Health Policy最新文献_第7页

A scoping literature review of rehabilitation policy recommendations during the COVID-19 pandemic in the WHO European Region 世卫组织欧洲区域2019冠状病毒病大流行期间康复政策建议的范围文献综述

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2026-01-01 Epub Date: 2025-10-27 DOI: 10.1016/j.healthpol.2025.105477

Callum Thomas , Justine Gosling , Ruth E Ashton , Rebecca Owen , Mark A Faghy

Background

As with other frontline healthcare services, the delivery of rehabilitation services has been greatly affected by the COVID-19 pandemic with many services suspended, despite WHO’s mandate that rehabilitation is an essential service.

Objective

This review aimed to provide an overview of policy responses that were taken across the WHO European Region to identify systems and processes that helped to inform and shape decisions pertaining to rehabilitation during the COVID-19 pandemic.

Methods

A scoping literature search was conducted according to PRISMA-ScR guidelines and prospectively registered on Prospero (ID: CRD42024550641). Cinahl, Cochrane, PubMed and Scopus databases were searched from inception to February 2024. Eligibility criteria for selecting publications: Published work that includes any policy documents that informed rehabilitation during the COVID-19 pandemic in any of the 53 World Health Organisation European member states. Search results were extracted using the PESTLE heading framework in Microsoft Excel.

Results

Seven publications comprising seven policy documents from Italy (N=2), England (N=2) and the United Kingdom (N=3) were included in this review. Five key areas were identified in response to COVID-19 and rehabilitation: 1) government direction, 2) funding, 3) education, 4) telerehabilitation, and 5) social distancing and isolation.

Conclusions

Our study's findings demonstrate a dearth of published government policy documentation referring to rehabilitation in response to the COVID-19 pandemic. This lack of published documents indicates that rehabilitation is not considered an essential health service during emergency response. Research should investigate the systems and processes of key decision-makers to inform future rehabilitation pandemic preparations.

与其他一线卫生保健服务一样，康复服务的提供受到COVID-19大流行的极大影响，尽管世卫组织规定康复是一项基本服务，但许多服务已暂停。本综述旨在概述整个世卫组织欧洲区域采取的政策应对措施，以确定在2019冠状病毒病大流行期间帮助告知和制定康复相关决策的系统和流程。方法根据PRISMA-ScR指南进行范围文献检索，并在Prospero （ID: CRD42024550641）进行前瞻性注册。检索了Cinahl、Cochrane、PubMed和Scopus数据库，检索时间从成立到2024年2月。选择出版物的资格标准：已发表的作品，包括在世界卫生组织欧洲53个成员国中的任何一个国家在COVID-19大流行期间为康复提供信息的任何政策文件。在Microsoft Excel中使用PESTLE标题框架提取搜索结果。结果共纳入意大利（N=2）、英国（N=2）和英国（N=3）的7篇出版物，包括7份政策文件。确定了应对COVID-19和康复的五个关键领域：1)政府指导，2)资金，3)教育，4)远程康复，5)保持社会距离和隔离。我们的研究结果表明，在应对COVID-19大流行的过程中，缺乏公开的政府政策文件。缺乏公开的文件表明，在应急期间，康复不被视为一项基本的保健服务。研究应调查关键决策者的系统和程序，以便为今后的大流行康复准备工作提供信息。

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引用次数: 0

Cash transfers and health outcomes: Evidence from Italian municipalities 现金转移支付与卫生成果：来自意大利各市的证据。

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2026-01-01 Epub Date: 2025-11-07 DOI: 10.1016/j.healthpol.2025.105494

Stefania Fontana , Calogero Guccio , Giacomo Pignataro , Domenica Romeo

Background

Cash transfer programs are widely used to support household income and improve socioeconomic well-being. We examine the health impact of a nationwide transfer introduced in Italy in 2015, targeted at middle-income groups and providing up to €960 annually per beneficiary.

Objective

To assess the effect of the program on municipal all-cause mortality.

Methods

Leveraging panel data for all municipalities from 2010 to 2019, we exploit variation in treatment intensity induced by eligibility rules. Intensity is measured via per capita disbursements and share of beneficiaries. We estimate fixed-effects regressions with socio-demographic and economic covariates, regional time trends, and controls for spatial dependence.

Results

Increased transfer intensity is significantly associated with lower mortality: an additional €1 per capita corresponds to 0.004 fewer deaths per 1000 residents, while a one-percentage-point increase in the beneficiary share corresponds to a 0.03 decrease in the same outcome. Heterogeneity analyses suggest stronger effects in municipalities with higher education levels and better healthcare access, indicating that these factors enhance the translation of income support into health gains.

Conclusions

Although not designed with health objectives, broad-based income support programs can yield measurable improvements in population health, particularly when complemented by education and healthcare investments.

背景：现金转移支付项目被广泛用于支持家庭收入和改善社会经济福祉。我们研究了2015年意大利引入的一项全国性转移支付对健康的影响，该转移支付针对中等收入群体，每年为每位受益人提供高达960欧元的资金。目的：评价该项目对城市全因死亡率的影响。方法：利用2010 - 2019年所有城市的面板数据，利用资格规则引起的治疗强度变化。强度是通过人均支出和受益人份额来衡量的。我们估计固定效应回归与社会人口和经济协变量，区域时间趋势和控制的空间依赖性。结果：转移强度的增加与死亡率的降低显著相关：人均每增加1欧元，每1000名居民的死亡人数就会减少0.004人，而受益人份额每增加1个百分点，同一结果就会减少0.03人。异质性分析表明，在教育水平较高、医疗保健条件较好的城市，影响更大，表明这些因素有助于将收入支持转化为健康收益。结论：尽管没有为健康目标而设计，但基础广泛的收入支持计划可以在人口健康方面产生可衡量的改善，特别是在教育和医疗投资的补充下。

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引用次数: 0

How do strategy, scanning, and assessment shape decision-making on technologies in hospitals? insights from a qualitative study in Dutch hospitals 策略、扫描和评估如何影响医院的技术决策？来自荷兰医院定性研究的见解

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2026-01-01 Epub Date: 2025-11-05 DOI: 10.1016/j.healthpol.2025.105486

Maria Pinelli , Marcia Tummers , Janneke Grutters

Background

Rapid advancements in technology affect the quality and sustainability of the healthcare system. Decisions regarding technology procurement and adoption are made by different actors at various levels within hospitals.

Objective

The aim of this study was to understand hospitals’ strategies, scanning and assessment processes towards technology in hospitals and identify inherent trends and challenges connected to them.

Methods

Semi-structured interviews were performed covering hospitals’ strategies, scanning and assessment processes, examined through thematic analysis. Interviewees were members of board of directors, medical doctors, medical physicists, chief (medical) information officers and innovation managers, working in 7 different hospitals in the Netherlands.

Results

The number of respondents was 24: 6 Chief Executive Officers or Board of Directors members, 6 Medical Doctors, 4 Chief Information/Medical Information Officers, 4 Innovation Managers, and 4 Medical Physicists. Thematic analysis revealed hospitals prioritize optimal patient care, with academic hospitals emphasizing their additional role in research and education. They focus on specific clinical areas in order to excel. Some aim to pioneer new technologies. Typically, the implementation of new technologies is initiated by professionals and approved by management. Hospitals' scanning and assessment of emerging technologies, and assessment of implemented technologies, lacks a systematic approach, with some interviewees preferring better standardization. Other interviewees advocated for experimentation with innovative technology without evaluation constraints.

Conclusions

This paper shows there is not a standard strategy, scanning and assessment of health technologies within hospitals. More systematic technology scanning and assessment processes could potentially benefit hospitals, facilitating streamlined decision-making and efficient use of resources.

技术的快速进步影响着医疗保健系统的质量和可持续性。有关技术采购和采用的决定由医院内各级不同行为者作出。本研究的目的是了解医院对医院技术的战略、扫描和评估过程，并确定与之相关的内在趋势和挑战。方法进行半结构化访谈，内容涵盖医院的策略、扫描和评估过程，并通过专题分析进行审查。受访者是在荷兰7家不同医院工作的董事会成员、医生、医学物理学家、首席（医疗）信息官和创新经理。结果受访人员共24人，其中首席执行官或董事会成员6人，医生6人，首席信息官/医疗信息官4人，创新经理4人，医学物理学家4人。专题分析显示，医院优先考虑最佳患者护理，学术医院强调其在研究和教育中的额外作用。他们专注于特定的临床领域，以便脱颖而出。一些人的目标是开拓新技术。通常，新技术的实施是由专业人员发起并由管理层批准的。医院对新兴技术的扫描和评估以及对已实施技术的评估缺乏系统的方法，一些受访者倾向于更好的标准化。其他受访者则主张在没有评估约束的情况下进行创新技术试验。结论医院内部卫生技术缺乏标准的策略、扫描和评估。更系统的技术扫描和评估过程可能有利于医院，促进精简决策和有效利用资源。

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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 : 2026-01-01 Epub 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

Backlogs, waiting times and waiting lists of elective surgeries across OECD countries 经合组织国家选择性手术的积压、等待时间和等待名单

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2026-01-01 Epub Date: 2025-10-28 DOI: 10.1016/j.healthpol.2025.105478

Luigi Siciliani , Gaetan Lafortune , Marie-Clémence Canaud , Chekwube Madichie

Background

Many OECD countries suspended elective (non-emergency) care during the pandemic to divert efforts towards COVID-19 patients, which generated a backlog of patients.

Objective

This study measures the extent to which waiting times and volume changed over time before and after COVID-19 in OECD countries (between 2016-2023). We test whether COVID-19 had a different effect on the waiting time of the patients on the list versus the wait of patients treated, two common measures of waiting times. It discusses how waiting times and volume can be used as measures of health system resilience for elective care.

Methods

The study uses data on a selection of high-volume elective surgeries and OECD countries that report waiting times for patients on the list or from addition to the list to treatment. We use regression methods to quantify the extent to which waiting times increased and volumes decreased after the pandemic across OECD countries.

Results

We find that the wait on the list increased on average by 27-30% in the first three years. In contrast, the wait to treatment increased only to a small extent and the effect was not statistically significant. Volume reduced on average by 19% and 10% in the first two years. There were heterogeneous effects across countries, but these do not appear to be systematically related to health spending, physicians and acute beds.

Conclusion

Measures of health system resilience for elective care should monitor both the wait on the list and the wait to treatment, in addition to volumes.

许多经合组织国家在大流行期间暂停了选择性（非紧急）护理，以将精力转移到COVID-19患者身上，这导致患者积压。本研究测量了经合组织国家（2016-2023年）COVID-19前后等待时间和数量随时间变化的程度。我们测试了COVID-19对名单上患者的等待时间和治疗患者的等待时间是否有不同的影响，这是两种常见的等待时间衡量标准。它讨论了如何等待时间和数量可以作为卫生系统弹性选择性护理的措施。方法：本研究使用了大量选择性手术和经合组织国家的数据，这些国家报告了名单上患者的等待时间或从加入名单到治疗的等待时间。我们使用回归方法来量化经合组织国家大流行后等待时间增加和数量减少的程度。结果我们发现，在前三年，名单上的等待人数平均增加了27-30%。相比之下，等待治疗的时间只增加了很小的程度，效果没有统计学意义。头两年，运输量平均下降了19%和10%。各国之间存在异质性影响，但这些影响似乎与卫生支出、医生和急症床位没有系统关系。结论卫生系统选择性护理弹性措施应监测名单上的等待和等待治疗，除了数量。

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引用次数: 0

Mortality risk factors in Catalonia’s long-term care system: A population-based survival analysis 加泰罗尼亚长期护理系统的死亡率危险因素：基于人群的生存分析

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2026-01-01 Epub Date: 2025-10-30 DOI: 10.1016/j.healthpol.2025.105482

Albert Prades-Colomé

Background

As populations age, understanding the health impact of long-term care systems is critical for shaping effective policy.

Objective

This study investigates the association between long-term care benefits and mortality risk among older adults in Catalonia, Spain, using comprehensive administrative data from July 2015 to December 2024.

Methods

The analysis focuses on applicants of long-term care benefits in Catalonia aged 50+, categorizing them by severity of their needs (Grades I–III) and type of benefit received: home care, residential care, a combination of both or no benefit. It applies survival analysis techniques—including Kaplan-Meier estimators and Cox proportional hazards models.

Results

Individuals with long-term care needs receiving benefits have significantly lower mortality hazards. Notably, individuals transitioning from home to residential care exhibit the most favourable hazard ratios, suggesting that responsive care pathways are associated with better survival outcomes, potentially due to a most accurate matching of care to needs. Residential care alone is associated to higher mortality risk than home care in the population with the highest grades of long-term care needs. Individuals with recognized long-term care needs who do not receive any benefits face significantly higher risks. Mortality risk also varies by sex, age, and clinical profile, with higher hazards observed among men, older individuals, and those with previous haematological, neoplastic, or respiratory conditions.

Conclusion

These findings underscore the association between formal long-term care systems and lower mortality risk and emphasize the importance of timely, adaptive care pathways in mitigating health decline among ageing populations.

随着人口老龄化，了解长期护理系统对健康的影响对于制定有效政策至关重要。目的本研究利用2015年7月至2024年12月的综合行政数据，调查西班牙加泰罗尼亚老年人长期护理福利与死亡风险之间的关系。方法分析的重点是加泰罗尼亚50岁以上的长期护理福利申请人，根据他们的需求严重程度（I-III级）和所获得的福利类型对他们进行分类：家庭护理，住宿护理，两者结合或没有福利。它应用生存分析技术，包括Kaplan-Meier估计和Cox比例风险模型。结果有长期护理需要的患者死亡率显著降低。值得注意的是，从家庭过渡到住宿护理的个体表现出最有利的风险比，这表明响应性护理途径与更好的生存结果相关，可能是由于护理与需求的最准确匹配。在长期护理需求等级最高的人群中，单独的住宿护理比家庭护理具有更高的死亡率风险。有长期护理需要但没有得到任何福利的个人面临着明显更高的风险。死亡风险也因性别、年龄和临床情况而异，在男性、老年人和既往有血液病、肿瘤或呼吸系统疾病的人群中观察到更高的风险。这些发现强调了正规长期护理系统与降低死亡风险之间的关联，并强调了及时、适应性护理途径在缓解老龄化人群健康下降方面的重要性。

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引用次数: 0

Health and care workforce preparedness in response to the influx of Ukrainian refugees: a qualitative study from the Czech Republic 卫生和保健工作人员应对乌克兰难民涌入的准备：来自捷克共和国的定性研究。

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2026-01-01 Epub Date: 2025-11-08 DOI: 10.1016/j.healthpol.2025.105495

Zuzana Kotherová , Karolína Dobiášová , Jolana Kopsa Těšinová , Elena Tulupova

Background

Health and care workforces across Europe face overlapping crises that test their resilience and governance capacities. In the Czech Republic, the COVID-19 pandemic was swiftly followed by a major influx of Ukrainian refugees, creating new pressures on both frontline healthcare workers and intercultural care workers.

Objective

To explore, from the perspectives of frontline healthcare workers and intercultural care workers, how governance capacities and gaps shaped workforce functioning, adaptation, and resilience during the refugee response in the CR, and what lessons this experience offers for strengthening workforce governance in times of multiple crises.

Methods

Thirty semi-structured interviews with frontline healthcare workers and three focus groups with 20 intercultural care workers (September 2022–June 2023) were analysed thematically within a multi-level governance framework.

Results

Fragmented coordination, lack of intercultural training, and limited psychosocial and managerial support undermined resilience. Intercultural care workers played critical but unrecognised roles bridging linguistic and cultural gaps, while refugee health workers remained underused due to rigid qualification rules and limited pathways for integration. Despite strong moral commitment and informal collaboration, reliance on individual initiative rather than structured governance weakened equity and preparedness.

Conclusions

Preparedness depends on governance that sustains the human and cultural dimensions of care. Strengthening coordination across levels, formally recognising intercultural roles within health organisations, and enabling refugee health worker integration through flexible qualification procedures are timely and achievable governance priorities for building resilient and inclusive health workforces across Europe.

背景：整个欧洲的卫生和保健工作人员面临重叠的危机，考验他们的复原力和治理能力。在捷克共和国，2019冠状病毒病大流行之后，乌克兰难民迅速涌入，给一线医护人员和跨文化医护人员带来了新的压力。目的：从一线卫生保健工作者和跨文化护理工作者的角度，探讨在难民应对过程中，治理能力和差距如何影响劳动力的功能、适应和复原力，以及这一经验为在多重危机时期加强劳动力治理提供了哪些教训。方法：在多层次治理框架下，对一线医护人员进行30次半结构化访谈，并对20名跨文化医护人员进行3个焦点小组（2022年9月至2023年6月）进行主题分析。结果：不协调、缺乏跨文化培训以及有限的社会心理和管理支持削弱了适应力。跨文化护理工作者在弥合语言和文化差距方面发挥了关键但未得到承认的作用，而由于严格的资格规定和有限的融入途径，难民卫生工作者仍未得到充分利用。尽管有强烈的道德承诺和非正式合作，但对个人主动性的依赖而不是结构化治理削弱了公平和准备。结论：准备工作取决于能够维持护理的人力和文化层面的治理。加强各级协调，正式承认卫生组织内的跨文化作用，并通过灵活的资格认证程序使难民卫生工作者能够融入社会，这些都是在整个欧洲建立具有复原力和包容性的卫生工作者队伍的及时和可实现的治理重点。

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引用次数: 0

Impact of quality clusters on antibiotic prescribing patterns. A difference-in-differences study from Danish general practice 质量集群对抗生素处方模式的影响。来自丹麦全科实践的差异研究。

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2026-01-01 Epub Date: 2025-11-05 DOI: 10.1016/j.healthpol.2025.105493

Line Bjørnskov Pedersen , Maria Bundgaard , Eskild Klausen Fredslund , Jens Søndergaard , Marius Brostrøm Kousgaard , Sonja Wehberg , Dorte Ejg Jarbøl

Globally, a more rational use of antibiotics is needed to face the threat of antimicrobial resistance. In 2018, quality clusters were introduced in Danish general practice as a new quality improvement initiative. In the clusters, general practitioners engage in self-selected quality improvement topics, such as antibiotics prescribing. This study investigates whether engaging with antibiotics as a topic in quality clusters improves antibiotics prescribing, and whether choice and number of quality improvement strategies matter for behaviour change. We link register data on redeemed antibiotics prescriptions from Danish general practice from 2015–2020 with survey data from 2020 on whether, when, and how practices in clusters engaged with antibiotics as a quality improvement topic. We use a difference-in-differences approach including general practice fixed effects and practice-averaged time-varying patient population characteristics in linear regressions models. We find that practices engaged with antibiotics as a quality improvement topic increase their proportion of narrow spectrum antibiotics prescriptions compared to other practices, while there is no difference in changes in the total number of prescribed antibiotics. Neither the choice nor the number of surveyed quality improvement strategies seem to influence the behavioural outcomes. In conclusion, engaging in antibiotics in quality clusters to some extent improved antibiotic prescribing.

在全球范围内，需要更合理地使用抗生素，以应对抗菌素耐药性的威胁。2018年，质量集群作为一项新的质量改进举措被引入丹麦全科实践。在集群中，全科医生从事自我选择的质量改进主题，如抗生素处方。本研究调查了在质量集群中使用抗生素作为一个主题是否会改善抗生素处方，以及质量改进策略的选择和数量是否对行为改变有影响。我们将2015-2020年丹麦全科医生的抗生素处方注册数据与2020年的调查数据联系起来，调查数据涉及集群中是否、何时以及如何将抗生素作为质量改进主题。我们在线性回归模型中使用了一种差分方法，包括一般实践固定效应和实践平均时变患者群体特征。我们发现，与其他实践相比，将抗生素作为质量改进主题的实践增加了窄谱抗生素处方的比例，而抗生素处方总数的变化没有差异。所调查的质量改进策略的选择和数量似乎都不会影响行为结果。综上所述，在质量集群中加入抗生素在一定程度上改善了抗生素的处方。

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引用次数: 0

Corrigendum to “Shall we call for a doctor? How to build trust toward AI in healthcare: Insights from a Polish cross-sectional preference study” [Health policy 159 (2025) 105379] “我们要不要叫医生？”如何在医疗保健领域建立对人工智能的信任：来自波兰横断面偏好研究的见解”[卫生政策159 (2025)105379]

IF 3.4 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy

Pub Date : 2026-01-01 Epub Date: 2025-11-06 DOI: 10.1016/j.healthpol.2025.105470

Katarzyna Kolasa , Katarzyna Baliga-Nicholson , Jaroslaw Wasniewski , Krystyna Milian , Dominika Ciupek

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 : 2026-01-01 Epub 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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