Health Policy and Technology最新文献

{"title":"\"Vaccine hesitancy and acceptance in Latvia and Lithuania after the COVID-19 pandemic \"","authors":"Liubove Murauskiene ,&nbsp;Daiga Behmane ,&nbsp;Ausra Berzanskyte","doi":"10.1016/j.hlpt.2025.101146","DOIUrl":"10.1016/j.hlpt.2025.101146","url":null,"abstract":"<div><h3>Objectives</h3><div>This study investigates vaccine hesitancy and acceptance in Latvia and Lithuania following the COVID-19 pandemic, contextualising current attitudes within historical and institutional frameworks, quantifying public preferences for vaccine features and policy measures, and identifying predictors of vaccine acceptance to inform future public health strategies.</div></div><div><h3>Methods</h3><div>A cross-sectional survey using the VaxPref database was conducted with demographically balanced samples from Latvia (<em>n</em> = 1109) and Lithuania (<em>n</em> = 1010). A discrete choice experiment elicited preferences for vaccine characteristics and public health policies. Latent class analysis explored heterogeneity in vaccine acceptance, incorporating sociodemographic and attitudinal predictors such as trust in public health authorities and prior vaccination behaviour.</div></div><div><h3>Results</h3><div>Three classes emerged: Provaxers, Refusers, and Hesitants. Nearly half of respondents in both countries were Refusers, a marked increase from earlier surveys.Refusers were indifferent to vaccine attributes and strongly averse to vaccination, while Provaxers and Hesitants preferred higher vaccine effectiveness and Westernmanufactured vaccines. Trust public health authorities and prior COVID-19 vaccination were the strongest predictors of acceptance. Policy-related variables, such as social restrictions and mandates, had statistically significant but minor associations, with both countries preferring the absence of constraints. Gender and religious affiliation influenced hesitancy in a country-specific manner.</div></div><div><h3>Conclusions</h3><div>Vaccine attitudes in Latvia and Lithuania are shaped more by trust public health authorities and prior behaviours than by traditional sociodemographic factors. The high proportion of systematic Refusers poses a significant challenge for pandemic preparedness, highlighting the need for targeted trust-building initiatives and contextspecific policies to improve vaccine uptake.</div></div><div><h3>Public interest summary</h3><div>Our study looked at why many people in Latvia and Lithuania are hesitant or refuse to get vaccinated, even after the COVID-19 pandemic. We found that nearly half of adults in both countries are strongly against vaccines, and this reluctance is not driven by age, education, or income. Instead, the main reasons are a lack of trust in public health authorities and past experiences with vaccination. While some people prefer vaccines that are more effective or made in Western countries, regulations such as societal limitations or mandates little affected their choices. To increase vaccine uptake in the future, context-specific approaches and trust-building are essential.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 2","pages":"Article 101146"},"PeriodicalIF":3.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions, attitudes, and intention to adopt artificial intelligence in healthcare among medical and pharmacy students","authors":"Luu Thi Thuy ,&nbsp;Hoang Thi Ngoc Sen ,&nbsp;Nguyen Huong Giang ,&nbsp;Huynh Huu Bon ,&nbsp;Vo Thi Ngoc Ha","doi":"10.1016/j.hlpt.2025.101145","DOIUrl":"10.1016/j.hlpt.2025.101145","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to describe medical and pharmacy students' perceptions, attitudes, and intention to adopt artificial intelligence (AI) in healthcare and identify factors influencing their intention to use AI.</div></div><div><h3>Methods</h3><div>This cross-sectional study was conducted in Vietnam in December 2024 using a convenience sampling strategy. A self-administered questionnaire was employed to evaluate students’ perceptions of AI applications, attitudes toward AI, and their intention to integrate AI into healthcare. Hierarchical regression analysis was carried out to identify significant factors influencing intention.</div></div><div><h3>Results</h3><div>Most participants acknowledged AI’s advantages, with 66.9 % recognizing its role in patient documentation, 63.5 % agreeing it supports preventative health recommendations, and 61.9 % endorsing its contribution to capacity planning. However, skepticism remained, as 28.1 % doubted AI’s effectiveness in psychiatric counseling, 25.7 % questioned its application in surgery, and 22.0 % were uncertain about its ability to analyze patient data for prognoses. Attitudinally, 63.1 % expressed concern over AI’s impact on job security, though 47.2 % maintained a generally positive outlook on AI’s role in healthcare. Over half of the respondents expressed a strong willingness to integrate AI into their future practice, with 60.1 % affirming their intent to use AI-based technology. Hierarchical regression analysis highlighted attitudes toward AI (ß = 0.528), perceptions of AI in individual patient care (ß = 0.207), and self-assessed technology skills (ß = -0.121) as significant predictors of intention.</div></div><div><h3>Conclusions</h3><div>Attitudes, perceptions of AI in individual patient care, and technology skills strongly influenced students’ intention to adopt AI. Integrating AI education into medical curricula may improve preparedness for AI-driven healthcare.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 2","pages":"Article 101145"},"PeriodicalIF":3.7,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review on the impact of healthcare consolidation in the digital era","authors":"Min Chen ,&nbsp;Arman Ghafoori ,&nbsp;Wenbin Zhang","doi":"10.1016/j.hlpt.2025.101138","DOIUrl":"10.1016/j.hlpt.2025.101138","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;This systematic review examines how healthcare provider consolidation, particularly among hospitals and health systems, affects Health Information Technology (HIT), with a focus on Electronic Health Records (EHRs) and interoperability.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we reviewed literature published through June 2023 using major databases such as PubMed and Cochrane. Data from 16 peer-reviewed studies covering 125 quantitative analyses were synthesized to analyze how provider consolidation shapes HIT infrastructure and performance, including information exchange, EHR vendor diversity, and downstream outcomes such as healthcare access, cost efficiency, and care quality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The findings show that consolidation is significantly associated with improvements in information exchange and increased healthcare utilization, particularly in emergency department and primary care settings. While the improvements are encouraging, they are often incremental and do not yet reflect full interoperability, which involves not only data sharing but also the seamless, meaningful use of information across systems. Evidence on cost-effectiveness, care quality, and patient outcomes is mixed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Consolidation may improve certain aspects of digital infrastructure, especially data exchange, but does not guarantee full interoperability or better downstream outcomes. These findings point to the need for future research to go beyond measuring data exchange by assessing actual interoperability performance and examining the real-world challenges of HIT integration in consolidated systems. As healthcare consolidation continues, careful evaluation of its digital, clinical, and organizational impacts will help advance interoperability and support equitable, high-quality care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Public Interest Summary&lt;/h3&gt;&lt;div&gt;This review explores how hospital and health system consolidations affect Health Information Technology (HIT), particularly Electronic Health Records (EHRs) and interoperability. Through a systematic search, we identified 16 papers and 125 quantitative analyses. The findings show that consolidation is significantly associated with improved information exchange and increased healthcare use. While the improvements are encouraging, they are often partial and do not mean that systems can fully and effectively use shared data across all settings. The impact on cost-effectiveness, care quality, and patient outcomes varies across studies. Our review highlights the need for more research that looks beyond basic data sharing to evaluate how well health systems actually use information and to understand the practical challenges of integrating technology after hospitals or health systems merge. The findings also offer insights to inform policy efforts aimed at promotin","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 2","pages":"Article 101138"},"PeriodicalIF":3.7,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does a tiered diagnosis and treatment system enhance self-rated health outcomes among middle-aged and older patients with hypertension or diabetes? Evidence from China","authors":"Wen He","doi":"10.1016/j.hlpt.2025.101137","DOIUrl":"10.1016/j.hlpt.2025.101137","url":null,"abstract":"<div><h3>Objective</h3><div>Addressing healthcare challenges in aging societies represents a pressing global priority for countries worldwide. To increase healthcare accessibility and equity, China introduced its tiered diagnosis and treatment (TDT) system in 2015. This study examines the impacts of this policy change on self-rated health outcomes among middle-aged and older patients with hypertension or diabetes.</div></div><div><h3>Methods</h3><div>Under a quasi-experimental framework, this study leveraged longitudinal data from four waves (2011–2018) of the China Health and Retirement Longitudinal Study (CHARLS) and employed a difference-in-differences (DID) approach to identify the impacts. To supplement this analysis, a moderating effects model was implemented to explore the potential moderating influence of health insurance coverage, primary care utilization, and treatment compliance.</div></div><div><h3>Results</h3><div>The findings revealed that following the implementation of TDT, middle-aged and older patients with hypertension or diabetes experienced a marked 31.03% enhancement in self-rated health outcomes (<em>P</em> &lt; 0.05), with effects intensifying progressively over time. Additionally, moderating analysis demonstrated that patients' health insurance coverage (<em>P</em> &lt; 0.01), expanded insurance benefits (<em>P</em> &lt; 0.05), heightened primary care utilization (<em>P</em> &lt; 0.1), and enhanced treatment compliance (<em>P</em> &lt; 0.01) collectively amplified the positive health impacts.</div></div><div><h3>Conclusions</h3><div>This study offers compelling new causal evidence that strengthening primary care systems and strategically refining healthcare resource allocation have provided tangible health benefits to vulnerable populations. Notably, as China's TDT operates on a voluntary basis, its experience provides valuable insights for countries grappling with escalating medical demands alongside fragmented healthcare systems.</div></div><div><h3>Public Interest Summary</h3><div>This study explored the impacts of the tiered diagnosis and treatment reform in China on self-rated health outcomes among middle-aged and older patients with hypertension or diabetes. By leveraging longitudinal data from a national survey and conducting a DID analysis, it provides novel evidence that the policy reform significantly enhanced the health status of this vulnerable population, with health insurance coverage and benefits, primary care utilization, and treatment compliance acting as pivotal factors in amplifying these health benefits.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101137"},"PeriodicalIF":3.7,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"...it saves so much time\": A qualitative exploration of the use of Generative Artificial Intelligence by the health workforce","authors":"Mia Nazir ,&nbsp;Jane Ellen Carland ,&nbsp;Melanie Keep ,&nbsp;Anna Janssen","doi":"10.1016/j.hlpt.2025.101136","DOIUrl":"10.1016/j.hlpt.2025.101136","url":null,"abstract":"<div><h3>Objectives</h3><div>Generative Artificial Intelligence (Gen AI) has become an increasingly prevalent conversation in healthcare over the past few years. Though there have been research projects and articles exploring the administrative and clinical uses of such technologies, there has been little exploration of health professional perspectives, hopes and concerns. This study sought to explore perspectives and examine the barriers and enablers of Gen AI in healthcare.</div></div><div><h3>Methodology</h3><div>Australian health professionals participated in a mixed-methods study. A survey (n=31) explored the Six Dimensions of Healthcare Quality Framework, capturing quantitative (Likert-scale responses) and qualitative (free-text) data. Semi-structured interviews (n=10) explored participant perceptions of Gen AI. Quantitative data was analysed using descriptive statistics. Qualitative data was thematically analysed.</div></div><div><h3>Results</h3><div>Most survey respondents (74.14 %) reported having used Gen AI to support their work, but only a few (25.81 %) reported organisational supports for use of these technologies. Analysis of the qualitative data aligned with the survey responses. Five themes were generated through thematic analysis, aligning with health professional’s perceived use of Gen AI chatbots, benefits, risks, as well as drivers of safe use and opportunities for the future.</div></div><div><h3>Conclusion</h3><div>Health professionals see potential for using Gen AI to support their work, with enthusiasm about the potential of Gen AI to reduce workloads, particularly in offloading administrative tasks. There is also awareness that Gen AI chatbots pose risks both at the individual level such as limited capability in using these technologies and at the organisational level such as lack of training to support in upskilling, and systemic concerns around policy gaps.</div></div><div><h3>Public Interest Summary</h3><div>Generative Artificial Intelligence (Gen AI) is increasingly topical in all aspects of life, and the health sector is no exception. Though there have been research projects focusing on Gen AI in healthcare, there has been little exploration of health professional views and concerns. This study spoke to health professionals and found that though there is a lot of interest in potential applications of Gen AI in healthcare, particularly in administrative offloading and clinical support, however, the benefits don’t yet outweigh the risks. Software developers must work alongside health professionals in developing a substantially beneficial program to support the safe use of Gen AI in healthcare as well as be well supported on an organisational level. There are also opportunities to develop education to build health professionals capacity to use GenAI safely and effectively, and for health service organisations to develop guidance and policies to clearly articulate what safe use looks like.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101136"},"PeriodicalIF":3.7,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biosimilar medicines in Malaysia: Unveiling new guidance for practice","authors":"N Saad,&nbsp;Coleen SB Choo,&nbsp;H Chandriah,&nbsp;N Ahmad","doi":"10.1016/j.hlpt.2025.101135","DOIUrl":"10.1016/j.hlpt.2025.101135","url":null,"abstract":"<div><h3>Background</h3><div>Biologics have transformed the treatment of chronic diseases, but their high-cost limits access and burdens healthcare budgets. Biosimilars, highly similar versions of approved biologics, offer a more affordable alternative. However, their complex nature necessitates distinct regulatory and clinical guidance to ensure their safe and effective use in the healthcare facilities.</div></div><div><h3>Objective</h3><div>This article highlights the policy initiatives undertaken by the Ministry of Health (MOH) Malaysia to develop a Position Statement, aimed at guiding the integration of biosimilars into Malaysia’s public healthcare system.</div></div><div><h3>Method</h3><div>A multi-stage process began in 2019 and involved structured stakeholder engagement, literature reviews, and consensus-building across medical and regulatory disciplines. Key areas addressed included interchangeability, switching, automatic substitution, prescribing, procurement, and pharmacovigilance. Two rounds of review were conducted, and stakeholder consensus was obtained through a binary survey, with a 70 % agreement threshold.</div></div><div><h3>Results</h3><div>Stakeholders from multiple specialties emphasized cautious but positive attitudes toward biosimilar use, especially for treatment-naïve or short-term therapy patients. The final guidance includes ten statements across five domains, emphasizing physician-led switching, prohibition of automatic substitution, indication-specific prescribing, and the need for robust pharmacovigilance. A total of 83 % of stakeholders supported the content, and 88 % endorsed its dissemination. The document was officially endorsed by the MOH Medicines Formulary Panel for implementation across all MOH facilities.</div></div><div><h3>Conclusion</h3><div>The position statements represent a critical step toward structured biosimilar adoption in Malaysia’s public healthcare. Ongoing implementation, education, and post-market evaluation will be essential to strengthen prescriber confidence, improve pharmacovigilance, and enhance patient trust in biosimilars.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101135"},"PeriodicalIF":3.7,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of assistive technologies on caregiver burden and perseverance for people with dementia at home","authors":"G. Bagnasco ,&nbsp;J. van Exel","doi":"10.1016/j.hlpt.2025.101134","DOIUrl":"10.1016/j.hlpt.2025.101134","url":null,"abstract":"<div><h3>Objectives</h3><div>This study examines the relationship between the use of assistive technologies and the burden and perseverance time of informal caregivers of community-dwelling people with dementia.</div></div><div><h3>Methods</h3><div>An online survey of 342 informal caregivers in the Netherlands assessed objective burden (tasks and time involved in caregiving), subjective burden (personal experience of stress and strain), current perseverance time (time expected to be able to continue providing care), and well-being (overall happiness). Data included demographics, housing, neighbourhood characteristics, assistive technology use, and preferences for additional technologies. Multiple logistic regressions examined associations between assistive technology categories and caregiver outcomes (i.e., below-median weekly caregiving hours, Self-Rated Burden score; above-median CarerQol-7D score, CarerQol-VAS score, and Current Perseverance Time in months). Furthermore, multiple logistic regressions estimated the impact of the most desired technology category on the likelihood of extending the perseverance time by more than six months. Analyses were stratified by caregiver living arrangement (co-residing vs living nearby).</div></div><div><h3>Results</h3><div>Among co-residing caregivers, daily living support technologies were associated with reduced caregiving hours, whereas risk prevention technologies were linked to longer current perseverance time but also higher self-rated burden. Risk response technologies were also associated with higher self-rated burden. Among caregivers living nearby, risk prevention technologies were associated with higher quality of life. Moreover, daily living support and risk response technologies most strongly extended perseverance time beyond six months in both groups.</div></div><div><h3>Conclusions</h3><div>Assistive technologies play a nuanced role in supporting informal caregivers of community-dwelling people with dementia, with impacts differing by living arrangement and technology type.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101134"},"PeriodicalIF":3.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value-centred commissioning in primary health care: reform lessons from the Portuguese experience","authors":"Paulo Santos ,&nbsp;Isabel Nazaré ,&nbsp;Luísa Sá","doi":"10.1016/j.hlpt.2025.101133","DOIUrl":"10.1016/j.hlpt.2025.101133","url":null,"abstract":"<div><h3>Background</h3><div>Portuguese Primary Health Care commissioning has transitioned from centrally managed agreements to performance-based models. Despite this evolution, persistent structural and procedural inefficiencies limit its capacity to generate value. Comparative European experiences highlight alternative frameworks that emphasise outcome relevance, decentralisation, and system learning.</div></div><div><h3>Objective</h3><div>To propose a conceptual model for primary health care commissioning aligned with structure–process–outcome logic.</div></div><div><h3>Methods</h3><div>We conducted a narrative review to trace the evolution of commissioning in Portuguese Primary Health Care, focusing on its regulatory, financial, and performance roles. We used several sources, including legislation, policy documents, national and European reports, and academic literature. Analysis followed a structure–process–outcome framework. Comparative insights highlighted governance models, incentive structures, and reform opportunities aligned with value-based care and European benchmarks.</div></div><div><h3>Results</h3><div>Portuguese commissioning systems lack clinically meaningful outcome indicators and remain rigid in design. The new model offers a framework for aligning commissioning processes with population health needs, clinical relevance, and system adaptability. Comparative analysis shows that decentralised, context-sensitive models from other European countries are applicable and promising.</div></div><div><h3>Conclusions</h3><div>Commissioning reforms should centre around auditable, evidence-based outcome indicators tailored to local contexts. These indicators can enhance motivation, accountability, and continuous learning. Reforms are achievable within current organisational structures and planning cycles. Policymakers should consider decentralisation and a value-oriented approach to improve Primary Health Care delivery and responsiveness, particularly in systems facing similar structural constraints.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101133"},"PeriodicalIF":3.7,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145569334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Four years upscaling telemonitoring to future-proof health care delivery in Dutch university hospitals: Before and after - where do we stand and what are the results?","authors":"HJ Harm Gijsbers ,&nbsp;S Azam Nurmohamed ,&nbsp;Linda W Dusseljee–Peute ,&nbsp;Tom H van de Belt ,&nbsp;Marlies P. Schijven","doi":"10.1016/j.hlpt.2025.101132","DOIUrl":"10.1016/j.hlpt.2025.101132","url":null,"abstract":"<div><h3>Objectives</h3><div>Upscaling digital solutions is crucial for future-proofing healthcare, yet effective and sustainable methods are underrepresented in literature. In the Netherlands, a University Medical Center (UMC) network collaborated within the Citrien eHealth program to future-proof care using telemonitoring (TM). From 2020–2022, three TM activities were initiated: TM for cardiac rhythm abnormalities/heart failure (TMCardio), TM of blood pressure in high-risk pregnant women (TMAnteNatal), and continuous wireless monitoring of vital functions (TMVitals). This study evaluated the scale-up of these TM programs in seven Dutch UMCs.</div></div><div><h3>Methods</h3><div>An uncontrolled before-after study design was used.Primary outcome, ‘normalization of telemonitoring,’ was assessed using the 20-item NoMAD questionnaire. Results were structured according to the non-adoption, abandonment, scale-up, spread and sustainability (NASSS) framework. Secondary outcomes included the number of UMCs offering TM programs and the number of patients using TM.</div></div><div><h3>Results</h3><div>The NoMAD questionnaire had a 61 % response rate. Respondents were familiar with TM (<em>N</em> = 85, mean = 7.27, SD=2.13) and believed it would become more normal in their work (<em>N</em> = 98, mean = 8.42, SD=1.64). However, a significant difference between current practice and expected future use of TM was observed (<em>p</em>≤ 0.001). All UMCs ran TM programs, but not all implemented all three projects. TMCardio patients increased from 190 to 5185, TMAnteNatal from 41 to 1162, and TMVitals from 2666 to 13630.</div></div><div><h3>Conclusion</h3><div>Telemonitoring uptake increased across Dutch UMCs, but not uniformly. The complexity of scale-up is highest in NASSS domains 4, 5, and 6, with a focus on management, resources, health care reimbursement, and regulations. Understanding the impact of the Citrien network collaboration on scale requires further qualitative analysis.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101132"},"PeriodicalIF":3.7,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145569230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teleconsultation for chronic disease management among community-dwelling older adults: A call for innovation","authors":"Su Wei Wan ,&nbsp;Lina Choe ,&nbsp;Gretel Jianlin Wong ,&nbsp;Wee Ling Koh ,&nbsp;Janelle Shaina Ng ,&nbsp;Wee Hian Tan ,&nbsp;Joanna Li Xin Ooi ,&nbsp;Jacquelyn Melody ,&nbsp;Ker Kan Tan","doi":"10.1016/j.hlpt.2025.101131","DOIUrl":"10.1016/j.hlpt.2025.101131","url":null,"abstract":"<div><h3>Objectives</h3><div>Telehealth services have been around for a while but utilization of teleconsultation among older adults remains low despite its extensive and known benefits. Behavioural intentions are multifactorial and nuanced, and qualitative evidence describing the acceptance of teleconsults for chronic disease management is scarce. Hence, this study explored the perspectives of older adults towards teleconsultation use in the primary care setting.</div></div><div><h3>Methods</h3><div>A descriptive multi-site qualitative study was conducted. Semi-structured interviews guided by the Unified Theory of Acceptance and Use of Technology (UTAUT) model were held with twenty community-dwelling older adults ≥ 65 years on routine follow-up for three common chronic diseases in Singapore: hypertension, hypercholesterol, and type II diabetes mellitus. Data was analysed using the inductive thematic approach.</div></div><div><h3>Results</h3><div>Five themes were yielded: (i) more than just a physical consult; (ii) the difference in modes – does it really matter?; (iii) psychological receptivity to new technology; (iv) appropriateness of teleconsultation for medical condition; and (v) moderating factors. Participants were generally ambivalent towards teleconsultation as they could foresee its advantages but also its limitations which were thought to affect treatment. Many lacked knowledge of this remote modality which led to preconceptions of it being non-intuitive and difficult to adopt in the absence of facilitators that promote their viability.</div></div><div><h3>Conclusions</h3><div>Older adults’ acceptance of teleconsultation for chronic disease management seems conditional and non-optimistic at present. Physician advocacy, digital trainings, structured policies and age-appropriate teleconsult configurations with matured features that can mitigate the shortfalls of remote consultation will help enhance older adults’ acceptance of such services.</div></div><div><h3>Public interest summary</h3><div>While the potential and proven merits of telemedicine are plentiful, this remote modality remains foreign and intimidating to the majority of older adults. This study explored teleconsult acceptability for chronic disease management with the UTAUT framework. Findings revealed several pressing concerns which indicate the need for more digital initiatives and healthcare advocacy for its uptake in the community. Besides user-related programs, there is room for system improvements to include mature features that may offload the burden on users to learn the technology.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101131"},"PeriodicalIF":3.7,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145569231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}