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

Portugal is one of the European Union countries with the highest rates of people aged 65 or more. The old-age dependency index is the third highest in Europe. Longevity is a remarkable human achievement but without a comprehensive approach to fostering healthy ageing over the life-course, the burden on health and care systems and social services will increase. This issue is compounded as life expectancy rises, but many of these additional years are not lived in good health. Promoting healthy ageing is an essential political and moral strategy for the well-being both of individuals and societies. Concerning this, Portugal endorsed the Lisbon Outcome Statement drawn up based on the 2023 Regional Summit on Policy Innovation for Healthy Ageing and made its commitment for the creation of age-friendly environments. The National Programme for Age-Friendly Cities and Communities in Portugal is one of the first concrete steps to fulfill that endorsement.

The 340B Drug Pricing Program aims to help facilities serving low-income and uninsured patients to stretch scarce resources by allowing covered entities to purchase outpatient drugs at federally mandated discounted rates while often receiving reimbursement for them at higher rates by commercial payers and Medicare. Despite increasing focus on the expansion and impact of the program, profit margins under 340B have not been fully explored. We aimed to examine drug-, facility-, and geographic-level factors that influence drug margins among 340B covered entities. We conducted a cross-sectional analysis of predictors of facility-level 340B margins for 5 drug classes in a multivariable regression model using 2021 data linked across multiple proprietary and public datasets. Regression results show that drug, facility characteristics, and geographic healthcare market-level characteristics influence drug margins under the 340B program. Adjusted 340B margins were higher in hospital outpatient departments than free-standing offices (ie, hospital-affiliated physician offices and independent, 340B eligible clinics) and among covered entities in more concentrated (ie, less competitive) markets. Covered entity market power, quantified by a facility-level measure of non-340B drug margins indicating pricing power, and area wealth were both associated with higher 340B drug margins. Margins on 340B drugs were higher among facilities in stronger bargaining positions and those serving wealthier areas. These findings add to the growing body of literature on expansions of the 340B program into more affluent communities, informing calls for reforms to ensure the 340B program serves low-income and uninsured patients.

Postoperative cognitive dysfunction (POCD) is the development of cognitive decline following anesthesia and surgery. The incidence of POCD is more pronounced in patients undergoing cardiac surgery than in patients undergoing non-cardiac surgery. This study aims to evaluate the experiences, knowledge status, and clinical practice interventions of nurses caring for patients diagnosed with POCD. Ten nurses working in the intensive care unit of cardiovascular surgery participated in this study, which used a phenomenological design, one of the qualitative research types. We collected the data face-to-face between January and March 2023 using the individual in-depth interview method. The data were analyzed by the researcher using thematic analysis. The study identified 13 main themes: cognitive, behavioral, emotional problems, occupational difficulties, increasing duration, age, premorbid period, psychological resilience, effective coping skills, interaction, restraint, external support systems, and cognitive structuring. After cardiovascular surgery, patients should be evaluated not only for cardiac but also for cognitive, emotional, and behavioral factors. In addition, the risk factors that cause POCD, the difficulties faced by nurses, and their coping skills are the effects that shape the patient care process of POCD.

The February 2022 Russian invasion in Ukraine delayed healthcare reforms. The conflict has led to disruption of medical supply chains and a rapid need for integration between military and civilian entities. This study aims to assess the organization and logistics of the Ukrainian trauma system since the Russian invasion. Qualitative key informant interviews were conducted among Ukrainian military and civilian health care workers using a Ukraine Trauma System Assessment Tool from September 2023 to February 2024. Thematic content analysis was used to derive key themes related to medical logistics and organizational leadership from interviews. Thematic saturation was reached after 36 key informant interviews. Respondents described the roles of the Ministry of Health and Ministry of Defense, as well as the collaboration and integration between military and civilian trauma systems with medical logistics as a key area of focus. Respondents discussed on-going efforts to develop a centralized logistics system to better coordinate supplies and overcome current bureaucratic and communication challenges. The organizational structure and the logistics of the trauma care system in Ukraine are integral to the facilitation of healthcare delivery among both the civilian and military health systems. While rapid coordination has supported triage and increased the efficiency of resources, barriers are still recognized by healthcare personnel including disruptions in the medical supply chain, unpreparedness for large-scale combat operations, inadequate training, outdated equipment, and attacks on infrastructure.

Following COVID-19 containment measures, healthcare service utilization was expected to decline, including in Kenya, across all healthcare tiers. We investigated the impact on community-level health indicators before and during the pandemic. This pre-post study examined community health utilization in 2019 (pre-pandemic) and 2020 (pandemic year) from March to December. Normality was assessed using the Shapiro-Wilk test, followed by Mann-Whitney U or Welch t-tests as appropriate. During the pandemic, facility deliveries (159.2 ± 39.0 vs 496.4 ± 288.2; +237.96%, P = .0232) and ANC referrals (191.0 ± 55.3 vs 630.1 ± 287.2; +229.89%, P = .0008) increased significantly. Child immunization referrals also rose (57.3 ± 11.7 vs 350.2 ± 259.3; +511.17%, P = .0060), while diarrhea treatments in children declined (59.2 ± 47.6 vs 9.2 ± 6.7; -84.46%, P = .0001). Diabetes referrals increased (108.7 ± 65.3 vs 319.5 ± 310.2; +211.15%, P = .035). Households with handwashing facilities saw a non-significant rise (78073.7 ± 16367.9 vs 118457.9 ± 90291.8; +51.73%, P = .3527). Community-level prevention and promotion programs persisted and were enhanced, due to increased fiscal and training support. Even amid crises, community health strategies can adapt and thrive with proper training and funding.

Bystander cardiopulmonary resuscitation (BCPR) significantly improves survival rates for out-of-hospital cardiac arrest (OHCA), yet racial disparities persist. Black and Hispanic individuals are markedly less likely to receive BCPR than White individuals, contributing to preventable deaths and inequities in survival outcomes. Structural factors such as educational barriers, implicit bias, and systemic racism contribute to these disparities. This article examines key contributors to racial disparities in BCPR administration and presents targeted, evidence-based solutions. Educational barriers, including limited CPR training access in historically marginalized communities, low health literacy, and language differences, impede knowledge acquisition and response readiness. Implicit bias among bystanders and first responders influences CPR administration, reinforcing disparities. To address these issues, a multifaceted approach is needed, emphasizing community engagement, culturally responsive training, bias awareness for emergency responders, and policy reforms. Strategies include subsidizing CPR training in underserved communities, developing multilingual and culturally tailored educational materials, integrating CPR instruction into school curricula, and incorporating bias awareness training into first responder certification programs. Additionally, policy interventions should ensure equitable resource allocation to support CPR training and emergency response infrastructure in high-risk communities. Reducing racial disparities in BCPR requires coordinated efforts from policymakers, public health officials, and community stakeholders. Implementing targeted interventions can improve CPR accessibility, enhance response equity, and ultimately reduce preventable mortality among historically disadvantaged populations.

Effective medication management is essential for preventing complications and improving quality of life in individuals with chronic diseases. A comprehensive approach is required to support patients in improving their medication adherence. This study aimed to develop and validate personalized interventions, using technological tools, designed to support medication habit formation in patients with diabetes. The development process was guided by the Medical Research Council's framework, which includes phases of development, intervention design, feasibility testing, and recommendations for future research. Twenty-five experts in healthcare and psychology were invited and participated in the evaluation. To illustrate the intervention, a 5-min video was produced, showcasing a patient's experience through screen captures of individual components. The evaluation encompassed content validation, usability and usefulness assessments, and qualitative feedback. Expert evaluation identified key challenges and effective features relevant to digital interventions in diabetes care. The intervention, MediHabit, was designed based on digital behavior change principles and habit formation theories. It begins with personalized sessions aimed at establishing a consistent medication-taking routine. Direct and indirect cues are subsequently delivered via a mobile app and a smart medication dispenser, synchronized to ensure accurate and timely medication administration. Patients can self-monitor their adherence and receive motivational messages as rewards. Expert validation emphasized the strengths of customizability and individualization, affirming the content's relevance and the app's usability. However, experts also noted the need for improved accessibility across age groups and more meaningful use of patient-generated data. The findings indicate that the MediHabit intervention holds promising potential for improving medication adherence among diabetic patients. Further research is needed to evaluate its real-world effectiveness, long-term impact, and scalability across diverse populations.

Live-in migrant care workers constitute a vital labor force in home-based eldercare in Taiwan; where demographic changes have heightened the demand for such assistant. Despite this, qualitative research exploring the experiences of family caregivers who employ these workers for relatives with dementia remains scarce in the Taiwanese context. This qualitative study aimed to investigate the motivations behind families' decisions to hire migrant workers for home-based dementia care within Taiwan, as well as to assess the associated benefits and challenges they encounter. In-depth interviews were conducted with 4 family caregivers, aged between 52 and 63 years, who had hired live-in migrant care workers between April and August 2022. The transcripts from these interviews were analyzed thematically to derive insights from the findings. The results revealed that family caregivers in Taiwan opted to hire migrant workers for dementia care following a thorough evaluation of their personal circumstances and available resources. Live-in migrant care workers acted as surrogate caregivers, enabling family members to alleviate their daily caregiving burden, improve their emotional well-being, and sustain their personal lives. However, family caregivers faced several challenges, including resistance from dementia-affected relatives toward migrant workers, difficulties in recruiting care workers amidst fluctuating external conditions, and instances of migrant care workers displaying irresponsibility or lacking essential knowledge and skills related to dementia care. Notably, as family caregivers' understanding of dementia evolved, they recognized the critical need to utilize public long-term care services to bolster the dementia-related knowledge and skills of their migrant employees. The study suggests implementing additional dementia-specific training programs tailored for both family caregivers and live-in migrant care workers in Taiwan. Such initiatives would enhance caregiving knowledge and competencies, ultimately improving the quality of life for both caregivers and care recipients.

In Canada, healthcare reforms typically aim to improve the quality of care and access while making healthcare systems more efficient. These reforms have led to a 2-level healthcare system consisting of provincial and regional health authorities (RHAs). RHAs are responsible for providing and administering health services within specific territories. One of the 2 language-based RHAs in New Brunswick (NB) operates in French-speaking rural minority communities. This study explored key factors affecting the retention of nurses and physicians within a RHA operating in a language minority context. This descriptive qualitative study explored how macro-level decisions are experienced on the frontlines. Data were collected through semi-structured interviews with 21 physicians and 37 registered nurses, as well as 2 focus groups involving 20 key informants in managerial roles. Thematic analysis was used to identify key themes. Three main factors emerged: organizational accountability and frustration, local autonomy and contextual responsiveness, and a culture of openness and perceived loss of control. These factors are associated with policy changes that affect operational settings and resource distribution within the RHA and influence the retention of nurses and physicians. Stakeholders in health system reforms, including governments and RHAs, must recognize that policy adjustments can have direct implications on everyday care. Participants expressed a growing disconnect from decision-making hierarchies and a perceived loss of control. Both are seen as barriers to delivering quality care. Ensuring adequate support and resources for implementing system-level changes is key to fostering professional engagement and enhancing job satisfaction.

Literatures shows that poor air quality index (AQI) is associated with several adverse health impacts, such as asthma, chronic obstructive pulmonary disease, diabetes mellitus, tuberculosis, cancer, pneumonia, cataracts, heart diseases, and mental health disorders. Nepal, one of the lower-middle-income countries, has become vulnerable to adverse health impacts due to poor AQI over time. The capital city of Nepal, Kathmandu, is frequently placed as one of the most polluted cities by IQAir. As such, this statement marks a caution for policymakers and the public to be aware of the future effects of prolonged exposure to air pollution and highlights its causative factors. To solve this burgeoning issue, because of the significant rise in urbanization and population growth, mitigation strategies such as creating awareness, reducing vehicular emission, reducing forest fires, creating and identifying vulnerability maps risk zones for forest fires, switching to electronic vehicles and personal interventions such as staying indoors and reducing physical outdoor activity, wearing face masks must be focused and given priority. Although our study is limited in its methodology and findings, it helps establish a policy base to underscore the need for longitudinal cohort studies to generate further evidences pertaining to not up to par air quality levels and their subsequent health impacts in the Nepalese population.