Israel Journal of Health Policy Research最新文献

This commentary examines the study "Frailty and Its Association with Long-Term Mortality Among Community-Dwelling Older Adults Aged 75 Years and Over" by Lewis et al. The retrospective cohort study utilized data from a primary healthcare provider in Israel to investigate frailty using the Frailty Index (FI) and its correlation with long-term mortality. Nearly half of the older adult cohort was identified as frail, with a strong association between higher frailty levels and increased mortality risk. The commentary emphasizes the importance of routine frailty screening in clinical practice and health policy. Integrating FI calculations into electronic health records can facilitate timely care for high-risk individuals. However, presenting frailty data must be managed carefully and in conjunction with patients' preferences to avoid stigmatizing and negatively influencing clinical decisions. While the FI is a valuable tool, it should complement, not replace, other assessments that provide a more holistic view of the patient's health. Furthermore, the commentary strongly advocates for a more comprehensive approach to patient care, emphasizing that non-geriatricians must also be proficient in recognizing and managing frailty. Effectively addressing frailty can lead to significant cost savings for healthcare systems, reduced burden on healthcare facilities, and decreased need for long-term care.

Background: Most western countries provide funded legal representation (LR) for involuntarily admitted psychiatric patients appearing before judicial committees. In 2004, an amendment to the Israeli Mental Health Act granted this right to involuntarily committed psychiatric patients. Psychiatrists then voiced concerns that LR may increase rates of premature discharge and compromise patients' safety and well-being. These worries have not been sufficiently addressed to date. This study aimed to provide answers to their concerns.

Methods: This study included 3124 and 3434 inpatients involuntarily admitted to psychiatric facilities in 2000 and in 2010 (respectively), prior to and after the introduction of LR in Israel. Data were acquired from the Israeli National Psychiatric Hospitalization Registry. Clinical measures included percentage of discharges by the District Psychiatric Board (DPB), duration of involuntary hospitalization and rates of readmissions within thirty days and six months of discharge by treating psychiatrists (TP) or DPB.

Results: The odds ratio (OR) of discharge by a DPB in 2010 (n = 221) compared to 2000 (n = 93) was 2.2 [95%CI 1.72-2.82]. The OR was similar for readmissions within thirty days or six months among patients discharged by TP and a DPB (OR = 1.08, p = 0.697 and OR = 0.92, p = 0.603, respectively) as well as between the two time points (p = 0.486 and p = 0.618). The duration of hospitalizations terminated by a DPB was significantly shorter than those terminated by TP, with no difference between the study time points. The mean hospitalization duration in 2010 was 21% shorter compared to 2000 among patients discharged by TP.

Conclusions: The number of DPB proceedings and the number of involuntarily hospitalized psychiatric patients discharged by DPBs increased considerably after the advent of state-funded legal representation in 2004. We found that this did not compromise beneficence and non-malfeasance of patient care. Our results emphasize the feasibility of affording even the most severely mentally ill patients the rights to due process. These findings may relieve concerns about state-funded LR procedures in involuntary psychiatric hospitalizations.

Background: On October 7th, 2023, Hamas launched a surprise attack on Israel, triggering a conflict with Israel in the Gaza Strip. This ongoing war, now six months old, has also seen threats from Hezbollah in Lebanon, as well as from Yemen and Iran. The precarious security situation along Israel's southern and northern borders led to extensive evacuations, with residents relocating within Israel under uncertain conditions concerning their return and property safety. This study compares resilience (societal, SR; community, CR; and individual, IR), hope, morale, distress symptoms (anxiety and depression symptoms), and perceived danger between general Hebrew-speaking adults and evacuee adults a few months post-conflict initiation.

Methods: Data was collected using structured self-reported questionnaires focusing on resilience and coping strategies, administered through two online panel companies. The general population data was collected from January 14-21, 2024 (N = 1,360), and the evacuees' data from March 1-9, 2024 (N = 372; 133 from the north, 239 from the south).

Results: Evacuees reported lower SR and CR, hope, and morale, and higher distress symptoms and perceived danger compared to the general population. No differences in IR were found. Regression analyses identified different primary predictors of SR for each group: hope for the general population and governmental support for evacuees. Additionally, IR significantly predicted outcomes only among evacuees, whereas age, religiosity, and education were significant predictors solely in the general population. One notable similarity emerged: CR served as the second most influential predictor in both samples.

Conclusions: The entire population of Israel is affected by the ongoing war, yet evacuees endure a disproportionately severe impact, with potential for increased harm as the conflict persists. The adjustment to a new wartime emergency routine is more complex for evacuees than for the general population. It is crucial for policy and decision-makers to address the distinct differences between evacuees and the general populace to effectively meet their specific needs. Yet, it should be acknowledged that the evacuees represent a heterogenic group, necessitating a detailed subdivision into subgroups to accurately assess and address their unique challenges.

Background: In the 21st century's digital age, health organizations face challenges from reduced public healthcare spending, creating a competitive market that impacts healthcare management. The struggle is hardest for small organizations, such as private clinics. Competing under unfavorable conditions, these small businesses must run as independent, profitable units in a government-regulated market where they are subject to numerous restrictions yet receive no financial support. In a world of increasing dependence on digital technologies, these small businesses must adopt competitive business models and be adaptive and flexible in embracing change.

Methods: This qualitative study is based on a thematic qualitative analysis of 20 in-depth, 45-minute-long interviews with dentists and owners of private dental clinics in various specialties. The study employs the strategic change model to examine how dentists who run private dental clinics implement new strategies and technologies to adjust to changes and create a competitive edge.

Results: Six main categories emerged from the analysis of the interviews: changes in the organization's environment; instituting and assimilating changes; obstacles in embracing change; added value obtained from embracing the change; quality of care and service; and cost-benefit considerations. The categories were map and evaluated in light of the strategic change model. The analysis indicated that digital strategies have been only partially adopted, suggesting an absence of a cohesive, long-term strategic vision for the organizations.

Conclusions: The study explored the actions, perceptions, and challenges of adapting to a competitive digital market in dental private clinics. Based on these insights, recommendations have been provided for global change management, aiming for a sustainable and stable healthcare system that benefits the broader community.

Background: Home care provides an excellent opportunity for personalizing treatment as nurses see patients in their natural environment. Along with its many advantages, the home care environment carries unique risks, as nurses are usually alone, without the protection and security provided by primary care clinics. There are no accurate data in Israel on the scope and characteristics of client violence against nurses during home visits. We conducted a qualitative study to investigate the nature of client violence faced by Israeli nurses during home visits, to gain insights into their perceptions and experiences, and to contribute to the development of effective policies and strategies to combat client violence in the healthcare sector.

Methods: Twenty-seven female nurses from primary care clinics, who were exposed to client violence during a home visit, were interviewed using a semi-structured interview guide. The interviews were transcribed and analyzed, and categories and themes were extracted.

Results: Most nurses interviewed experienced at least three incidents of client violence, the most common of which was verbal abuse. The nurses perceived that the location of the encounter between the nurse and the patient in the patient's natural surroundings, rather than within the controlled boundaries of a clinic, contributes to the risk of violence. Violence affected the nurses' professional decisions. The nurses reported that their organization had no established guidelines or instructions for safely conducting home visits, they were not provided with protective or security measures for emergencies, nor did they perceive that they had sufficient training to deal with client violence in clients' homes.

Conclusions: Nurses encounter a range of challenges that make it difficult for them to deal with client violence during home visits, affecting their personal safety and professional decisions. Their ability to manage such situations is shaped by a complex interplay of personal and organizational factors and requires a range of strategies and resources to effectively address them.

Background: Patients expect their information to remain confidential, and physicians have a legal and ethical obligation to keep it this way. Confidentiality is not just a legal requirement but a crucial element in establishing trust between patients and healthcare providers. Patients must feel confident that their personal and medical information is kept confidential and shared only with those who need to know. Previous studies have primarily concentrated on patients' perceptions of medical confidentiality, data privacy, and data protection issues. However, research on the practical practices and perceptions of medical confidentiality among hospital physicians is scant, underscoring the need for a deeper understanding of this critical issue.

Methods: Through qualitative methods and as part of a large-scale study on aspects of patient dignity and responsiveness in Israel, physicians shared their views and practices on managing medical information.

Results: The study revealed the practical challenges physicians face in upholding various aspects of data protection within hospital settings. These challenges, strategies, and deviations from data protection principles that physicians discussed are of significant practical relevance. The importance of patient consent and the practical measures for safeguarding patient information were also highlighted. While physicians acknowledged the importance of protecting patient information, they also grappled with the realities of doing so in a complex healthcare environment. In future healthcare policies, it is critical to ensure robust measures are in place to safeguard and uphold medical confidentiality. These can include specific measures to increase compliance, such as regularly monitoring compliance with confidentiality policies, producing safe and anonymous channels to voice concerns, and enforcing consequences for any breaches to ensure accountability.

Conclusions: While protecting medical information has emerged as an important goal, it is equally crucial to strike a balance between the need to share information to advance and provide quality medical care. Physicians and policymakers must navigate this delicate balance. Additionally, organizations should strengthen compliance to enhance their monitoring and enforcement of confidentiality policies. Ineffective implementation of medical confidentiality leads to theoretical guidelines that do not translate effectively into practice.

Background: Sheba Medical Center (SMC) is the largest hospital in Israel and has been coping with a steady increase in total Emergency Department (ED) visits. Over 140,000 patients arrive at the SMC's ED every year. Of those, 19% are admitted to the medical wards. Some are very short hospitalizations (one night or less). This puts a heavy burden on the medical wards. We aimed to identify the characteristics of short hospitalizations.

Methods: We retrospectively retrieved data of consecutive adult patients admitted to our hospital during January 1, 2013, to December 31, 2019. We limited the cohort to patients who were admitted to the medical wards. We divided the study group into those with short, those with non-short hospitalization and those who were discharged from the ED.

Results: Out of 133,126 admissions, 59,994 (45.0%) were hospitalized for short term. Patients in the short hospitalization group were younger and had fewer comorbidities. The highest rate of short hospitalization was recorded during night shifts (58.4%) and the rate of short hospitalization was associated with the ED daily patient load (r = 0.35, p < 0.001). The likelihood of having a short hospitalization was most prominent in patients with suicide attempt (80.0% of those admitted for this complaint had a short hospitalization), followed by hypertension (68.6%). However, these complaints accounted for only 0.7% of the total number of short hospitalizations. Cardiac and neurological complaints however, made up 27.4% of the short hospitalizations. The 30-days mortality rate was 7.0% in the non-short hospitalization group, 4.3% in the short hospitalization group and 0.9% in those who were discharged from the ED.

Conclusions: Short hospitalizations in medical wards have special characteristics that may render them predictable. Increasing the rate of treating personnel per patient during peak hours and referring subsets of patients with cardiac and neurological complaints to ED-associated short term observation units may decrease short admissions to medical departments.

Background: Sexually active adolescents sometimes seek contraceptives without parental consent, posing challenges due to minors' confidentiality and consent regulations. This is especially the case under the un-nuanced Israeli legal scheme regarding adolescents' care.

Methods: Israeli OBGYNs were contacted through mailing lists and social media groups and asked to fill an online questionnaire regarding their experience and protocols concerning prescription of contraceptives to minors. They were also asked about their comprehension of the relevant legal obligations, the importance they ascribe to different ethical interests and considerations, as well as their training.

Results: Of the 177 responding gynecologists, 132 (74.58%) consulted minors about contraceptives during the past year, regardless of a vast lack of training on providing care to minors. More than a third of respondents believed that there is no legal requirement to involve parents in the process, and only 8% assumed a legal obligation for parental involvement in all minors under the age of 18. Three quarters would "almost always" prescribe contraceptives without parental knowledge, if requested, while 20% never would. No correlation was found between respondents' practices and their perception of the relevant legal obligations. Participants agreed that the risk to the health of the minor as a result of having sex without contraceptives is of utmost importance. Yet, those willing to prescribe gave greater weight to this consideration, while those who do not prescribe were more concerned with the legal ramifications of such an act. The majority identified the age of 15 as the threshold for consistently prescribing contraceptives to minors without parental involvement.

Conclusion: This study highlights the significant gaps in both the legal framework and the training of Israeli OBGYNs, and further supports confidential prescription of contraceptives to minors 15 years and older, via Article 6 of the Israeli Legal Competence and Guardianship Law. Legislative reform, professional guidelines and education and training programs are all needed to ensure consistent and legally sound practices, that safeguard the health and rights of minors. It is imperative to guide healthcare providers, including OBGYNs prescribing contraceptives to minors, on managing the care of minors refusing parental involvement, clarifying the legal framework and ethical considerations involved.

Background: Community water fluoridation began in the 1945 as a public health measure to prevent and control caries and was implemented in Israel in 1981. Community water fluoridation reduced caries significantly, but in 2014, the Ministry of Health decided to stop Community water fluoridation in Israel. The aim of our study was to examine the effect of fluoridation cessation on the dental health of children aged 3-5, treated in "Assuta Tel Aviv" dental clinics, under general anesthesia or deep sedation.

Methods: The computerized Maccabi-Dent database provided data for this retrospective study. Records from the years 2014-2019 including treatment codes for procedures relevant to the study, the number of stainless-steel crowns and restorations of all types were examined. Kruskal-Wallis test was performed to compare the results from before and after fluoridation cessation.

Results: A statistically significant increase in the mean number of treatments in the years after fluoridation cessation (P < 0.05) was found. There was approximately a two-fold increase in the number of all treatments for all ages.

Conclusion: The results of the study emphasize the advantages of water fluoridation and are further proof of the need to restore community water fluoridation in Israel.

The appropriate use of diagnostic imaging, particularly MRI, is a critical concern in modern healthcare. This paper examines the current state of MRI utilization in Israel, drawing on a recent study by Kaim et al. that surveyed 557 Israeli adults who underwent MRI in the public health system. The study revealed that 60% of participants had undergone other imaging tests before their MRI, with 23% having more than one prior examination. While these findings highlight potential inefficiencies in the diagnostic pathway, they also underscore the complexity of medical decision-making in imaging.The paper discusses various factors influencing MRI utilization, including regulatory pressures, healthcare system structure, and the need for evidence-based guidelines. It explores potential strategies for optimizing MRI justification and scheduling, such as implementing clinical decision support systems, enhancing interdisciplinary communication, and leveraging artificial intelligence (AI) for predictive analytics and resource optimization.The need for comprehensive research into MRI justification and scheduling optimization is presented. Key areas for investigation include the effectiveness of decision support tools, patient outcomes, economic analyses, and the application of quality improvement methodologies.