Israel Journal of Health Policy Research最新文献

Background: Environmental management in the Israeli health system is driven primarily by safety regulations. Such regulations aim to reduce hazardous exposures to employees, patients, and visitors, as well as some specific aspects of broader environmental toxicity to humans and nature. Most environmental precautions in the system target traditional exposures and do not specifically consider the health system's own impact on climate change. This article aims to justify incorporating climate change mitigation actions into short- and long-term plans in Israeli health organizations and present a schematic strategic roadmap to do so.

Main body: Climate change poses many threats to global health, including risks from severe weather events, changes in vector-borne diseases, increased hazardous air pollutants, food and water shortages, and adverse effects on reproductive health. The most effective effort in climate change mitigation is reducing greenhouse gas emissions to the atmosphere. Ignoring the health sector's emissions contradicts the ancient medical principle: first, do no harm (primum non-nocere). Furthermore, many climate mitigation methods introduce additional health co-benefits. Special attention and medical considerations are needed to safely reduce emissions from the health sector. This article reviews healthcare's most common emission sources, including energy consumption, transportation, food, waste, supplies, and the supply chain. An organizational carbon management strategy should include recognizing the problem and committing to action, estimating the organizational carbon footprint, developing and prioritizing alternative interventions, and developing a carbon management plan with measurable short- and intermediate-term goals.

Conclusion: Climate mitigation in the health sector is encompassed by the moral obligation of the Israeli healthcare system to do no harm. Performance measures to support GHG emission reductions should be adopted into the existing, successful Israeli programs of quality measures in medicine, both in the community and hospitals. In addition, Israel academic institutions for health and medical education should incorporate sustainable health into their curricula for students of health professions and as part of continuous medical education. Such policy actions will contribute to a healthy health system that supports climate change mitigation while providing health co-benefits to the Israeli population.

Background: Disparities in dental health resulting from social and economic inequality are a pressing public health concern. Poor and vulnerable populations bear a higher burden of caries exacerbated by limited access to quality dental care. Recent publications have suggested a possible association between intellectual capability and caries risk, as well as lower compliance with publicly funded healthcare services among populations with lower educational levels. The objective of this study was to explore potential associations between severe dental caries treatment needs (root canal treatments and extractions), socioeconomic factors and intellectual capability.

Methods: Dental records of 21,052 soldiers recruited into Israeli military service between 2019 and 2021 were reviewed, and data on the need for root canal treatments and extractions were retrieved. Sociodemographic information, including age, sex, socioeconomic strata, intellectual capability scores, body mass index, and place of birth, were extracted and analyzed.

Results: The findings from the multivariate generalized linear model indicated that lower intellectual capability scores and socioeconomic strata were associated with a significantly greater requirement for root canal treatments and extractions (p < 0.001). The model also identified male gender and older age as predictors for higher treatment needs. Non-native Israelis were found to be at a greater risk for needing root canal treatments compared to native Israelis. Additionally, a significant positive correlation was observed between intellectual capability scores and socioeconomic strata (p < 0.001).

Conclusions: Groups with lower intellectual capability scores and socioeconomic strata exhibited a greater need for dental treatments, including root canal treatments and extractions. Given their higher likelihood of requiring more invasive treatments, health policy should prioritize intervention plans aimed at improving attendance at preventive care services for these disadvantaged populations under the Israeli free dental care reform.

Background: Telepharmacy, the use of telecommunications technology to facilitate pharmacy services, has emerged as an integral component of telehealth, particularly during the COVID-19 pandemic. In Israel, the shortage of pharmacists nationwide has led to longer wait times and reduced consultation opportunities at community pharmacies. In response, the Pharmaceutical Society of Israel (PSI) established a telepharmacy call center to provide free pharmaceutical consultations to the public. This study aimed to describe the framework of this center, the types of pharmaceutical consultations and patient satisfaction with the service.

Methods: This cross-sectional observational study analyzed unidentified data from 1,542 ambulatory patient inquiries to the PSI telepharmacy call center between October 2022 and June 2023. The consultations were categorized into clinical, logistical, and patient rights-related inquiries. A satisfaction survey was conducted among a representative sample of callers.

Results: The majority of inquiries (93.3%) were received via telephone, with the 65-85 age group accounting for 38.4% of callers. A small proportion of inquiries were submitted via email, either exclusively or in combination with a telephone communication. Clinical inquiries comprised 89% of the total, with the most common topics being drug interactions (26.7%), general drug usage guidance (17.8%), and inquiries about drug side effects (16.4%). The patient satisfaction survey revealed that 87% of respondents strongly agreed that the pharmacists demonstrated empathy and attentiveness, and 93.5% were satisfied with the responses provided. The overall service rating was 8.9 out of 10, and 94.1% of respondents were willing to recommend the call center to others.

Conclusion: This study highlights the value and feasibility of operating a national telepharmacy call center in Israel, addressing the diverse pharmaceutical needs of the public, particularly the elderly population. The high satisfaction levels among callers underscore the potential for such initiatives to enhance access to comprehensive pharmaceutical consultation and improve medication management.

Background: The October 7, 2023 terrorist attack and subsequent war in Israel have created an unprecedented mental health crisis. This commentary examines emerging data on the psychological impact of these events and argues for a paradigm shift in the Israeli mental healthcare system.

Main body: Recent studies reveal a dramatic increase in PTSD, depression, and anxiety among the Israeli populace. These findings underscore the long-lasting and pervasive nature of psychological trauma. Certain populations are disproportionately affected: women, ethnic minorities (particularly Israeli Arabs, who comprise 18.1% of the population), and those experiencing traumatic loss, displacement, or economic hardship. These groups require prioritized and tailored interventions. While existing outcome research provides a solid foundation for treating common trauma-related disorders like PTSD, depression, and anxiety, the Israeli mental health system is ill-equipped to handle the surge in demand. Too many clinicians lack training in evidence-based trauma therapies and standardized assessments. To address this gap, we advocate a system-wide transformation. This involves widespread training in evidence-based assessments and time- limited therapies, a focus on precision psychiatry tailored to individual needs, and the implementation of task-shifting and task-sharing models to expand access to care.

Conclusion: These strategies are crucial for mitigating the long-term mental health consequences of the October 7th attacks and fostering individual and societal resilience. Failure to act decisively will exacerbate the existing crisis, placing further strain on individuals, families, and Israeli society as a whole.

Background: Proper nutrition is fundamental to the regular mental and physical development of infants, toddlers, and children. Overexposure to manganese (Mn) in infants has been correlated to various behavioral and neurological symptoms such as lower IQ, attention deficit hyperactivity disorder, and impairment in fine motor skills. The following study aims to evaluate exposure to Mn in formula-fed infants in Israel from birth to nine months of age.

Methods: Over 200 infant formulas of multiple brands were sampled by the Israeli National Food Service, as part of a routine monitoring of levels of various nutritional components, including Mn. Data on levels of Mn in water was drawn from routine monitoring programs carried out by the Ministry of Health (MOH). Total energy requirements were calculated based on current infant weight and growth data collected over the past decade in MOH-operated family care centers. Dietary exposure was assessed for infants from birth to six months as the sum of Mn intake from infant formula and potable water. For infants aged seven-nine months, Mn intake from complementary feeding was assessed based on national surveys of feeding behavior in infants aged nine-twelve months.

Results: Milk-based infant formula brands consistently demonstrated lower levels of Mn compared to other formulations. Almost half of the sampled formula brands exceeded regulatory tolerance to deviation from labelling of nutritional components. Though some variation in Mn concentrations is evident in water sources across Israel, the overall contribution of water to Mn intake is negligible given the high levels of desalination in Israel. Excessive Mn intake in formula-fed infants is evident across multiple formula brands.

Conclusions: When breastfeeding is not optional, milk-based formulas are the most suitable in terms of their relative contribution to Mn intake. Equating maximal levels of Mn in potable waters to levels set in EU and USA regulations is advisable. A greater regulatory tolerance for deviation from labelling of mineral content is advisable so as not to hinder importation of infant formulas.

Background: The increasing complexity of mass casualty incidents (MCIs) necessitates highly effective training for emergency responders. Traditional training methods, while effective in teaching core skills, often fail to replicate the dynamic, high-pressure environments responders face in real-world crises. Virtual reality (VR) offers a novel approach to emergency training, providing an immersive, controlled setting that can simulate real-life scenarios. This study explores the effectiveness of VR in training paramedic students for MCIs and compares the outcomes to those from conventional training methods.

Methods: A comparative study was conducted with 37 paramedic students who underwent either VR-based training or conventional training using mannequins and real-world equipment. The VR application simulated a mass casualty car accident, focusing on triage and patient management. Both groups were assessed based on their performance in key areas, including the accuracy of situational reporting (METHANE), patient triage, heart rate monitoring, and perceived demand using the NASA Task Load Index (NASA-TLX).

Results: The VR group demonstrated significantly lower mental demand (p < 0.001) and frustration levels (p = 0.021) compared to traditional training. However, task completion times were slower in the VR setting (p < 0.001), likely due to the interface's unfamiliarity. Accuracy in situational reporting was higher in VR (p = 0.002), while heart rate monitoring did not reveal a significant difference between the groups (p = 0.516). Although VR did not reduce temporal demand (p = 0.057), it showed potential for improving focus and precision in training. Error rates in triage were similar across both training methods (p = 0.882), indicating comparable performance levels in patient classification.

Conclusions: VR presents a promising tool for training emergency responders, particularly in situations that require rapid upskilling, such as crises or wars. The ability to simulate realistic, high-pressure scenarios in a controlled environment can enhance both cognitive and emotional preparedness. Further research is necessary to optimize VR systems and interfaces, making them more efficient for real-time decision-making. As VR technology advances, it holds potential as a key component in future emergency preparedness strategies.

Background: Patients commonly seek outpatient physical therapy services for musculoskeletal disorders. Understanding these patient groups in Israel provides valuable insights into the healthcare system. We aimed to investigate physician referral patterns for physical therapy across different age and sex groups, focusing on neck and low back pain. Additionally, we sought to explore the therapeutic interventions provided by physical therapists for these conditions.

Methods: For this retrospective, cross-sectional study we utilized data from a national health maintenance organization covering > 4 million people at 100 physical therapy outpatient clinics. We measured the prevalence rates of physicians' referral patterns for neck and low back pain according to age and sex, as well as therapeutic interventions prescribed by physical therapists. We used Z-tests to assess the differences in prevalence rates between women and men within the same age group. Logistic regression analyses were used to evaluate the likelihood of patients of a specific age group being referred to physical therapy compared with the total sample. We analyzed prevalence rates of different treatment protocols used by physical therapists according to these referrals.

Results: Overall, 1,593,592 physician referrals for physical therapy were made over 6 years for all musculoskeletal conditions. Of those, 32.4% were for spine disorders, with 21.2% for low back pain and 11.1% for neck pain, mostly chronic (80.6% and 72.7%, respectively). Women were more likely than men to be referred for both low back pain (odds ratio = 1.36, 95% confidence interval = 1.34-1.38, p < 0.001) and neck pain (1.40, 1.37-1.43, p < 0.001). All referral rates increased with age. The most common treatment provided by physical therapists for neck and low back pain was education and advice for an active lifestyle.

Conclusions: This study provides comprehensive data that highlight significant trends related to age, acuteness, and sex. Chronic low back and neck pain are the predominant reasons for physical therapy referrals, particularly among women and older adults. Physician referrals for neck and low back pain aligned with the epidemiology of such conditions in the Israeli population, underscoring the need for targeted rehabilitation strategies, early intervention programs, and effective healthcare service planning.

Background: Implementation Science (IS) is a scientific discipline that has been in existence for approximately thirty years. The goal of this discipline is to develop and refine rigorous approaches to producing change in the health system, and thereby to shrink the quality gap between best practice and current practice more quickly and more completely than could occur through naturalistic change alone.

Main body: In this perspective, we review two prominent examples of health systems that invested in building capacity for IS- the Veterans Affairs Health System and Intermountain Healthcare in the United States- and how this investment has catalyzed system-level improvements over time. We make the case that Israel should similarly invest in building IS capacity.

Conclusion: Investing in building IS capacity does not produce quick results, and is not easy. Nevertheless, a plan to build IS capacity should be an important ingredient in our plan to improve Israel's health system over time.

Background: Healthcare facilities often encounter patients with incomplete records from previous visits, leading to duplicated tests. Recent Electronic Health Records (EHR) investments aim to address this issue. This study examines how viewing patient information via OFEK EHR affects the frequency of tests ordered by the physician. The OFEK system, developed in Clalit Health Services, is an advanced online medical records system used in hospitals. It was expanded to all hospitals and HMOs starting in 2013, allowing medical information to be shared and accessed in the Israeli healthcare system.

Methods: The study was conducted at the Israel Center for Medical Simulation (MSR), with 26 physicians engaged in encounters with simulated patients (SP). The SPs provided relevant clinical histories and signs for two abdominal pain cases. The physicians ordered diagnostic tests, and after receiving the tests' results they set a final diagnosis and could order additional tests. They had randomized access to the OFEK system to vary test-ordering patterns. In both scenarios, we examined three key variables to see if access to the OFEK system influenced the decision to order diagnostic tests ("QTestsBefore" - the number of tests ordered by the physician after the patient visit; "QTestsAfters" - the number of tests ordered by the physician after receiving the results of the first round; "QSumTests" - The total number of tests).

Results: In the study group with access to the OFEK EHR, an average of 5.5 tests were ordered, compared to 6.85 in the control group (p-value = 0.01). Ordinary Least Squares regressions confirmed that the overall number of tests, particularly the second round ordered after receiving initial results, was significantly lower with OFEK. Additionally, years of clinical practice also correlated with fewer ordered tests.

Conclusions: The findings show that the OFEK EHR system reduces the number of medical examinations by allowing physicians to access medical histories and past tests, which supports efficient decision-making. This leads to fewer ordered medical tests and, thus, reduces the time procedures patients spend in EDs or hospitals. Efficient decision-making and fewer redundant medical tests can improve patient flow, free up resources, and reduce overcrowding in emergency departments.