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

People with disabilities (PWD) are vulnerable to underlying and chronic conditions and often face barriers to healthcare access, resulting in unmet needs and poor health outcomes. Mobile health (mHealth), defined as the use of mobile technologies to deliver or support healthcare, may help address these gaps by enabling symptom monitoring and self-management, supporting medication adherence, and providing remote care beyond traditional in-person clinical settings. To assess the feasibility and effectiveness of a tailored hybrid mHealth intervention in improving health outcomes, physical function, and self-management behaviors among PWD. This single-arm pre-post study was conducted from April to August 2023 and included 48 participants with physical disabilities, brain injuries, or visual impairments recruited from disability service facilities. The hybrid mHealth platform comprised synchronous telehealth sessions (medication, nutrition, exercise) and asynchronous app-based modules that were developed specifically to support monitoring and self-management. Effectiveness was evaluated using behavioral and health-related outcomes, including medication adherence, physical function, and chronic disease management. Significant improvements were observed in medication adherence (2.6 ± 2.2 vs 3.4 ± 2.5, P = .0001) and medication knowledge (6.8 ± 1.9 vs 9.3 ± 1.6, P < .0001). The physical function results were also significantly improved for participants who completed the exercise intervention. Preliminary findings suggest that the mHealth intervention may enhance chronic disease management, physical function, and self-management among PWD, potentially improving healthcare accessibility. Further research with larger, more diverse populations and longer follow-up periods is warranted to confirm and expand these results.

Introduction: This study aimed to investigate the factors influencing infection control performance among healthcare workers in long-term care facilities using self-administered questionnaires.

Methods: This cross-sectional study included a total of 180 healthcare workers selected from 2 representative medium-to-large long-term care facilities in the Gwangju and Jeonnam regions of the Republic of Korea. Individuals with less than 3 months of work experience were excluded.

Results: Statistical analyses showed significant differences in organizational culture for infection control based on educational level (F = 7.414, P < .001), and in the infection prevention environment based on both occupation (F = 3.217, P = .042) and educational level (F = 2.739, P = .045). Multiple regression analysis revealed that perception of standard infection control guidelines (β = .223, P = .001) and organizational culture (β = .479, P < .001) were significant predictors of infection control performance.

Conclusion: These findings suggest that strengthening institutional infection prevention systems and fostering a culture of infection safety can improve occupational health outcomes and reduce the risk of healthcare-associated infections in long-term care settings.

This study explores the psychological and social dimensions of chronic hypertension among women in rural Eastern and Northern Uganda. It examines how they experience, interpret, and cope with the condition within their socio-cultural environments and local health system contexts. A qualitative research design was employed using in-depth interviews and focus group discussions with 30 women aged 35 to 65 who had lived with hypertension for more than 2 years. Participants were purposively selected to obtain rich, context-specific insights. Data were analyzed using Interpretative Phenomenological Analysis (IPA). Findings show that chronic hypertension significantly disrupts women's daily routines, caregiving roles, and personal identities. Despite these challenges, many draw on spirituality, communal solidarity, and traditional narratives to foster psychological resilience. However, barriers such as poor health communication, difficulties with medication adherence, and limited psychosocial support complicate disease management in rural settings. The study highlights the need for culturally grounded and community-based interventions that integrate psychosocial support with routine hypertension care. Empowerment-focused health education and narrative-based counseling models are recommended to enhance coping and adherence. By amplifying the voices of rural Ugandan women, this research contributes to health psychology and global health scholarship by underscoring the emotional labor, indigenous resilience systems, and socio-cultural meanings associated with chronic illness.

Depression and anxiety are common, disabling conditions that often require sustained psychiatric care. While digital mental health interventions (DMHIs) offer scalable access, few integrate measurement-based care (MBC) to track outcomes such as minimal clinically important difference (MCID) and remission. The purpose of this study was to evaluate the rate and timing of MCID and remission in depression and anxiety among patients with elevated baseline depression and anxiety scores receiving psychiatry services through Rula Health, a MBC-based DMHI that connects patients with psychiatric care. Symptoms were assessed prior to psychiatric visits over a 24-week period and used to evaluate effect sizes, as well as rates of MCID and remission. Kaplan-Meier and Cox proportional hazards models were used to estimate the timing of MCID and remission, and to identify demographic and clinical factors associated with achieving each outcome. A total of 7124 adults with elevated depression symptoms and 7628 with elevated anxiety symptoms at baseline were included. Depression and anxiety symptoms decreased with large effect sizes (d's = -1.17 to -1.62). The median survival time to MCID in depression was 12 weeks and remission 22 weeks. The median survival time to MCID in anxiety was 11 weeks and remission 19 weeks. Several demographic and clinical characteristics were associated with time to MCID and remission. MBC-based digital psychiatry services can support sustained, clinically meaningful change. Faster improvement among patients with varying clinical and demographic characteristics highlights Rula Health's ability to address a range of patient needs.

Although significant progress has been made in reducing malaria transmission in Zimbabwe, the path to elimination remains challenging. The disease remains a persistent threat, particularly in resource-constrained areas such as Mberengwa, necessitating an urgent need to understand the demographic, behavioural, socioeconomic, and structural factors influencing long-lasting insecticide-treated net use and case severity. This study investigated these factors using individual malaria case data to inform the development of locally tailored strategies for malaria elimination. Individual malaria case data from 2019 to 2024 were collected from the District Health Information System Tracker-2 database for this study. Data were triangulated with line list and health facility register data to verify records and complete the missing data. The resulting 662 cases were analysed using stratified descriptive analysis, multivariate logistic regression, and Random Forest classification models. There is an overall gradual decline in the annual Test Positivity Rate, despite seasonal peaks. A critical finding was the disparity between long-lasting insecticide-treated net ownership (95%) and use (7.7%), suggesting that ownership does not translate to protective use. In the multivariate logistic regression, none of the tested variables were significant determinants of Long-Lasting Insecticide Net use. However, random forest modelling identified age, time to seek care, religious group, distance to health facilities, and education level as the top 5 influential factors. For malaria case severity, greater distance to a health facility (P < .001) and increasing age (P = .002) were consistently identified as significant factors associated with severity. The Random Forest model demonstrated enhanced performance in discriminating case severity compared to Logistic Regression. The findings of this study highlight that effective malaria elimination requires a combined focus on behavioural change, structural improvements in healthcare access, and data-driven programming supported by advanced analytics. Tailored malaria elimination strategies must address the long-lasting insecticide-treated net use gap and structural barriers.

Nursing staff including registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs) are critical to nursing home (NH) operations but account for approximately 27% of net revenues. Understanding how nursing staff wages affect financial performance is particularly important as policy efforts seek to expand NH minimum staffing hours. Drawing from efficiency wage theory, which posits that employers may pay above-market wages to enhance worker productivity and retention, this study examined the relationship between nursing staff wages and NH financial performance. We used secondary datasets, including Payroll-Based Journal data and Medicare cost reports (N = 37 933 facility-year observations, 2020-2022). The dependent variable was operating margin, while the independent variables were facility-level RN, LPN, and CNA wages. An instrumental variable (IV) approach was used to address potential endogeneity in RN wages, with county-level average wages (excluding the index facility) serving as the instrument. The first stage modeled RN wages as a function of the instrument, and the second stage estimated the effect of predicted wages on operating margin. Ordinary least squares models were used for LPN and CNA wages, for which endogeneity was not detected. A $1 increase in RN wages was associated with a 0.70 percentage-point decrease in operating margin (P = .01, 95% CI [-1.27, -0.14]). For LPNs, a $1 increase was associated with a 0.17-point decrease (P < .001, 95% CI [-0.20, -0.13]), and for CNAs, a 0.31-point decrease (P < .001, 95% CI [-0.37, -0.26]). These findings underscore the tension between workforce investment and financial sustainability in an industry that operates in a resource-constrained environment. Policy interventions such as wage subsidies or higher Medicaid reimbursements may be necessary to balance staffing investments with financial viability.

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.

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.

Patient mobility is a crucial indicator in healthcare resource allocation and improvement. This mobility is due to the uneven distribution of healthcare facilities in its provincial sense. The objective here is to designate the Alzheimer's disease patients' mobility patterns in Iran. Through this longitudinal study, by applying process mining techniques on the 28 425 physician office visits recorded in the Salamat Health Insurance (SHI) database between 2019 and 2023, the inter-provincial patient mobility patterns across Iran are revealed. Based on the extracted knowledge about the most essential care flows, patient mobility patterns in provinces with the highest rates of trajectories are constructed, a task that traditional statistical methods cannot assess in healthcare. The inter-provincial process model of patients with the highest count of out-of-province patient mobility (more than 50%) is attributed to Ilam, Alborz, Sistan, and North and South Khorasan provinces; though, Tehran, Alborz, and Isfahan provinces are the preferred medical destinations for 70% of AD treatment. The provinces with the lowest count of patient mobility are Qom, Yazd, Fars, Gilan, Isfahan, Eastern Azerbaijan, and Khorasan Razavi, with rates <1%. The potential of process mining techniques in addressing new problems in healthcare services and the integration between the 2 disciplines is introduced here to better understand their contribution to the health industry. The top provinces with the highest counts of referrals from other provinces (eg, Tehran, Alborz, and Isfahan) have also a high count of the specialist share. Consequently, efforts should be made to promote a rational balance in medical resource allocation throughout provinces nationwide, thereby eliminating the monopolistic status of a particular province.