Health Policy最新文献_第7页

Physician and relatives’ role change after shifting to an opt-out organ donation system in the Netherlands: A before and after ethnographic study 在荷兰，医生和亲属在转移到选择退出器官捐赠系统后的角色变化：一项人种学研究的前后

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-10-22 DOI: 10.1016/j.healthpol.2025.105473

Niek Kok , Myrthe van de Meulenhof , Wilson F. Abdo , Jelle L.P. van Gurp , Gert Olthuis

Background

In 2020, the Netherlands adopted an opt-out registration system for organ donation meaning that consent for donation is presumed except when someone actively objects against this. This change in organ donation default policy may change the division of roles between relatives and physicians during conversations.

Objectives

To compare role performance of relatives and physicians in organ donation conversations in the opt-in and opt-out systems.

Methods

We applied an institutional ethnographic approach to compare cases from the former opt-in system in which there was ‘no registration’ to the ‘presumed consent cases’ in the opt-out system.

Results

We audio-recorded six no registration conversations from the opt-in period, and compared these with eight presumed consent conversations from the opt-out period, and conducted sixteen interviews with physicians conducting the conversations. The data show the effect of the system transition on the role division between relatives and physicians in donation conversations. In the opt-in system, physicians and relatives together aimed for a yet to be taken decision, while in the opt-out system, the physicians started the conversation with the registered choice. Ethical deliberation about organ donation is therefore pushed to the background the role of the physician is more tilted to providing relevant factual information and implementing the patient’s choice.

Conclusions

The change to opt-out did likely alleviates the burdensome role of relatives to make morally charged donation choices for their relatives, since organ donation conversations about patients presumed to consent commence with a clear picture of what the potential donor’s wish is.

2020年，荷兰采用了器官捐赠选择退出登记制度，这意味着除非有人积极反对，否则推定同意捐赠。器官捐赠默认政策的这一变化可能会改变亲属和医生在谈话中的角色划分。目的比较选择加入和选择退出制度下亲属和医生在器官捐献对话中的角色表现。方法我们采用了一种制度人种学方法来比较前选择加入系统中“没有登记”的案例与选择退出系统中“假定同意案例”的案例。结果我们录音了选择加入期间的6次未注册对话，并将其与选择退出期间的8次推定同意对话进行了比较，并对进行对话的医生进行了16次访谈。数据显示了制度变迁对亲属和医生在捐赠对话中的角色划分的影响。在选择加入系统中，医生和家属共同针对尚未做出的决定，而在选择退出系统中，医生开始与注册选择对话。因此，关于器官捐赠的伦理考虑被推到后台，医生的角色更倾向于提供相关的事实信息和执行患者的选择。选择退出的改变很可能减轻了亲属为他们的亲属做出道德上的捐赠选择的负担，因为关于假定患者同意的器官捐赠对话始于对潜在捐赠者愿望的清晰描述。

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引用次数: 0

Conceptualising the primary health care workforce: A meta-narrative-inspired review of stakeholder perspectives in Denmark 初级卫生保健工作人员的概念化：对丹麦利益相关者观点的元叙述启发的审查

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-10-21 DOI: 10.1016/j.healthpol.2025.105474

Andreas Nielsen Hald , Ulrika Enemark , Martin Limbikani Mwale , Viola Burau

Background

Primary healthcare (PHC) systems across Europe are under increasing pressure. In response, research has focused on how to develop and support PHC workforces. However, studies often neglect how stakeholders conceptualise the PHC workforce, even though this may influence reform processes. Denmark offers a relevant case due to the involvement of many stakeholders and longstanding tensions over workforce organisation.

Objective

To examine the literature on how stakeholders in Denmark conceptualise the PHC workforce and how conflicting narratives influence policy contestation.

Methods

We conducted a meta-narrative-inspired literature review, following RAMESES guidelines. The review included 49 sources (1980–2025), drawing on peer-reviewed articles, organisational documents, professional journals, policy texts, and political news. Documents were screened, appraised, and synthesised using an iterative narrative analysis. We identified dominant stakeholders, primary narratives, and key areas of policy contestation relevant to the PHC workforce.

Results

Across 45 years of reform and policy debate, three primary narratives have structured stakeholder perspectives: a medical narrative emerging in the mid-1960s, a health economics narrative gaining prominence during the 1990s, and a community narrative growing since the early 2010s. These narratives compete across and within stakeholder groups, most visibly in debates over governance, task-shifting, and whether recipients are framed as patients or citizens.

Conclusions

Stakeholders in Denmark conceptualise the PHC workforce differently depending on the narratives they invoke and the reform context in which they act. Reforms are more likely to gain traction when engaging these perspectives. Narrative-informed approaches can help anticipate resistance and support more effective PHC workforce development.

整个欧洲的初级卫生保健（PHC）系统正面临越来越大的压力。作为回应，研究的重点是如何发展和支持初级保健工作人员。然而，研究往往忽视了利益相关者如何概念化初级保健劳动力，尽管这可能会影响改革进程。丹麦提供了一个相关的案例，由于许多利益相关者的参与和长期紧张的劳动力组织。目的研究丹麦利益相关者如何概念化初级保健人力资源的文献，以及相互冲突的叙述如何影响政策争论。方法：我们按照RAMESES的指导方针进行了一项元叙事启发的文献综述。该综述包括49个来源（1980-2025），参考了同行评议的文章、组织文件、专业期刊、政策文本和政治新闻。使用迭代叙事分析对文件进行筛选、评估和综合。我们确定了与PHC劳动力相关的主要利益相关者、主要叙述和政策争论的关键领域。在45年的改革和政策辩论中，三种主要叙事构成了利益相关者的观点：20世纪60年代中期出现的医学叙事，20世纪90年代崭露头角的卫生经济学叙事，以及自2010年代初以来不断增长的社区叙事。这些说法在利益相关者群体之间和内部相互竞争，最明显的是关于治理、任务转移以及接受者是被定义为患者还是公民的辩论。丹麦的利益相关者根据他们援引的叙述和他们采取行动的改革背景，对初级保健劳动力有不同的概念。当这些观点参与进来时，改革更有可能获得动力。基于叙述的方法可以帮助预测阻力并支持更有效的初级保健劳动力发展。

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引用次数: 0

Exploring financial challenges of students and early-career professionals working in the healthcare sector: A scoping review 探索在医疗保健部门工作的学生和早期职业专业人员的财务挑战：范围审查

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-10-21 DOI: 10.1016/j.healthpol.2025.105475

Samin Huq , Yoonjung Choi , Paul Künzle , Mfonobong Timothy , Cornelia Santoso , Stephanie Hwang , Sherly Meilianti

Background

The global healthcare workforce is facing a substantial shortage and an uneven distribution of qualified professionals, which restricts access to essential healthcare services. This shortage may be mitigated through more effective support of healthcare workers in training. Therefore, an overview of existing economic barriers for this demographic is necessary.

Objective

To review the existing literature on financial challenges of students and early-career professionals in the healthcare sector.

Methods

Following the PRISMA-ScR guidelines, articles published between January 2008 and February 2024 were identified using PubMed and Scopus. A total of 17,268 articles were screened by reviewing their titles and abstracts followed by a detailed review of full texts with cross-validation. Themes were identified, clustered, and analyzed.

Results

This scoping review included 167 articles focusing on the themes debt (36.5%, n=61) and loans (10.2 %, n=17) and their influence on career pathways, the role of employment for career satisfaction, summarizing findings concerning salary (29.9%, n=50), finances (25.1%, n=42), funding (10.8%, n=18), and savings (10.2%, n=17), and obstacles toward a sustainable lifestyle, which included results considering career choice (34.1%, n=57), migration (7.2%, n=12), gender disparity (6.0%, n=10), and working conditions (2.4%, n=4).

Conclusions

Efforts to close the healthcare workforce gap require greater investment in training, compensation, and support for junior healthcare workers. Students and early-career professionals warrant particular attention to build a sustainable, resilient, and reliable healthcare workforce.

背景全球医疗保健人员面临着严重短缺和合格专业人员分布不均的问题，这限制了获得基本医疗保健服务的机会。这一短缺可以通过更有效地支持保健工作者的培训来缓解。因此，有必要对这一人口的现有经济障碍进行概述。目的回顾现有的关于医疗保健行业学生和早期职业专业人员财务挑战的文献。方法根据PRISMA-ScR指南，使用PubMed和Scopus对2008年1月至2024年2月间发表的文章进行鉴定。共筛选了17,268篇文章，方法是对标题和摘要进行审查，然后对全文进行交叉验证的详细审查。主题被识别、聚类和分析。结果本研究纳入167篇文章，重点关注债务（36.5%,n=61）和贷款（10.2%,n=17）及其对职业道路的影响、就业对职业满意度的作用，总结了有关工资（29.9%,n=50）、财务（25.1%,n=42）、资金（10.8%,n=18）和储蓄（10.2%,n=17）的研究结果，以及可持续生活方式的障碍，其中包括考虑职业选择（34.1%,n=57）、移民（7.2%,n=12）、性别差异（6.0%,n=10）的研究结果。工作条件（2.4%,n=4）。结论要缩小卫生保健人力资源差距，需要加大对初级卫生保健工作者的培训、薪酬和支持方面的投资。学生和早期职业专业人士需要特别关注建立可持续、有弹性和可靠的医疗保健队伍。

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引用次数: 0

Exploring barriers to nutritional support for oncology patients in regional and rural settings: A scoping review through the lens of Levesque’s accessibility framework 探索区域和农村环境中肿瘤患者营养支持的障碍：通过Levesque可及性框架的视角进行范围审查

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-10-17 DOI: 10.1016/j.healthpol.2025.105455

Annemarie De Leo , Christelle Schofield , Emily Jeffery , Emily Mountford , Elle Cotton , Joshua Lewis , Jonathan Hodgson , Mary A. Kennedy

Background

Integrating supportive cancer services into routine cancer care is challenging, especially in regional and rural settings where accessibility to healthcare is a known issue. This scoping review aimed to describe and map barriers to nutrition services from the perspectives of people living with cancer and health service providers. Exploring the applicability of Levesque’s Accessibility Framework in identifying and prioritising service gaps was a secondary aim.

Methods

Electronic database searches were conducted in Allied and Contemporary Medicine, CINAHL, Informit, Medline and SPORTDiscus between May-July 2023. Studies reporting on perceived barriers to nutrition services from the perspectives of health service providers and people living with cancer in regional and rural settings were included. We categorised these into demand or supply determinants, which were mapped across the ten dimensions of Leveque’s Accessibility Framework.

Results

Eight studies were included in this review. Thirty-seven barriers were identified and mapped across the ten dimensions described within Levesque’s Accessibility Framework. The most frequently reported barriers related to: Availability and Accommodation of regional health services, Approachability of regional health services and Ability of patients to engage.

Conclusion

This review identified the most commonly reported barriers to nutrition services for people living with cancer in regional and rural settings. Levesque’s Accessibility Framework demonstrates value in categorising barriers to accessibility, which can be used to identify service gaps and inform future policy-setting agendas.

背景：将支持性癌症服务纳入常规癌症治疗具有挑战性，特别是在地区和农村环境中，在那里获得医疗保健是一个已知的问题。这项范围审查旨在从癌症患者和卫生服务提供者的角度描述和绘制营养服务的障碍。探索Levesque的无障碍框架在识别和优先考虑服务差距方面的适用性是第二个目标。方法于2023年5 - 7月在Allied and Contemporary Medicine、CINAHL、Informit、Medline和SPORTDiscus等电子数据库进行检索。从保健服务提供者和区域和农村环境中的癌症患者的角度报告了对营养服务的感知障碍的研究。我们将这些因素分类为需求或供应决定因素，并将其映射到Leveque无障碍框架的十个维度上。结果本综述共纳入8项研究。在Levesque的无障碍框架中，我们确定了37个障碍，并在十个维度上进行了映射。最常报告的障碍涉及：区域卫生服务的可获得性和可提供性、区域卫生服务的可获得性和患者参与的能力。本综述确定了区域和农村地区癌症患者获得营养服务最常见的障碍。Levesque的无障碍框架展示了对无障碍障碍进行分类的价值，可用于识别服务差距并为未来的政策制定议程提供信息。

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引用次数: 0

Population health impacts of national health insurance coverage for neonatal intensive care unit admission in South Korea: evidence from regression discontinuity analyses 韩国新生儿重症监护病房入院的国民健康保险覆盖范围对人口健康的影响：来自回归不连续分析的证据。

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-10-15 DOI: 10.1016/j.healthpol.2025.105471

Jin-Hwan Kim , Woojoo Lee

Background

Neonatal intensive care units (NICUs) are among the most resource-intensive pediatric services. While benefits for extremely preterm or low-birth-weight infants are well established, evidence is mixed for moderately at-risk groups.

Objective

To evaluate the impact of South Korea’s staged expansions in public insurance coverage for NICU admission on infant mortality (IM) and under-five mortality (U5M).

Method

We analyzed 3461,281 birth–death–linked records (2010–2017) using two quasi-experimental designs. A local-randomization regression discontinuity (RD) design exploited clinical thresholds in birthweight (≤1750 g; 1751–2000 g) and gestational age (≤33; 34–35 weeks) to compare full, partial, and no coverage. A regression discontinuity in time (RDiT) design examined births around the March 1, 2013 policy reform. Analyses used exact matching within ±250 g or ±2 weeks, with narrower windows for sensitivity checks.

Results

Full coverage had no measurable effect on mortality compared to no coverage. However, full coverage was associated with higher mortality than partial coverage at the 1,750g/34-week cutoff (IM: +6.1; U5M: +7.1). Partial coverage was associated with lower mortality than no coverage at the 2,000g/35-week threshold (IM: –9.3; U5M: –8.7), but these effects did not persist under narrower bandwidths. RDiT analyses found no significant effect of the policy change on either outcome.

Conclusion

NICU coverage showed no mortality benefit for the most vulnerable infants and may have led to overuse near full-coverage thresholds. Targeted policies and rigorous evaluation are needed to maximize benefits and avoid harm.

背景：新生儿重症监护病房（NICUs）是资源最密集的儿科服务之一。虽然对极早产或低出生体重婴儿的益处已得到充分证实，但对中度风险群体的证据却参差不齐。目的：评价韩国分阶段扩大新生儿重症监护病房住院公共保险覆盖范围对婴儿死亡率（IM）和五岁以下儿童死亡率（U5M）的影响。方法：采用两种准实验设计对2010-2017年3461,281例出生-死亡相关记录进行分析。局部随机回归不连续（RD）设计利用出生体重（≤1750 g; 1751-2000 g）和胎龄（≤33；34-35周）的临床阈值来比较完全覆盖、部分覆盖和无覆盖。一个回归时间不连续（RDiT）设计调查了2013年3月1日政策改革前后的出生人口。分析在±250 g或±2周内使用精确匹配，灵敏度检查的窗口较窄。结果：与不覆盖相比，全覆盖对死亡率没有可测量的影响。然而，在1750 g/34周的临界值（IM: +6.1; U5M: +7.1）下，全覆盖比部分覆盖的死亡率更高。在2000 g/35周阈值（IM: -9.3; U5M: -8.7）下，部分覆盖比无覆盖的死亡率低，但这些影响在较窄的带宽下不持续。RDiT分析发现，政策变化对两种结果都没有显著影响。结论：新生儿重症监护病房的覆盖对最脆弱婴儿的死亡率没有好处，并可能导致接近全覆盖阈值的过度使用。需要有针对性的政策和严格的评估，以实现利益最大化和避免伤害。

{"title":"Population health impacts of national health insurance coverage for neonatal intensive care unit admission in South Korea: evidence from regression discontinuity analyses","authors":"Jin-Hwan Kim , Woojoo Lee","doi":"10.1016/j.healthpol.2025.105471","DOIUrl":"10.1016/j.healthpol.2025.105471","url":null,"abstract":"<div><h3>Background</h3><div>Neonatal intensive care units (NICUs) are among the most resource-intensive pediatric services. While benefits for extremely preterm or low-birth-weight infants are well established, evidence is mixed for moderately at-risk groups.</div></div><div><h3>Objective</h3><div>To evaluate the impact of South Korea’s staged expansions in public insurance coverage for NICU admission on infant mortality (IM) and under-five mortality (U5M).</div></div><div><h3>Method</h3><div>We analyzed 3461,281 birth–death–linked records (2010–2017) using two quasi-experimental designs. A local-randomization regression discontinuity (RD) design exploited clinical thresholds in birthweight (≤1750 g; 1751–2000 g) and gestational age (≤33; 34–35 weeks) to compare full, partial, and no coverage. A regression discontinuity in time (RDiT) design examined births around the March 1, 2013 policy reform. Analyses used exact matching within ±250 g or ±2 weeks, with narrower windows for sensitivity checks.</div></div><div><h3>Results</h3><div>Full coverage had no measurable effect on mortality compared to no coverage. However, full coverage was associated with higher mortality than partial coverage at the 1,750<em>g</em>/34-week cutoff (IM: +6.1; U5M: +7.1). Partial coverage was associated with lower mortality than no coverage at the 2,000<em>g</em>/35-week threshold (IM: –9.3; U5M: –8.7), but these effects did not persist under narrower bandwidths. RDiT analyses found no significant effect of the policy change on either outcome.</div></div><div><h3>Conclusion</h3><div>NICU coverage showed no mortality benefit for the most vulnerable infants and may have led to overuse near full-coverage thresholds. Targeted policies and rigorous evaluation are needed to maximize benefits and avoid harm.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"162 ","pages":"Article 105471"},"PeriodicalIF":3.4,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Determinants of time to access to EMA-approved cancer drugs in Spanish NHS in the past decade: a two cohorts study 在过去十年中，西班牙NHS获得ema批准的抗癌药物的时间决定因素：一项两组队列研究。

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-10-10 DOI: 10.1016/j.healthpol.2025.105469

Pelayo Nieto-Gómez , Celia Castaño-Amores , Antonio José García-Ruiz , Juan Oliva-Moreno

Background

Spain is the fourth largest pharmaceutical market in Europe, yet the time to reimbursement for cancer drugs has been considerably longer than in other European countries in recent years.

Objective

This study aimed to analyse the key factors influencing the time to reimbursement decision (TTRD) and access in Spain for a wide range of oncology indications.

Methods

Cancer drugs approved by the European Commission (EC) between 2010 and 2023 were reviewed. TTRD and time to reimbursement (TTR) were calculated. Variables were categorized into three groups: pricing and reimbursement aspects, the European regulatory process, and quality of evidence. Both univariate and multivariate Cox regression analyses were conducted.

Results

A total of 88 indications were included in cohort A (newly approved drugs) and 220 in cohort B (all indications). Median TTRD was 528 days for cohort A and 524 for cohort B. In cohort A, shorter TTRD was associated with phase III trials (HR: 9.98; 95 %CI (2.61–38.08); p < 0.001) and availability of quality of life (QoL) data (HR: 5.30; 95 %CI (2.01–13.96); p < 0.001). In cohort B, overall survival (OS) data availability correlated with shorter TTRD (HR: 2.27; 95 %CI (1.11–4.66); p < 0.05). Notably, TTRD was significantly longer during 2020–2023 compared to previous years in both cohorts. No significant associations were found for the remaining variables.

Conclusions

The quality of clinical evidence, including phase III trials, QoL, and OS data, plays a crucial role in shortening TTRD. In addition, recent years have seen a substantial delay in reimbursement timelines in Spain.

背景：西班牙是欧洲第四大医药市场，但近年来，癌症药物的报销时间比其他欧洲国家要长得多。目的：本研究旨在分析影响西班牙广泛肿瘤适应症的报销决策时间（TTRD）和可及性的关键因素。方法：回顾2010年至2023年欧盟委员会（EC）批准的抗癌药物。计算TTRD和TTR。变量被分为三组：定价和报销方面，欧洲监管过程和证据质量。进行单因素和多因素Cox回归分析。结果：A队列（新批准药物）共纳入88个适应症，B队列（全部适应症）共纳入220个。队列A的中位TTRD为528天，队列b为524天。在队列A中，较短的TTRD与III期试验相关(HR: 9.98; 95% CI (2.61-38.08)；p < 0.001)和生活质量（QoL）数据的可获得性(HR: 5.30; 95% CI (2.01-13.96)；P < 0.001)。在队列B中，总生存期（OS）数据可用性与较短的trd相关(HR: 2.27; 95% CI (1.11-4.66)；P < 0.05)。值得注意的是，与前几年相比，在2020-2023年期间，两个队列的TTRD明显更长。其余变量未发现显著关联。结论：临床证据的质量，包括III期试验、QoL和OS数据，在缩短TTRD方面起着至关重要的作用。此外，近年来，西班牙的偿还时间表大幅推迟。

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引用次数: 0

Health hazard discrimination or prejudice? A correspondence experiment in Italy 健康危害歧视或偏见？意大利的通信实验

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-10-03 DOI: 10.1016/j.healthpol.2025.105447

Paolo Buonanno , Flavio Porta , Marcello Puca

We study how infectious-disease threats can spill over into discriminatory behavior. Using early COVID-19 in Italy as a case study, we ran an email correspondence experiment with 5356 tourism providers, randomly varying the sender’s location and surname to signal origin from areas differentially hit by the first wave. Requests signaling origin from a highly affected area received about 5 percentage points fewer replies and more rejections than observationally equivalent requests; the penalty concentrated on North-sounding surnames and was absent for South-sounding surnames from the same city, pointing to prejudice rather than rational screening on contemporaneous infection risk. While our setting is tourism, the mechanism we uncover—disease-avoidance concerns activating social stereotypes—is general and consistent with theories of social stigma and the behavioral immune system. Such “health-hazard discrimination” can deter testing or travel, undermine equitable access to services, and amplify outbreaks when stigmatized groups avoid contact with providers. We discuss design and policy tools—bias-safe communication, temporary identity-blinding in first contacts, and platform-level fairness nudges—that can mitigate stigma-driven frictions during epidemics. Findings inform preparedness for future outbreaks beyond COVID-19.

我们研究传染病的威胁是如何演变成歧视行为的。以意大利早期的COVID-19为例，我们对5356家旅游提供商进行了电子邮件通信实验，随机改变发件人的位置和姓氏，以表明发件人来自第一波受影响不同的地区。与观察结果相同的请求相比，来自高度受影响地区的请求收到的答复少5个百分点，拒绝多；处罚集中在北音姓氏，而对同城南音姓氏的处罚则缺席，这表明存在偏见，而不是对同期感染风险进行合理筛查。虽然我们的研究背景是旅游业，但我们发现的机制——疾病预防涉及激活社会刻板印象——是普遍的，与社会耻辱和行为免疫系统的理论一致。这种“健康危害歧视”可能阻碍检测或旅行，破坏公平获得服务的机会，并在被污名化群体避免与提供者接触时扩大疫情。我们讨论了设计和政策工具——偏见安全沟通、初次接触时的临时身份盲化以及平台层面的公平推动——这些工具可以减轻流行病期间因歧视而产生的摩擦。调查结果为应对2019冠状病毒病以外的未来疫情提供了参考。

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引用次数: 0

Implementing integrated care infrastructure: A longitudinal study on the interplay of policies, interorganizational arrangements and interoperability in NHS England 实施综合护理基础设施：对政策，组织间安排和互操作性的相互作用的纵向研究在NHS英格兰。

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-10-01 DOI: 10.1016/j.healthpol.2024.105237

Andrey Elizondo , Robin Williams , Stuart Anderson , Kathrin Cresswell

Background

New models of care that integrate health and social care provision around the patient require a supportive infrastructure, including interorganizational arrangements and information systems. While public policies have been designed to facilitate visions of integrated care, these often neglect the implementation of effective and efficient delivery mechanisms.

Method

This study examines a decade of attempts to move from fragmented health and care delivery to integrated care at scale in NHS England by developing and implementing a support infrastructure. We undertook a longitudinal qualitative investigation -encompassing interviews and documentary analysis- of the implementation of interorganizational and digital interoperability infrastructures intended to support integrated care policies.

Findings

Our findings underscore the long-term symbiotic relationship between institutional interorganizational frameworks and the construction of interoperability infrastructures, emphasizing how they mutually reinforce each other to support their ongoing evolution. Iterative, flexible, and experimental approaches to implementation provide opportunities to adapt to local realities while learning in the making.

Conclusion

This study underlines the importance of adaptable, locally-informed implementation strategies in supporting the vision of integrated care, and the need to understand such development as a long-term, ongoing process of construction and learning.

背景：围绕患者提供综合卫生和社会护理的新护理模式需要支持性基础设施，包括组织间安排和信息系统。虽然公共政策旨在促进综合护理的愿景，但这些政策往往忽视了实施有效和高效的提供机制。方法：本研究通过开发和实施支持基础设施，考察了英国国民健康服务体系十年来从分散的健康和护理交付到大规模综合护理的尝试。我们对旨在支持综合护理政策的组织间和数字互操作性基础设施的实施情况进行了纵向定性调查，包括访谈和文献分析。研究结果：我们的研究结果强调了机构间组织框架和互操作性基础设施建设之间的长期共生关系，强调了它们如何相互加强以支持其持续发展。迭代的、灵活的和实验性的实施方法提供了在学习过程中适应当地现实的机会。结论：本研究强调了适应性强、因地制宜的实施策略对支持综合护理愿景的重要性，以及将这种发展理解为一个长期、持续的建设和学习过程的必要性。

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引用次数: 0

Fostering integrated healthcare in rural Australia: A review of service models for older Australians with preventable chronic conditions 促进澳大利亚农村综合保健：对患有可预防慢性病的澳大利亚老年人服务模式的审查。

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-10-01 DOI: 10.1016/j.healthpol.2025.105304

Mohammad Hamiduzzaman , Vanette McLennan , Harry Gaffney , Sarah Miles , Sarah Crook , Lewis Grove , Matthew Gray , Victoria Flood

Our review examines the operational dynamics and effectiveness of integrated healthcare models in Australia, focusing on their relevance for older rural adults with preventable chronic diseases. Using Whittemore and Knafl's (2005) systematic integrative review methods, we conducted a search across five databases, including Medline-EBSCO, PubMed, CINAHL, EMBASE, and SCOPUS. The Sustainable Integrated Chronic Care Models for Multimorbidity (SELFIE) framework, established by Leijten et al. (2018), was used for reflexive thematic synthesis. A two-stage screening process identified 15 integrated healthcare models, with five RCTs evaluating their effects on chronic conditions. The analysis revealed two key themes: aspects of care integration (service delivery, leadership, workforce, technology, and finance) and changes in patient and healthcare outcomes. Care coordination and multidisciplinary team care were common features, bridging gaps between health and social services for older patients. Despite challenges such as irregular funding and underutilisation of technology, several models demonstrated positive patient and healthcare outcomes. Virtual care platforms and remote monitoring systems have shown promise in improving patient engagement and enabling real-time care adjustments, particularly in rural areas with limited healthcare access. Our review highlights the need for integrated healthcare for older rural Australians with preventable chronic conditions, revealing the complexity of service models. Policy shifts towards coordinated services and changes in leadership and healthcare practices are essential to ensure this demographic receives integrated care that meets their needs.

我们的综述检查了澳大利亚综合医疗保健模式的运作动态和有效性，重点关注它们与患有可预防慢性疾病的农村老年人的相关性。使用Whittemore和Knafl（2005）的系统综合评价方法，我们在五个数据库中进行了搜索，包括Medline-EBSCO、PubMed、CINAHL、EMBASE和SCOPUS。由Leijten等人（2018）建立的可持续综合多病慢性护理模型（SELFIE）框架被用于反身性主题综合。两阶段筛选过程确定了15个综合医疗保健模式，其中5个随机对照试验评估了它们对慢性病的影响。分析揭示了两个关键主题：护理整合的各个方面（服务交付、领导、劳动力、技术和财务）以及患者和医疗保健结果的变化。护理协调和多学科团队护理是共同特点，弥补了老年患者保健服务和社会服务之间的差距。尽管存在资金不正常和技术利用不足等挑战，但一些模式显示出了积极的患者和医疗保健结果。虚拟护理平台和远程监测系统在提高患者参与度和实现实时护理调整方面显示出了希望，特别是在医疗保健机会有限的农村地区。我们的综述强调了对澳大利亚农村老年可预防慢性病患者进行综合医疗保健的必要性，揭示了服务模式的复杂性。政策转向协调服务以及领导和保健实践的变化对于确保这一人口群体获得满足其需求的综合护理至关重要。

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引用次数: 0

Understanding the influence of leadership, organisation, and policy on delivering an integrated child health and social care service in community settings: A qualitative exploration using the SELFIE framework 了解领导力、组织和政策对在社区环境中提供综合儿童健康和社会护理服务的影响：使用自拍框架的定性探索。

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2025-10-01 DOI: 10.1016/j.healthpol.2025.105335

I Litchfield , L Harper , M Syed , F Dutton , M Melyda , C Wolhuter , C Bird

Background

The Sparkbrook Children’s Zone is an example of a place-based integrated health and social care service developed to support children and young people living in marginalized populations in the United Kingdom. This model of care is expected to address both clinical need and the social determinants of health but evidence of the practical support needed is lacking.

Objective

To understand the infrastructural challenges of providing a service combining clinical and non-clinical staff from a range of organisations and settings.

Methods

A qualitative exploration of the experiences of staff delivering the service and used a directed content analysis to present the results within the Sustainable integrated chronic care model for multi-morbidity: delivery, financing, and performance (SELFIE) framework.

Results

A total of 14 staff were interviewed including clinicians, social care providers, local voluntary groups, and school-based family mentors. Participants described the gap between system-level integration and the lack of practical support for delivering a unified service on the ground; the training opportunities afforded by collocation; the complexity of securing staff from multiple employers using various funding sources; and the need for lengthier evaluations that extend beyond early instability.

Conclusions

Despite decades of structural reform aimed at integrating the health and social care system in the UK, there was a surprising lack of practicable support for delivering a place-based integrated health and social care service. Their delivery is also hindered by short-term funding cycles limiting the reliability of evidence gathered from complex and evolving services.

背景：Sparkbrook儿童区是为支持生活在联合王国边缘人群中的儿童和青年而开发的基于地方的综合保健和社会护理服务的一个例子。这种护理模式预计将同时满足临床需求和健康的社会决定因素，但缺乏所需实际支持的证据。目的：了解基础设施的挑战，提供服务结合临床和非临床人员从一系列组织和设置。方法：对工作人员提供服务的经验进行定性探索，并使用定向内容分析，在针对多疾病的可持续综合慢性护理模式：交付、融资和绩效（SELFIE）框架内呈现结果。结果：共采访了14名工作人员，包括临床医生、社会护理提供者、当地志愿团体和校本家庭导师。与会者描述了系统级集成与缺乏在实地提供统一服务的实际支持之间的差距；搭配提供的培训机会；使用不同的资金来源从多个雇主那里获得工作人员的复杂性；需要更长期的评估，超越早期的不稳定。结论：尽管英国进行了数十年的结构改革，旨在整合卫生和社会保健系统，但令人惊讶的是，缺乏提供基于地方的综合卫生和社会保健服务的切实可行的支持。短期供资周期限制了从复杂和不断变化的服务中收集的证据的可靠性，这也阻碍了它们的提供。

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