables frontline workers to evaluate their care practices against established standards. This study assessed the knowledge, attitude, and practice of clinical audit among frontline healthcare workers in selected hospitals in Gusau, Zamfara State. MethodsA descriptive cross-sectional study was conducted between February to September 2024 among 410 frontline healthcare workers across four health facilities in Gusau, ...

BackgroundA Hospital Medicine Advanced Practice Provider (HMAPP)-led care model developed in response to the high acuity and increased patient volumes associated with the Covid-19 pandemic. Although anecdotally perceived as a successful model, questions remained if there was adequate pre-planning and formal implementation strategy for stakeholder buy-in. ObjectiveTo elicit HM physicians and APPs perceptions of the HMAPP-led care model implementation and consider necessary steps for optimal futu...

BackgroundEffective education improves hypertension self-management but is not routinely delivered, and there is limited guidance to overcome barriers to support delivery in primary care. This study aimed to use co-design and an implementation science framework to develop and prioritize implementation strategies for the delivery of patient education to support blood pressure (BP) management across the hypertension journey in primary care. MethodsA two-stage, co-design study using implementation...

ObjectiveTo evaluate the views of physicians in Trinidad and Tobago towards low value care MethodsPhysicians were surveyed using a cross sectional study design. An online questionnaire was disseminated through social media platforms using convenience sampling. A descriptive analysis was performed. ResultsData from 218 physicians were analysed. Most participants worked in internal medicine (n=59, 27.1%) and the majority of participants were junior doctors (n=147, 67.4%). Most participants (n=97...

ObjectiveTo evaluate the impact of a comprehensive behavioral health (BH) program on healthcare utilization and total medical spending across 17 employer health plans. Study Setting and DesignA retrospective evaluation of benefit implementation across 17 employer-sponsored health plans between November 1, 2019, and January 1, 2025. Interrupted time series analysis models were used to estimate shifts in utilization patterns and medical spending across the entire health plan population before and...

BackgroundLiving with multiple long-term conditions (MLTC) is becoming increasingly common with far-reaching consequences for individuals and healthcare systems. People with MLTC often face complex care pathways through health systems - especially hospitals, which are largely configured for specialist treatment of single conditions - yet evidence on people with MLTCs lived experience in the hospital setting is limited. This study aimed to understand the hospital care experiences of people living...

Good leadership is a crucial aspect for a good primary healthcare system and for enhancing patient health outcomes. This qualitative exploratory study sought to explore the leadership role played by family medicine registrars in bedside teaching at Mangochi District Hospital and Nkhoma Mission Hospital in Malawi. Focus group discussions were held with healthcare workers who worked under the registrars, and the data was analyzed qualitatively using inductive and deductive analysis. From the study...

BackgroundTimely access to healthcare is vital especially during childbirth, as it affects unplanned out-of-hospital births, survival and morbidity outcomes. In Germany, the number of maternity wards decreased since 2014, potentially increasing travel times for pregnant women. We examined changes in the travel times after maternity ward closures from 2014 to 2024 and addressed spatial disparities, providing essential information to ensure maternal and newborn care accessibility. MethodsMaternit...

BackgroundImproving healthcare quality is fundamental to building patient trust, strengthening continuity of care, and improving service delivery. Within Egypts Health Insurance Organization (HIO), patient satisfaction and loyalty serve as critical performance indicators, particularly as the country transitions toward Universal Health Insurance (UHI). MethodsA cross-sectional analytical study was conducted among 983 HIO beneficiaries from four hospitals in Alexandria. A validated questionnaire ...

BackgroundThe physician assistant (PA) workforce has expanded rapidly in the United States, increasing the importance of effective physician-PA collaboration. Although PAs improve patient outcomes and access to care, the determinants of effective collaboration has not been well studied. North Carolina provides a relevant context due to its growing PA workforce and supervisory regulatory structure, in which physicians retain administrative responsibility for PA supervision across practice setting...

BackgroundEnsuring a sufficient and motivated health workforce requires not only retaining existing staff but also understanding the intentions of those entering the labour market. In Lao PDR, limited civil-servant quotas, prolonged volunteer pathways, and expanding private sector opportunities shape the early career choices of health professional students. Yet little is known about how final-year students perceive the public sector or what influences their decision to join or avoid government s...