Israel Journal of Health Policy Research最新文献

Background: Most older adults prefer to "age in place" within their communities. This preference cannot always be honored and dependent older adults may transfer to a long-term care facility. The Return Home is an Israel Ministry of Health initiated care model designed to prevent or delay a transfer of the dependent older adult to a long-term facility. The intervention team included a physician, nurse, social worker, occupational therapist, physical therapist, and a dietician, all participating in in-home visits. This study's aim was to examine the Return Home model's feasibility to prevent long-term care placement in a complex, dependent geriatric population.

Methods: We analyzed data from the electronic medical record (EMR) of the provider. Participants were recruited by the Israeli Ministry of Health from July 2021 to November 2022 at the time of hospital discharge. Caregiver input was obtained from interviews at the beginning and end of the one-year intervention.

Results: 138 patients were enrolled in the intervention. 86 (62%) completed the intervention in their homes, 39 (28%) died during the intervention, 5 (4%) were transferred to a long-term facility, 8 (6%) were dis-enrolled. Prescription medication usage declined by 0.79 medications per person on average. Forty patients had pressure ulcers at the time of admission; all of these ulcers healed during the program, after an average time of 1.5 months. Caregiver burden measured by the Zarit score, declined from 20.9 to 9.7, t (156) = 11.88, p < 0.001.

Conclusions: The Return Home intervention demonstrated the feasibility of preventing or delaying long-term care placement for a complex, dependent geriatric population. Further evaluation is needed to determine effectiveness and inform broader implementation.

Background: The gradual increase in referrals to the busy Emergency Departments (ED) raises concerns about the potential negative effect on the quality of medical care and patient satisfaction. Urgent Care Center (UCC) provides an alternative to the ED for non-life saving medical conditions. This study aimed to compare the admission rates, reasons for referrals and patient's satisfaction amongst UCCs based on their distance from the nearest ED.

Methods: This cross-sectional study included all medical records of four UCCs between 2017 and 2020. Admission rates, reasons for referrals, and patients' satisfaction were compared between UCCs located near and ED located farther away.

Results: The study included 216,903 patients with an average age of 32.4±24.4 years. Most referrals were independent, with 37.7% occurring on weekends. The average triage time and total time spent in the UCCs were approximately 5.3 minutes and 62.8 minutes, respectively. The proportion of residents visiting UCCs in cities with an ED was 14.4% with a level of satisfaction of 91.5%, compared with UCCs in cities without ED where these figures were 23.7% and 84.4%, respectively. UCCs in northern Israel treated more patients with trauma/injury (33.0%) than UCCs in southern Israel (28.2%).

Conclusions: UCCs in the two locations without an ED received a higher volume of patients, while their satisfaction levels were lower. UCC serves as an alternative to ED for non-lifesaving medical conditions.

Background: Prolonged shifts in residency contribute to physician fatigue, cognitive decline, and increased medical errors. This systematic review and meta-analysis evaluate how reducing shift length affects patient-physician safety, physician well-being, and residency training, addressing the ongoing challenge of balancing resident welfare, patient outcomes, and educational standards across varied implementation settings.

Methods: A comprehensive search of PubMed, EMBASE, The Cochrane Library, Google Scholar, and opengrey.eu was performed from database inception to January 2024. Eligible studies assessed the effects of duty hour limitations (≤ 24 h) on clinical, educational, or systemic outcomes. Both randomized controlled trials and observational studies were included. Meta-analyses used random-effects models. Risk of bias was assessed with RoB 2.0 and ROBINS-I tools. Subgroup analyses were performed by specialty, shift duration, and publication period. Sensitivity analyses excluded studies with extended timeframes.

Results: A total of 108 studies (8 RCTs, 100 observational) were included. Shift shortening was associated with improved resident well-being, including reduced fatigue and work-life balance. Patient safety remained stable, with a significant reduction in 30-day mortality for shifts ≤ 16 h (pooled OR 0.84, 95% CI 0.79-0.89). No significant effect on complications or adverse events was observed. Operative experience showed mixed results, with a non-significant reduction in case volume (pooled std. mean difference 0.65, 95% CI -0.04 to 1.34, P = 0.07), while test scores exhibited minimal changes. Effect directions remained consistent across publication periods. High heterogeneity and risk of bias were observed across most included studies.

Conclusions: Shortening shifts to 24 h or less appears to improve residents' satisfaction and work-life balance while maintaining patient safety outcomes. Educational outcomes were mixed; operative experience was preserved in some settings, while effects on non-surgical training remain less clear. These findings underscore the importance of tailoring reforms to specialty needs and training contexts. Future research should examine unstudied outcomes, such as residency attrition or shifts to less demanding specializations, and system-wide implementation costs. A stepped wedge cluster randomized trial is recommended for future policy evaluations.

Systematic review registration: PROSPERO CRD42023390197.

Background: The Child Dental Care Reform introduced in Israel in 2010 aimed to provide universal dental coverage for children, addressing high caries morbidity and inequalities in access to care. The reform initially covered ages 0-8 and expanded to include all children up to age 18 by 2019. This study examines age-related patterns of dental service utilization during the first decade of its implementation.

Methods: This retrospective study analyzed anonymized dental service data from 2011 to 2022, submitted by the four Health Maintenance Organizations to the Israeli Ministry of Health. The data included the number of children treated, categorized by age group, and the types of treatments provided.

Results: Service utilization showed distinct age-related patterns, with rates peaking at age 8 (48%) and gradually declining through adolescence (p < 0.001). Restorative care consistently outnumbered preventive care across all age groups (p < 0.001), with children aged 3-5 receiving the most restorative procedures per child. Preventive treatments increased with age, from 1.0 per patient in young children to 1.5 in teenagers, transitioning from mainly dental examinations in younger children to hygienist visits in adolescents. Restorative treatments included dental restorations (peaking at 50% at ages 8-9), extractions (25% at ages 10-11), and pulp treatments (25% at ages 6-8). Emergency dental visits were most common in infants and increased by 83% over the course of a decade (p < 0.001). General anesthesia utilization increased significantly in the younger age groups, with the 4-5 age group showing the most dramatic increase (2.39-fold increase, p < 0.001).

Conclusion: This study highlights distinct age-related patterns in dental service utilization among children in Israel, emphasizing the need for targeted prevention strategies and policy reforms to address current challenges disparities, including the increasing rate of treatment under general anesthesia. Preventive interventions, such as community water fluoridation and early childhood programs, alongside improved access to specialized dental care, are essential for fostering better long-term oral health outcomes. Integrating quality indicators will facilitate better incorporation of dental services into the national health system, ensuring comprehensive and equitable oral care.

Background: The study explored the relations between psychological capital, social support, and subjective well-being among Israel Defense Forces soldiers, focusing on differences between active-duty and reserve soldiers, as well as pre-war and wartime conditions.

Methods: The sample comprised 233 soldiers, divided into three groups based on their service conditions: active-duty soldiers before the war, active-duty soldiers during the war, and reserve soldiers during the war. Four questionnaires were administered: Demographic Questionnaire, Psychological Capital Questionnaire, Social Support Questionnaire, and Subjective Well-Being Questionnaire.

Results: The findings revealed significant positive correlations between psychological capital, social support, and subjective well-being, with social support mediating relations. While psychological capital remained stable across various service conditions, social support and subjective well-being were more pronounced among soldiers serving during wartime, underscoring the vital role of interpersonal connections in high-stress environments.

Conclusion: The results suggest psychological capital may function as a psychological buffer, positively associated with resilience and well-being. Moreover, the mediation effect of social support highlights the importance of social networks in sustaining psychological resilience and mitigating the adverse effects of combat stress. While these are established constructs, the study embeds them within a real-time war context, offering rare insight into how they operate under acute national trauma. Given the cross-sectional design, findings should be interpreted as associations rather than definitive causal relationships.

Background: Physicians who become patients-especially those involved in teaching-hold a dual perspective that may influence their comfort with medical student involvement in their care. Understanding these attitudes is essential for shaping medical education policies related to consent, patient assignment, and professional boundaries. This study explored Israeli family physicians' willingness to be examined by medical students and examined implications for clinical teaching policy.

Methods: A cross-sectional survey was conducted among Israeli family physicians during June-July 2024. A total of 149 participants completed a structured questionnaire assessing their comfort with students observing, taking medical histories, and performing physical, intimate, and invasive examinations. Data were analyzed using descriptive statistics and chi-square tests to compare subgroups by gender, age, and teaching status.

Results: Among the 149 respondents (mean age 47.2 years; 65.1% female), 92.6% were comfortable with students observing non-intimate exams, but only 29.5% agreed to student presence during intimate exams. Comfort increased slightly if the student was of the same gender (48.3%), but overall acceptance remained low. Female physicians were significantly less willing than males to undergo physical exams by students (63.5% vs. 88.2%; p = 0.006) and were more uncomfortable with male students performing intimate exams (48% vs. 28.1%; p = 0.014). Physicians aged ≤ 45 were less willing to student observation than those aged ≥ 46 (61.0% vs. 42.3%; p = 0.033). Only 16.8% agreed to allow students to perform invasive procedures. Interestingly, teaching physicians were significantly less likely than non-teachers to agree to student presence during intimate exams (29.7% vs. 51.6%; p = 0.018).

Conclusions: While student involvement in non-invasive care is widely accepted, substantial discomfort persists with intimate and invasive scenarios-particularly among female and teaching physicians. These findings raise ethical and educational concerns. Institutions should consider: (1) Allowing physician-patients to opt out of student involvement without stigma; (2) Implementing real-time, standardized informed consent for all patients, including physicians; (3) Creating clear guidelines on teacher-student dynamics in clinical care.

Mandatory military service creates a unique opportunity to examine health patterns in a near-comprehensive national cohort of young adults. In this context, large-scale, routinely collected military health data, particularly from dental records, can serve as a powerful lens through which to explore broader public health phenomena. Recent population-based studies conducted within the Israel Defense Forces have demonstrated how clinical records originally intended to ensure operational readiness can also illuminate associations between health outcomes and social determinants. These findings highlight the untapped potential of military health systems to contribute not only to force fitness, but to national health surveillance and epidemiologic insight. Particularly in the realm of oral health, where disease burden remains relatively high and disparities are both widespread and insufficiently explored, military data provide a scalable, real-world foundation for risk assessment, preventive strategies, and informed policy development. The integration of clinical, cognitive, and demographic data from this setting underscores the relevance of military research far beyond its operational context, informing strategies that bridge public health, clinical practice, and social equity.

Background: A recent call has been made in Israel to address the needs of citizens inflicted by multiple adversities such world pandemic, internal conflicts, events of mass trauma and ongoing war. Nonetheless, public's and mental health professional's view regarding these needs and their prioritization is not well understood. This study aims to bridge this gap in knowledge, by assessing mental health service users and professionals' views regarding the future of mental health in Israel.

Methods: Two surveys were distributed to mental health professionals and service users. Responders (286 professionals and 522 service users) were asked about their vision for future mental health services and their views regarding the integration of technology and innovation, using a close-ended measure developed by mental health professionals to address local challenges.

Results: The top-rated category among professionals and service users was improving accessibility, with 75% of the service users and 82% of the professionals ranking this item as one of top-three items. Individuals with less experience with the mental healthcare system tended to rank personalized care as second-ranked priority (OR = 0.48, p = 0.04), whereas highly experienced individuals were more likely to rank alternatives to psychiatric hospitalization as third-ranked priority (OR = 2.99, p < 0.001). Professionals ranked the level of innovation in Israel's mental healthcare as 3.37 (SD = 1.82), and service users ranked 3.18 (SD = 2.12) out of 10. Among mental health professionals, lack of resources was rated as the predominant challenge in implementing technology and innovation.

Conclusions: Policy and decision-makers in Israel should consider addressing the issue of mental healthcare accessibility as top priority when planning a mental health reform, as well as routes to improve personalized care and alternative to psychiatric admissions. Steps should be taken to improve innovation and technology as means to improve the quality of mental healthcare in Israel.

Background: The COVID-19 pandemic has transformed healthcare, affecting the diagnosis and management of common diseases. Our study aimed to assess the effect of the changes in reasons for primary care visits on primary care physicians' (PCPs') workload from 2019 to 2023, focusing on non-COVID-related diseases.

Methods: A cross-sectional study of electronic medical records conducted at Leumit Health Services between 2019 and 2023, approximately 510,000 patients who had at least one consultation with a PCP were included. The study categorized visits using ICD-9 codes and calculated the number of visits and the accumulated annual duration of time (AADT) for each code group.

Results: In 2023, there was a significant 38.9% increase in administrative visits compared to 2019, with these visits accounting for 21.8% of AADT. Additionally, a consistent rise in visits for hyperlipidemia, obesity, and diabetes was noted. Conversely, the AADT for respiratory tract infections and sexually transmitted diseases markedly declined. A lesser, yet still notable, decrease was observed in other infectious diseases, injuries, heart diseases, and pulmonary diseases.

Conclusions: COVID-19 altered the distribution of primary care visit reasons and subsequently impacted the burden on PCPs. Notably, there was an increase in visits for bureaucratic issues and a concerning reduction in follow-ups for cardiovascular risk factors, alongside a rise in metabolic conditions. These trends persisted even after the pandemic waned, despite the removal of social restrictions. Policymakers should evaluate how to optimize the utilization of PCPs' time and explore methods to regulate demand for improved efficiency.