Inquiry-The Journal of Health Care Organization Provision and Financing最新文献

The healthcare supply chain relies on real-time logistics Management Information System (LMIS). Despite Ethiopia's adoption of a digital LMIS in 2009, ongoing evaluation of software, infrastructure, and sustainability remains essential for improving performance from users' and health system's perspectives. The study aimed to evaluate the performance of the facility version of digital LMIS at public health facilities in the Amhara Region, Ethiopia. An institution-based cross-sectional study was used. Out of 102 surveyed facilities, only 37 implemented the digital LMIS. Data was collected using interviewer-administered questionnaires. Out of 37 facilities using digital LMIS, 28 (75.7%) were functional. The average frequency of use across 27 sub-dashlets was 3.13 ± 0.67 out of 4. End users rated the digital LMIS performance as 3.21 ± 0.43 out of 5 (64.2%). Significant differences in LMIS performance related to organizational support were found due to varying end users' experience and internet access (P-value < .05). The digital LMIS performance from end users' perspective was 64.2%, with significant differences in agreement related to health system and organizational support, influenced by internet access and users' experience.

Adolescent pregnancies are associated with several psychosocial challenges. This study explored the psychosocial experiences of pregnant adolescents in a rural District in the Volta Region of Ghana. The participants were 16 pregnant adolescents purposively sampled from 3 communities. Individual in-depth interviews were used for data collection and analyzed using the thematic analysis method. An inductive approach was used to identify emerging central themes from the sub-themes by merging the codes delving deep into the contents and grouping similar statements. Six themes and 14 sub-themes were identified and included (1) meanings attached to the pregnancy/feelings at the first discovery of pregnancy, (2) reaction from parents, friends, neighbors, and sexual partner/boyfriend, (3) participation in social activities in the community, (4) source of support, (5) challenges during pregnancy, and (6) perception of the antecedents to the pregnancy. The factors associated with an adolescent girl getting pregnant were ignorance, promise of marriage, lack of awareness, lack of knowledge on contraceptive use, and nature of interpersonal relationships with friends. Adolescents' reaction to the news of pregnancy was a feeling of dislike and unpleasantness. The adolescent's immediate thoughts of the pregnancy were to terminate the pregnancy. The type of interpersonal relationship with adolescents' parents, friends, and neighbors was strained. The sexual partners were the major sources of financial and resource support. Healthcare providers must use targeted intervention to train, educate, and support adolescents and parents to address psychosocial concerns arising from pregnancies. Future studies should quantify the magnitude of the psychosocial burden of teenage pregnancy. This can lead to developing and testing interventions to prevent or mitigate the liability of teenage pregnancy in the district.

Extremity fractures are increasingly common in Sub-Saharan Africa. In many resource-limited settings, patients with fractures have historically sought out traditional bonesetters (TBSs) and continue to do so, in part due to the undercapacity of existing orthopedic facilities. This qualitative study investigates key stakeholder perspectives on intersectoral collaboration between the formal healthcare system and TBSs in treating extremity fractures in the Rorya district, Tanzania. We combined focus group discussions and semi-structured interviews with four key stakeholder groups: patients with previous fractures, TBSs, hospital staff, and local government representatives. Questions concerned stakeholder experience, advantages of TBS and hospital care, perspectives on collaboration, and potential facilitators and/or barriers. Transcripts were analyzed using thematic analysis and inductive coding. Between June 2022 and August 2023, 35 TBSs, 9 patients with previous fractures, 5 hospital staff members, and 2 government representatives were interviewed. Participants unanimously recognized the need for collaboration between TBSs and hospitals. Identified barriers included TBSs' motivation for hospital referral, poor customer care at hospitals, and limited understanding of fracture management in hospitals by TBSs and patients. Implementation of a collaborative triage and referral system was most commonly suggested. This study summarized all relevant perspectives on intersectoral collaboration. A combined approach of a joint triage and referral system, augmented by community education and TBS training, may enhance the quality and accessibility of fracture care and potentially serve as a model for regions facing similar challenges. Further research is needed to evaluate the feasibility and effectiveness of such initiatives in practice.

We described disruptions in cancer-related healthcare appointments and perceived quality of healthcare during the COVID-19 pandemic and identified predictors, including socioeconomic factors, of perceived quality of healthcare among cancer survivors. In this cross-sectional study, we used 2021 Health Information National Trends Survey-Surveillance, Epidemiology, and End Results data from Iowa, Greater Bay Area (California), and New Mexico cancer registries. Among cancer survivors who visited a healthcare provider in the past 12-months (N = 1130), we reported weighted prevalence of disruptions in (cancelled and/or changed to telehealth) routine cancer screening, disruptions in cancer treatment or follow-up, and perceived quality of healthcare, by registry. Using logistic regression, we identified predictors associated with perceived quality of healthcare, adjusting for sex and age. Among cancer survivors with scheduled appointments, 25.0% (Iowa) to 39.6% (California) reported disrupted cancer screening and 16.6% (Iowa) to 33.9% (California) reported disrupted treatment or follow-up related to their cancer diagnosis. 12.5% (Iowa) to 22.5% (New Mexico) of survivors perceived suboptimal quality of healthcare. Survivors with disrupted cancer screening, lower education and income, longer wait times for results, did not spend enough time with their doctor, and did not receive assistance with health uncertainty had increased odds of perceiving suboptimal quality of healthcare (odds ratio range = 2.64-19.31). Disruptions in cancer screening, lower socioeconomic status, and negative patient experiences were associated with poorer perceived quality of healthcare. Continued efforts are needed to address existing disparities to ensure equitable access to quality of healthcare post-pandemic.

Telemedicine aims to slow the spread of infection, enhance the quality and cost of healthcare, and increase patient engagement and satisfaction. Recently, the Japanese government has promoted the use of telemedicine. Despite the efforts of the government, the service is not in widespread use in Japan, even in the era of the COVID-19 pandemic. The present study aims to assess the awareness of telemedicine among Japanese older adults and learn about their experiences with the service. Furthermore, it aims to understand the patients' needs and perspectives for creating a user-friendly telemedicine service. Therefore, one hundred and ten outpatients with chronic diseases were contacted during the COVID-19 pandemic, and data were collected from them using face-to-face questionnaires. Group 1 and group 2 separately include 55 patients aged 40 to 64 years, and 65 years and above, respectively. Statistical analyses were conducted using Microsoft Excel 2019, AutoSum feature "Ʃ," with statistical significance set at P < .05 by t-test, to compare the means of the 2 groups of participants. The survey results revealed that one patient in each group (2 out of 110 people) had experience using the remote consultation service. The acceptance of telemedicine concept by age and gender was found to be greater among middle-aged adults (2.9, SD 0.7) and male patients (2.9, SD 0.6) than among older adults (2.5, SD 0.8) and female patients (2.5, SD 0.9), and the difference in each aspect was significant (P = .012, 0.024), respectively. Middle-aged adults (2.8, SD 0.6) were also found to be more willing to use the service in the future than older adults (2.5, SD 0.7), and the difference was significant (P = .037). On the other hand, the limited use of telemedicine among the study participants was due to the following main factors; limited knowledge of the service, usability challenges of technology, and cultural factors. Regarding the development of telemedicine, key recommendations were made for creating a user-friendly telemedicine that meets the needs of as many as possible of patients. In conclusion, there are challenges that affect the growth of telemedicine in Japan. Therefore, learning about the patients' perspectives and needs play an important role in increasing telemedicine utilization. The outcomes of the present study will be useful to researchers, designers, engineers, and all those interested in this field of research.

Children remain vulnerable to several diseases posing a significant threat to their lives, while inequitable access to regular physical measurement, healthcare services and resources is unsteady. Therefore, this study aims to evaluate the physical measurements and effects of health education on changes in the physical measurements of children in Bangladesh. A non-randomized controlled trial and pre- and post-test design, conducted in Chandpur, Bangladesh, from September 2021 to September 2022. The school-aged children were enrolled and allocated into the intervention group (IG) and control group (CG), while the IG received 9 months of school nurse-based health education. Data were collected by a questionnaire and physical measurements such as vital signs, height, weight, body mass index, mid-upper arm circumference measurement, triceps and subscapular skinfold, vision screen, and blood test. A total of 455 children completed the study. Among them, 107 (53.2%) and 94 (46.8%) were 7 to 8 years old in IG and CG, respectively. In IG, 140 (53.2%) and in CG 123 (46.8%) children were female. Since several physical assessments differed at baseline, repeated measures ANCOVA was performed with endline data as the dependent variable, group as a fixed factor, and baseline data as a covariate. The mean of the participants' body height, weight, BMI, MUAC and skinfolds were greater among IG than the CG, which were statistically significant (P < .001). Systolic blood pressure was significantly lower in the IG than in the CG (P = .023), while diastolic blood pressure did not differ significantly (P = .120). Integrating regular physical assessments and evidence-based health education by school nurses can reduce health challenges. For the sustainability of school-based health initiatives, establishing a continuous monitoring system and engaging parents, teachers, and local health authorities is needed to assess whether these health benefits persist over time.

This study examines medication home delivery incidents reported in community pharmacies before and after the onset of the COVID-19 pandemic. Medication home delivery incidents are defined as medication errors that occur during the transportation of medication to patients outside the pharmacy through shipping, courier, or pharmacy delivery services. The objective was to analyze trends over time and identify contributing factors to inform patient safety improvements. A retrospective analysis was conducted on medication home delivery incidents reported to a national Community Pharmacy Incident Reporting system, Pharmapod (a Think Research company). Reports from 4091 community pharmacies across 10 provinces and 2 Territories were reviewed, covering the period from January 1, 2019, to January 27, 2022. A total of 156 medication home delivery incidents were identified and analyzed. Of the 156 incidents, 55 (35%) occurred pre-COVID and 101 (65%) post-COVID. The most frequent incident type was delivery to the incorrect patient, which decreased from 52.8% to 32.7%. In contrast, privacy breaches increased significantly from 29.2% to 41.6%. Contributing factors include staffing distribution, lack of quality control or independent checks, environmental distraction, operational workflow gaps, and insufficient staff training. Medication home delivery incidents increased following the onset of the COVID-19 pandemic, revealing emerging safety risks in pharmacy delivery practices. The shift in incident types and contributing factors highlights the need for improved verification protocols, enhanced privacy protections, and dedicated staff training. As home delivery services continue to expand, these findings underscore the importance of system-level interventions to safeguard medication safety in the community pharmacy setting.

To evaluate the impact of the integrated outpatient clinic for chronic diseases (IOC-CD) on the quality of life of hypertension patients in Rural medical alliance of Zhejiang Province, and offer optimization suggestions. We conducted a cross-sectional study using the EuroQol five-dimensional questionnaire (EQ-5D) from October to November 2023. A total of 295 outpatients with essential hypertension were enrolled through random sampling. Trained investigators collected data via face-to-face paper-based questionnaires in waiting areas, and health utility values were calculated accordingly. The average EQ-VAS and utility scores of hypertensive patients in the integrated chronic disease outpatient clinics of the sampled areas are both at a high level. Among the sampled population, the dimension with the most problems is pain/discomfort, while the dimension with the fewest problems is self-care. Multivariate analysis showed that being over 60 negatively impacted health utility and VAS scores. Have a family doctor and satisfaction with pre-/post-visit services positively affected these scores, while satisfaction with in-visit services improved health utility. Hypertensive patients in Zhejiang's county-level medical alliances receiving chronic disease integrated outpatient care have good health-related quality of life. Future work should expand this integrated clinic model, optimize resource allocation, and improve clinic management and service quality to better meet patients' health needs and enhance their quality of life.

During postgraduate medical education (PGME), individuals face both internal and external professional difficulties. This study examines the difficulties faced by medical residents, their consequences, and their coping strategies from the perspective of medical teachers. This phenomenological study, conducted during the 2024 to 2025 academic year, included 10 medical teachers (3 from Basic Sciences, 3 from Surgical Sciences, and 4 from Internal Sciences) from 3 medical faculties. Purposeful sampling with maximum variation was used to ensure diversity. Data were collected through semi-structured interviews were analyzed thematically. From the perspective of medical teachers, the difficulties encountered by residents during PGME were grouped into 7 themes: "curriculum," "medical teachers," "learners," "health system," "culture/climate," "specialization area," and "time/period." Intergenerational differences influenced perceptions of education and coping strategies, adding another dimension to the conceptualization of challenges. The consequences of these difficulties were identified as feelings of inadequacy and deterioration in well-being. Coping strategies primarily included individual efforts and external support. The study highlights that residents' difficulties arise from the complex interaction of educational, cultural, and systemic factors that shape PGME environments. While teachers often recognize these difficulties, they tend to frame them through personal or generational comparisons, reflecting limited pedagogical reflection. Sustainable improvement requires shifting from an individual resilience model to a relational and system-oriented approach that emphasizes empathy, reflective supervision, and psychological safety. Faculty development programs focused on mentoring, feedback literacy, and cultural awareness, together with institutional policies that balance service and education, are essential to foster humane, learning-centered environments. Such integrative strategies can enhance residents' well-being, strengthen teacher-learner relationships, and contribute to the long-term sustainability of PGME.

The No Surprises Act (NSA), implemented in 2022, has protected patients nationally from surprise medical bills in most settings. However, out-of-network care resulting in arbitration between insurers and providers under the NSA may result in very high costs for this care. The objective of this paper is to characterize payments for out-of-network care resulting from disputes that underwent arbitration under the NSA and compare the settlement amounts to in-network prices. Using 2023 dispute and claims data from Elevance Health (EH), we described insurer and provider bids, and compared the final settlement amounts to the qualifying payment amount (QPA) - which is used in arbitration and is intended to represent average in-network market rates - and to in-network prices for similar procedures. Lastly, we compared settlement amounts to Medicare rates. 7076 disputes between EH and providers with arbitration under the NSA were analyzed, eighty percent of which were won by providers. Median (mean) final arbitration amounts were 3.72 (4.99) times the QPA, 2.04 (3.23) times actual median local in-network commercial rates, and 4.5 (5.8) times Medicare rates for the same services. This analysis shows that settlement amounts were substantially higher than QPA and median in-network prices, indicating that out-of-network providers are receiving substantially higher payments than in-network providers when they go through arbitration under the NSA. This contrasts with the Congressional Budget Office's prediction of savings through arbitration settlements close to average in-network prices.