Frontiers in health services最新文献

Objective: The aim of this work is to evaluate trends in the utilisation, cost, and switching patterns of disease-modifying treatments (DMTs) for relapsing-remitting multiple sclerosis (RRMS) under the pharmaceutical benefits scheme (PBS) in Australia from 2010 to 2021.

Methods: A retrospective analysis was conducted using PBS claims data for 14 listed DMTs. Key outcomes included treatment uptake, switching behaviour, patient persistence, per-patient dosage, and direct drug costs.

Results: The cohort comprised 2,315 RRMS patients initiating DMTs between 2010 and 2021 (73% women; mean age 41.9 years). Over the study period, the number of patients receiving DMTs increased 5-fold, while total PBS expenditure on DMTs rose 4.5-fold (from AUD 109.4M to AUD 492.9M), representing a compound annual growth rate of 13.6%-significantly outpacing overall PBS expenditure growth. High-efficacy (HE) DMTs progressively replaced low-efficacy (LE) therapies for both treatment initiation and switching. Median treatment persistence was higher for HE DMTs (25.5 months) compared to LE DMTs (20.8 months). HE DMTs generally incurred higher per-patient costs; however, elevated annual dosages of the LE drug interferon Beta-1a resulted in higher costs than some HE therapies.

Conclusion: Rising PBS expenditure on DMTs was primarily driven by increasing patient numbers, shifts from low- to high-efficacy therapies, and longer treatment persistence. Analysis of individual DMT utilisation identified higher-than-expected use of interferon beta-1a relative to defined daily doses benchmarks, contributing to increased treatment costs. Overall, the findings demonstrate the value of claims data for postmarket monitoring of medicine utilisation and expenditure, and for informing policy review aimed at sustainable resource allocation.

Introduction: The research explores the perceived implementation and impact of the Chronic Dispensing Unit (CDU) within a South African primary healthcare system, with a focus on chronic disease management, using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) and CFIR (Consolidated Framework for Implementation Research) frameworks. Equitable access to healthcare and medicine is still a challenge; it demands long-term care and ongoing medical interventions. Introduced in 2005, the CDU in the Western Cape was designed to overcome the challenges in access by centralising dispensing and distribution of chronic medicines. Two decades after its implementation, its contribution is underexplored. This research evaluated the long-term performance and sustainability of the CDU using implementation frameworks.

Method: A qualitative design was used, using virtual semi-structured interviews with purposively selected participants (n = 8) involved in the implementation and maintenance of the CDU. Interviews were analysed thematically. A deductive-inductive strategy was applied, guided by the RE-AIM and CFIR frameworks.

Results: The CDU demonstrated substantial Reach and Effectiveness. It has refined operational processes and reduced patient waiting times. Challenges with data integration and the non-collection of medicine limit the CDU's ability to inform clinical outcomes and long-term sustainability.

Conclusions: The CDU is still an effective, well-integrated system that supports chronic disease management but is constrained by disconnected data systems. This study evaluated a large-scale health intervention that facilitated data-driven decision-making to monitor, evaluate, and report on evidence-based programmes addressing barriers to sustainment. Integrating two frameworks provided an assessment of a patient-centred intervention, granting insights into equity in access to medicine, to strengthen primary healthcare systems.

This conceptual analysis examines the transferability of social-cognitive theories from individual health behaviours to healthcare professionals' clinical behaviours. Although these theories provide a robust framework for explaining intentional and deliberative actions, their application to professional contexts risks oversimplifying the complex realities of healthcare work. Clinical behaviour is shaped not only by individual attitudes, beliefs, and perceived control but also by organizational hierarchies, procedural constraints, professional identity, and moral responsibility. Through analysis of empirical examples, the paper delineates the conditions under which social-cognitive theories retain explanatory power and those where alternative perspectives, such as workflow engineering, relational coordination, habit theory, and moral psychology, might offer greater insight. The paper argues for an integrative approach that situates individual cognition within environmental, organizational, and ethical contexts. By doing so, it refines understanding of when and how social-cognitive frameworks can inform implementation efforts, and where complementary theoretical lenses are needed to capture the realities of clinical practice.

Effectiveness-implementation hybrid type 1 studies primarily investigate the effectiveness of an intervention and have a secondary focus on exploring implementation-related factors. Integrating implementation aims into intervention effectiveness studies can improve the speed, quantity, and quality of intervention implementation, sustainment, and scale in routine practice, and thereby maximize the impact on population health. This article provides guidance for designing and conducting the implementation aims of effectiveness-implementation hybrid type 1 studies, summarizing past thinking and advancing new considerations for these approaches. The authors argue that hybrid type 1 approaches are suitable for most types of intervention effectiveness research (e.g., efficacy trials, comparative-effectiveness research, observational studies), for different kinds of interventions (e.g., treatment, screening, prevention), and in a broad range of settings (e.g., healthcare, public health, community, schools). The article offers methodological guidance for designing the implementation aims of hybrid type 1 studies, structured around three goals: (1) explain intervention implementation in the effectiveness trial, (2) explore stakeholder perceptions to inform future implementation research, and (3) examine stakeholder perceptions to inform the effectiveness trial. Each of these goals offers a distinct set of research questions and design considerations (e.g., timing, sampling, data collection). Finally, the authors provide some tools and resources for planning and designing hybrid type 1 studies.

Background: Fostering prosociality in children, defined as acting for the benefit of others, is essential for both individual and collective well-being. According to self-determination theory, satisfying the fundamental need for relatedness plays a crucial role in motivating prosociality. Integrating interventions that combine arts and philosophical approaches reinforces socio-emotional skills fundamental to prosociality by enhancing social awareness and empathy, as well as offering an adaptable and practical approach in academic settings.

Aim: This study examined how children engage with social contexts that call upon socio-emotional competencies, and how these experiences relate to the development of prosociality in art-based philosophical interventions. The study was guided by the following research question: What are the perceived benefits of an art-based philosophical intervention on children's prosociality and relatedness?

Methods: This study used a descriptive qualitative design with children in a school setting. Over 10 consecutive weeks, 60-minute workshops combining arts and philosophical inquiry were conducted. Data analysis included group discussions, observations, and 21 semi-structured interviews, with results interpreted through inductive thematic analysis.

Results: The findings indicated that the intervention fostered both connection and engagement among the students: Connection (perceived as emotional resonance) encouraged mutual respect, empathy, and admiration, whereas engagement (which offered comfort, trust, and fostered a sense of belonging) was observed through camaraderie, collaboration, and instances of disengagement.

Discussion: These findings highlight that the development of introspection, self-awareness, and autonomy through artistic and philosophical activities provided a foundation for students to act prosocially, thereby emphasizing empathy, care, and respect toward others.

Implications: The study demonstrates that integrating arts and philosophical inquiry in elementary education fosters prosociality, empathy, and self-awareness, supporting both academic and socio-emotional growth. It offers adaptable strategies for inclusive, cooperative classrooms and highlights implications for curriculum design and policy promoting student well-being and community.

Introduction: Stated aims for digital healthcare transformation frequently cite goals for better coordinated patient-centric systems. However, despite advances in medical science, digital technologies, health policies, and billions of dollars invested over the past 25 years, most healthcare providers are far from fully realizing the demonstrated benefits of today's digital technologies for improving patient care. Sharing information across healthcare systems remains challenging. Problems with fragmentation, quality, inequities, and rising costs of care delivery persist. A recent study of 1,026 U.S. hospital systems found that only 15.8 percent achieved a digital maturity level needed to provide digitally enabled healthcare services to better coordinate patient care. More importantly, hospital systems that were most successful in digitally transforming demonstrated significantly superior patient outcomes. From a system engineering framework, we pose the problem as: How do we transform a system as complex as U.S. healthcare delivery from today's costly, fragmented provider-centric system to a better coordinated patient-centric system with improved quality, access, affordability, and patient and provider experience.

Methods: This mixed methods, cross disciplinary research employs an integrative approach, synthesizing diverse sources of evidence to explore challenges and issues associated with healthcare digital transformation. Data extraction was performed by studying the full text of over 100 articles, case studies, and other sources, which were then analyzed thematically employing a "framework synthesis" methodology, which uses a deductive approach rather than the more common inductive synthesis approaches.

Results: Research points to multiple factors impeding progress, not the least of which is the sheer complexity of the problem. Healthcare systems that achieved significantly superior results reported different approaches to digital transformation in ways that may not necessarily be apparent on the surface, primarily because it is not just about what they did but, more importantly, about how they did it. A growing body of knowledge indicates that achieving digital transformation requires substantially different systemic approaches to the problem that intersect across clinical, technical, behavioral, and organizational domains. In other words, systemic problems cannot be solved with siloed solutions.

Discussion: This research explores these differences with the aim of determining how approaches differ, why the differences matter, and implications for achieving better results. Conceptualizing the healthcare delivery system as distinct from the practice of healthcare (medical practice) makes an important contribution to the evolving science of healthcare delivery - working on the healthcare delivery system versus working in the system.

Background: Intimate partner violence (IPV) has serious health consequences, yet routine IPV screening remains inconsistently implemented in hospital trauma centres. Despite evidence supporting screening, implementation challenges persist. This study used Cognitive Task Analysis (CTA) to examine how trauma care providers perceive and enact IPV screening, with attention to cognitive processes, barriers, and facilitators to implementation.

Methods: We conducted CTA group interviews with nine trauma care providers from two trauma centers in Edmonton, Alberta, Canada. Participants included trauma surgeons, nurse practitioners, social workers, and patient care managers. Using a structured interview guide and concept mapping techniques, we elicited knowledge structures, decision-making processes, and perceived constraints related to IPV screening. We applied an interpretive qualitative approach to uncover underlying themes related to cognitive work and task complexity. Grounded theory techniques, such as open and axial coding, were used in conjunction with CTA to analyze how participants reasoned through clinical scenarios. We paid close attention to how providers assessed cues, coordinated across roles, shifted priorities, and navigated organizational constraints. This hybrid approach allowed us to bridge systems-level implementation science with cognitive insights, drawing conceptually on CFIR and Proctor et al.'s implementation outcomes to generate actionable knowledge for IPV screening interventions in trauma care settings.

Results: Themes were synthesized into six overarching cognitive domains: trauma care workflow, team collaboration and knowledge, critical situations and decision-making, IPV screening practices and challenges, understanding patient experiences, and institutional support. These were further illustrated through refined concept maps that visually represented participants' mental models, task sequences, and decision-making strategies.

Conclusion: Trauma care providers are well-positioned to identify IPV, yet screening is constrained by limited institutional support, unclear procedures, and poor integration into trauma workflows. Findings highlight the need for system-level strategies that align IPV screening with the cognitive and organizational realities of trauma care. By applying CTA, this study informs the design and implementation of context-sensitive IPV screening interventions that are more acceptable, appropriate, and feasible in hospital trauma settings. Furthermore, this study informs implementation strategies for integrating IPV screening interventions into trauma care, with particular implications for improving the acceptability, appropriateness, feasibility, and sustainability of evidence-based practices.