Health Policy and Technology最新文献

There is a growing global interest in integrating health and care through digitalisation. However, many ambitious digitalisation initiatives in the healthcare sector fail to achieve their intended outcomes. One contributing factor is the failure to apply lessons learned from past endeavours. We here leverage the experiences gained from large-scale digitalisation efforts within the National Health Service (NHS) in England to distil valuable insights for strategic decision-makers who are embarking on the development and implementation of initiatives aimed at integrating health and social care through digitalisation. While not exhaustive, our compilation of eight key lessons serves as a foundational resource to inform such initiatives, seeking ultimately to contribute to realising maximum benefits for health and care organisations and service users.

Introduction

Electronic health (e-Health) modalities effectively address healthcare access limitations; however, there are limited data on their adoption by Hispanic/Latina women who are disproportionally affected by health disparities.

Methods

We conducted a cross-sectional study by disseminating an anonymous electronic questionnaire via social media to assess the perception of Hispanic/Latina women of reproductive age regarding facilitators and barriers for using e-Health modalities, including telemedicine and mobile apps, to monitor gynecologic health.

Results

The questionnaire was completed by 351 Hispanic/Latina participants with high levels (98.3 %) of advanced technological expertise. Current use of a gynecologic mobile app was reported by 63.8 %, primarily for menstruation (85.1 %) and ovulation (46.3 %) tracking. While only 17.6 % of participants were offered the option of a gynecologic consultation via telemedicine, the majority (90.5 %) would agree to one. Higher education and advanced technological expertise correlated with acceptance of telemedicine for gynecological consults. Being younger (<29 y/o), a student, not having a preferred gynecologist and having a lower income significantly correlated with gynecologic mobile app acceptability.

Conclusions

We showed that e-Health modalities are highly acceptable for Hispanic/Latina women of reproductive age to facilitate gynecological care and documented factors that are significantly associated with e-Health acceptability. These findings are relevant to public health emergencies that cause access to care limitations disproportionally affecting this already underserved population.

LAY SUMMARY

Electronic health (e-Health) modalities, including telemedicine and mobile applications (apps) can effectively improve access to healthcare; however, there is limited data on their adoption by Hispanic/Latina women who are affected by health disparities. This study showed that e-Health modalities are acceptable for Hispanic/Latina women of reproductive age during public health emergencies highlighting opportunities to help facilitate access to gynecological care for this population.

BACKGROUND

: In recent years, the geographical maldistribution of physicians has become a major problem in Japan, and prefectures are formulating plans to secure additional physicians. During the same period, the percentage of female physicians in Japan has been continuously increasing, and they now account for 40 % of the total enrollment in medical schools. The purpose of this study is to clarify the impact of the increasing proportion of female physicians on the maldistribution of physicians.

METHODS

: We used individual data from the surveys of physicians, dentists, and pharmacists from 1996 to 2018 and government-aggregated data with the same statistics from 1996 to 2020. The Gini coefficient was used to measure geographic maldistribution. Physicians were divided into four groups according to age and gender: men under 40, females under 40, men over 40, and females over 40, and the temporal trends in the maldistribution and contribution ratio of each group were calculated.

RESULTS

: Physician geographical maldistribution worsened after 2006 and continued to worsen until 2016. The contribution ratio of female physicians to the worsening geographical maldistribution exceeded 100 % for both under 40 and over 40 age groups. However, geographical maldistribution within female physicians has become more stable in recent years.

Conclusion

: The large contribution of the female physician group to the deterioration of the Gini coefficient for all physicians may be due to the greater weight of these groups. However, the Gini coefficient for the female group tended to be stable.

Objective

This paper interrogates bias caused by heterogeneity in coding processes through an analysis of electronic medical records EMR databases in France. In general, researchers and professionals often apply data not only for its primary function but also for multiple alternative purposes. However, how they code information might be inconsistent with alternative purposes that exploit existing databases.

Methods

Using the EMR acute care and the EMR rehabilitation care databases, we select more than 800,000 patients coded as socially vulnerable during their rehabilitation stay. Statistical analysis was conducted to describe the types of heterogeneity and to compare the distribution of vulnerability coding processes across different hospital statuses and individual social vulnerability roles. Coding process rates were also analyzed.

Results

This paper shows the heterogeneity in this process of social vulnerability coding, exploiting acute care database and rehabilitation care database. For groups of patients with ICD-10 coded as socially vulnerable during their rehabilitation stays, the probability of being previously coded as such during their acute care stay is 11.4 % higher in the public sector than in the private one.

Conclusion

Implementing the EMR system leads to heterogeneity in the coding process. The paper concludes by arguing that heterogeneity in coding is not random but rather calculated. Applying this database in epidemiologic studies or health economics projects that factor in patients’ vulnerability information may lead to unintended biased results. These findings might also be useful for policymakers using EMR to plan for implementing new reforms in many healthcare settings.

Background

During the COVID-19 pandemic, a surge of conspiracy theories and misinformation proliferated across social media platforms. Recognizing the severity of the issue, medical associations began to regard it as a significant threat to public health systems. The objective of this study was to quantify the proportion of COVID-19 misinformation and official government information within the most frequently shared items on Polish social media.

Methods

The analysis utilized the BuzzSumo Enterprise Application. Polish-language social media posts from January 1 to June 30, 2022, were scrutinized using keywords such as "COVID," "koronawirus," or "SARS-CoV-2." A comprehensive report was generated, encompassing shares, comments, likes, and reactions (engagements). We analyzed the top 40 items that generated the most engagement. To ensure accuracy, two of the authors, both medical doctors, independently assessed each of them for potential misinformation.

Results

We identified 161,404 items in the Polish language that were shared on social media, representing 41,432,352 engagements. The top 40 items (0.02 % of all items) accounted for 7.71 % of engagements (3,194,900). Four items classified as misinformation accounted for 7.7 % of the Top 40 items, accumulating 244,700 engagements. All identified items were labeled as "manipulated news" due to their reliance on unverified or inappropriately interpreted data; none were classified as fabricated news. Government sources accounted for 4.1 % of the Top 40 items, accumulating 130,800 engagements.

Conclusions

This study highlights the significant prevalence of COVID-19 misinformation. Remedial measures should be implemented, addressing both social media platforms and real-life contexts, to enhance public health literacy.

Background

Orphan drugs, for patients with a rare disease, are increasingly available but often do not meet standard cost-effectiveness criteria for reimbursement. Consequently, policymakers regularly face the dilemma whether to relax these criteria for reimbursing orphan drugs. We examined whether—and why—there would be societal support for such differential treatment of orphan drugs.

Methods

We conducted a labelled discrete choice experiment in a sample of the adult population (n = 1,172) in the Netherlands. Respondents were presented with ten choices on whether to reimburse an orphan drug given that a non-orphan drug with similar characteristics would not be reimbursed, because it was not cost-effective, and asked to explain their choices. We used random-intercept logit regression models and inductive coding for analysing the quantitative and qualitative data.

Results

Of the respondents, 36.4% consistently chose for reimbursing the orphan drug, mostly because “everyone is entitled to live a healthy life and good quality healthcare”, and 17.3% consistently for not reimbursing the orphan drug, mostly because “[this] is unfair to patients with a common disease”. The remaining 46.3% made alternating choices and were more likely to choose for reimbursing orphan drugs when patients were aged between 1 and 70 years, had moderate disease severity, and considerable health gain from treatment.

Conclusions

This study finds considerable support but also strong preference heterogeneity amongst members of the public in the Netherlands for differential treatment of orphan drugs in reimbursement decisions, when these drugs do not meet common cost-effectiveness criteria. However, a substantial minority opposes differential treatment, mostly on moral grounds.

Background and objectives The Stage Two Development of eHRSS aimed to broaden the scope of sharable data and advance technical capability for sharing of Chinese Medicine (CM) information. This study aims to evaluate the adoption level and perceived difficulties of Chinese medicine practitioners (CMPs) towards EC Connect, and its impact on CM services.

Methods All registered or listed CMPs were recruited in study 1. Descriptive analysis included age, gender, socioeconomic status, and past medical history was performed with multiple logistic regression models. In-depth interviews were conducted among EC Connect Users and Healthcare Providers (HCP) who upload information of Chinese Medicine to eHRSS.

Results A total of 420 participants were included in this study. The majority of the respondents were in the 31–40 years age group (N = 133, 31.7 %) and practicing in private clinic (N = 311, 74.0 %). Respondents whom agreed that the expansion of sharing scope would be helpful to various stakeholders were 5 times more likely to be interested in joining eHRSS (aOR = 5.01, 95 % CI = 2.73–9.20, p < 0.001). Study 2 found that eHRSS allowed CMPs to share and record medical data, and to access patients’ western medical records while inconsistency of medical systems between Western and Chinese medicine should be considered.

Conclusions We found that accessing and sharing medical records was important to CMPs. eHRSS helped to facilitate more accurate association between Western and Chinese medical doctors, while more efforts were needed to increase the acknowledgement among the general public.

Objectives

As current health technology assessment (HTA) frameworks do not provide specific guidance on the assessment of medical artificial intelligence (AI), this study aimed to propose a conceptual framework for a broad HTA of medical AI.

Methods

A systematic literature review and a targeted search of policy documents was conducted to distill the relevant medical AI assessment elements. Three exemplary cases were selected to illustrate various elements: (1) An application supporting radiologists in stroke-care (2) A natural language processing application for clinical data abstraction (3) An ICU-discharge decision-making application.

Results

A total of 31 policy documents and 9 academic publications were selected, from which a list of 29 issues was distilled. The issues were grouped by four focus areas: (1) Technology & Performance, (2) Human & Organizational, (3) Legal & Ethical and (4) Transparency & Usability. Each assessment element was extensively discussed in the test, and the elements clinical effectiveness, clinical workflow, workforce, interoperability, fairness and explainability were further highlighted through the exemplary cases.

Conclusion

The current methodology of HTA requires extension to make it suitable for a broad evaluation of medical AI technologies. The 29-item assessment list that we propose needs a tailored approach for distinct types of medical AI, since the conceptualisation of the issues differs across applications.

Mobile health applications can address health disparities in prenatal care due to adverse social determinants of health. We assessed the uptake and use of, preferences for, and barriers to mobile health applications among Medicaid-insured pregnant and postpartum individuals enrolled in prenatal care from March to May 2021. Medicaid-insured pregnant and postpartum individuals frequently used (56 %) and were potentially interested in using (90 %) mobile health applications for health-related tasks and had reliable internet access to do so (94 %). Over two fifths (44 %) reported barriers to using mobile health applications. Further research is needed to understand whether using mobile health applications to address social needs in the peripartum period can affect prenatal care utilization and decrease health disparities.

Background

As part of the TRANS-SENIOR international training and research network, this study aimed to describe and compare the appropriateness of triage decisions (within the context of safety and efficiency) for real world patient records of younger and older patients dispatched by operators of a national out-of-hours (OOH) telephone triage service to receive further medical care by a general practitioner (GP).

Methods

A descriptive study was conducted using anonymized registry data obtained from the 1733 OOH telephone triage service in the Flemish region of Belgium linked with medical patient records made available via the Mediris platform. All calls received between May 24, 2019 and December 31, 2020 were analyzed. Appropriateness of triage decisions was assessed by comparing the level of urgency estimated by the 1733 telephone triage operator during the call versus the GP during follow-up physical triage of the patient (considered as the gold standard).

Results

N = 8,664 calls were included for analysis. In total, 69.1% of calls involved children or younger adults while 30.9 % involved older adults (65 years and over). The majority of calls (83.5 %) dispatched by operators to receive an OOH GP home visit involved older adults. The total percentage of appropriately triaged calls were distributed as 98.5 % in children and 96.5 % in younger adults versus 72.5 % in older adults. The percentage of under-triage in older adults was distributed as 1.5 % (65 to 74 years), 3.9 % (75 to 84 years) and 3.0 % (≥ 85 years) versus over-triage in older adults distributed as 16.2 % (65 to 74 years), 22.0 % (75 to 84 years) and 29.6 % (≥ 85 years).

Conclusion

Our findings suggest that while the 1733 service may generally be a safe and efficient tool for managing unplanned care needs of the population, there is room for improvement with regards to the efficiency of these services, particularly for older adults. Fruitful research efforts should aim to evaluate and compare findings with calls dispatched to obtain care from emergency medical services using the 1733 service as well as further investigate the nature of over- and under- triaged calls.