Israel Journal of Health Policy Research最新文献

Background: Israel is unique in offering a formal subspecialty in Medical Administration and mandating it for physicians applying for senior roles. Data on the prevalence and characteristics of these specialists are limited.

Methods: The national registry of licensed physicians was used to identify all living physicians who completed the Medical Administration subspecialty by December 31, 2022. Data on year of medical licensing, city of residence, and list of additional recognized specialties along with their respective date of completion were extracted. Websites of key public health organizations were sampled to identify qualifications of persons in senior leadership positions.

Results: Since 1987, 277 physicians have completed the Medical Administration subspecialty, with a significant increase in annual certifications from 4.5 in 2015 (interquartile range [IQR] 4-6) to 13 (IQR 10.5-15) in 2022 (p < 0.001). Specialists completed the subspecialty a median of 18 years (IQR 13-21) post-licensing, with 269 physicians (97.1%) holding additional specialties, primarily in Internal Medicine, Pediatrics, Family Medicine, or Public Health. Compared to the general physician population, some base specialties like Public Health are over-represented while others, like Anesthesiology, are under-represented. Only 40 (14.4%) specialists reside outside major metropolitan areas. Nineteen (61.3%) general hospital CEOs, 2 (20%) psychiatric hospital CEOs, 13 (35.1%) Ministry of Health and 4 (7.8%) Sick Fund executives are specialists in Medical Administration (p < 0.005).

Conclusions: The steady growth in the number of specialists in Medical Administration demonstrates the sustainability and scalability of this model, which may serve as a template for other healthcare systems. However, the limited representation of these specialists in senior roles of some organizations, and their concentration within certain specialties and regions, indicates areas for policy attention to enhance leadership diversity and reduce healthcare disparities.

Background: Workforce diversity in healthcare has been shown to improve the quality of patient care. A paucity of data exists globally on this subject in ophthalmology. The purpose of this study was to analyze nationwide trends in gender-, ethnic- and country of graduation disparities among ophthalmologists in Israel.

Methods: Cross-sectional, workforce-based study using data retrieved from the Israeli Ministry of Health. Data included gender, ethnicity, and medical graduation country. Proportions and trends among new residents and board-certified ophthalmologists (BCO) were assessed.

Results: During 2006-2021, 18,624 medical licenses were issued (41.7% Israeli Medical Graduates (IsrMGs), 42.2% female), average yearly increase (AYI) was 6.9%, females and IsrMGs had an average yearly decrease of 1% and 0.53%, respectively. 561 physicians began ophthalmology residency (57.5% male, 75% Jewish, 69.9% IsrMGs), reflecting a 6.2% total AYI, but 8.1% and 4.8% for female versus male residents, respectively. There were fewer female residents despite population and graduate pool adjustments (p = 0.002 and p = 0.002, respectively), but differences disappeared after 2015 (p = 0.52). Arab and Jewish residents AYIs were 6.4% and 5.7% respectively, with ethnic differences elucidated by adjusting for population sizes (p = 0.097). BCO densities in 2006 and 2021 were 7.5 and 9.06, respectively, with a 1.3% AYI (p < 0.001). Proportions of female and Arab BCO were lower than expected based on population proportions. (p < 0.001 and p < 0.001, respectively). Gender-differences remained after adjusting for population sizes (p < 0.001), but AYIs for female and male BCO were 1.38% and 1.15%, respectively. AYIs for Arab and Jewish BCO were 12% and 0.61%, respectively.

Conclusions: Jewish and male dominance was seen among Israeli BCOs and was unrelated to population size or graduate distribution. Among new ophthalmology residents, Arab representation was adequate to their population proportion. In early years, male predominance was noted, however this disparity was no longer evident after 2015. These trends are encouraging, and efforts should be made to ensure the field remains inclusive and representative of the broader population.

Background: Conducted in May 2024, this study examines the well-being of Israeli evacuees and non-evacuees from conflict zones. We assess health-related quality of life (HRQoL), meaning in life (MIL), coping strategies, psychological symptoms, and self-mastery. Aims include exploring effects of trauma and socio-demographics on HRQoL and MIL, analyzing mediating roles of psychological symptoms and coping, and evaluating if evacuation status moderates these relationships during ongoing conflict.

Methods: In May 2024, seven months post-October 7th attacks, we conducted a cross-sectional study with 366 participants (221 evacuated, 145 non-evacuated) via a survey company. We assessed HRQoL (SF-12), MIL (MLQ), psychological symptoms (PHQ-4), self-related and other-related coping strategies (Brief COPE), and self-mastery (Self-Mastery Scale) through self-reported measures. Path and moderated mediation analyses evaluated relationships among socio-demographics, psychological symptoms, coping variables, HRQoL, and MIL.

Results: Except for self-mastery, northern and southern evacuees showed no significant differences and were combined into one group. Path analysis revealed significant associations between traumatic life events, HRQoL, and MIL. Traumatic events were negatively associated with the physical component summary (PCS) of HRQoL and positively with anxiety, depression, and coping (self and others- problem-solving). Depression negatively related to PCS, mental component summary (MCS), and MIL, while coping (self and others) was positively associated with MIL. Moderated mediation analysis showed evacuated participants had higher dysfunctional coping, whereas non-evacuated participants demonstrated a stronger positive relationship between anxiety and the search for meaning.

Conclusion: Despite regional differences, evacuees exhibited similar psychological responses, likely due to the shared experience of displacement. Traumatic events negatively impacted their HRQoL and MIL. Adaptive coping strategies-self-related and problem-focused coping through helping others-played significant roles in mitigating these effects. The theoretical frameworks of Conservation of Resources (COR) theory, Taylor's "tend and befriend" model, and Frankl's existential framework provided a basis for explaining these findings.

Background: Preserving new graduate nurses in the profession is an essential step for addressing the nursing shortage and sustaining the future of the profession. This study aimed to examine the relationship between employment characteristics and job satisfaction of novice nurses and their willingness to stay in the nursing profession in the next 5 years.

Methods: Novice nurses' intention to stay in the profession was assessed, considering demographics, employment characteristics, and components of job satisfaction. Among the sample of 216 novice nurses (93% response rate), four components of job satisfaction were extracted and included in the multivariable logistic regression model with the intention to stay in the profession as a dependent variable.

Results: Professional self-accomplishment was significantly and positively associated with the intention to stay in the profession, with an elevation of one standard deviation in this component associated with more than a two-fold increase in the odds of staying (OR = 2.3, 95% CI 1.3-3.9). This component contributed 10% to the variance in intention to stay. Independently, managerial support also contributed 10% to the variance and was significantly associated with willingness to stay (OR = 1.9, 95% CI 1.2-3.0). Overall, self-accomplishment, managerial support, and healthier organizational culture were significantly associated with novice nurses' intention to stay, whereas work conditions and rewards were not. The multivariable analysis model explained 38.0% of the variance in the intention to stay in the profession.

Conclusions: This study found that novice nurses' intention to stay in the profession is highly associated with their self-accomplishment and better managerial support. Thus, to enhance the retention of novice nurses, managers must establish an environment that fosters professional development and support. This involves providing engaging work assignments, facilitating the seamless integration of novice nurses into the team, and offering managerial support and guidance.

Background: Climate-related disasters have tripled in the past 30 years. Between 2006 and 2016, the global sea levels rose 2.5 times faster than the entire 20th century. More than 20 million people a year are forced out of their homes because of climate change impacts. Rapid urbanization and increasing population density in coastal mega-metropolitan areas will inevitably lead to more large-scale disasters due to extreme weather events, i.e., stronger storms and massive flooding. Despite the inevitability of these events, disaster risk reduction is still locally based in each country, many of which have scarce resources to devote to the activity. It is widely assumed that the global community will respond when a calamity occurs. This perspective article explores the appropriateness of the current international relief and aid paradigm in light of near and middle-term trends in global disasters.

Main body: After briefly summarizing the anticipated effects of global climate change, population growth, and progressive urbanization in low-lying coastal and riverine environments on the frequency and scale of future disasters, this paper examines how existing concepts of international relief following disasters are insufficient to address the challenges to come. Current paradigms are tested against selected case studies demonstrating the growing frequency of mega-disasters. For example, in 2010, the world saw a catastrophic earthquake in Haiti, very large-scale floods in Pakistan, a major earthquake in Chile, and heat waves that resulted in the death of tens of thousands of people in Russia and many more in other countries. However, the world exhausted most of its humanitarian aid, responding to Haiti in January of that year. The review closes with a proposition for a new paradigm to re-organize international relief to meet the challenge posed by our rapidly changing world - one that is more adaptable to the current challenges of climate change and other trends that will almost certainly increase the frequency and intensity of disasters.

Conclusion: The future of international disaster aid depends on our ability to foster greater cooperation between the various organizations and donor countries and more seamless cooperation between both groups and the affected countries or regions. Planning and relief operations should utilize new technologies and innovative financing where feasible. A holistic approach that focuses on building large-scale agreements and coordination mechanisms, teaching citizens how to help each other until aid arrives, and strengthening resilience at the local level will equip communities for adaptive action during a disaster, improve coping and long-term rehabilitation, will lead to a more efficient, fairer and more durable global aid system.

Background: Antibiotic treatment (AT) for patients with advanced dementia and pneumonia is a complex issue. AT can prolong life, but it can also prolong suffering for the patient and the family. In this study we evaluated physicians' attitudes to this issue.

Methods: A vignette-based survey among community-based physicians (CBP) and hospital-based physicians (HBP) who work in southern Israel. The physicians were asked to complete a questionnaire on their knowledge and attitudes to AT, based on a case description of a patient with advanced dementia and pneumonia.

Results: 211 physicians participated in the study including 134 CBP (63.5%) and 77 HBP (36.5%). 177 physicians chose the AT option for the patient presented in the case, with 59.7% of the HBP and 32.8% of the CBP choosing intravenous (IV) AT (p = 0.017). In contrast, in the same case, but with themselves as the patient, 68.8% of HBP and 32.8% of CBP chose the option of palliative care without AT, with only 14.3% of HBP and 10.4% of CBP choosing the option of hospitalization with IV AT. In two logistic regression models, physicians who chose IV AT for themselves were fourfold more likely to make a similar choice for their patients. Over 75% of the physicians were not knowledgeable about the administration of AT in accordance with the Dying Patient Act.

Conclusions: The results of this study indicate the need for an educational intervention among physicians to expand their knowledge and expertise on end-of-life treatment for patients with advanced dementia. In addition, we invite policy makers to convene a discussion on the possibility of changing the law to facilitate the conduct of studies of patients with advanced dementia. Such studies would make it possible to develop an evidence-based treatment strategy.

Background: Rising mental health challenges among children and adolescents are a global concern. However, a shortage of professionals, inadequate competence and lack of resources hamper necessary care, presenting a major challenge to health service provision. Community pediatricians, frequently the initial contact for mental health issues, are in a key position to improve access to care. The Delphi method was employed as an initial step toward redefining the role of pediatricians and the re-design of pediatric responses within Israeli primary mental health care.

Method: Ninety-two experts, including pediatricians, psychiatrists, mental health and child-development professionals, and parents of children with emotional-behavioral challenges participated in a three-round Delphi study. A survey including 6 topics (37 items, 9 demographic questions) was distributed, probing the envisioned role of pediatricians in children's mental health care.

Results: There was strong endorsement between experts regarding pediatricians' potential roles in risk identification, parental guidance, psycho-education, and health policy isuues such as referrals to mental health professionals, and the need for training in this domain. However, discord arose concerning changes in the service framework and pediatricians' role in psychiatric drug prescription. The majority agreed on the necessity of close support from mental health experts, despite differing in the form it should take.

Conclusions: This study underscores the critical need for mental health training among pediatricians and advocates for a structured, consensus-driven model to bolster early detection and initial treatment of mental health issues in children. The findings highlight the potential for leveraging this model to drive health policy changes and improve service delivery in pediatric mental health care, and might inform other health systems considering extending pediatricians' roles. By equipping pediatricians with essential competencies, this approach can broaden mental health service delivery and reduce stigma. Aligning the model with expert consensus paves the way for impactful policy reform, enhancing pediatricians' roles in mental health risk identification and intervention, and advancing child health services.

Background: Child safety in schools is paramount for decision-makers globally, with a focus on ensuring children return home safely. However, the prevalent issue of injuries across educational systems demands a comprehensive investigation into their causes, incorporating interdisciplinary perspectives and social dynamics, to develop effective prevention strategies. The objective of this study is to comprehensively analyze the factors contributing to school-related injuries and examine the impact of school climate on student safety. By employing advanced data analysis techniques, the research aims to develop targeted, effective strategies to enhance child safety in educational settings. This research aims to develop a multidimensional taxonomy to understand child injuries in elementary schools better, enhancing precision in decision-making.

Methods: Data from 363 Israeli primary schools and 10,855 school injuries attended to by MDA, the principal EMS provider, were analyzed. The study utilized a two-level taxonomy, employing clustering methodology to classify schools into distinct climate "patterns," with each pattern further delineating school injury characteristics into sub-patterns. The chosen method proved effective in revealing nuanced relationships between school injuries and climate characteristics.

Results: Analysis revealed five school climate clusters, ranging from "good" to "bad," each exhibiting two homogeneous sub-clusters of school injuries. Schools with a "positive" climate witnessed boys predominantly experiencing head injuries during breaks, while girls often sustained limb injuries from playing in corridors. Conversely, within the "negative" climate cluster, subgroups emerged based on injury nature, whether linked to playing or falling from a height.

Conclusion: The research delineates a nuanced association between school climate and injury rates, emphasizing the necessity for sophisticated analytical techniques beyond conventional methodologies. Utilizing a diverse dataset from various disciplines, the study highlights the multidimensional aspects of school health. The developed taxonomy reveals the complex dynamics within school environments, advocating for customized health policies to mitigate injuries. Critical findings prompt a reevaluation of established assumptions about the school climate-injury relationship, informing strategic policymaking. For example, it suggests collaboration to enhance school safety through targeted, gender-sensitive interventions and improvements. Integrating different data sources offers a holistic understanding crucial for effective health policy formulation in educational contexts.

Background: Over 1.9 million Arabs live in Israel and constitute 21% of the total population. Despite being a disadvantaged minority population with wide gaps in health indicators, Arabs have higher Human Papillomavirus (HPV) and Measles, Mumps, and Rubella (MMR) vaccination rates compared with the general Jewish population.

Methods: In-depth interviews with 21 health care providers, 16 Arab mothers, and 16 teenagers were conducted to collect information about health system enablers to HPV and MMR vaccination. All interviews were conducted in Arabic by an Arab researcher, audio-recorded, transcribed, and analysed using thematic analysis of the transcripts. Themes were mapped according to the WHO Health Systems Building Block Framework.

Results: We identified several health system enablers. On the service delivery level, accessible and availability of vaccination services, delivery of vaccines through the school system and mother child clinics, and framing vaccinations as the norm were themes. Personable characteristics of the health workforce, the health care providers belonging to the same cultural group, and high levels of trust towards healthcare professionals were reported. Vaccination provided at no cost was also identified. On the leadership/governance level, the Arab community felt equal treatment and distribution of services, which was also an enabler reported. Despite high vaccine uptakes, parents and teenagers had limited knowledge regarding vaccination, particularly HPV.

Conclusions: This study highlights that a combination of good access and delivery to vaccination, delivered by a culturally competent, available, accessible respectful workforce can enable disadvantaged minorities to achieve high vaccine coverage, in particular in a cultural context where the population trusts and follows medical advice. Such evidence can serve as a basis for developing policies, interventions, and guidance to improve vaccine uptake among other underserved minority communities.

Background: Hospital at Home (HaH) is an alternative care model that provides acute hospital-level services to patients at their homes. Despite its proven advantages and global experience, HaH did not gain significant traction in Israel until the COVID-19 pandemic. The issue was highlighted at the 2022 Dead Sea Conference on Health Policy. This study compares perceptions of HaH among the Israeli public and physicians, Jewish and Arab, identifying facilitators and barriers to its expansion in Israel.

Methods: Two online surveys were conducted, one with 342 physicians and another with 424 members of the public aged 35+. Respondents were sampled based on age, gender, district of residence, and population group. Descriptive statistics and chi-square tests explored perceptions, and logistic regression analyzed multivariate relationships.

Results: Results showed 39% of the public believed HaH care quality is as good as or better than hospitals, compared to 65% of physicians. 44% of the public felt HaH safety is as good or better, while 75% of physicians agreed. 58% of the public saw communication between patients/families and the healthcare professionals in HaH as good or better, contrasted with 91% of physicians. 78% of the public and 97% of physicians viewed HaH as a good alternative to hospitalization and would consider using it personally. Arab and lower-income respondents were less positive about HaH than Jewish and higher-income respondents. Community-based physicians preferred HaH more than hospital-based ones. Barriers to HaH expansion included lack of specialized manpower, resources, and awareness.

Conclusions: The findings suggest that both the public and physicians show confidence in HaH, and it is gaining popularity among both. Policymakers could use these insights to expand HaH, focusing on increasing awareness, reducing family burden, tailoring services for diverse populations, involving hospital staff, and investing in resources and training.