Frontiers in health services最新文献

Introduction: Digital competence is essential for students and professionals in health and nursing education. Based on the DigComp 2.2 framework, this study examines the self-assessed digital competencies of students from Germany, Ukraine, and Kazakhstan across five core dimensions, aiming to identify national differences and potential misalignments between perceived and reported digital competences.

Methods: A cross-sectional online survey (n = 269) was conducted among students in health-related fields. Participants rated their digital competence on 15 items aligned with DigKomp 2.2 questionnaire. Quantitative data were analyzed descriptively and with ANOVA (two-tailed, p < 0.05), using Games-Howell post-hoc tests in case of heterogeneity of variances and Kruskal-Wallis/Mann-Whitney tests as sensitivity analyses. In addition, an open-ended knowledge question asked respondents to describe their strategies for finding reliable online information. Responses were analyzed descriptively and qualitatively using inductive coding.

Results: While all groups reported generally high digital competence, German students rated themselves significantly lower in the Digital content creation dimension compared to their peers and the KaWuM reference sample. However, their responses to the open-ended question revealed methodologically advanced search strategies, including systematic literature reviews (n = 8), Boolean operators (n = 6), and use of AI tools (n = 1). Ukrainian students emphasized heuristic and comparative approaches, while Kazakhstani responses reflected pragmatic strategies under infrastructural constraints.

Discussion: The findings suggest a mismatch between self-assessed and actual digital competence, particularly among German students, who may underestimate their skills. This highlights the importance of triangulating quantitative self-reports with qualitative diagnostics. The study underscores the need for embedded digital skills training, especially in Digital content creation, across national contexts in health education.

Background: Type 2 diabetes mellitus (T2DM) is a growing health burden in China. High complication rates contribute to increased morbidity, mortality, and costs. However, evidence is limited regarding how these complications develop and cluster over time in real-world settings, which this study examined.

Methods: This retrospective cohort study used big data from the Cheeloo Lifespan Electronic Health Research Data Library, comprising data from over 5 million individuals in Shandong Province, China, to investigate the trajectories, onset timing and key risk factors of T2DM-related complications.

Results: The prevalence of T2DM-related complications increased from 30.4% in 2013 to 53.1% in 2023. The median time from diagnosis to the first complication was 7.5 years. Ophthalmic, neurological, and circulatory complications were among the most common and showed the largest relative increases in prevalence over the study period. Complication profiles exacerbated over time: most patients developed multiple complications by Year 9. Frequent follow-up visits (≥4 times/year) and using primary health care (PHC) services were significantly associated with a reduced risk of complications, whereas being unmarried, being overweight, being obese, alcohol use, and poor medication adherence were significantly associated with a higher risk.

Conclusion: Patients with T2DM in China face a substantial and growing burden of complications, with most developing multiple complications within ten years of diagnosis. Follow-up visits, the use of PHC services, and regular medication adherence are potential protective factors to prevent or delay the development of complication. These findings highlight the importance of integrated, community-based, and personalized management strategies to improve outcomes in T2DM populations.

Introduction: The care provided to patients with severe mental disorders remains a major challenge for the organization of healthcare systems. Data on recent treatment patterns within mental health services are essential to estimate the unmet needs for care and to guide service planning and resource allocation.

Aim: To identify individual patient and organizational-level predictors of the provision of minimally adequate care for patients with severe mental illness.

Methods: A population-based study was designed, retrieving data from Healthcare Utilization databases of Lombardy region (Italy). 72,115 patients from Departments of Mental Health (DMHs) in care for schizophrenic, bipolar or major depressive disorder, were identified. Minimally Adequate Treatment (MAT) was calculated as either minimum psychiatric visits (≥4) with pharmacological treatment (≥2 months) or psychotherapy sessions (≥8, for major depressive disorder only). Patients meeting these criteria were considered as having received MAT; others were classified as having received less than adequate treatment. Multilevel analyses were performed to estimate the association between patients' individual (e.g., age, sex, education, marital status) and DMHs' aggregate (i.e., organizational features, activity volume, staff employed in facilities providing MHC) characteristics and provision of MAT.

Results: Overall, 45% of patients received MAT. Patients with increased probability of receiving MAT included married individuals (8%, 95% CI: 4%-12%), those with schizophrenia (11%, 95% CI: 9%-13%) or bipolar disorder (23%, 20%-25%), younger patients (22%, 20%-25%), and those with previous continuity of care (48%, 46%-51%). Differences in DMHs' structural features (e.g., number of day-treatment facilities, presence of multidisciplinary teams) contributed to heterogeneous MAT coverage. Moreover, the composition of psychiatric teams (in terms of hours worked by each category of healthcare professionals) and the number of affiliated facilities were associated with MAT delivery.

Conclusions: This study ascertained that the quality of care offered to psychiatric patients is still low and not adequate. Administrative data can usefully contribute to identify both individual and organizational-level predictors of MAT provision, offering a valuable benchmark for managing organizational features of DMHs and for optimally allocating the working hours in multidisciplinary professional teams, with the goal of maximizing the provision of adequate mental healthcare.

The United States has long sought to create a scalable community mental health and substance use continuum. Federal Certified Community Behavioral Health Clinics (CCBHC) have grown to be the dominant model for comprehensive community mental health services across the US since 2014. In parallel, the state of Massachusetts established its Community Behavioral Health Center (Massachusetts CBHC) model, going live in 2023. Central to both models is a foundational outpatient clinic offering multidisciplinary health and social services that utilizes a bundled payment structure-typically a day-rate or, in some cases for CCBHCs, a monthly rate-eschewing a traditional fee-for-service payment structure. These models differ in other aspects of their clinical models, federal financial support, and provider payment mechanisms.

Many patients experience unexpected harm while receiving healthcare, with a lasting impact on patients, families, and caregivers. Communication and Resolution Programs are being adopted with increased frequency, as a more systematic, transparent, and equitable approach to these unexpected outcomes. The aim of this study was to identify whether demographic factors played a role in identifying patients with unexpected death, as managed in our CRP. This nested case-controlled compared 236 patients who experienced an unanticipated death with 2,360 controls who died expectedly over a 10-year period. Patients with unexpected death were more likely to be Black (AOR 2.18 95% CI 1.01-4.68), higher comorbidity burden (AOR 1.07 per additional co-morbidity, 95% OR 1.01-1.14), and a lower Relative Expected Mortality (AOR: 5.39; 95% CI: 1.76-16.55). Awareness of these demographic risk factors for unexpected mortality may lead to changes in how these patients are evaluated and treated. Communication and Resolution Programs can be used to identify the patients at the highest risk for unexpected outcomes.

A significant gap in perioperative safety persists due to the absence of internationally recognized guidelines for managing surgeon fatigue. While other high-risk fields utilize robust fatigue management systems, surgical institutions frequently rely on fragmented coping strategies and inconsistent local policies. This oversight is concerning, as evidence confirms that sleep deprivation compromises surgical performance, with simulator studies reporting technical skill reductions of up to 32%. Current countermeasures, such as work-hour limits or caffeine use, are insufficient substitutes for restorative sleep and have an inconclusive impact on patient care. This paper proposes a systemic solution, urging global, national, and hospital-level collaboration to establish a standardized framework for fatigue risk management. Key recommendations include the use of fatigue-monitoring tools, mandating rest periods that allow for at least six hours of sleep before elective procedures, creating backup on-call rosters, and making fatigue management a part of surgical training. Adopting these evidence-based protocols is an essential step toward protecting patients and fostering a sustainable, safer surgical culture.

Background: Various intravenous iron formulations show great promise in the treatment of iron deficiency anemia (IDA), and economic evaluation results are becoming increasingly important as criteria for allocating healthcare resources. This study aimed to systematically evaluate the economics of six main intravenous iron formulations in the treatment of IDA.

Methods: Computerized search of relevant studies in PubMed, Embase, Web of Science, and The Cochrane Library to collect economic evaluation of six intravenous iron formulations for the treatment of patients with IDA; the time limit for searching was from the establishment of the database to 30 July 2025. Two reviewers independently screened literature, extracted data, evaluated the quality of included studies using the Consolidated Health Economic Evaluations Reporting Standards 2022, and performed descriptive analyses.

Results: Of the 2,288 articles retrieved, 17 studies were included, including five drugs, conducted in 10 different countries. Six studies compared ferric carboxymaltose (FCM) with iron sucrose (IS); two studies compared FCM, ferric derisomaltose (FDI), and IS; one study compared FCM, iron dextran (ID), and IS; one study compared FCM, IS, ID, and FDI at three dose levels; one study obtained an economic ranking for FCM, ID, IS, and ferrous gluconate (FG); five studies compared FDI and FCM; and one study compared FDI with IS. The overall quality of the included studies was high. A total of 13 studies conducted sensitivity analyses to check the robustness of their results.

Conclusion: This review systematically evaluates the economic characteristics of the six main intravenous iron formulations for treating IDA. Current evidence suggests that the efficacy of FDI is better than IS, and the economic ranking of the four intravenous iron formulations can be summarized as FCM, ID, IS, and FG. Further research is needed to justify the economic comparison between FCM and FDI.

Objective: This review will examine existing research to compare the differences in healthcare access for people with disabilities in rural vs. urban areas. The goal is to identify common obstacles and helpful factors that affect their ability to get healthcare, which can inform the creation of specific programs to close these gaps.

Methods: This systematic review was pre-registered with PROSPERO (Registration No. CRD42025648258). A comprehensive search was conducted across databases including PubMed, Scopus, Web of Science, and the Cochrane Library, for peer-reviewed articles published between January 1, 2010, and December 31, 2024. Studies were included if they addressed healthcare access for disabled individuals and made comparisons between rural and urban settings. Data extraction was performed using standardized forms, and quality assessment was conducted using the Mixed Methods Appraisal Tool (MMAT). Data synthesis involved a narrative synthesis and thematic analysis to identify key barriers and facilitators to healthcare access in rural and urban areas. The reporting of this review follows the PRISMA guidelines.

Results: Eight studies from Peru, China, the United States, Mozambique, and South Africa were included in the final review. A clear distinction emerged between the barriers to healthcare access in rural and urban areas. Rural settings were defined by infrastructure-related challenges, such as transportation difficulties, a lower number of healthcare facilities, and limited provider availability. Meanwhile, urban areas presented different barriers, including overcrowded facilities and extended wait times. Both settings struggled with socioeconomic disparities, but the specific barriers and facilitators varied. In rural areas, telemedicine and mobile clinics were identified as key facilitators, while in urban areas, specialized healthcare services and better public transportation were the most helpful in bridging access gaps.

Conclusion: This systematic review confirms that disabled individuals face significant, yet distinct, healthcare access disparities depending on their location. In rural areas, the primary barriers are transportation and a lack of facilities, which necessitates the development of community-specific solutions such as mobile clinics and expanded telemedicine. In urban settings, access is hindered by system overcrowding and socioeconomic divides, calling for interventions that improve public transportation access and address systemic inequalities. Ultimately, addressing these disparities requires a dual approach: empowering rural communities with technological and logistical support while simultaneously optimizing urban healthcare systems to be more accessible and equitable.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025648258, PROSPERO CRD42025648258.

Introduction: The COVID-19 pandemic highlighted pre-existing weaknesses, revealing deep-rooted issues in infrastructure, access, and resource allocation that have long impeded African countries' ability to effectively meet population health needs. It also became evident during the pandemic that there were discrepancies in how vaccines were distributed, delivered and accessed in these countries. We aimed to identify vaccine distribution, service delivery processes and related barriers in Botswana to contextually explore practices that either enhance or hinder access and equity in vaccine distribution and delivery.

Methods: We conducted in-depth interviews, using a semi-structured interview guide, with a purposive sample of 18 key informants, including public health sector officials, non-state actors, policy makers, regulatory bodies and other stakeholders. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted following a deductive approach according to the six-step analysis framework by Braun and Clarke: (i) familiarization with the data; (ii) generation of initial codes; (iii) searching for themes; (iv) reviewing themes; (v) refining and naming themes; and finally, (vi) producing the report. Steps i-iii were conducted by two researchers. Attention was given to aspects of credibility, dependability, and transferability of the findings through key strategies, including team data review, coding, consensus on themes and review of both secondary and grey literature on vaccine roll-out in the country.

Results: Seven primary themes emerged from the findings. COVID-19 vaccine distribution and delivery in Botswana followed the existing primary health care system structures for routine vaccine delivery. Traditional mechanisms such as static public health facilities, private facilities, outreach campaigns, and mobile stops, were augmented through different roles played by stakeholders in the private sector, civil society organizations and non-governmental organizations. Religious and cultural norms were reported to affect vaccine uptake centered around smaller population groups that are historically known to be anti-vaccines. There is no deliberate gender and the disabled population programming for vaccine distribution and delivery in Botswana. The private sector improved access to vaccines by supporting supply chain logistics with transportation, especially to hard-to-reach areas.

Discussions: Achieving equitable vaccine access involves not only logistical and infrastructural considerations, but also coordination and collaboration across several sectors, enhancing gender diversity and inclusivity in planning, coordination, and decision making and implementation of strategies tailored to the needs of a wide range of vulnerable population groups.