Health Policy and Technology最新文献

{"title":"Multi-dimensional scaling of healthcare system profiles and pandemic outcomes in Cuba, Spain, Italy, and Germany","authors":"Giuseppe Orlando","doi":"10.1016/j.hlpt.2025.101120","DOIUrl":"10.1016/j.hlpt.2025.101120","url":null,"abstract":"<div><h3>Objectives:</h3><div>This study examines how baseline health risks in Cuba, Spain, Italy, and Germany relate to COVID-19 mortality trajectories and to identify system features associated with better outcomes. While previous comparative studies have emphasized GDP levels or hospital capacity, few have systematically linked baseline health risks and health-system models to pandemic trajectories; this study addresses that gap.</div></div><div><h3>Study design:</h3><div>Cross-country observational study of four contrasting health system models using publicly available secondary data (Cuba: state-socialist; Spain/Italy: Mediterranean welfare states; Germany: corporatist Bismarckian).</div></div><div><h3>Methods:</h3><div>We applied Multi-Dimensional Scaling (MDS) in two complementary stages: (i) a cross-sectional map of <em>Baseline Health Indicators</em> (BHI; eight pre-pandemic variables), and (ii) a trajectory-based map of <em>Pandemic Trajectory Metrics</em> (PTM; monthly reported indicators, 2020–2023) using correlation distance.</div></div><div><h3>Results:</h3><div>The BHI stage revealed distinct pre-pandemic configurations: Cuba separated on higher cardiovascular mortality and male smoking; Spain on elevated female smoking; Italy on older age structure and higher population density; and Germany on demographic pressures with higher diabetes prevalence. In the PTM stage, Cuba recorded the lowest cumulative COVID-19 mortality among the four (776 deaths per million), whereas European countries reached 2070–3261 deaths per million.</div></div><div><h3>Conclusions:</h3><div>The two-stage design clarifies how baseline risk profiles relate to pandemic trajectories. The Cuba–Europe separation is stable under the perturbations examined, while within-Europe distances are more variable; accordingly, we refrain from ranking Italy, Spain, and Germany. Reduced separability among the European cases is consistent with increasing financialization/marketisation and policy convergence in their health systems, which may compress structural differences in delivery and epidemic response and thus limits discrimination in the PTM space at our sample size and resolution.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101120"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145289841","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":"Going online or offline? Patients’ selection of healthcare service channels","authors":"Tingting Zhang ,&nbsp;Yuhan Wei ,&nbsp;Xiangbin Yan ,&nbsp;William Yu Chung Wang","doi":"10.1016/j.hlpt.2025.101124","DOIUrl":"10.1016/j.hlpt.2025.101124","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;&lt;strong&gt;:&lt;/strong&gt; The geographically uneven distribution of healthcare resources is a serious global problem. Online healthcare platforms serve as a viable means to redistribute healthcare resources across regions. This study aims to investigate the factors influencing patients’ healthcare channel choices in the context of online–offline healthcare service integration by employing cue utilization theory and cognitive dissonance theory.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;&lt;strong&gt;:&lt;/strong&gt; This study adopted a scenario-based survey method to collect data. The questionnaire was designed and distributed via an online survey platform. The proposed research model was empirically tested using the data collected and structural equation modeling methods.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;&lt;strong&gt;:&lt;/strong&gt; The results showed that channel accessibility, flexibility, and physician communication negatively affected both cognitive and emotional dissonance. Physician competence was found to negatively affect cognitive dissonance, while physician empathy was found to negatively affect emotional dissonance. In addition, both cognitive and emotional dissonance positively influenced patients’ subsequent channel-selection behavior, with physicians’ suggestions playing a moderating role in the relationship between cognitive dissonance and patient behavior. Moreover, the influence of emotional dissonance on subsequent channel-selection and the moderating effect of a physician’s suggestion on this relationship differ fundamentally between online and offline contexts.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;&lt;strong&gt;:&lt;/strong&gt; These results enrich the literature on the integration of online and offline channels in the healthcare field and patients’ channel-selection behavior in this context. Furthermore, the study findings have practical implications for healthcare service facility management and policymakers in promoting the integration of online and offline healthcare services.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Public interest summary&lt;/h3&gt;&lt;div&gt;The uneven distribution of healthcare resources is a significant global issue, and online platforms can help redistribute resources. This study explores the factors influencing patients’ healthcare channel choices in the context of online-offline healthcare service integration using cue utilization and cognitive dissonance theories. The research model was tested using data from a scenario-based survey and structural equation modeling methods. Results showed that channel accessibility, flexibility, and physician communication negatively affected cognitive and emotional dissonance. While physician competence was found to negatively affect cognitive dissonance, physician empathy was found to negatively affect emotional dissonance. Both cognitive and emotional dissonance positively influenced patients’ subsequent channel-selection behavior with physicians’ suggestions playing a moderating role, where the stren","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101124"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145364528","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":"Orphan medicine policy and decision-making frameworks: A narrative review of HTA methodologies","authors":"Mohammadreza Mobinizadeh ,&nbsp;William V. Padula ,&nbsp;Min-Hua Jen ,&nbsp;Efat Mohamadi ,&nbsp;Sahar Salehi","doi":"10.1016/j.hlpt.2025.101130","DOIUrl":"10.1016/j.hlpt.2025.101130","url":null,"abstract":"<div><h3>Objectives</h3><div>Orphan medicinal products (OMPs) often face unique policy and reimbursement challenges due to small patient populations, limited clinical data, and high costs. This review aims to provide the first comprehensive, cross‑methodological and cross‑stage synthesis of how CEA, GCEA, MCDA, and BIA have been applied in OMPs policymaking, addressing critical gaps in integrating findings across HTA stages and income‑level contexts.</div></div><div><h3>Methods</h3><div>This narrative review searched PubMed and Google Scholar for English‑language studies published between 2008 and 2024, using keywords related to rare diseases, policymaking, and the three key stages of the health technology policymaking process: topic selection, assessment, and appraisal. Studies were included if they addressed at least one of these stages in the context of OMPs.</div></div><div><h3>Results</h3><div>This review identified 17 studies related to policymaking for orphan medicinal products, of which 6 focused on topic selection—including 3 that explicitly examined horizon scanning—and 11 on the combined assessment and appraisal stages. Methodologically, 3 studies applied CEA or GCEA, 8 explored MCDA (2 for topic selection and 6 for assessment and appraisal stages), and 2 employed BIA, with some studies using more than one approach. CEA serves as the standard but struggles to incorporate societal, ethical, and dynamic market factors, often limiting its applicability for OMPs. GCEA addresses such gaps with additional considerations like disease severity and equity but remains methodologically complex. MCDA offers a more comprehensive framework by integrating clinical, economic, and qualitative benefits, although challenges like attribute weighting and stakeholder inclusion persist. BIA is instrumental in assessing affordability but lacks clinical outcome integration. Additionally, Managed Entry Agreements (MEAs) although not an HTA methodology in themselves - have emerged in several countries as practical policy tools for mitigating financial risk and bridging evidence gaps, thereby complementing the application of CEA, GCEA, MCDA, and BIA in real‑world OMPs decision‑making.</div></div><div><h3>Conclusion</h3><div>Integrating GCEA, MCDA, BIA, and complementary tools such as MEAs alongside systematic horizon scanning within the topic selection stage creates a robust framework for addressing the complexities of orphan drug policymaking across all HTA stages. Future work should focus on developing a technical input–output design for the proposed integrated chain HTA model, ensuring that outputs from horizon scanning and topic selection feed directly into structured assessment modules, and that appraisal outputs are systematically linked to policy tools such as MEAs and BIA.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101130"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614465","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":"Is the paper-based card a reliable storage medium for self-sampling HPV tests? A scoping review","authors":"Giselle Aparecida de Souza Rezende,&nbsp;Mariana Trevisan Rezende,&nbsp;Cláudia Martins Carneiro","doi":"10.1016/j.hlpt.2025.101122","DOIUrl":"10.1016/j.hlpt.2025.101122","url":null,"abstract":"<div><h3>Objectives</h3><div>Self-sampling devices and commercial Human Papillomavirus (HPV) tests are evolving. Despite the encouraging results of a “paper smear” in 2002, along with the advantages of its transportation, brushes are more commonly used than paper-based cards for self-sampling in HPV testing. Thus, the study aimed to investigate this technology and analyze its reliability.</div></div><div><h3>Methods</h3><div>A review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews, from August to October 2024, and updated in July 2025. Six databases - Pubmed, Embase, CINAHL, Cochrane, Scopus and China National Knowledge Infrastructure (CNKI) - were used to retrieve records, with search strings translated accordingly across them.</div></div><div><h3>Results</h3><div>Of 122 studies, 10 met the inclusion criteria and were considered for analysis. The study populations were predominantly at higher risk of HPV infection. The findings reveal an overall agreement range of 82.4 % to 93.3 % between self-collected samples on FTA elute (Flinders Technology Associates) card/cartridge and physician-collected samples, which is slightly inferior to that found for Evalyn Brush, the most popular self-collection device worldwide. There is a lack of standardized procedures in the diagnostic chain using paper-based cards, but the use of POI (Preventive Oncology International) card and Whatman 903 filter paper expand the potential scenario of alternative low cost devices.</div></div><div><h3>Conclusions</h3><div>Paper-based cards, particularly the FTA elute card/cartridge, show promising results for HPV self-sampling, with high concordance, sensitivity, and specificity. However, current evidence is limited by small sample sizes, heterogeneity across studies, and lack of standardized protocols, underscoring the need for further research to validate their reliability and expand their application in HPV testing and beyond.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101122"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145289815","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":"Determining fair medicines prices. What do citizens think?","authors":"Alexander Roediger ,&nbsp;Lennart Pirktl ,&nbsp;Georg Schönbächler ,&nbsp;Helmut Brand","doi":"10.1016/j.hlpt.2025.101126","DOIUrl":"10.1016/j.hlpt.2025.101126","url":null,"abstract":"<div><h3>Objectives</h3><div>There is a lively debate about the fair price of medicines, mainly led by experts. Little is known about the public’s opinion, although in most health systems with universal coverage medicines are procured by public money through payers or governments. This study assesses public opinion about fair medicine prices, the criteria that define fairness, and the policy implications.</div></div><div><h3>Methods</h3><div>A population survey amongst 1000 people across the Swiss population in all 3 language regions has been conducted between September and October 2024.</div></div><div><h3>Results</h3><div>Access for all (986), transparency of the cost structure (914) and a price reflecting the costs of a medicine (911) have ranked as the most relevant factors for a fair price of medicine. In contrast, the additional benefit of a new therapy is considered less important as a criterion. A large majority supports pharmaceutical companies making a profit. Asked how to align the different objectives, the majority supports the statement that medicines prices should be the result of a fair process (568), followed by the statement that governments should control profits (431).</div></div><div><h3>Conclusions</h3><div>This study suggests that citizens consider the balance between patient access and investment in research and development as the most relevant for a fair price of a medicine. When access and cost create a dilemma, citizens favour fair procedures. In contrast to expert opinions, the additional benefit of a medicine seems to be a less relevant criterion. The survey results indicate a nuanced and pragmatic approach to fairness, considering societal, scientific, and economic factors.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101126"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145418421","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":"2026-02-01","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}

{"title":"Co-design and formative usability evaluation of a multifunctional mhealth app for chronic vestibular syndrome management","authors":"Xuejiao Cao ,&nbsp;Yanping Yu ,&nbsp;Ruiqi Zhang ,&nbsp;Huawei Li ,&nbsp;Wenyan Li ,&nbsp;Peixia Wu","doi":"10.1016/j.hlpt.2025.101128","DOIUrl":"10.1016/j.hlpt.2025.101128","url":null,"abstract":"<div><h3>Objectives</h3><div>Chronic vestibular syndrome (CVS) refers to chronic dizziness and imbalance symptoms persisting for ≥3 months. The treatment and management of patients with CVS remain a global challenge. The effectiveness of mobile application in assisting people with other chronic conditions has been proved. This study aims to co-design and develop an app prototype for patients with CVS innovatively, then explore users’ formative evaluation for this app prototype.</div></div><div><h3>Methods</h3><div>This research adopted the qualitative research method. Two rounds of focus groups were conducted to determine the modules and functions of the app. Then the app prototype was developed accordingly. Subsequently, patients or their main caregiver were interviewed to explore their formative evaluation and optimization requirements, which in accordance with the ISO 9241–11 usability framework.</div></div><div><h3>Results</h3><div>During the focus groups, eight modules were identified for this app, including 20 specific functions in total. On the basis of focus group results, an app prototype was developed over a period of six months. Interview results indicated that participants expressed positive evaluations regarding the usefulness of this app. However, there were several impediments in terms of usability. In the end, seven user requirements for app optimization were obtained.</div></div><div><h3>Conclusions</h3><div>This study designed and developed an app based on expert focus groups. Target users provided relatively positive evaluations on this prototype. This study provided preliminary evidence on the acceptability and usability of mobile apps for managing patients with CVS.</div></div><div><h3>Public Interest Summary</h3><div>Chronic dizziness and imbalance can significantly affect daily life, making it hard for people with chronic vestibular syndrome (CVS) to manage their condition. In our study, we created a user-friendly mobile health app specifically designed for CVS patients. The app offers features to support symptom tracking, rehabilitation exercises, and educational resources. By involving both medical experts and patients in the co-design process, we ensured the app meets the real needs of users. Preliminary feedback from patients suggests that the app is practical and could help improve their quality of life. This innovation has the potential to make managing CVS more accessible and effective, reducing the challenges these patients face every day.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"15 1","pages":"Article 101128"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467652","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":"Using mental health demand to prioritize areas for improving telehealth capacity","authors":"Kendra Ratnapradipa,&nbsp;Ronnie Horner,&nbsp;Josiane Kabayundo,&nbsp;Meghan Brashear,&nbsp;Shinobu Watanabe-Galloway","doi":"10.1016/j.hlpt.2025.101119","DOIUrl":"10.1016/j.hlpt.2025.101119","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess behavioral healthcare demand relative to provider availability and identify public health regions in Nebraska that could benefit from improved broadband access to enhance telehealth services.</div></div><div><h3>Methods</h3><div>An ecological, cross-sectional design was used. Behavioral Risk Factor Surveillance System, Health Professions Tracking Service, and Federal Communications Commission broadband access data were analyzed. Behavioral health demand was measured through the age-adjusted prevalence of four indicators: binge drinking, marijuana use, diagnosed depression, and poor mental health days.</div></div><div><h3>Results</h3><div>The percentage of the population lacking broadband coverage ranged from 0.06 % to 66 % across health districts. The ratio of a health indicator (e.g., binge drinking) to the number of providers varied widely. Two health districts with a high ratio of health problems to providers, combined with low broadband coverage, stood out as potential areas that could benefit from broadband expansion.</div></div><div><h3>Conclusion</h3><div>The findings emphasize the critical need to improve broadband access in rural Nebraska to support telehealth services. Telehealth could be a valuable tool for addressing behavioral healthcare shortages in regions with adequate broadband infrastructure.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 6","pages":"Article 101119"},"PeriodicalIF":3.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157617","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":"An impact evaluation of the Scottish take-home naloxone programme","authors":"Tobias Joseph Adams ,&nbsp;Joseph Tay Wee Teck ,&nbsp;Alexander Baldacchino ,&nbsp;Patrice Forget","doi":"10.1016/j.hlpt.2025.101072","DOIUrl":"10.1016/j.hlpt.2025.101072","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe the change in opioid-related deaths (ORDs) recorded across Scotland since National ‘Take Home’ Naloxone Programme (NNP) implementation between baseline pre-implementation (2006 – 2010) and 10-year post implementation (2011 – 2020) periods. To describe and contextualise the change in ORDs within 4 weeks of prison release and hospital discharge across the same pre- and post-implementation periods and evaluate the reach of naloxone to people at risk of opioid overdose during this period.</div></div><div><h3>Methods</h3><div>Descriptive statistics as part of a pre-post secondary contribution analysis approach. The Better Evaluation Rainbow Framework for impact evaluation was utilised and data was obtained from official statistics and monitoring reports via Public Health Scotland.</div></div><div><h3>Results</h3><div>An increase in total ORDs nationwide was observed post-NNP implementation. In 2006–10, 9·8 % of ORDs (193 of 1970) were in people released from prison within 4 weeks of death, whereas only 4·4 % of ORDs (281 of 6439) in 2011–20 followed prison release, representing a 55 % reduction. A similar reduction in ORDs following hospital discharge was not observed. Cumulative reach of take-home naloxone to individuals at risk of opioid overdose across the post-implementation period was 58 %.</div></div><div><h3>Conclusions</h3><div>Implementation of the Scottish NNP has coincided with an increase in total ORDs nationwide, increased availability of take-home naloxone for management of opioid overdose and a reduction in the proportion of opioid-related fatalities among recently released prisoners. Unfortunately, the proportion ORDs after hospital discharge remain unchanged suggesting that this population may benefit from further research and additional distribution approaches.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 6","pages":"Article 101072"},"PeriodicalIF":3.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721585","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":"Healthcare networks and the waiting time to begin oral cancer treatment: An ecological study","authors":"M.V.C. Borges ,&nbsp;E.M. Costa ,&nbsp;V.P. Rodrigues ,&nbsp;E.B.A.F. Thomaz","doi":"10.1016/j.hlpt.2025.101116","DOIUrl":"10.1016/j.hlpt.2025.101116","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze the total, direct, and indirect effects of services and work process on healthcare network points, namely, primary healthcare (PHC), secondary healthcare (SHC), and tertiary healthcare (THC), on the time to begin oral cancer treatment in Brazil.</div></div><div><h3>Study design</h3><div>Retrospective observational ecological study.</div></div><div><h3>Methods</h3><div>Data were obtained from the Brazilian Unified Health System, using health regions as units of analysis. The outcome was the proportion of oral cancer patients who waited &gt;60 days to start treatment. Independent variables were represented by PHC, SHC, and THC data. Structural equation modeling assessed total, direct, and indirect effects on the outcome using standardized factor loadings (SFLs). Analyses were conducted at a 5 % significance level.</div></div><div><h3>Results</h3><div>Health regions that performed oral biopsies in PHC tended to begin the treatment earlier (Direct effect, SFL = −0.155, <em>p</em> = 0.038), and those with better socioeconomic status had undergone higher rates of oral cancer biopsy in PHC, which decreased the mean time to begin oral cancer treatment (Indirect effect, SFL = −0.041, <em>p</em> = 0.035). Health regions with a higher proportion of advanced-stage diagnoses tended to experience greater delays in treatment (Direct effect, SFL = 0.252, <em>p</em> = 0.001).</div></div><div><h3>Conclusions</h3><div>Findings suggest associations between PHC actions, socioeconomic conditions, and treatment timeliness across health regions, but the ecological design precludes causal inference and warrants caution due to ecological fallacy. These results underscore the need for individual-level studies to clarify links between early diagnosis and timely cancer care.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 6","pages":"Article 101116"},"PeriodicalIF":3.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048764","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}