Health Policy and Technology最新文献

{"title":"The impact of the COVID-19 pandemic on satisfaction with healthcare services in Türkiye","authors":"Zeynep B. Uğur ,&nbsp;Aysenur Durak","doi":"10.1016/j.hlpt.2024.100888","DOIUrl":"10.1016/j.hlpt.2024.100888","url":null,"abstract":"<div><h3>Objectives</h3><p>This study aims at evaluating whether the healthcare system in Turkey performed well or not from the perspective of patients during the COVID-19 pandemic.</p></div><div><h3>Methods</h3><p>For this purpose, we compare the satisfaction with healthcare services pre-pandemic and during the pandemic. We utilize the Life Satisfaction Survey conducted by Turkish Statistical Institute (TurkStat) between 2013 and 2021 and employ probit regression method.</p></div><div><h3>Results</h3><p>The research results do not show any change in satisfaction with healthcare services in the pandemic years of 2020 and 2021. In addition, the satisfaction with healthcare services of people with health conditions, those without health insurance, and those whose premiums are covered by the state (green card holders) did not decrease during the pandemic period. The analysis results reveal that the satisfaction of people over 65 years old and those having health conditions with healthcare services increased during the pandemic period.</p></div><div><h3>Conclusion</h3><p>When the findings are evaluated as a whole, we can conclude that Turkey performed well from the users’ perspective during the pandemic.</p></div><div><h3>Public interest summary</h3><p>This study analyzes the impact of the pandemic on satisfaction with healthcare services in Turkey. To do this, we utilize Life Satisfaction Survey between 2013 and 2021. The regression results indicate that satisfaction with healthcare services has not changed during the pandemic. Moreover, we report an increase in satisfaction scores for elderly and those with health conditions in the pandemic years. We also find satisfaction of people without health insurance, and those whose premiums are covered by the state (green card holders) does not change. Our analysis points Turkey did well in managing pandemic period in terms of healthcare services satisfaction.</p></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"13 3","pages":"Article 100888"},"PeriodicalIF":3.4,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141638940","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":"Estimating a cost-effectiveness threshold for healthcare decision-making in the Greek NHS","authors":"","doi":"10.1016/j.hlpt.2024.100882","DOIUrl":"10.1016/j.hlpt.2024.100882","url":null,"abstract":"<div><h3>Background</h3><p>The introduction of new health technologies improves quality of life and longevity, but also imposes additional strains in the scarce resources of the health system. Consequently, decisions on the adoption of new technologies are typically based, among other criteria, on the difference between costs and outcomes among competing alternatives. This paper aims to estimate a cost-effectiveness threshold that can be used as an input in the decision-making process for the funding (or reimbursement) of health technologies in Greece.</p></div><div><h3>Methods</h3><p>For a 30-year period, we calculate the Quality-Adjusted Life Expectancy (QALE) of the Greek population and regress it against per capita public health expenditure, using an instrumental variable approach and controlling for a set of covariates. The estimated coefficients of expenditure on QALE are used to inform a cost-effectiveness threshold, estimatead as the cost per QALY gained through a permanent increase in per capita spending.</p></div><div><h3>Results</h3><p>Based on the estimated coefficient of health expenditure, we estimate a base case cost-effectiveness threshold of €27,117 per QALY gained for the Greek healthcare system, from a third-party payer perspective.</p></div><div><h3>Conclusions</h3><p>In the Greek healthcare system, which is currently in the stage of establishing a comprehensive health technology assessment process, decision rules which are not based on heuristics or “rules of thumb”, are essential.</p></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"13 3","pages":"Article 100882"},"PeriodicalIF":3.4,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141402129","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":"Evaluating dyNamic myocardial blood flow qUantitation as a Cost-effective care modeL for diabEtic patients with coronary artery diSease (NUCLEuS): A randomized controlled trial – Rationale and Design","authors":"Jie Jun Wong ,&nbsp;Louis LY Teo ,&nbsp;Fei Gao ,&nbsp;Liang Zhong ,&nbsp;Weimin Huang ,&nbsp;Nicholas Graves ,&nbsp;Ru-San Tan ,&nbsp;Terrance SJ Chua ,&nbsp;Felix JY Keng ,&nbsp;Angela S. Koh","doi":"10.1016/j.hlpt.2024.100881","DOIUrl":"https://doi.org/10.1016/j.hlpt.2024.100881","url":null,"abstract":"<div><h3>Background</h3><p>Recent advancements in quantifying myocardial blood flow (MBF) and coronary flow reserve using dynamic SPECT MPI have demonstrated comparable hemodynamic correlations with invasive angiography and PET. Implementation into routine practice, however, imposes attendant demands on resources. Diabetes mellitus is a rising pandemic associated with accelerated atherosclerosis, yet there is potential for under-detection of significant ischemia.</p></div><div><h3>Objectives</h3><p>We postulate that quantifying myocardial blood flow (MBF) by dynamic SPECT reduces post-test resource utilization and improve economic efficiency over conventional SPECT.</p></div><div><h3>Methods</h3><p>NUCLEuS is an ongoing prospective open-label randomized clinical trial that will enroll 300 diabetic patients without known coronary artery disease (CAD) referred clinically for SPECT MPI from March 2022 to March 2025. The aim is to determine the incremental prognostic value and post-test resource utilization of dynamic MBF over conventional SPECT in diabetic patients with suspected CAD. The primary endpoint is diagnostic failure, defined as unnecessary coronary angiography (absence of ≥50% stenosis in ≥1 coronary artery) or additional anatomical testing (e.g., coronary computed tomography angiography) within 90 days. Secondary endpoints are referrals for angiography or revascularization, escalation of anti-anginal medications, and quality-of-life scores at 12 months. Long-term endpoints are major adverse cardiovascular events (cardiac mortality, myocardial infarction, unstable angina, revascularization) within 36 months. The incremental cost-effectiveness ratio will be estimated based on cost and clinical effectiveness.</p></div><div><h3>Conclusions</h3><p>NUCLEuS will be an imaging-directed clinical trial that will compare differences in outcomes and resource utilization of dynamic MBF over conventional SPECT MPI in the routine clinical management of CAD in diabetes mellitus.</p></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"13 3","pages":"Article 100881"},"PeriodicalIF":6.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312741","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":"Digital lifestyle interventions for cardiovascular risk reduction: A systematic review and network meta-analysis","authors":"Teketo Kassaw Tegegne ,&nbsp;Desalegn Markos Shifti ,&nbsp;Jonathan Charles Rawstorn ,&nbsp;Paul Jansons ,&nbsp;Yuxin Zhang ,&nbsp;Reza Daryabeygikhotbehsara ,&nbsp;Sheikh Mohammed Shariful Islam ,&nbsp;Ralph Maddison","doi":"10.1016/j.hlpt.2024.100879","DOIUrl":"https://doi.org/10.1016/j.hlpt.2024.100879","url":null,"abstract":"<div><h3>Objectives</h3><p>To compare the relative effectiveness of different digital lifestyle interventions in improving cardiovascular risk factors.</p></div><div><h3>Methods</h3><p>A comprehensive systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) was conducted. Seven electronic databases were searched from 1990 to April 4, 2024. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. A Bayesian random-effects network meta-analysis (NMA) was performed. Continuous outcomes are reported as mean differences (MD) with their 95 % credible intervals (CrI).</p></div><div><h3>Results</h3><p>The combinations of physical activity + diet + smoking cessation (PA+<em>D</em>+Sm), and physical activity + diet (PA+<em>D</em>) components were the most effective interventions, leading to substantial improvements in multiple cardiovascular risk factors compared to usual care or some other digital lifestyle interventions with low to high certainty. Dietary interventions significantly reduced body weight and glycosylated hemoglobin (HbA1c) compared to usual care. Although the effect sizes did not meet established clinical significance thresholds for most cardiovascular risk factors, they still hold clinical relevance, highlighting the potential for significant health improvements.</p></div><div><h3>Conclusions</h3><p>Multifactorial digital lifestyle interventions, particularly those combining PA+<em>D</em>+Sm and PA+<em>D</em> components, appear the most promising for reducing cardiovascular risk factors.</p></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"13 3","pages":"Article 100879"},"PeriodicalIF":6.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S221188372400042X/pdfft?md5=a95f7e2f82a073a60e8ee9323871b80d&pid=1-s2.0-S221188372400042X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Following the data”: Perceptions of and willingness to use clinical decision support tools to inform HIV care among Haitian clinicians","authors":"Andrew M. Secor ,&nbsp;John Justafort ,&nbsp;Chenet Torrilus ,&nbsp;Jean Guy Honoré ,&nbsp;Sharon Kiche ,&nbsp;Tracy K. Sandifer ,&nbsp;Kristin Beima-Sofie ,&nbsp;Anjuli D. Wagner ,&nbsp;Jillian Pintye ,&nbsp;Nancy Puttkammer","doi":"10.1016/j.hlpt.2024.100880","DOIUrl":"10.1016/j.hlpt.2024.100880","url":null,"abstract":"<div><h3>Background</h3><p>Clinical decision support (CDS) tools can support HIV care, including through case tracking, treatment and medication monitoring, and promoting provider compliance with care guidelines. There has been limited research into the technical, organizational, and behavioral factors that impact perceptions of and willingness to use CDS tools at scale in resource-limited settings, including in Haiti.</p></div><div><h3>Methods</h3><p>Our sample included fifteen purposively chosen Haitian HIV program experts, including active clinicians and HIV program managers. Participants completed structured quantitative surveys and one-on-one qualitative semi-structured interviews.</p></div><div><h3>Results</h3><p>Study participants had high levels of familiarity and experience with CDS tools. The primary motivator for CDS tool use was a perceived benefit to quality of care, including improved provider time use, efficiency, and decision-making ability, and patient outcomes. Participants highlighted decision-making autonomy and how CDS tools could support provider decision making but should not supplant provider knowledge and experience. Participants highlighted the need for sufficient provider training/sensitization, inclusion of providers in the system design process, and prioritization of tool user-friendliness as key mechanisms to drive tool use and impact. Some participants noted that systemic issues, such as limited laboratory capacity, may reduce the usefulness of CDS alerts, particularly concerning differentiated care and priority viral load testing.</p></div><div><h3>Conclusion</h3><p>Respondents had largely positive perceptions of EMRs and CDS tools, particularly due to perceived improvements in quality of care. To improve tool use, stakeholders should prioritize tool user-friendliness and provider training. Addressing systemic health system issues is necessary to unlock the full potential of these tools.</p></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"13 3","pages":"Article 100880"},"PeriodicalIF":3.4,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141398396","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":"How do self-motivation and social motivation contribute to consumers’ acceptance of m-health services?","authors":"Da Tao ,&nbsp;Kaifeng Liu","doi":"10.1016/j.hlpt.2024.100878","DOIUrl":"https://doi.org/10.1016/j.hlpt.2024.100878","url":null,"abstract":"<div><h3>Objectives</h3><p>The study aimed to propose a unified model integrating the technology acceptance model (TAM), social-determination theory (SDT), and social motivation to examine the roles of self-motivation (i.e., autonomy, relatedness, and competency) and social motivation (i.e., social influence and social recognition) in consumer acceptance of m-health services. In addition, the study aimed to explore whether relationships among the antecedent factors and consumer acceptance of m-health services would be moderated by consumers’ demographic characteristics.</p></div><div><h3>Methods</h3><p>Partial least squares structural equation modelling (PLS-SEM) approach was used to test the proposed model with data from 614 Chinese m-health users. Multi-group analyses were performed to examine whether the results were different or equivalent across demographic backgrounds.</p></div><div><h3>Results</h3><p>Usage behavior was significantly influenced by behavioral intention. While self-motivations mostly exerted impacts on behavioral intention through the mediating roles of perceived usefulness and perceived ease of use, social motivations affected behavioral intention both directly and indirectly through the mediating roles of perceived usefulness. In addition, most of the hypothesized relations remained unchanged across gender, age, and usage experience.</p></div><div><h3>Conclusions</h3><p>This study reveals the important roles of varied self- and social motivations in developing consumer acceptance of m-health services. To facilitate consumers’ acceptance, m-health services should be designed to meet consumers’ internal requirements on autonomy and relatedness and earn recognition from social perspectives. The findings provide insights into the design and implementation of m-health services in support of consumer acceptance across different demographic backgrounds.</p></div><div><h3>Public interest summary</h3><p>M-health has long been considered as a promising tool to support individuals’ health care activities and achieve improved efficiency and quality in the delivery of health care services. However, the introduction of m-health to consumers has proven difficult, and wide acceptance has not been achieved. We conducted a field survey of 614 Chinese m-health users to identify the roles of self-motivation and social motivation in consumers’ acceptance of m-health services. We found that self-motivation can exert impacts on consumers’ acceptance through the mediating roles of perceived usefulness and perceived ease of use, while social motivation affected acceptance both directly and indirectly through the mediating roles of perceived usefulness. In addition, these effects mostly remained unchanged across consumers’ gender, age, and usage experience. Based on our findings, we propose implications to design and implement m-health services in support of consumer acceptance across different demographic backgrounds.</p></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"13 3","pages":"Article 100878"},"PeriodicalIF":6.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141291121","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":"Public database on pharmaceutical ties in Japan: Traffic and user attitudes on industry-professional relationships","authors":"Yosuke Suzuki ,&nbsp;Anju Murayama ,&nbsp;Akihiko Ozaki ,&nbsp;Hiroaki Saito ,&nbsp;Toyoaki Sawano ,&nbsp;Erika Yamashita ,&nbsp;Tetsuya Tanimoto","doi":"10.1016/j.hlpt.2024.100847","DOIUrl":"10.1016/j.hlpt.2024.100847","url":null,"abstract":"<div><h3>Background</h3><p>It is imperative to understand the specific details of the usage of the databases documenting financial ties between pharmaceutical companies and the healthcare sector and the attitudes of such database in evaluating how the citizens would recognize this issue. This study aimed to elucidate usage patterns and user attitudes regarding value transfers by analyzing data from the Yen For Docs Database in Japan (YDJ).</p></div><div><h3>Methods and Materials</h3><p>The study spanned the entire available data period, from January 15, 2019, to May 24, 2021, using Google Analytics to extract YDJ visitor data, including details on unique users, sessions, page views, and access paths over time. All visitors were invited to participate in a questionnaire survey gauging their attitudes towards value transfers from pharmaceutical firms to healthcare professionals. The survey data were analyzed separately for distinct groups, including non-healthcare or industry respondents, healthcare professionals, and those affiliated with pharmaceutical companies.</p></div><div><h3>Results</h3><p>YDJ received 604,903 accesses from 354,863 unique users, viewing 5,635,087 pages. Usage spiked initially and at later points. A survey of 399 respondents revealed negative views on value transfers from pharmaceutical companies, with over half finding it unethical. More than two-thirds supported stricter regulations. Non-healthcare respondents were less favorable compared to healthcare professionals and those affiliated with pharmaceutical companies.</p></div><div><h3>Conclusion</h3><p>YDJ achieved substantial user engagement, and the embedded questionnaire survey revealed prevalent critical perspectives among users regarding value transfers from pharmaceutical companies to the healthcare sector. Non-healthcare or industry respondents, in particular, expressed the most negative views about such relationships.</p></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"13 2","pages":"Article 100847"},"PeriodicalIF":6.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139754565","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":"Working with epistemic uncertainties: Emerging entanglements within conditional reimbursement practices","authors":"Rik Wehrens,&nbsp;Bert de Graaff","doi":"10.1016/j.hlpt.2024.100850","DOIUrl":"10.1016/j.hlpt.2024.100850","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;p&gt;HTA agencies are experimenting with conditional reimbursement approaches allowing greater flexibility to cope with epistemic uncertainties generated by new health technologies and pharmaceuticals lacking evidence. While some research into promises and effects of conditional reimbursement is conducted, little empirical research investigates how such policies play out in practice. In this paper, we analyze two cases of conditional reimbursement in the Netherlands.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;Case studies were purposively selected. We conducted document analysis combined with semi-structured in-depth interviews (&lt;em&gt;n&lt;/em&gt; = 28). We analyzed both case studies together through initial thematic analysis and additional abductive analysis. Results were verified through data triangulation. We performed a member check in which we presented our preliminary analysis during a reflection meeting with key stakeholders.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;We identified three tensions in the practices of CED-schemes: proceduralism versus improvisation, steering professionals versus providing leeway, involving patients as data subjects versus legitimate stakeholders. These tensions explicate several sources of epistemic uncertainties that extend beyond methodological and more well-known socio-political pressures such as from industry on regular reimbursement decision-making process. We note the importance of improvisation work, of normative considerations, and of epistemic hierarchies.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;We postulate that the emerging uncertainties within the practice of CED-schemes are to an extent unavoidable as they emerge from the necessarily interactive and normative nature of human relations. We conceptualize this with the notion of ‘epistemic entanglements’, which highlights how normative and scientific dimensions are interwoven in reimbursement decisions. As epistemic uncertainties are difficult to reduce and tame in practice the need for a more reflexive and inclusive approach to conditional reimbursement decision-making becomes apparent.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Public interest abstract&lt;/h3&gt;&lt;p&gt;New technologies and personalized medicines can have great health benefits for patients, but often not enough knowledge is available to assess whether these innovations live up to their expectations. At the same time, despite this uncertainty, governments need to make a decision about whether or not to reimburse these innovations. Many countries are experimenting with forms of conditional reimbursement: temporarily reimbursement of technologies until more evidence is collected regarding (cost-)effectiveness in practice. Although much literature addresses potential benefits and drawbacks of conditional reimbursement policies, few studies look into how such policies play out in practice. In our research we study two examples of conditional reimbursement practices. We show conditional reimbursement practices lead to three new t","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"13 2","pages":"Article 100850"},"PeriodicalIF":6.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139814846","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":"Telemedicine decision-making in primary care during the COVID-19 pandemic: Balancing patient agency and provider expertise","authors":"Kimberly A. Muellers ,&nbsp;Katerina Andreadis ,&nbsp;Rahma S. Mkuu ,&nbsp;Jenny J. Lin ,&nbsp;Carol R. Horowitz ,&nbsp;Rainu Kaushal ,&nbsp;Jessica S. Ancker","doi":"10.1016/j.hlpt.2024.100839","DOIUrl":"10.1016/j.hlpt.2024.100839","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;p&gt;The COVID-19 pandemic precipitated the expansion of telemedicine use worldwide, introducing a new dimension of healthcare decision-making – choosing a visit format – not previously experienced by most patients or providers. To date, the pandemic's impact on decisions about using telemedicine versus in-person visits in primary care has not been fully explored. The purpose of this study was to examine patient and provider accounts of decision-making about the choice between telemedicine and in-person care during the COVID-19 pandemic.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;Primary care providers and patients were recruited from four healthcare systems across three states in the United States. Participants completed semi-structured interviews about their experiences using telemedicine for primary care during the pandemic. Data pertaining to decision-making about telemedicine were examined as a secondary analysis using interpretive description.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Twenty-one providers and 65 patients completed interviews. Patients’ ability to choose their own visit format influenced their level of satisfaction with telemedicine care, while providers expressed concern about leaving visit format entirely up to their patients. Patients and providers generally agreed that telemedicine was well-suited for routine follow-ups, reviewing results, and medication management. However, in cases of urgent health problems, patients and providers differed in their criteria for determining what visit format is most appropriate but agreed that telemedicine could be a useful tool for “quick fixes” and for fast and effective triage.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Primary care patients and providers emphasized the importance of agency during care delivery and shared opportunities for effective triage via telemedicine. Further research should focus on developing tools to support shared healthcare decisions regarding telemedicine use under changing healthcare conditions, particularly for urgent health questions.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Public Interest Summary&lt;/h3&gt;&lt;p&gt;The COVID-19 pandemic has increased telemedicine use around the world. This study looked at patient and provider decisions about using telemedicine versus in-person care during the pandemic. We asked 21 primary care providers and 65 patients from four healthcare systems across three U.S. states about their experiences using telemedicine during the pandemic. Patients were more satisfied if they were able to choose whether to have an in-person or video visit, while providers worried that allowing patients to choose the visit format could get in the way of care when patients need physical exams or laboratory testing. Patients and providers gave different reasons for choosing a visit format, but both agreed that telemedicine was useful for “quick fixes” and making decisions together in emergencies. Healthcare systems should create tools to help patients and providers decide when t","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"13 2","pages":"Article 100839"},"PeriodicalIF":6.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139410566","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":"Apps don't work for patients who don't use them: Towards frameworks for digital therapeutics adherence","authors":"David G. Schwartz ,&nbsp;Sivan Spitzer ,&nbsp;Michael Khalemsky ,&nbsp;Arturo Heyner Cano-Bejar ,&nbsp;Soumya Ray ,&nbsp;Jeng-Yuan Chiou ,&nbsp;Rizan Sakhnini ,&nbsp;Raya Lanin ,&nbsp;Menachem M. Meir ,&nbsp;Ming-Che Tsai","doi":"10.1016/j.hlpt.2024.100848","DOIUrl":"10.1016/j.hlpt.2024.100848","url":null,"abstract":"<div><h3>Objectives</h3><p>Digital therapeutics such as mobile health applications (mHealth apps) are becoming part of patients’ treatment programs. Ensuring patients actually use (adhere to) an app as prescribed, effectively measuring and interpreting usage, and detecting clinical non-compliance are fundamental to effective treatment. Clinicians are not currently prepared to deal with issues of patients’ adherence to digital therapeutics (DTx). This study proposes and analyses potential frameworks for clinician-patient dialogue about DTx adherence.</p></div><div><h3>Methods</h3><p>Purposive sampling is used to select three leading adherence frameworks, one at each of the micro (patient), mesa (physician), and macro (system) levels of healthcare. The ABC taxonomy of adherence stages; Osterberg and Blaschke's medication adherence framework; and the Morisky Medication Adherence Scale-8 (MMAS8). Each framework is deconstructed and analysed from the perspective of DTx adherence.</p></div><div><h3>Results</h3><p>Modifications to ABC can improve suitability to conceptualize DTx adherence whilst maintaining the overall framework. Osterberg and Blaschke's framework provides many metrics adaptable to app assessment alongside some that are inapplicable. Significant modification of MMAS-8 appears necessary to build relevance to DTx adherence reporting. Specific reconceptualizations of each framework element are presented.</p></div><div><h3>Conclusions</h3><p>A strong basis for studying and measuring DTx adherence exists in existing treatment adherence research and practice, and can help guide policy. However, important adaptations are needed to ensure the development of methods for use in clinical environments.</p></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"13 2","pages":"Article 100848"},"PeriodicalIF":6.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139657677","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}