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The shift toward digital-first healthcare models presents both opportunities and challenges for health systems worldwide. This case study critically examines the evolution of eMed GP at Hand (formerly Babylon GP at Hand) within the NHS, tracing its journey from an innovative digital provider to the largest GP practice in England, and ultimately, its downsizing. By bringing together an analysis of reviews, media coverage, and existing research, the study evaluates the model's impact on accessibility, continuity of care, and health inequalities. Findings reveal that while the digital-first approach improved access for younger, healthier populations, it inadequately served vulnerable groups, such as the elderly and those with complex conditions. The study also highlights systemic challenges, such as limitations in Babylon's business model, regulatory gaps in digital health oversight, and the complexities of integrating private sector innovation within public healthcare systems. These insights emphasise the necessity for robust regulation, tailored digital solutions, and a complementary relationship between digital and traditional care models to ensure sustainable and equitable healthcare delivery.

Medical mistrust, clinical trial knowledge, and clinical trial risk impact research participation, yet are rarely studied among racial and ethnic groups. Data were from a cross-sectional survey (n = 1,794). Multinomial logistic regression models examined associations of medical mistrust, clinical trial knowledge, and clinical trial risk with willingness to participate in health research (Yes, No, Unsure) among Chinese, Korean, South Asian, Haitian, North American Latiné, South American Latiné, and Southwest Asian and North African (SWANA) NYC residents with one model per group. Overall, 46.0% of participants reported willingness to participate, ranging from 35.8% (Chinese participants) to 58.7% (South Asian participants). Increased mistrust was associated with less willingness among Chinese (OR: 1.06, 95%CI: 1.00, 1.12) and South American Latiné (OR: 1.15, 95%CI: 1.02, 1.30) participants; more willingness among Haitian participants (OR: 0.87, 95%CI: 0.81, 0.94); more uncertainty among Korean (OR: 1.13, 95%CI: 1.05, 1.22), South Asian (OR: 1.06 95%CI: 1.01, 1.12), and North American Latiné (OR: 1.18, 95%CI: 1.10, 1.28) participants; and less uncertainty among Haitian (OR: 0.91, 95%CI: 0.84, 0.99) and SWANA (OR: 0.91, 95%CI:0.86, 0.97) participants. Knowledge was associated with more willingness for Haitian participants (OR: 2.77, 95%CI: 1.15, 6.65), less willingness for Chinese participants (OR: 0.55, 95%CI: 0.34, 0.88), and more uncertainty among South Asian (OR: 2.09, 95%CI: 1.07, 4.07) and SWANA (OR: 2.71, 95%CI: 1.21, 6.03) participants. Some risk and more willingness were linked for South American Latiné participants (OR: 0.13, 95%CI: 0.02, 0.82). Associations varied by group. Studying multiple racial and ethnic groups advances equitable research representation.

Background: The VHA is the largest healthcare system in the US and an early adopter of telehealth. Barriers to adoption may exist among subpopulations of VHA patients.

Objective: To identify patterns in use of telehealth by modality, race, rurality, age and priority group before and during the COVID-19 pandemic.

Design: We used data from the VHA Pyramid Analytics database to determine quarterly telehealth utilization rates from October 2015 to March 2023 using a pre-post analysis. Main measures were stratified by race, rurality, age group, and VA priority groups.

Participants: Unique patients who used any VHA care within each Fiscal Year of the study period.

Interventions: N/A.

Main measures: Quarterly encounters by modality and number of users with one or more Provider to Home (PTH) encounters per 1000 unique patients.

Key results: There were 36,315,299 telehealth encounters completed by 4,597,055 users during the analytic period. From October 2015-March 2020, PTH video encounters grew from 3.2% of VHA telehealth encounters to 38%. From April 2020-March 2023, PTH video encounters accounted for 90.7% of VHA telehealth encounters. Uptake of PTH during the pandemic differed significantly between demographic groups. Quarterly users per 1000 unique patients (increase relative to reference group; p-values < 0.01) increased significantly more for urban-residing patients (44.9 relative to rural); Black, Asian, or Multi-Racial patients (Black: 52.1; Asian: 48.2; multi-racial: 57.5 relative to White), younger Veterans (age < 45: 113.0; age 45-64: 80.3 relative to age ≥ 65); and Veterans with major disabilities (127.3 relative to Veterans without special considerations).

Conclusions: With the expansion of PTH telehealth during the pandemic, there was a shift in sociodemographic patterns among patients receiving at-home video-based care. Moving forward, VA may choose to test implementation strategies that target different demographic groups to support equitable access to PTH care.

Supplementary information: The online version contains supplementary material available at 10.1007/s44250-025-00256-0.

Background: One major preconception risk driving poor childbirth outcomes in Black/African American women is cardiovascular health. Preconception counseling (PC) can reduce maternal health inequities, prevent fatal cardiovascular conditions, and improve the overall health of mothers before, during, and after pregnancy. This article examines contextual factors influencing the implementation of a community-based and culturally tailored PC intervention, ensuring equitable access amongst underserved populations.

Methods: We used the Practical Robust Implementation Science Model (PRISM) to guide a mixed-methods assessment among community partner sites to inform the implementation of a PC intervention for Black adults in the Southeastern U.S. We developed a regional accountability board (RAB) of community stakeholders and conducted a partner site survey (n = 10) to identify organizational characteristics and group interviews with site staff and community members that receive services at our partner sites.

Results: There was strong community and organizational buy-in for the PC intervention. Partner sites indicated moderate capability to implement PC; however, there was a need for enhanced infrastructure and organizational support for implementation, given limited experience providing PC and organizational funding, staff turnover, and lack of on-site medical services. Existing community trust and robust referral networks were major strengths among all sites.

Conclusion: Collaborative community partnerships engaged throughout this process surfaced key community priorities, strengths, and needs for PC implementation. Using multiple methods to gather community data and feedback informed iterative revisions to the implementation plans that have positioned partner sites to deliver culturally congruent PC to at-risk communities.

Despite improvements in health workforce density, the World Health Organization (WHO) African Region Member States an additional 6.1 million additional health workers by 2030 to achieve universal health coverage (UHC) and health sustainable development goals (SDGs) targets and ensure health security. Additional investments are needed for their education, employment, and retention. However, most countries cannot meet this and require support to secure increased sustainable long-term domestic and external investments in the health workforce to strengthen health systems as part of broader health and national development efforts to improve health, economic, and social outcomes. The Africa Health Workforce Investment Charter, launched by the WHO Africa Regional Office in May 2024, outlines a set of key principles that countries can adapt to stimulate and secure the multisectoral domestic and external investments needed to reduce Africa's health workforce shortages by 2030. This would ultimately increase access and availability of health care workers and primary healthcare services, especially in rural and underserved communities. The Investment Charter sets out the following key principles for coordinating and sustaining investments in education, employment, retention, and public health functions: (1) Enabling government leadership and stewardship; (2) Applying evidence-informed prioritisation investment; (3) Aligning multisectoral investments through partnership and collaboration; (4) Stimulating more and better investments; and (5) Securing sustainable health workforce investments.

This study addresses the needs of skilled birth attendants (SBAs) of primary healthcare centers (PHCs) in Nigeria using the human resources for health (HRH) solutions model. A model analysis approach was adopted to understand existing frameworks in the global HRH landscape. An initial framework identification and contextualization were conducted to guide the analysis of the models identified in the literature. Relevant frameworks were identified, reviewed, and consolidated using the WHO HRH Action Framework (HAF). A total of 109 articles were included in the study after thorough screening out of which only nine (9) models of improving HRH planning and implementation in global health were reviewed. These were the Task Shifting/Sharing Model, Community Midwifery Model (CMM), Performance-Based Financing Model (PBF), Needs-Based Planning Model, Facilities-Based HRH Planning Model, Utilization-Based HRH Planning Model, Workforce Indicator Staffing Needs Model, USAID-Financing Innovations for Nutrition (FINFI) Model, and Micro-Learning Model. The proposed HRH solution model was adapted based on the gaps identified in all analyzed models. This study showed that there are different HRH models which address specific elements of the HRH value chain. However, these models are not comprehensive, therefore, tackling the challenges of SBA shortage in Nigeria would either require the integration of multiple models or the deployment of models in a phased approach which is what informed the proposed HRH solution model in addressing SBAs' needs of PHCs in Nigeria. We therefore recommend the implementation of the model.

Background: The use of big data and large language models in healthcare can play a key role in improving patient treatment and healthcare management, especially when applied to large-scale administrative data. A major challenge to achieving this is ensuring that patient confidentiality and personal information is protected. One way to overcome this is by augmenting clinical data with administrative laboratory dataset linkages in order to avoid the use of demographic information.

Methods: We explored an alternative method to examine patient files from a large administrative dataset in South Africa (the National Health Laboratory Services, or NHLS), by linking external data to the NHLS database using specimen barcodes associated with laboratory tests. This provides a deterministic way of performing data linkages without accessing demographic information. In this paper, we quantify the performance metrics of this approach.

Results: The linkage of the large NHLS data to external hospital data using specimen barcodes achieved a 95% success. Out of the 1200 records in the validation sample, 87% were exact matches and 9% were matches with typographic correction. The remaining 5% were either complete mismatches or were due to duplicates in the administrative data.

Conclusions: The high success rate indicates the reliability of using barcodes for linking data without demographic identifiers. Specimen barcodes are an effective deterministic linkage tool that enable creation of large linked datasets without compromising confidentiality.

Purpose: This study investigated the necessity of culture change in clinical care and medical education within a US academic hospital before and during the COVID-19 pandemic. It explored how the syndemics of COVID-19, racism, and the mental health crisis magnified the urgency of culture change in healthcare and aimed to understand the impact of these syndemics on healthcare and educational culture.

Method: An 11-item survey with 8 open-ended questions was distributed to healthcare teams and trainees at a large academic medical center before (Dec 2019 to March 2020) and during the pandemic (Feb 2021 to April 2021). The survey examined need for culture change, where it has worked well, and factors contributing to successful culture change. Responses were analyzed and themes were generated by qualitative analysis.

Results: The study revealed a strong focus on person-centered care before the pandemic with an emphasis on interdisciplinary care, communication, and safety. Within the pandemic, the focus shifted to COVID-19 safety, increased staffing and support, addressing health disparities and racism in healthcare, and use of telemedicine. As the pandemic evolved, burnout and mental health concerns became more prominent raising questions about the sustainability of culture changes..

Conclusion: The study highlighted cultural shifts within healthcare and medical education magnified by syndemics. There is a growing emphasis on anti-racism, respect, and psychological safety. It emphasized the importance of understanding cultural shifts within institutions to drive effective culture change. Future research should explore different healthcare settings and post-pandemic culture changes. This study provided valuable insight into the landscape of culture change, clinical care, and education, especially in response to COVID-19 pandemic challenges.

Supplementary information: The online version contains supplementary material available at 10.1007/s44250-025-00241-7.