Pub Date : 2025-08-01DOI: 10.1016/j.hlpt.2025.101040
Saqib Mehmood , Samera Nazir , Jianqiang Fan (Vice Dean) , Zarish Nazir (MS Scholar) , Sana Nazir (MSs Scholar)
Background
The COVID-19 pandemic has drastically disrupted health service delivery, particularly in resource-limited countries such as Pakistan. This study aims to assess how Pakistan's healthcare infrastructure has adapted in response to the pandemic, focusing on governmental strategies, technology integration, and socioeconomic factors influencing public health outcomes.
Materials and Methods
A stratified random sampling approach was employed, distributing 300 questionnaires to management and staff across hospitals in Punjab. The data collected were analyzed using PLS-SEM4 software to uncover the relationships among the variables of interest.
Results
The findings reveal the complex impacts of the pandemic on healthcare delivery. Effective government regulations were identified as crucial in managing the crisis, while technology integration emerged as a key factor in enhancing healthcare services. Socioeconomic conditions were found to significantly affect public health outcomes, underscoring the interconnection of these components.
Conclusion
This study provides valuable insights for policymakers, healthcare professionals, and researchers aiming to strengthen the resilience of Pakistan's healthcare system. By applying resilience theory, public health policy theory, and complex adaptive systems theory, the research emphasizes the need for adaptability, effective governance, and systemic interconnection in addressing public health challenges. The implications extend globally, offering strategies to improve healthcare infrastructure during crises.
{"title":"Investigating the moderating effect of COVID-19 on Pakistan's healthcare sector","authors":"Saqib Mehmood , Samera Nazir , Jianqiang Fan (Vice Dean) , Zarish Nazir (MS Scholar) , Sana Nazir (MSs Scholar)","doi":"10.1016/j.hlpt.2025.101040","DOIUrl":"10.1016/j.hlpt.2025.101040","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic has drastically disrupted health service delivery, particularly in resource-limited countries such as Pakistan. This study aims to assess how Pakistan's healthcare infrastructure has adapted in response to the pandemic, focusing on governmental strategies, technology integration, and socioeconomic factors influencing public health outcomes.</div></div><div><h3>Materials and Methods</h3><div>A stratified random sampling approach was employed, distributing 300 questionnaires to management and staff across hospitals in Punjab. The data collected were analyzed using PLS-SEM4 software to uncover the relationships among the variables of interest.</div></div><div><h3>Results</h3><div>The findings reveal the complex impacts of the pandemic on healthcare delivery. Effective government regulations were identified as crucial in managing the crisis, while technology integration emerged as a key factor in enhancing healthcare services. Socioeconomic conditions were found to significantly affect public health outcomes, underscoring the interconnection of these components.</div></div><div><h3>Conclusion</h3><div>This study provides valuable insights for policymakers, healthcare professionals, and researchers aiming to strengthen the resilience of Pakistan's healthcare system. By applying resilience theory, public health policy theory, and complex adaptive systems theory, the research emphasizes the need for adaptability, effective governance, and systemic interconnection in addressing public health challenges. The implications extend globally, offering strategies to improve healthcare infrastructure during crises.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 4","pages":"Article 101040"},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827286","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}
Pub Date : 2025-08-01DOI: 10.1016/j.hlpt.2023.100810
M. A. Khan, Md. Rabiul Islam, Asif Rahman, Afsana Mim, Rasel Ahmmed
Objectives
The healthcare management authorities are responsible for delivering convenient services to the patients. The traditional healthcare management system is quite old and impractical in many cases, including a physical visit. Additionally, the COVID-19 epidemic makes the existing system unattainable, which creates an uncomfortable situation for visiting doctor's chambers that is risky both for doctors and patients. An electronic-prescription (e-prescription) management system can switch the existing one to the online appointment and doctor consulting system. Many developed countries have already adopted such e-prescription management systems, although low-and-middle-income countries (LMICs) like Bangladesh are apathetic. So implementing e-prescription management systems in all countries, including Bangladesh, is the demand of time, especially when information and communication technologies (ICT) are at hand.
Method
We design, develop and test an ICT-based online doctor and patient management system utilizing the latest software and web development tools.
Results
In the developed e-prescription management system, the patient can visit their profile to make an appointment according to their need and doctor's availability. After that, the patient consults with the doctor based on the appointment's approval by the admin panel. Finally, the patient receives an online e-prescription and collects the medicine from a registered pharmacy with access to the online e-prescription. The e-prescription management system records patient history, including e-prescription, making handling patients easy.
Conclusion
The proper use of the developed e-prescription management system will solve many existing problems of the existing healthcare management system, including many concerns that arise due to the advent of COVID-19.
{"title":"E-Prescription: A practical application of information and communications technology in perspective of Bangladesh","authors":"M. A. Khan, Md. Rabiul Islam, Asif Rahman, Afsana Mim, Rasel Ahmmed","doi":"10.1016/j.hlpt.2023.100810","DOIUrl":"10.1016/j.hlpt.2023.100810","url":null,"abstract":"<div><h3>Objectives</h3><div>The healthcare management authorities are responsible for delivering convenient services to the patients. The traditional healthcare management system is quite old and impractical in many cases, including a physical visit. Additionally, the COVID-19 epidemic makes the existing system unattainable, which creates an uncomfortable situation for visiting doctor's chambers that is risky both for doctors and patients. An electronic-prescription (e-prescription) management system can switch the existing one to the online appointment and doctor consulting system. Many developed countries have already adopted such e-prescription management systems, although low-and-middle-income countries (LMICs) like Bangladesh are apathetic. So implementing e-prescription management systems in all countries, including Bangladesh, is the demand of time, especially when information and communication technologies (ICT) are at hand.</div></div><div><h3>Method</h3><div>We design, develop and test an ICT-based online doctor and patient management system utilizing the latest software and web development tools.</div></div><div><h3>Results</h3><div>In the developed e-prescription management system, the patient can visit their profile to make an appointment according to their need and doctor's availability. After that, the patient consults with the doctor based on the appointment's approval by the admin panel. Finally, the patient receives an online e-prescription and collects the medicine from a registered pharmacy with access to the online e-prescription. The e-prescription management system records patient history, including e-prescription, making handling patients easy.</div></div><div><h3>Conclusion</h3><div>The proper use of the developed e-prescription management system will solve many existing problems of the existing healthcare management system, including many concerns that arise due to the advent of COVID-19.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 4","pages":"Article 100810"},"PeriodicalIF":3.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134934267","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}
Pub Date : 2025-07-28DOI: 10.1016/j.hlpt.2025.101081
Akemi Hara , Tetsuya Tanimoto , Piotr Ozieranski , James Larkin , Michioki Endo , Hiroaki Saito , Akihiko Ozaki
Objective
To assess the extent and distribution of pharmaceutical and medical device industry honorarium payments to medical association leadership, enhancing our understanding of industry-physician financial ties in Japan.
Methods
We conducted a retrospective analysis of publicly disclosed payment data from pharmaceutical companies affiliated with the Japan Pharmaceutical Manufacturers Association and medical device companies affiliated with the Medical Devices Network. Data covered honorarium payments for speaking, writing, and consulting to board members of 18 major professional medical associations from 2019 to 2021.
Results
Of the 399 executive board members, 373 (93.5 %) received payments totaling $15.99 million. The median payment per member over the three years was $22,529, (interquartile range [IQR], $7230.8–$57,223.9). Payments were concentrated, with four professional medical associations—representing Internal Medicine ($2.97 million), Ophthalmology ($1.78 million), Dermatology ($1.78 million), and Urology ($1.87 million)—accounting for 52.5 % of the total. Surgical specialties received a higher proportion of payments from medical device companies, while non-surgical specialties – pharmaceutical companies. Payments declined in 2020, coinciding with the COVID-19 pandemic, recovering by 2021. None of the 18 associations' leadership publicly disclosed their board members' financial ties.
Conclusions
We found extensive and concentrated ties between industry and medical association leadership in Japan, with the pharmaceutical and medical device sectors each displaying distinctive payment patterns. The substantial scale of payments and limited transparency displayed by the association highlight the urgent need for legally mandated disclosure, including specialty-specific solutions.
{"title":"Quantifying pharmaceutical and medical device industry-physician financial ties: An analysis of honorarium payments to Japanese medical association leadership between 2019 and 2021","authors":"Akemi Hara , Tetsuya Tanimoto , Piotr Ozieranski , James Larkin , Michioki Endo , Hiroaki Saito , Akihiko Ozaki","doi":"10.1016/j.hlpt.2025.101081","DOIUrl":"10.1016/j.hlpt.2025.101081","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the extent and distribution of pharmaceutical and medical device industry honorarium payments to medical association leadership, enhancing our understanding of industry-physician financial ties in Japan.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of publicly disclosed payment data from pharmaceutical companies affiliated with the Japan Pharmaceutical Manufacturers Association and medical device companies affiliated with the Medical Devices Network. Data covered honorarium payments for speaking, writing, and consulting to board members of 18 major professional medical associations from 2019 to 2021.</div></div><div><h3>Results</h3><div>Of the 399 executive board members, 373 (93.5 %) received payments totaling $15.99 million. The median payment per member over the three years was $22,529, (interquartile range [IQR], $7230.8–$57,223.9). Payments were concentrated, with four professional medical associations—representing Internal Medicine ($2.97 million), Ophthalmology ($1.78 million), Dermatology ($1.78 million), and Urology ($1.87 million)—accounting for 52.5 % of the total. Surgical specialties received a higher proportion of payments from medical device companies, while non-surgical specialties – pharmaceutical companies. Payments declined in 2020, coinciding with the COVID-19 pandemic, recovering by 2021. None of the 18 associations' leadership publicly disclosed their board members' financial ties.</div></div><div><h3>Conclusions</h3><div>We found extensive and concentrated ties between industry and medical association leadership in Japan, with the pharmaceutical and medical device sectors each displaying distinctive payment patterns. The substantial scale of payments and limited transparency displayed by the association highlight the urgent need for legally mandated disclosure, including specialty-specific solutions.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 6","pages":"Article 101081"},"PeriodicalIF":3.7,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144830493","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}
Pub Date : 2025-07-28DOI: 10.1016/j.hlpt.2025.101079
Y. Tony Yang
{"title":"The digital equity paradox: When good intentions pave the road to technological stratification","authors":"Y. Tony Yang","doi":"10.1016/j.hlpt.2025.101079","DOIUrl":"10.1016/j.hlpt.2025.101079","url":null,"abstract":"","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 5","pages":"Article 101079"},"PeriodicalIF":3.7,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144770677","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}
Pub Date : 2025-07-26DOI: 10.1016/j.hlpt.2025.101077
Akhil Sasidharan , Sajith Kumar S , Suchitralakshmi G , Kavitha Rajsekar , Bhavani Shankara Bagepally
Background
Heart failure with reduced ejection fraction (HFrEF) imposes significant clinical burden and costs in India. While sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated clinical benefits, their cost-effectiveness within the Indian healthcare perspective remains unassessed.
Methods
A Markov model with a lifetime horizon and one-year cycles was developed to evaluate the cost-effectiveness of SGLT2i as an add-on therapy to standard of care (SoC) compared to SoC alone in patients with HFrEF in India. The analysis adopted an abridged societal perspective, incorporating direct medical and non-medical costs, as well as out-of-pocket expenditures. Clinical efficacy data were obtained from meta-analyses while cost data were sourced from published Indian studies and databases. Costs (2024) and Quality-Adjusted Life Years (QALYs) were used to determine the incremental cost-utility ratio (ICURs). A willingness-to-pay (WTP) threshold of one time India’s GDP per capita [₹2,26,765 (US$2,710)] per QALY was used. Uncertainty was assessed through one-way sensitivity analysis (OWSA) and probabilistic sensitivity analysis (PSA). Scenario analyses were conducted to test structural assumptions, and a price threshold analysis was performed to estimate the price at which SGLT2i would become cost-effective.
Results
Despite additional gains in QALYs, add-on SGLT2i were not cost-effective at their current market prices, with an ICUR of ₹6,12,406 (US$7,318) per QALY. Cost-effectiveness estimates were sensitive to variations in drug pricing. PSA confirmed the robustness of these findings. Price threshold analysis indicated that a 71 % reduction in the average market prices for SGLT2i would be required for cost-effectiveness.
Conclusions
While SGLT2i improve clinical outcomes in HFrEF, their current cost renders them not cost-effective in the Indian healthcare setting. Substantial price reductions, potentially through price negotiations with manufacturers, are necessary to enhance their affordability and optimize resource allocation for Heart failure management in India.
{"title":"Cost-utility analysis of add-on SGLT2 inhibitors for heart failure with reduced ejection fraction in India","authors":"Akhil Sasidharan , Sajith Kumar S , Suchitralakshmi G , Kavitha Rajsekar , Bhavani Shankara Bagepally","doi":"10.1016/j.hlpt.2025.101077","DOIUrl":"10.1016/j.hlpt.2025.101077","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure with reduced ejection fraction (HFrEF) imposes significant clinical burden and costs in India. While sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated clinical benefits, their cost-effectiveness within the Indian healthcare perspective remains unassessed.</div></div><div><h3>Methods</h3><div>A Markov model with a lifetime horizon and one-year cycles was developed to evaluate the cost-effectiveness of SGLT2i as an add-on therapy to standard of care (SoC) compared to SoC alone in patients with HFrEF in India. The analysis adopted an abridged societal perspective, incorporating direct medical and non-medical costs, as well as out-of-pocket expenditures. Clinical efficacy data were obtained from meta-analyses while cost data were sourced from published Indian studies and databases. Costs (2024) and Quality-Adjusted Life Years (QALYs) were used to determine the incremental cost-utility ratio (ICURs). A willingness-to-pay (WTP) threshold of one time India’s GDP per capita [₹2,26,765 (US$2,710)] per QALY was used. Uncertainty was assessed through one-way sensitivity analysis (OWSA) and probabilistic sensitivity analysis (PSA). Scenario analyses were conducted to test structural assumptions, and a price threshold analysis was performed to estimate the price at which SGLT2i would become cost-effective.</div></div><div><h3>Results</h3><div>Despite additional gains in QALYs, add-on SGLT2i were not cost-effective at their current market prices, with an ICUR of ₹6,12,406 (US$7,318) per QALY. Cost-effectiveness estimates were sensitive to variations in drug pricing. PSA confirmed the robustness of these findings. Price threshold analysis indicated that a 71 % reduction in the average market prices for SGLT2i would be required for cost-effectiveness.</div></div><div><h3>Conclusions</h3><div>While SGLT2i improve clinical outcomes in HFrEF, their current cost renders them not cost-effective in the Indian healthcare setting. Substantial price reductions, potentially through price negotiations with manufacturers, are necessary to enhance their affordability and optimize resource allocation for Heart failure management in India.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 6","pages":"Article 101077"},"PeriodicalIF":3.7,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772788","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}
Pub Date : 2025-07-25DOI: 10.1016/j.hlpt.2025.101078
Elena Bignami , Luigino Jalale Darhour , Wolfgang Buhre , Maurizio Cecconi , Valentina Bellini
The integration of Artificial Intelligence (AI) in Intensive Care Units (ICUs) has the potential to transform critical care by enhancing diagnosis, management, and clinical decision-making. Generative and Predictive AI technologies offer new opportunities for personalized care and risk stratification, but their implementation must prioritize ethical standards, patient safety, and the sustainability of care delivery. With the EU AI-Act entering into force in February 2025, a structured and responsible adoption of AI is now imperative. This article outlines a strategic framework for ICU AI integration, emphasizing the importance of a formal declaration of intent by each unit, detailing current AI-use, implementation plans, and governance strategies. Central to this approach is the development of tailored AI education programs adapted to four distinct professional profiles, ranging from experienced clinicians with limited AI knowledge to new intensivists with strong AI backgrounds but limited clinical experience. Training must foster critical thinking, contextual interpretation, and a balanced relationship between AI tools and human judgment. A multidisciplinary support team should oversee ethical AI-use and continuous performance monitoring. Ultimately, aligning regulatory compliance with targeted education and practical implementation could enable a safe, effective, and ethically grounded use of AI in intensive care. This balanced approach would support a culture of transparency and accountability, while preserving the central role of human clinical reasoning and improving the overall quality of ICU care.
{"title":"Artificial intelligence in healthcare: Tailoring education to meet EU AI-Act standards","authors":"Elena Bignami , Luigino Jalale Darhour , Wolfgang Buhre , Maurizio Cecconi , Valentina Bellini","doi":"10.1016/j.hlpt.2025.101078","DOIUrl":"10.1016/j.hlpt.2025.101078","url":null,"abstract":"<div><div>The integration of Artificial Intelligence (AI) in Intensive Care Units (ICUs) has the potential to transform critical care by enhancing diagnosis, management, and clinical decision-making. Generative and Predictive AI technologies offer new opportunities for personalized care and risk stratification, but their implementation must prioritize ethical standards, patient safety, and the sustainability of care delivery. With the EU AI-Act entering into force in February 2025, a structured and responsible adoption of AI is now imperative. This article outlines a strategic framework for ICU AI integration, emphasizing the importance of a formal declaration of intent by each unit, detailing current AI-use, implementation plans, and governance strategies. Central to this approach is the development of tailored AI education programs adapted to four distinct professional profiles, ranging from experienced clinicians with limited AI knowledge to new intensivists with strong AI backgrounds but limited clinical experience. Training must foster critical thinking, contextual interpretation, and a balanced relationship between AI tools and human judgment. A multidisciplinary support team should oversee ethical AI-use and continuous performance monitoring. Ultimately, aligning regulatory compliance with targeted education and practical implementation could enable a safe, effective, and ethically grounded use of AI in intensive care. This balanced approach would support a culture of transparency and accountability, while preserving the central role of human clinical reasoning and improving the overall quality of ICU care.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 6","pages":"Article 101078"},"PeriodicalIF":3.7,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721584","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}
Pub Date : 2025-07-23DOI: 10.1016/j.hlpt.2025.101075
Liliana Freitas , Mónica D. Oliveira , Ana C.L. Vieira
Objectives
Stakeholder involvement is recognized as essential in Health Technology Assessment (HTA), yet engagement remains insufficient, particularly in medical device (MD) evaluations. Literature on how to systematically identify and integrate stakeholders remains scarce. This study proposes a reflective framework to support HTA practitioners think about stakeholder inclusion and applies it to explore perspectives within the medical device context in Portugal.
Methods
We adapted Ulrich’s Critical Systems Heuristics (CSH) as a conceptual lens to structure reflection on stakeholder roles and contributions in MD HTA. The framework is organized around four sources of influence (motivation, control, knowledge, and legitimacy) and was operationalized through 26 semi-structured interviews with experts from Portugal’s HTA agency, hospitals, patient associations, and industry. Interview data were analysed using directed content analysis and the Framework Method, allowing to contrast current ('is') and ideal ('ought') views within each source of influence. The common themes were then used to construct interpretative narratives that captured rationales for stakeholder inclusion.
Results
The application of the framework revealed context-specific insights into stakeholder engagement in MD evaluation. Findings show stakeholder roles in MD evaluations extend beyond traditional classifications. For each CSH source of influence, rationales and conditions for stakeholder engagement were identified. Under motivation, stakeholders identified diverse purposes and measures of success, ranging from improved patient access to innovation to system-wide resource optimization. Under control, providers, purchasers, and payers were seen as central decision-makers, yet ideal processes included multidisciplinary governance and clearer procedural support. Under knowledge, multiple actors (including patients) were valued as contributors of contextual expertise, but gaps were highlighted in methodological tools. Under legitimacy, patients and the public were underrepresented and called for stronger mechanisms for direct involvement and broader societal alignment. Across all sources of influence, significant gaps were found between current practices and stakeholder expectations to highlight areas for development.
Conclusions
Rather than prescribing fixed engagement procedures, the proposed reflective framework offers a structured lens to support HTA practitioners in reasoning through stakeholder roles, values, and contributions in MD evaluations. The framework is transferable to other decision-making contexts and fosters more transparent and inclusive deliberation.
{"title":"Guiding stakeholder involvement in health technology assessment for medical devices: A novel approach for clarifying stakeholders’ roles and contributions","authors":"Liliana Freitas , Mónica D. Oliveira , Ana C.L. Vieira","doi":"10.1016/j.hlpt.2025.101075","DOIUrl":"10.1016/j.hlpt.2025.101075","url":null,"abstract":"<div><h3>Objectives</h3><div>Stakeholder involvement is recognized as essential in Health Technology Assessment (HTA), yet engagement remains insufficient, particularly in medical device (MD) evaluations. Literature on how to systematically identify and integrate stakeholders remains scarce. This study proposes a reflective framework to support HTA practitioners think about stakeholder inclusion and applies it to explore perspectives within the medical device context in Portugal.</div></div><div><h3>Methods</h3><div>We adapted Ulrich’s Critical Systems Heuristics (CSH) as a conceptual lens to structure reflection on stakeholder roles and contributions in MD HTA. The framework is organized around four sources of influence (motivation, control, knowledge, and legitimacy) and was operationalized through 26 semi-structured interviews with experts from Portugal’s HTA agency, hospitals, patient associations, and industry. Interview data were analysed using directed content analysis and the Framework Method, allowing to contrast current ('is') and ideal ('ought') views within each source of influence. The common themes were then used to construct interpretative narratives that captured rationales for stakeholder inclusion.</div></div><div><h3>Results</h3><div>The application of the framework revealed context-specific insights into stakeholder engagement in MD evaluation. Findings show stakeholder roles in MD evaluations extend beyond traditional classifications. For each CSH source of influence, rationales and conditions for stakeholder engagement were identified. Under motivation, stakeholders identified diverse purposes and measures of success, ranging from improved patient access to innovation to system-wide resource optimization. Under control, providers, purchasers, and payers were seen as central decision-makers, yet ideal processes included multidisciplinary governance and clearer procedural support. Under knowledge, multiple actors (including patients) were valued as contributors of contextual expertise, but gaps were highlighted in methodological tools. Under legitimacy, patients and the public were underrepresented and called for stronger mechanisms for direct involvement and broader societal alignment. Across all sources of influence, significant gaps were found between current practices and stakeholder expectations to highlight areas for development.</div></div><div><h3>Conclusions</h3><div>Rather than prescribing fixed engagement procedures, the proposed reflective framework offers a structured lens to support HTA practitioners in reasoning through stakeholder roles, values, and contributions in MD evaluations. The framework is transferable to other decision-making contexts and fosters more transparent and inclusive deliberation.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 6","pages":"Article 101075"},"PeriodicalIF":3.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763983","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}
Pub Date : 2025-07-18DOI: 10.1016/j.hlpt.2025.101072
Tobias Joseph Adams , Joseph Tay Wee Teck , Alexander Baldacchino , Patrice Forget
Objectives
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.
Methods
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.
Results
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 %.
Conclusions
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.
{"title":"An impact evaluation of the Scottish take-home naloxone programme","authors":"Tobias Joseph Adams , Joseph Tay Wee Teck , Alexander Baldacchino , 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":"2025-07-18","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}
Pub Date : 2025-07-18DOI: 10.1016/j.hlpt.2025.101076
Augustino Mwogosi
Background
Tanzania has prioritized EHR systems adoption through systems like GoTHoMIS to enhance healthcare delivery and data management. However, the success of EHR implementation depends critically on system usability and healthcare providers’ satisfaction, which influence system acceptance and continued use.
Objectives
This study assessed the determinants of EHR system usability and satisfaction among healthcare providers in Tanzania’s public primary healthcare facilities. Specific objectives were to examine the influence of EHR system usability on provider satisfaction, the role of organizational factors, the contribution of usability to frequency of system use, and variations across demographic and professional groups.
Methods
A cross-sectional quantitative survey was conducted among 288 healthcare providers in Dodoma and Dar es Salaam regions. The regions were purposively selected to represent urban, peri‑urban and rural settings based on EHR system implementation maturity. Data were collected through a structured questionnaire administered via Google Forms. Google Forms data were encrypted and complied with Tanzania’s Data Protection Act 2022. Multiple linear regression and Structural Equation Modeling using SmartPLS were employed to analyze factors associated with EHR systems satisfaction and usage frequency.
Results
Improvement in work efficiency was the strongest predictor of provider satisfaction (β = 0.258, p < 0.001), followed by system reliability, adequate training, and organizational support. Factors such as ease of integration into clinical workflows and enhancement of collaboration significantly predicted the frequency of EHR system use. Demographic variables had limited moderating effects. Generally, system usability, organizational environment, and perceived efficiency gains were critical for successful EHR adoption.
Conclusion
Effective EHR systems implementation in primary healthcare settings in Tanzania requires a complex approach addressing not only technical usability but also organizational support, user training, and workflow integration. Policy interventions should prioritize these areas to enhance user satisfaction and system sustainability.
Public interest summary
This study looked at how healthcare providers in Tanzania use electronic health record systems, which are digital tools for storing patient information. The results showed that healthcare workers were more satisfied and used the systems more often when the records were reliable, easy to use, and supported by strong training and leadership. These insights could help healthcare organizations improve digital systems and make healthcare services better for patients
坦桑尼亚通过GoTHoMIS等系统优先采用电子病历系统，以加强医疗保健服务和数据管理。然而，EHR实施的成功主要取决于系统可用性和医疗保健提供者的满意度，这影响系统的接受度和持续使用。目的：本研究评估坦桑尼亚公共初级卫生保健机构医疗服务提供者的电子病历系统可用性和满意度的决定因素。具体目标是检查EHR系统可用性对提供者满意度的影响，组织因素的作用，可用性对系统使用频率的贡献，以及人口统计学和专业群体之间的差异。方法对多马和达累斯萨拉姆地区288名医疗服务提供者进行横断面定量调查。根据EHR系统实施成熟度，有目的地选择代表城市、城郊和农村的区域。数据通过谷歌表格进行结构化问卷调查收集。谷歌表单数据经过加密，并符合坦桑尼亚2022年数据保护法。采用多元线性回归和SmartPLS结构方程模型分析影响电子病历系统满意度和使用频率的因素。结果工作效率的提高是服务提供者满意度的最强预测因子(β = 0.258, p <；0.001)，其次是系统可靠性、充分的培训和组织支持。整合到临床工作流程的便利性和加强协作等因素显著预测了电子病历系统的使用频率。人口统计变量的调节作用有限。一般来说，系统可用性、组织环境和可感知的效率收益对于成功采用EHR至关重要。结论：在坦桑尼亚初级卫生保健机构实施有效的电子病历系统需要一个复杂的方法，不仅要解决技术可用性问题，还要解决组织支持、用户培训和工作流程集成问题。政策干预应优先考虑这些领域，以提高用户满意度和系统可持续性。本研究着眼于坦桑尼亚的医疗保健提供者如何使用电子健康记录系统，这是存储患者信息的数字工具。结果表明，当记录可靠、易于使用，并得到强有力的培训和领导支持时，卫生保健工作者更满意并更频繁地使用系统。这些见解可以帮助医疗机构改进数字系统，为患者提供更好的医疗服务
{"title":"Determinants of EHR systems’ usability and provider satisfaction in public primary healthcare facilities in Tanzania","authors":"Augustino Mwogosi","doi":"10.1016/j.hlpt.2025.101076","DOIUrl":"10.1016/j.hlpt.2025.101076","url":null,"abstract":"<div><h3>Background</h3><div>Tanzania has prioritized EHR systems adoption through systems like GoTHoMIS to enhance healthcare delivery and data management. However, the success of EHR implementation depends critically on system usability and healthcare providers’ satisfaction, which influence system acceptance and continued use.</div></div><div><h3>Objectives</h3><div>This study assessed the determinants of EHR system usability and satisfaction among healthcare providers in Tanzania’s public primary healthcare facilities. Specific objectives were to examine the influence of EHR system usability on provider satisfaction, the role of organizational factors, the contribution of usability to frequency of system use, and variations across demographic and professional groups.</div></div><div><h3>Methods</h3><div>A cross-sectional quantitative survey was conducted among 288 healthcare providers in Dodoma and Dar es Salaam regions. The regions were purposively selected to represent urban, peri‑urban and rural settings based on EHR system implementation maturity. Data were collected through a structured questionnaire administered via Google Forms. Google Forms data were encrypted and complied with Tanzania’s Data Protection Act 2022. Multiple linear regression and Structural Equation Modeling using SmartPLS were employed to analyze factors associated with EHR systems satisfaction and usage frequency.</div></div><div><h3>Results</h3><div>Improvement in work efficiency was the strongest predictor of provider satisfaction (β = 0.258, <em>p</em> < 0.001), followed by system reliability, adequate training, and organizational support. Factors such as ease of integration into clinical workflows and enhancement of collaboration significantly predicted the frequency of EHR system use. Demographic variables had limited moderating effects. Generally, system usability, organizational environment, and perceived efficiency gains were critical for successful EHR adoption.</div></div><div><h3>Conclusion</h3><div>Effective EHR systems implementation in primary healthcare settings in Tanzania requires a complex approach addressing not only technical usability but also organizational support, user training, and workflow integration. Policy interventions should prioritize these areas to enhance user satisfaction and system sustainability.</div></div><div><h3>Public interest summary</h3><div>This study looked at how healthcare providers in Tanzania use electronic health record systems, which are digital tools for storing patient information. The results showed that healthcare workers were more satisfied and used the systems more often when the records were reliable, easy to use, and supported by strong training and leadership. These insights could help healthcare organizations improve digital systems and make healthcare services better for patients</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 6","pages":"Article 101076"},"PeriodicalIF":3.7,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721586","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}
Pub Date : 2025-07-18DOI: 10.1016/j.hlpt.2025.101074
Fatemeh Sadat Hosseini , Mohammadreza Mobinizadeh
{"title":"Towards equity-oriented topic selection in health technology assessment for orphan drugs in Iran: A commentary","authors":"Fatemeh Sadat Hosseini , Mohammadreza Mobinizadeh","doi":"10.1016/j.hlpt.2025.101074","DOIUrl":"10.1016/j.hlpt.2025.101074","url":null,"abstract":"","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 6","pages":"Article 101074"},"PeriodicalIF":3.7,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721587","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号