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

Health literacy competencies enable physicians to communicate effectively, fostering patients' understanding, trust, and shared decision-making. However, research has largely emphasized physicians' views rather than patients'. This study examined how patients perceive physicians' health literacy competencies and how these perceptions shape their views of "good communication" in family medicine. Forty-four Q-statements were developed based on established indicators of physician health literacy and professional competencies. A total of 62 patients were randomly invited from family medicine outpatient clinics at 2 medical centers in northern Taiwan, with 42 completing the Q-sorting task. Data were analyzed using Q-factor analysis, combining quantitative statistical methods with qualitative interview data to identify distinct groups of patient perspectives. The Q-factor analysis identified 5 distinct patient perspectives, accounting for 50.88% of the total variance. These perspectives were categorized as: (1) Paternalistic Model - Physician-Dependent, characterized by patient reliance on physician authority; (2) Interpretive Model - Self-Empowered, emphasizing patient autonomy and active participation; (3) Interpretive Model - Shared Decision-Making, reflecting a balance of physician expertise and patient autonomy; (4) Informative Model - Patient-Centered, prioritizing clear communication and patient rights; and (5) Deliberative Model - Physician-Respecting, balancing professional competence with empathetic patient engagement. Patients perceive "good communication" in various ways influenced by health literacy, cultural values, and expectations of the physician's role. The findings emphasize the need for communication training that adjusts to patients' different health literacy levels and preferences, incorporating these perspectives into physician education and practice to encourage patient-centered, health literacy-oriented care.

The study examines the barriers and facilitators influencing rural smokers in seeking treatment at quit-smoking clinics using Andersen's Healthcare Utilization Model. It explores predisposing, enabling, and need factors affecting healthcare utilization and provides recommendations for improving quit-smoking clinics services. Qualitative research design was employed. Data were collected through purposive sampling, and in-depth interviews (IDIs) were conducted with eligible informants. Framework analysis was used to analyze data. Fourteen informants (11 referred clients to the quit smoking clinic, 3 voluntary) participated in this study. Framework analysis revealed subthemes related to predisposing factors (social influences, individual perceptions, knowledge of smoking cessation methods) and enabling factors (access to services and medical, distance, employment, waiting times and treatment as well as effectiveness of services). The need factors which have been identified are poor health symptoms due to smoking and greater perceived need for help to quit smoking. Recommendations from informants to enhance smoking cessation clinic services are discussed. The findings of our study emphasize the role of predisposing, enabling, and need factors in shaping treatment-seeking behaviors. Key recommendations include enhancing clinic promotion, improving accessibility, implementing group counseling, strengthening policies on tobacco control, refining treatment approaches, and conducting follow-up studies on former smokers. These insights are valuable for clients, healthcare providers, and policymakers in supporting smoking cessation efforts and advancing public health initiatives.

Violence during pregnancy is a significant public health concern, which is associated with different psychological consequences-including depression and suicidal ideation. Although several qualitative studies have been conducted, limited data are available on its prevalence during pregnancy and associated depression and suicidal ideation in Bangladesh. This study identifies the prevalence of violence against pregnant women and depression and suicidal ideation among affected individuals in rural Bangladesh. Our study is a secondary analysis of cross-sectional data, collected in a rural southern subdistrict in Bangladesh using the Edinburgh Postnatal Depression Scale (EPDS). The prevalence of domestic violence (DV), lifetime intimate partner violence (IPV), and IPV during pregnancy were 5.9% (n = 21; 95% CI: 3.7-8.9), 5.4% (n = 19; 95% CI: 3.3-8.3), and 9.9% (n = 35; 95% CI: 7.0-13.5), respectively. Among women exposed to DV, 66.7% (n = 14; 95% CI: 42.6-84.3) reported antenatal depression. Similarly, 68.4% (n = 13; 95% CI: 42.7-86.3) of those with a history of lifetime IPV and 42.9% (n = 15; 95% CI: 27.1-60.3) of those experiencing IPV during pregnancy had depressive symptoms. Suicidal ideation was present in 14.3% (n = 3; 95% CI: 4.2-38.7) of DV victims, 5.3% (n = 1; 95% CI: 0.6-33.8) of lifetime IPV victims, and 5.7% (n = 2; 95% CI: 1.3-21.4) of those experiencing IPV during their current pregnancies. The concerning prevalence of violence and associated mental health issues during pregnancy demands urgent targeted interventions, including policy reforms, health education, and community awareness initiatives.

Adolescents and young women (AGYW) represent 15.1% of the global population and face a heightened risk of depression, especially in low and middle-income countries. We investigated the prevalence and determinants of Depression among AGYW at risk of HIV in urban slums of Kampala. A quantitative cross-sectional design was used to assess depression in 394 AGYW (14-24 years) using the Patient Health Questionnaire from January to May 2023. Prevalence was analyzed using proportions and 95% confidence intervals. Statistical tests, including chi-square, Fisher's exact, ANOVA, and Mann-Whitney U, explored associations. Logistic regression models assessed risk, and the Hosmer-Lemeshow test evaluated the model fit. The prevalence of depression was 7.9% (95% CI = 5.6%-11.0%). Marital status (P = .024), having a high number of multiple sexual partners in the last 3 months (P = .029), and having a high number of multiple paying sexual partners in the last 3 months (P = .005) were significantly associated with depression. Thus, advocacy is crucial for improving depression screening and treatment for AGYW.

Climate change and mental health research has predominantly focused on adults in non-clinical settings; investigations among youth and in clinical settings are lacking. Our objectives were to understand the relationship between adult caregiver and adolescent patient climate-anxiety and to examine caregivers' community-level concerns and their association with adolescent climate anxiety. This cross-sectional study occurred in a single-center pediatric emergency department (ED) and data collection spanned January to December 2024. Exposures included adolescent demographic factors (age group, sex, race and ethnicity, insurance payor) and adolescent and caregiver general anxiety disorder-7 (GAD-7) scores, as well as caregiver perspectives captured on (1) the climate change anxiety scale (CCAS), (2) a domestic and global issues poll, and (3) an environmental community survey. The outcome was adolescent climate anxiety, operationalized using the CCAS. In total, 557 patient-caregiver dyads completed CCAS surveys, with low within-dyad agreement in scores, ICC = 0.224 (95% CI 0.142, 0.274). Both caregivers and adolescents had higher levels of climate anxiety if the caregiver reported concerns about housing, public services, and pollution in their community (P < .05). Moderate-severe generalized anxiety (GAD-7) was the strongest predictor of climate anxiety in both adolescents and caregivers (OR_adj 6.59, 95% CI 3.52-12.30, P < .001). Caregivers viewing climate change as very important had higher odds of moderate-severe CCAS (OR_adj = 4.50 (95% CI 2.03, 9.98), P < .001), with no significant effect of their perception on adolescent CCAS (P = .172). Generalized anxiety and adult caregiver community-level concerns appear to be associated with adolescent climate anxiety in this large pediatric study, but there is no direct relationship between caregiver climate anxiety and the climate anxiety of the adolescent.

Long COVID increases healthcare utilization, yet differences in healthcare spending patterns between individuals with and without long COVID remain poorly characterized, especially at the national level. To evaluate differences in healthcare expenditures among U.S. adults with and without long COVID using nationally representative data. This cross-sectional study analyzed data from the 2022 Medical Expenditure Panel Survey (MEPS), including 16 762 unweighted adults (weighted population: 239 915 159). Healthcare spending outcomes included total expenditures and specific categories including office-based care, outpatient services, emergency room visits, hospital admissions, home healthcare, and prescription medications. A survey-weighted generalized linear model (GLM) with a log link and gamma distribution was used to estimate adjusted differences in expenditures between groups. Individuals with long COVID had significantly higher total healthcare expenditures (mean $11 567; SD $25 334) compared to those without long COVID ($7448; SD $21 734, P < .01). After adjusting for demographic characteristics, insurance status, chronic conditions, and other potential confounders, individuals with long COVID incurred 40% higher total expenditures (β = 1.40, P = .01). Expenditures were significantly elevated for office-based visits (35% higher; β = 1.35, P = .02) and outpatient services (118% higher; β = 2.18, P < .01). No significant differences were found in emergency room, hospital admissions, or dental care expenditures. Long COVID imposes a substantial financial burden on individuals and healthcare systems, primarily through increased outpatient and office-based service utilization. Understanding these spending patterns can help inform policy decisions, optimize healthcare resource allocation, and guide targeted interventions to manage long COVID more effectively.

Using AI-powered mobile applications for mental health screening can help reduce maternal mental health disparities among Black mothers who are pregnant or parenting in the United States. A maternal health education question and answer mobile application chatbot has the potential to intervene in the maternal depression cascade, specifically screening. Extant research demonstrates the usability of mobile applications addressing mental health. However, limited scholarship explores the intersection between AI-powered mobile application chatbots and maternal mental health. This study uses a multimethod analysis to evaluate the usability of an AI-powered mobile application to address maternal mental health among Black women. Data sources, including mobile application engagement, mental health disorder scales, and secondary qualitative analysis from focus group discussions (n = 5), will be assessed through a multimethod approach. The study team previously collected data across the United States for this clinical intervention in 2022. Findings indicate that the mobile application demonstrated promise in the application's usability to screen for maternal health depression indicators. This was achieved using the mobile application's intent classification functionality that classified users' questions that contained targeted search terms (e.g., postpartum depression) or specific inquiries about mental health and appropriate follow-up from the study team to provide mental health resources. Critical interconnected themes were assessed and reflected high confidence, acceptance, and usability of the mobile application in addressing maternal mental health inquiries. Findings contribute to evidence about the usability of AI-powered mobile applications informed by Black mothers in appropriate screening for maternal depression indicators and inquiries. This study provides insight into closing the gap in maternal health disparities in depression outcomes for Black mothers.Trial Registration: ClinicalTrials.gov NCT06053515; https://clinicaltrials.gov/study/NCT06053515.

Although group participation benefits older adults' health, its effects may vary by group type. The Japanese Health and Welfare Co-operative (Hew Co-op) organises peer-led group participation called 'Han Kai' meetings to promote health literacy, but the impact of Han Kai participation on health indicators remains unexplored. This study aimed to examine whether the frequency and duration of Han Kai participation were associated with risk of functional disability. This was a prospective cohort study conducted in Japan between 2018 and 2022. The participants were Han Kai members aged ≥ 65 years who did not receive a Long-Term Care certification. The exposure variables were the frequency of participation in Han Kai per year and the years of participation in 2018. The main outcome was a risk assessment scale score for predicting incident functional disabilities in 2022. Multivariate linear regression was conducted to adjust for covariates. In the study, 2359 older adults participated. Overall, the frequency of Han Kai participation was not significantly associated with disability risk scores. However, participants with ≥10 years of involvement had significantly lower scores (β = -1.95, 95% CI: -3.64 to -0.26, P = .024). Among those aged ≥ 75 years, both frequency and duration showed a significant inverse association with risk scores, with a dose-response relationship. Sustained participation in peer-led group meetings such as Han Kai may help mitigate functional decline, particularly among the oldest age groups. These findings support policies that promote long-term community engagement as part of healthy ageing strategies.

This study attempts to examine how cancer drug lags in South Korea, along with submission-to-approval and approval-to-reimbursement decision time spans, have evolved over the last decade, from 2013 to 2022. For the same set of cancer drugs, the drug lags observed in South Korea were compared with those of United States, European Union, and Japan. Multivariate linear regression and multivariate Cox regression analyses were performed to conduct quantitative analyses. Compared with the 3 other advanced medicine agencies, South Korea (Ministry of Food and Drug Safety [MFDS]) displays an average delay of 1 to 2 years in submission and approval over the sample period. However, the average review processing time is much shorter than the submission and approval lags, and the MFDS fares even better than the European Union (European Medicines Agency [EMA]) in terms of reviewing efficiency. Notable progress has been made in addressing delays in the reimbursement decision process, roughly cut in half over the period, whereas other lags are rather elongated. The multivariate regression results confirm that the variations in approval delays in South Korea are largely associated with submission delays. The fact that South Korea fares poorly in submission and ensuing approval lags compared to other nations and regions with advanced medicine agencies mirrors the reality that South Korea is still not yet being considered as one of the most preferred testing grounds for innovative cancer drugs. The findings highlight that the goal of regulators should be geared towards ensuring more equitable access to oncology drugs in a timely manner for the Korean population.

This study aimed to identify unique social connection factors associated with cognitive impairment among older adults. Longitudinal data from the 2010 to 2020 Health and Retirement Study were used. Discrete-time survival models were applied to examine the impact of the social factors like loneliness, depression, positive and negative support from family and friends, volunteerism, attending sports or social clubs, charity work, and computer use on cognitive impairment. The sample included 15 548 adults aged 50 and older, with 11.4% living in poverty. Key factors associated with cognitive impairment were loneliness, depression, charity work, participation in sports or social clubs, computer use, positive family support, and negative family support. In adults living in poverty, depression and computer use were most strongly linked to cognitive impairment. These results underscore the need for interventions and educational programs that help older adults maintain or improve cognitive function through enhanced social connections.