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

The Japanese health care system provides universal coverage with relatively low cost sharing and patients have a free choice of providers. Although Japan's government price controls have helped to restrain the growth in health care spending, the country's rapidly growing elderly population and adoption of new drugs and technologies have placed increased fiscal pressures on its health care system. Additionally, the Japanese health care system does not have the infrastructure in place to restrain utilization, which may be a key driver of increases in health care spending. Although the US health care system has many shortcomings, such as the highest health care prices among developed countries and a significant uninsured population, it has been able to manage utilization by using various tools, such as prior authorization and gatekeeping. The US health care system might be able to offer Japan some lessons on ways to reduce unnecessary utilization and supply to create greater value in its health care system.

Police officers are vulnerable to psychological distress and trauma since they are constantly exposed to significant physical and mental violence. Poor mental health can lead to increased healthcare costs for individuals, organizations, and nations and negatively impacts public safety. Mental health interventions tailored to the nature of police work are needed; however, a research gap exists regarding understanding the mental health of police officers. This study aimed to explore the barriers, facilitators, and needs for mental health promotion among police officers. This study adopted a qualitative approach in South Korea. Twelve police officers working in a metropolitan city were recruited using purposive sampling methods. One-on-one interviews were conducted with open-ended questions regarding barriers, facilitators, and needs for improving mental health. Content analysis was used to derive relevant themes. The participants included 3 women and 9 men, with an average age of 37.8 years and working experience of 12.6 years. Three themes and 9 subcategories emerged. The theme related to barriers was "difficulty accessing resources"; the theme related to facilitators was "supportive environment for mental health prevention and management"; and the theme related to needs was "education and policies to promote mental health." Considering the occupational and organizational characteristics of the police profession, individual and organizational interventions and policies are needed to adequately manage the mental health of police officers.

Substantial variability in patients' medication adherence underscores the key significance of pharmacists and other healthcare providers proactively aiding individuals in achieving optimal medication outcomes. Medication-taking behaviours, barriers, and beliefs varies significantly among medication users. It is crucial to ascertain these factors when designing adherence interventions. The OsloMet Adherence-to-medication Survey tool (OMAS-37) is designed to quantify the degree of adherence, and to assess 37 unique causes for non-adherence. The aim of this study was to assess non-adherence among medication users in the general population utilising the OMAS-37 tool. A cross sectional study among medication users in Norway was conducted in 2021. The features of the general population and three patient subgroups-cardiovascular, pain, and mental health disorders-were characterized and compared using Kruskal-Wallis tests. Of the 812 participants, with a median age of 50 (IQR 37-59) and 91% (n = 736) identifying as female, 64% (n = 517) exhibited high non-adherence scores indicating poor medication. Main reasons included forgetfulness (42%, n = 343), perceived improvement in health (40%, n = 326), and fear of adverse drug reactions (39%, n = 320). Statistically significant positive adherence factors encompassed increasing age, higher education, medication decision involvement, and pill organiser usage. The cardiovascular subgroup exhibited significantly better adherence than the pain and mental health disorders subgroups. The total sample and all three subgroups demonstrated some variation in the main causes for non-adherence. This first study employing OMAS-37 reveals high non-adherence levels and varying causes of non-adherence among different patient groups, emphasizing the need for targeted adherence interventions.

Adolescence is characterized by heightened emotion dysregulation, impulsivity, and engagement in high-risk behaviors, such as substance use, violence, and unprotected sexual activity. Dialectical Behavioral Therapy for Adolescents (DBT-A) is an evidence-based intervention that targets emotion regulation and impulsivity among adolescents, proven effective at decreasing high-risk behaviors. However, limited research exists on adolescents' perceptions of DBT-A, particularly in schools. The current study aimed to understand adolescents' perspectives on a DBT-A skills group delivered within urban high schools in a midwestern state. The study sample of 18 youth (mean age 14.7; 66.7% male; 38.9% Black) completed individual semi-structured qualitative interviews assessing their perspectives on the DBT-A skills group. Interview topics included the program's impact on youths' daily lives, risk-taking behaviors, skill acquisition, and general feedback about the group. Fifteen of the eighteen participants (86%) reported acceptability of the program, expressing that they enjoyed the content and would recommend the group to peers. Participants observed positive impacts on their daily lives, including self-reported enhanced ability to regulate their emotions, communicate with teachers, effectively adapt their mindsets and motivations, and make healthy relationship decisions. Additionally, some noted an increased feeling of connection to their peers following the group. Delivering the DBT-A skills group in schools was shown to have high rates of acceptability among youth and resulted in improved emotion regulation and reduced impulsivity. Further research is needed to assess long-term effects of this program and to identify best training practices for school staff to implement and sustain the program long-term.

While telegenetic counseling has increased substantially since the start of the COVID-19 pandemic, previous studies reported concerns around building rapport, nonverbal communication, and the patient-counselor relationship. This qualitative evaluation elicited feedback from genetic counselors, referring clinicians, and patients from a single healthcare organization to understand the user-driven reasons for overall satisfaction and experience. We conducted 22 in-depth, semi-structured interviews with participants from all 3 groups between February 2022 and February 2023. Interview recordings were transcribed and analyzed using a pragmatic thematic approach. Participants across all groups felt the style and content of the genetic counseling visit lent itself perfectly to telegenetics specifically because of no physical exam component. Most patient and counselor participants expressed having the genetic counseling over phone or video had no impact on the patient-counselor relationship or the amount of trust and emotional connection they were able to achieve remotely. Preference for visit type can be influenced by in-person masking requirements impeding full facial expressions or expressing strong emotions over phone. All respondents expressed strong support for all modalities going forward. Counselors with broad experience across platforms should be the focus of future recruitment as should patient education around the nature of the genetic counseling visit and the accuracy of various testing options. Telegenetic programs should consider perspectives from all 3 groups to ensure that specific needs of each are addressed.

Technology-based online support services are emerging as a resource for people recovering from substance abuse. This study presents findings on how individuals seeking help for a substance use disorder through 12-step fellowship meetings (Alcoholics Anonymous, Narcotics Anonymous) adjusted to virtual rather than in-person meetings during the COVID-19 pandemic. Fifty individuals (50) were interviewed, recruited primarily from 12-step meetings in 3 locations in a rural New England state in the United States. Subjects were asked about whether they had attended virtual meetings during the pandemic, how online meetings compare to in-person meetings, and if they encountered any obstacles when attending virtual meetings (eg, Internet connectivity). More individuals preferred in-person meetings for a variety of reasons, although many participants were willing to give virtual meetings a try. Some participants continued to attend virtual meetings, even after in-person meetings returned. Positives of virtual recovery meetings included convenience and the fact that they could be accessed from anywhere. Internet connectivity and technical difficulties presented a challenge for some. Some individuals were unable to focus in virtual meetings and got easily distracted. Digital recovery support services should continue to be offered as some recovering individuals find them helpful. Virtual meetings are a resource, particularly for those individuals living in rural areas without many in-person resources readily available, or access to adequate transportation. Treatment providers working in rural states may consider advocating to policymakers for quality Internet services (eg, high-speed broadband access), to sufficiently meet residents' treatment and other healthcare needs.

Prior studies of the role of state spending on home and community-based services (HCBS) in nursing home use focused on adults over the age of 65. However, medically complex children and adults under 50 years old represent a small (about 5%) but highly vulnerable subset of nursing home patients. We measured the impact of HCBS spending on short-term and long-term nursing home stays by children and adults under 44 years old and compared the impact between Non-Hispanic White (NHW) individuals and Black, Indigenous, and People of Color (BIPOC). We used the Minimum Data Set to measure nursing home stays in each state per year in 2012 to 2019. The Medicaid Long Term Services and Supports annual expenditure reports were used to measure HCBS expenditures per state resident with a disability. Our outcome was nursing home use by children (<18 years old) and adults (18-43 years old) associated with a change in HCBS expenditures per state resident with a disability (measured in $1000 increments) estimated using linear regression. Higher HCBS expenditures per resident were associated with fewer short-term and long-term nursing home stays among NHW children. We did not find statistically significant association between changes in HCBS expenditures and nursing home stays among BIPOC children. Investments in HCBS are necessary to reduce nursing home use among younger adults. However, to mitigate racial disparities in nursing home use among children, HCBS spending alone may not be sufficient.

Objective structured clinical examination (OSCE) is widely used in health programs and has been applied in medical education to enhance clinical knowledge and help build clinical competence and confidence. It is carried out in different clinical stations that simulate real clinical situations and scenarios and helps prepare students for clinical training and practical applications. The purpose of this study was to investigate the change in professional identity and self-efficacy of occupational therapy students after applying OSCE utilizing simulated learning. A pre-post study design was used. The participants were 48 occupational therapy university students at 1 university in Saudi Arabia. Total scores and subscale scores for professional identity and self-efficacy were compared before and after OSCE using the Wilcoxon signed- rank test. Spearman's rank correlation coefficient was calculated to examine the relationship between professional identity and self-efficacy. There were significant increases in both professional identity and self-efficacy total scores after OSCE (P < .05). Most items in the professional identity, such as choosing occupational therapy again (P < .01) and improving occupational therapy skills (P < .01) and the self-efficacy, such as doing very well in class (P < .01) and ability to learn the material for class (P < .01) increased significantly. OSCE utilizing simulated-based learning plays a supportive role in forming occupational therapy students' identities as clinicians and can potentially enhance their overall self-efficacy, professional identity and growth. It is a beneficial teaching and learning strategy for occupational therapy educators and considered important steppingstones for students transitioning to real life occupational therapy practice.

Outpatient clinic access for patients diagnosed with non-emergent ocular conditions has been shown to decrease patient load in the Emergency Department (ED)/Urgent Care and improve patient satisfaction with care. We sought to quantify referral completion rates and ED/Urgent Care visit durations at a pediatric tertiary care center and analyze how demographic factors may influence these quality indicators. We discuss an overarching strategy to improve access to subspecialty care through a same-day access program. We retrospectively reviewed ED/Urgent Care patient encounters from 2019 to 2024. Patients diagnosed with conjunctivitis, vision loss, corneal abrasion, or iritis referred for follow-up care were included in this report. Visit duration in the ED/Urgent Care, referral completion rates, and patient demographics were analyzed. Seven hundred six patient encounters met the initial inclusion criteria. The average visit duration in the ED/Urgent Care per month was 3.36 hours (median, 3.45; IQR, 2.84-3.81), the average proportion of incomplete referrals per month was 21.9% (median, 20%; IQR, 10.6%-30%), and average proportion of ED/Urgent Care visits over 4 hours per month was 33.1% (median, 33.3%; IQR, 21.3%-43.5%). Demographic subgroup analysis (n = 411) revealed a relationship between age, insurance status, zip code, and race with completed referral rates and visit duration in the ED/Urgent Care. Our results indicate long visit durations in the ED/Urgent Care and a large proportion of incomplete referrals for patients with non-emergent ocular issues. A same-day access program could streamline access to subspecialty care by moving patients directly to the ophthalmology department from the ED/Urgent Care.