Frontiers in health services最新文献

Introduction: Over half of the children and youth with mental illness do not receive appropriate or adequate treatment in both Canada and the United States. The burden of mental illness and substance use is the leading cause of disability due to years lost to disability, leading to the youth mental health crisis. Despite ongoing efforts to improve mental health and substance use services, many youth disengage prematurely, with evidence that this leads to poorer outcomes. In this paper, we explore the question: how to use youth-friendly methods in research for service improvement.

Methods: We used innovative and participatory action mixed methods. Youth between the ages of 12 and 25, with lived experience accessing mental health and addiction services, were recruited for focus groups. The focus groups were stratified based on their level of service needs, and data were analyzed using thematic analysis. The themes were interpreted into a fictional narrative summarized in an animated video. This video was embedded in a survey that was sent to the participants. The purpose was to validate the analysis and explore the factors that led them to participate. A descriptive analysis of the quantitative data and an inductive content analysis of the qualitative data were completed for the survey.

Results: A total of 44 youth completed the screening to stratify the level of need. Fourteen youth participated in three pilot focus groups, and another 24 participated in four focus groups stratified by need. The mean age was 22.3 years, and 78% and 22% identified as male and female, respectively. Youth-friendly research was the main theme, with two main sub-themes: youth want to participate in research, and there were strategies for research approaches involving youth service users. Fundamentally, choice throughout the process was important.

Conclusion: Youth service users want to be engaged meaningfully. Youth are not afraid to speak their truth and want opportunities to provide their unique perspectives. Service improvements from youth service-user feedback may lead to improved outcomes with full treatment because youth remain engaged with services. Service improvement may need youth-friendly research.

Community Health Workers (CHWs) are central to extending primary health care in low-resource settings, yet their compensation remains a policy challenge. This paper reports findings from a five-arm quasi-experimental study conducted by Living Goods Uganda to test how different mixes of fixed stipends and performance-based incentives (PBIs) affect CHW performance, motivation, and retention. Over a nine-month period, 1,104 CHWs were assigned to five compensation models-70:30, 50:50, 30:70 PBI-to-stipend ratios, a 100% stipend arm, and a control-implemented across five districts. Quantitative data were analyzed using a difference-in-differences model with cluster-robust standard errors and wild-bootstrap inference, complemented by qualitative interviews and focus groups exploring experiences and perceptions. Results showed that moderate performance-based incentives (30%-50%) achieved the most balanced outcomes: improved household coverage, immunization follow-up, and referrals, alongside higher motivation and satisfaction. The 70% PBI arm generated stronger performance gains but increased stress and reduced retention, while the stipend-only arm offered stability but lower service coverage. Overall retention exceeded 95%, though sustained motivation depended heavily on supervision quality, recognition, and fairness of pay. Findings highlight that hybrid pay structures combining predictable stipends with moderate PBIs can enhance CHW productivity while safeguarding motivation and sustainability. The study offers practical guidance for Uganda's National Community Health Strategy and similar programs seeking equitable, gender-sensitive, and financially feasible CHW compensation models.

Background: Adverse event reporting for medical devices is essential for post-market surveillance and public health, preventing harm like patient injury, misdiagnosis, or death and is shaped by regulation that defines policies, enforcement, and responsibilities. Various factors-poor maintenance, manufacturing defects, user error, or clinical issues-can cause adverse events, complicating root cause identification, sometimes leading to ambiguous accountability and hindering prevention.

Objective: To examine perceptions, behaviors, and challenges in incident reporting among key stakeholders in the public and private sector in Israel, as a case study for a country where a Medical Devices Law is not yet effective.

Methods: A qualitative thematic analysis was conducted based on 31 in-depth interviews with stakeholders from the Ministry of Health, healthcare institutions (e.g., physicians, nurses, management), and medical device companies (e.g., CEOs, regulatory affairs managers). Interviews were transcribed and coded using inductive thematic analysis.

Results: Four key themes emerged. First, the complexity of causality in device-related events often shifted responsibility between device manufacturer and user, complicating root cause identification and accountability. Second, communication among stakeholders was often described as complex and unclear, sometimes influenced by conflicting interests. Third, reporting behavior was shaped by organizational culture, particularly management's attitude, which could foster or suppress engagement. Nurses were generally more active reporters than physicians. Fourth, a lack of feedback was a recurring concern, reducing motivation to report.

Conclusion: Barriers to reporting include regulatory gaps, unclear procedures, communication challenges, and legal concerns. Still, many participants described positive inter-organizational collaboration. Stronger regulation and feedback mechanisms, clearer role definitions, particularly between physicians and nursing staff, and supportive managerial attitudes may foster a more responsive reporting culture. By incorporating diverse stakeholder perspectives, this study highlights lessons of broader relevance for improving medical device vigilance and patient safety worldwide.

Background: Smoking cessation at or around the time of lung cancer diagnosis is associated with improved treatment outcomes, enhanced quality of life and increased survival. However, many patients continue smoking post-diagnosis.

Aim: This study evaluated the effectiveness of a national initiative in Denmark that integrated smoking cessation support into the diagnostic workup for lung cancer within a pragmatic, multicenter, cluster-randomised controlled trial.

Methods: Nine Danish hospitals were cluster-randomised to either the intervention group (integrated cessation support) or the control group (usual care). The intervention was implemented in five hospitals. Eighty-six patients (intervention = 39; control = 47) who were active smokers at referral completed questionnaires assessing smoking cessation initiation, motivation, quality of life and psychosocial consequences of diagnostic workup at baseline and 6-weeks follow-up. Logistic and multiple regression analyses were conducted. Additionally, 140 healthcare professionals completed a survey on cessation support practices pre-intervention, and 54 completed it post-intervention. Descriptive analyses were used to assess changes in clinical practice.

Results: There were no statistically significant differences in smoking cessation initiation between the intervention and control groups (OR = 0.81 [0.41, 1.58], p = 0.53; adjusted OR = 0.79 [0.35, 1.79], p = 0.57). Among healthcare professionals in the intervention group, a larger proportion reported they "almost always" provided cessation after the implementation (35.1%) than before (18.3%). But the proportion who responded that they "almost never" provide support was also considerably larger after the implementation (13.5%) than before (3.2%). In the control group, proportions tended to shift more generally towards providing more support over time, and a considerably larger proportion reported to refer patients to external smoking cessation support at the follow-up measurement.

Conclusion: The study was inconclusive, showing no significant effect of smoking cessation support during lung cancer diagnostic workup on patients' cessation initiation, possibly influenced by selection bias and varying intervention fidelity at study sites.

Real-World Evidence (RWE) is a critical enabler of personalized medicine (PM), offering granular insights into how interventions perform across diverse, real-life populations. This manuscript, grounded in over 30 years of health data science and regulatory experience, explores the evolving role of RWE in transforming healthcare delivery-from regulatory frameworks and policy alignment to artificial intelligence (AI)-enabled patient stratification. Through real-world case examples in oncology, ophthalmology, and dermatology, the article illustrates how digital tools and data integration can enhance patient-centred care. Each vignette concludes with an "adoption path" outlining data requirements, minimal IT changes, training, and payer-relevant endpoints. The discussion critically examines risks-such as bias, opacity in algorithms, and lack of harmonization-and translates them into a pre-deployment audit checklist and an equity checklist for subgroup performance and representativeness audits. To guide global regulatory practice, a "regulatory pragmatics" checklist is proposed, covering data quality, traceability, validation, transparency, and patient voice, including patient-generated health data (PGHD). Building on the Healthcare 5.0 vision, the manuscript aligns RWE with human-centric, sustainable, and resilient pillars, highlighting IoT wearables, environmental sensors, and continuous lifestyle data streams. Policy and implementation recommendations, together with a global convergence roadmap, position RWE as a strategic tool for regulators, payers, and clinicians. The paper concludes with a call for systemic accountability: industry must innovate responsibly, regulators must approve with foresight, payers must assess tools beyond medications, and health systems must bridge infrastructure gaps. Over the next 12-24 months, measurable commitments are required across all stakeholders to ensure that PM becomes everyday care. PM must serve patients-not just science, policy, or business-and that demands leadership grounded in scientific integrity and human empathy.

Supplier-induced demand occurs when the supplier or physician, acting on behalf of the consumer or patient, generates a level of demand that surpasses what the consumer would have chosen if fully informed. Supplier-induced demand indicates the level of demand that exists beyond what would be seen in a market where consumers have complete information. In other words, the agency relationship between a patient and a physician stems from the patient's limited understanding of health, diagnosis, and treatment, which creates information asymmetry, requiring dependence on the physician's guidance. A perfect agent would suggest therapies that match the patient's needs and preferences, taking into account aspects like health issues and financial situations. Although health economics plays a critical role in understanding supplier-induced demand, this research seeks to illustrate the econophysics viewpoint of this occurrence. It specifically aims to clarify the mechanism by which supplier-induced demand develops, employing the principles of Newtonian physics. In this context, we propose interpreting supplier-induced demand through an econophysical perspective by integrating ideas from physics and economics to develop a novel conceptual framework. The mathematical structure of econophysics allows us to reproduce results through a single equation, indicating that specific patterns require monitoring.

Article processing charges (APCs) pose a material barrier to the dissemination of health research from low income countries where recent funding cuts compound limited domestic financing and fragile health systems. Despite carrying a disproportionate share of global disease, these settings contribute under one percent of global research publications. This Perspective piece explores how APCs and funding cuts intersect to shape research output, summarises mitigation efforts and gaps, and proposes practical options for more equitable access to scholarly publishing. APCs are reported to shape venue choice for researchers in low income countries, while reduced external funding leaves fewer upstream resources to absorb costs. Country examples point to institutional and capacity pressures. Early career researchers often face disproportionate obstacles including slower progression and reduced competitiveness. Waiver policies and regional initiatives such as AJOL, SciELO South Africa and AfricArXiv offer partial relief, yet inconsistencies in eligibility, awareness and implementation persist with ethical implications. A rights and equity oriented response would include tiered APC models, automatic waivers linked to country income classification, ring fenced support for health research in low income settings, greater investment and independent evaluation of diamond open access platforms, and focused research on the effects of funding cuts on APCs and dissemination in low income contexts.

The process of advance care planning (ACP) can educate and prepare patients and caregivers to make better in-the-moment end of life decisions. Two nationwide studies on ACP implementation in Singapore identified gaps and barriers across various ACP practice settings, contributing to low ACP up-take and completion rates. This case study describes the key steps on how stakeholders were engaged and supported development of a quality practice guideline for ACP implementation. A knowledge exchange platform was convened through a multi-level partnership to form a workgroup tasked to translate evidence and develop quality ACP practice guidelines. Key knowledge users such as ACP implementers were engaged throughout the Knowledge-to-Action (KTA) action-cycle phase completing various associated tasks, including an e-survey conducted to prioritize barriers identified from the nationwide studies and other relevant evaluations. Prioritized barriers and their mapped Theoretical Domains Framework (TDF) were linked with relevant intervention functions and their associated implementation strategies, then contextualized into potential local applications by the workgroup. The implementation strategies were grouped into broader categories that formed domains in the practice guideline. The last action phase was engagement with ACP teams across various organizations to conduct pilot studies using implementation strategies that would facilitate quality implementation of ACP. Our quality guideline development process was supported by the KTA model that is iterative in nature with action-phases operationalized through a multi-level partnership. This is a novel approach to formulate a national quality practice guideline with lessons learned that could be applied to others pursuing similar endeavors.

Introduction: Current models of gastrointestinal endoscopy provision in Queensland are heavily reliant on the use of specialist anaesthetists to deliver sedation. We evaluated the implementation of Endoscopist-Directed Nurse-Administered Propofol Sedation (EDNAPS) as a model of care for low-risk colonoscopy procedures in Queensland.

Method: Staff were recruited and trained using a combination of face-to-face sessions, self-directed learning and high-fidelity simulation. 118 colonoscopies were performed using EDNAPS and compared to 118 procedures with anaesthetist-delivered sedation (comparison group). A mixed-methods approach was used to collect data regarding the timing, safety and adenoma detection rate, as well as obtaining survey responses from patients and clinicians on the safety and effectiveness.

Results: Our study found no statistically significant difference in safety or clinical outcomes between the two groups (EDNAPS vs. comparison). However, the time spent in the Post-Anaesthesia Care Unit (PACU) post-endoscopy was significantly shorter in the EDNAPS group (p < 0.01). 48 Patient Survey responses obtained (21% response rate) were largely in favour of the safety and effectiveness of EDNAPS.

Conclusion: The findings of our study not only re-affirm the safety and effectiveness of EDNAPS, but also provide a locally endorsed implementation model which can aid in the wider adoption of this practice, statewide and nationally.

Momentum is building across mental health research and practice toward collaborative, equity-driven approaches, yet institutional cultures often remain rooted in hierarchy and individual achievement. Co-production has emerged as a framework for redistributing power, fostering reciprocity, and embedding lived experience into research and system design. However, it is typically framed as something that occurs externally with communities, while the internal research dynamics within institutions go unexamined. In this commentary, we argue that peer-led co-production is a vital but under-recognized strategy for transforming mental health systems from within. Drawing on the experience of the Network for Early Career X Trainee Researchers in Youth Mental Health (NExT) in Canada, we examine how early career researchers (ECRs) are modelling alternative ways of working through relational leadership, shared accountability, and collaborative infrastructures. We identify structural barriers that constrain this work, including siloed training pathways, narrow professional evaluation metrics, rigid role definitions, and funding mechanisms that undervalue relational practices. Building on these insights, we outline a roadmap for embedding peer-led co-production within institutions, calling for four shifts: sustained investment in relational infrastructure; training that embeds collaborative competencies; evaluation systems that reward both outcomes and processes; and leadership models that support shared governance. Peer-led networks demonstrate that these shifts are not abstract ideals but viable practices already in motion. Realizing their potential requires institutional commitment to reconfiguring funding, training, evaluation, and leadership so that co-production becomes foundational of mental health research and system change.