Background Individuals with traumatic spinal cord injuries (TSCI) can encounter different experiences when accessing care, especially between individuals receiving care from the Veterans Affair (VA) health care insurance and commercial insurance. Objectives The purpose of this study was to explore the barriers and facilitators in access to care among individuals with TSCI receiving care from the VA and commercial insurance. Design We used a qualitative descriptive study and interviewed 31 participants ( n = 13, receiving care through the VA; n = 18, commercially insured). Methods Participants and their caregivers participated in a semi-structured interview. To analyze the data, we used thematic text analysis to identify overarching themes. Results We identified four themes: (a) challenges identifying appropriate and adequate specialized care, (b) financial assistance is limited when accessing care, (c) lack of proximity to care leads to social and contextual barriers, and (d) enhancing care through close social support systems. The first three themes were barriers to care while the latter theme was identified as a facilitator. Most participants from the VA noted challenges finding an adequate formal caregiver, whereas individuals receiving care from commercial insurance reported primarily receiving help from informal caregivers. Financial impediments were discussed between both groups, but those receiving care through commercial insurance noted the most challenges. Finally, individuals receiving care from the VA had support from the VA regarding adaptations to their home environment, whereas civilians often asked informal caregivers (e.g., family, friends, community) for help. Conclusions The findings from this study illuminate the need for specialized care centers, caregivers, and additional supports for individuals with TSCI.
Background The management of autism and other comorbidities among children and young adults places a substantial economic and logistical burden on families. Telemedicine offers potential benefits for children and young adults with autism by improving access to care, reducing costs, and supporting families in managing ongoing treatment needs, all highlighted during the COVID-19 pandemic. While telemedicine has shown positive benefits in neurotypical pediatric populations, limited evidence supports and describes the use of telemedicine for children with autism. Objective This study examined children and young adults with autism and assessed the association between telemedicine services and annual combined out-of-pocket (OOP) medical costs among children and young adults with autism. Design Cross-sectional data from the U.S. nationally representative Medical Expenditure Panel Survey (MEPS) were analyzed. Independent variables included demographics, medical conditions, utilization patterns, and healthcare expenditures. A weighted log-linear regression model estimated combined medical OOP costs, and a binary weighted logistic regression examined factors associated with telemedicine use. Data The study cohort included 189 children and young adults with autism aged 1–21 years from 2020 to 2023. Results Among them, 62 (32.8%) used telemedicine. By 2023, telemedicine utilization among children and young adults with exceeded those who did not use telemedicine. Telemedicine utilization did not have a significant effect on OOP costs (EXP(β) = 1.30, p = 0.17). Insurance type showed a strong effect, with individuals without Medicaid having much higher odds of incurring OOP costs than those with Medicaid (EXP(β) = 15.91, p < 0.001). Black or African American children had significantly lower odds of telemedicine use compared to non-Hispanic White children (Exp(β) = 0.17, p < 0.05). Conclusion Telemedicine use was not significantly associated with combined OOP medical costs among children and young adults with autism. However, differences were observed in telemedicine use and OOP costs.
Background Clinal Quality Registries (CQRs) often collect patient reported measures (PRMs) for the purpose of reporting these data to clinicians. By incorporating PRM data, CQRs and participating healthcare providers can gain a more comprehensive understanding of patient experiences and outcomes to inform both individual care and broader health service improvements. However, many CQRs do not routinely provide patient access to PRM data or report these data back to patients. Objectives To understand how PRMs captured in CQRs should be reported to patients, and to develop a guide for reporting registry-collected PRMs to this population. Methods First, a targeted literature review was undertaken, involving a structured search of the scientific literature to identify evidence on patient preferences regarding the reporting of PRMs. Data were extracted and managed using Microsoft Excel. Second, focus group discussions were conducted with 15 registry consumers to explore their PRM information needs, and preferences for how registry-collected PRM data should be reported. Results The literature review identified 23 studies and found that many patients preferred to receive their own PRM data. Access to these data helped them better understand their health, support discussions with clinicians, and feel more empowered in their care. Graphical displays and lay summaries were most preferred. Focus group participants also valued receiving aggregate reports and being informed about how their data were used and recommended clear terminology and accessible formats for diverse audiences. Conclusion Based on the findings from this study, we developed a guide with practical resources, examples, and guidance for CQRs on how to engage with patients in the PRMs’ reporting process. The goal of this document is to support transparency in PRMs reporting, patient engagement with CQRs, and the real-world use of this data for improving healthcare quality.
Background The “code of silence” in healthcare refers to reluctance among professionals to report misconduct or unsafe practice. Prior research in the United States identified tensions between personal ethics, professional standards, and organizational pressures in shaping speaking-up behavior. It remains unclear whether these dynamics extend across institutional and cultural contexts. Purpose This study examines whether patterns of awareness and response to inappropriate practice previously identified in a U.S. sample replicate in Romania, and how institutional context may shape interpretations of responsibility and reporting behavior. Design and Method Using a structured replication design, we administered the same core survey instrument used in the prior U.S. study to all licensed clinical staff at a large Romanian public hospital (N=458 invited; 201 complete responses). Comparative analysis examined descriptive patterns of indirect and direct awareness, actions taken, reasons for inaction, and perceived outcomes. Results Reluctance to act following awareness of inappropriate practice was observed in both contexts, suggesting cross-system robustness of silence-related dynamics and raises the possibility of important differences. Exploratory evidence suggests that U.S. respondents appear to report higher awareness levels and greater reliance on formal supervisory reporting channels, whereas Romanian respondents seem to more frequently report direct interpersonal intervention and greater uncertainty about outcomes. Differences appear consistent with variation in regulatory structures, reporting mandates, and hierarchical norms. Conclusion The code of silence appears across healthcare systems but may operate through context-specific mechanisms. In more formalized regulatory environments, responsibility may be more often enacted through institutional escalation, whereas in other settings it may be framed as interpersonal correction. The findings also suggest that effective interventions must distinguish between episodic and recurring problems, as well as between clinical error and inappropriate conduct. To clarify these distinctions, we propose a Deming-inspired governance framework indicating that different types of problems require different institutional responses, ranging from learning-oriented process improvement to formal accountability mechanisms.
This study investigated the spatiotemporal variability of fine particulate matter (PM 2.5 ) in Addis Ababa, Ethiopia and assessed its associated health risks and economic burden using data from January 2022 to December 2023. Hourly PM 2.5 concentrations were collected through a hybrid monitoring network comprising seven low-cost sensors and two Beta Attenuation Monitors (BAM). Spatiotemporal analysis was performed using Python, and health risks were assessed by estimating the Hazard Quotient (HQ) and Excess Lifetime Cancer Risk (ELCR). The economic burden attributable to PM 2.5 exposure was assessed by monetizing disease-specific Disability-Adjusted Life Years (DALYs) using a locally adapted Value of Statistical Life (VSL) approach. Over the two-year periods, mean PM 2.5 concentrations ranged from 15 to 33 μg/m 3 across monitoring sites, with an overall a citywide average of 27 μg/m 3 , exceeding the World Health Organization (WHO) Air Quality Guideline (AQG) of 5 μg/m 3 by more than fivefold. Seasonal analysis revealed elevated PM 2.5 concentrations during the wet season (Kiremt), while diurnal patterns showed peaks of 38 µg/m 3 at 7:00 AM. The HQ values for all age groups exceeded the acceptable threshold of 1, indicating non-carcinogenic health risks. ELCR estimates calculated using a slope factor of 0.008 exceeded the risk threshold (1 ×10 -4) , whereas estimates based on the slope factor of 0.0012 remained within the acceptable limits, highlighting the sensitivity of cancer risk estimates to the toxicity parameter applied. The economic burden attributable to PM 2.5 exposure was estimated at USD 652.95 million over the two-year study period, contributing an external cost share to national GDP of 0.25% in 2022 and 0.25% in 2023. Cardiovascular diseases, particularly ischemic heart disease (IHD), accounted for the largest share of economic losses, significantly exceeding acute respiratory infections and PM 2.5 related cancers. These findings provide evidence to support targeted policies aimed at reducing PM 2.5 related cancers combined.
Background Maryland implemented an all-payer hospital global budget revenue (GBR) model in 2014 to decouple hospital revenue from volume and improve revenue predictability. This study evaluated whether Maryland’s 2014 GBR implementation was associated with differential changes in hospital total margins, inpatient revenue per discharge, and COVID-period margin volatility relative to Massachusetts. Methods A matched hospital-year panel for Maryland and Massachusetts spanning 2010–2023 (2,261 matched observations) was constructed by merging Medicare cost report-based financial measures with provider characteristics using CMS certification identifiers. Two-way fixed-effects difference-in-differences models with hospital and year fixed effects and hospital-clustered standard errors estimated post-2014 changes in outcomes in Maryland relative to Massachusetts. Identification was assessed using an event-study specification and a placebo test (fake treatment in 2012, restricted to the pre-period). Financial stability under pandemic shock was evaluated using a COVID-period differential effect on margin volatility, defined as the absolute year-over-year change in total margin. An additional restricted sensitivity analysis for 2010–2019 adjusted for available case-mix and payer-mix covariates. Results GBR implementation was not associated with a statistically detectable change in total margins (β = 0.021, p = 0.232). In contrast, GBR was associated with higher log inpatient revenue per discharge in Maryland relative to Massachusetts after 2014 (β = 0.287, p = 0.003), consistent with an approximate 33% increase in revenue per discharge (exp[0.287]−1). However, in the restricted 2010–2019 sensitivity analysis adjusting for available case-mix and payer-mix covariates, this association was attenuated and no longer statistically significant (β = 0.030, p = 0.513). Margin volatility during COVID-19 did not differ significantly between states (β = −0.018, p = 0.161). The placebo test showed no spurious effect in the pre-period (β = −0.008, p = 0.801), supporting the validity of the design. Conclusions Maryland’s all-payer global budgets were associated with higher revenue per discharge in the primary model, but with no detectable change in total margins or in differential margin volatility during COVID-19. The revenue-per-discharge finding was sensitive to adjustment for available case-mix and payer-mix covariates in a restricted sensitivity analysis, supporting a cautious interpretation. These findings are consistent with GBR altering revenue intensity without clear evidence of improved profitability or shock-absorbing effects over 2010–2023.
Background Best-practice recommendations for stroke care are available worldwide, yet there are challenges implementing these guidelines, contributing to gaps in stroke care. Clinicians delivering stroke services can inform improvements in stroke care delivery and outcomes. Objectives We aimed to conduct an in-depth examination of clinicians’ perspectives on current gaps in stroke care throughout the entire care continuum, with a specific focus on the context of Ontario, Canada. Design This is a qualitative interpretive descriptive study. Methods Semi-structured interviews and focus groups were conducted with licensed clinicians who had experience providing stroke care in hospital or community settings in Ontario. The interviews were audio-recorded and transcribed verbatim. Analysis followed Thorne’s interpretive description analysis techniques. Results Fourteen clinicians from five organizations participated in this study. Clinicians were occupational therapists (n=4), speech-language pathologists (n=5), physiotherapists (n=2), nurses (n=2), and a stroke coordinator (n=1). Clinicians identified the following four overarching gaps in patient- and family-centred stroke care: delays in recognition and response to stroke symptoms (theme 1), challenges in delivering and retaining stroke education (theme 2), variation in stroke care resources, quality, and rehabilitation access (theme 3), and gaps in continuity of care across the stroke care continuum (theme 4). Conclusion The findings from this study offer critical insights into current gaps in stroke care. Addressing these patient- and family-centred gaps may improve the quality of stroke care and outcomes for patients and families.
Background Older adults with mental health (MH) challenges often face significant barriers when navigating complex healthcare systems, especially during critical transitions, such as hospital discharge. These challenges are compounded by comorbid physical illnesses, cognitive impairments, and social determinants of health. Objectives This qualitative study aimed to gain insights from patients and providers on factors influencing the implementation of an innovative occupational therapy (OT) led Patient Navigation Program (PNP) supporting older adults with complex MH care needs. Methods We conducted a qualitative study that was informed by the Consolidated Framework for Implementation Research. Data were collected through semi-structured interviews and focus groups. Results Seven patients and caregivers, and 17 healthcare professionals who served as the MH PNP or collaborated with the MH PNP participated in the study. MH Navigators offered valuable, specialized skills to address gaps in MH and functional outcomes among older adults and were highly effective at bridging hospital and community care. However, the success of such a role depends on alignment across organizations, sufficient professional support, clear role expectations, and integrated team structures. Significant barriers for implementation included organizational cultural differences, system constraints, and the high complexity of patient needs. Conclusion The OT-led MH PNP holds significant promise for optimizing care delivery for older adults with MH care needs by bridging gaps in the healthcare system and fostering better continuity of care. Insights from this study can refine navigation processes, enhance interprofessional collaboration, improve patient experiences, and provide valuable guidance for implementing MH navigation programs at other sites.
Background Patient navigation (PN) exemplifies a complex health intervention, involving multiple interacting components yet tailored to individual patient contexts and needs. Identifying functions and processes of complex interventions like PN enables a better understanding of how they are meant to work, moving beyond descriptions of program components such as tasks and services. With broad variation across programs, the navigator role can look quite different depending on context. Objective To explore the functions of PN from the perspective of patient navigators in Alberta, Canada. Design Qualitative descriptive approach. Methods Semi-structured interviews were conducted with patient navigators working in a range of patient-facing program types and settings across Alberta. Interviews were recorded and transcribed, then coded using NVivo 12 TM software. A thematic content analysis approach guided data analysis. Results We interviewed 29 navigators from a range of PN programs including cancer care, primary care networks, community agencies, and youth to adult transition. Nursing was the most common educational background of participants (n=12), followed by social work (n=9). Themes generated through thematic analysis highlighted three core functions of PN that collectively define its role as a complex, adaptive intervention: 1) creating a safety net for patients (theme 1), by addressing health and psychosocial needs (theme 1a) or by reducing barriers to care (theme 1b), 2) using advocacy and skill-building to enable patients to become more active participants in managing their health (theme 2), and 3) building relationships to strengthen patient trust and engagement (theme 3). Conclusions PN is a complex, multi-functional intervention that enhances patient care through relational, practical, and systemic support. Defining and understanding these key functions provides clarity and is critical for effective implementation and integration of PN into health systems and to inform future implementation and evaluation of PN programs in Canada.
Background Hepatitis B virus (HBV) poses a significant occupational risk to healthcare workers (HCWs), particularly midwives in highly endemic settings such as Ghana, where frequent exposure to blood and bodily fluids during clinical practice increases their risk of occupational exposure and infection. Despite the availability of HBV vaccination and Post-Exposure Prophylaxis (PEP), uptake remains suboptimal due to multiple barriers. This study explores individual and organizational-level barriers to HBV PEP in northern Ghana. Method A qualitative exploratory study was conducted in the Kassena-Nankana West District of Ghana, involving 20 midwives recruited purposively from three healthcare facilities. Semi-structured interviews were conducted, and thematic analysis was used to identify key patterns in line with the socioecological model. Results Two major overarching themes emerged across the individual and organizational socioecological levels. At the individual level, participants demonstrated inadequate knowledge of post-exposure prophylaxis (PEP) for HBV, including inadequate knowledge of the concept of PEP and HBV-specific protocols and guidelines. At the organizational level, health facility barriers included unstructured exposure reporting and PEP management pathways, absence of facility-level HBV-specific protocols and guidelines, and inadequate training on PEP for HBV were the factors identified as affecting PEP uptake. Conclusion Despite the availability of a national occupational health and safety policy recommending structured HBV PEP, protocol implementation at the facility level was weak, leaving midwives unprotected. The study underscores the urgent need for improved HBV education, structured exposure management pathways, and strengthened facility-level policies to enhance HBV PEP uptake. Addressing these gaps is crucial to reducing the risk of occupational HBV infection and ensuring midwives' safety in highly endemic settings.
Introduction Burnout among healthcare workers threatens workforce well-being and quality of care. Evidence from Ghana remains limited, particularly regarding demographic and professional differences in tertiary hospitals. This study aimed to examine burnout prevalence and its association with key demographic characteristics, including age, gender, marital status, and professional category among healthcare workers in a tertiary facility in Ghana. Methods A cross-sectional retrospective study analyzed secondary data from a routine clinical audit of 333 healthcare workers (86 doctors, 233 nurses, and 14 health assistants) at Cape Coast Teaching Hospital. Burnout was measured using the validated Burnout Assessment Tool with sound psychometric properties. Associations between burnout and age, gender, marital status, and profession were examined using descriptive statistics and multivariable logistic regression. Statistical significance was set at p≤ 0.05. Results Among the 333 healthcare workers studied, the overall burnout prevalence was 62.4% (n = 208). Women and men had comparable overall burnout prevalence (62.9% versus 61.7%), although women reported higher psychosomatic symptoms. Burnout prevalence declined with increasing age, from 64.4% among those aged 20–29 years to 56.5% among those aged 50–59 years. Single healthcare workers experienced slightly higher burnout prevalence than married workers (64.7% versus 59.6%). Bivariate analysis identified profession as the only demographic factor significantly associated with burnout (χ 2 = 6.24, p = 0.044). In multivariable logistic regression analysis, nurses and health assistants had significantly lower odds of burnout compared to doctors (adjusted odds ratio [aOR] = 0.47, 95% CI: 0.26–0.83; p = 0.009). Conclusion Burnout at Cape Coast Teaching Hospital is both substantial and varies by profession, underscoring the need for differentiated responses. Nurses and health assistants had lower odds of experiencing burnout compared to doctors. These findings highlight the need for targeted interventions, including workload adjustments, structured mental health support, and organizational wellness programs.
Introduction Reproductive health awareness is a fundamental component of public health, gender equity, and human rights. This narrative review aimed to systematically describe and synthesise evidence on reproductive health awareness among tribal women and adolescent girls in India and internationally, examine major reproductive health schemes implemented in India, and identify strategies to strengthen awareness and service utilisation. Material and Methods A structured narrative review was conducted in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) guidelines. Literature published between January 2005 and January 2026 was identified through PubMed, Scopus, Web of Science, and Google Scholar. Peer-reviewed articles, review papers, policy documents, and relevant grey literature published in English were eligible for inclusion. Studies focusing on reproductive health awareness among tribal or Indigenous women and/or adolescent girls were screened and synthesised thematically. A total of 36 evidence sources were included in the review. Results A total of 36 studies were included. International and Indian evidence consistently demonstrates lower reproductive health awareness among tribal populations. Awareness of at least one modern contraceptive method among tribal women ranged from approximately 55-90% across studies, while utilisation remained substantially lower (20-60%), highlighting a persistent awareness-utilisation gap. Partial knowledge, menstrual stigma, gendered decision-making, and reliance on traditional practices were common across contexts. Although awareness of government schemes such as JSY, JSSK, and PMMVY was moderate to high, utilisation remained variable, revealing a persistent awareness-utilisation gap. Conclusion Reproductive health awareness among tribal women and adolescent girls is shaped by complex socio-cultural and structural determinants. Strengthening culturally responsive health communication, adolescent-friendly services, community engagement, and frontline health worker capacity is essential to improve awareness and equitable utilisation of reproductive health services and schemes. The findings provide policy-relevant evidence to guide tribal health programmes and support progress toward reproductive health equity.
Background Vietnam has made substantial progress in maternal health, achieving high coverage of antenatal care (ANC) under the Millennium Development Goals. However, focusing solely on the number of ANC contacts may obscure whether women receive the essential services recommended during pregnancy. This study examined trends in ANC contacts and service content across sociodemographic groups and assessed whether inequalities changed over time. Methods We analyzed nationally representative Multiple Indicator Cluster Survey (MICS) data from 2011, 2014, and 2021 for women aged 15-49 years who had a live birth in the two years preceding the survey (N = 4,413). Outcomes included ANC coverage (≥4 and ≥8 contacts), ANC provided by skilled health personnel, ANC provided by medical doctors, receipt of four core ANC services (tetanus immunization, blood pressure measurement, blood test, and urine test), and a Complete ANC Coverage Index reflecting both service contacts and essential ANC content. Survey-weighted logistic regression models examined temporal trends and differences by wealth, residence, region, and ethnicity. Results From 2011 to 2021, all ANC indicators improved significantly (all p < 0.001). Coverage of ANC provided by skilled health personnel increased from 93.3% to 97.0%, while ANC provided by medical doctors increased from 80.6% to 95.0%. The proportion of women receiving all four core ANC services increased from 39.9% to 63.2%, and the Complete ANC Coverage Index more than doubled from 15.2% to 39.2%. Improvements were observed across all sociodemographic groups; however, substantial inequalities persisted. For the Complete ANC Coverage Index, temporal trends differed significantly across regions and places of residence ( p < 0.05). Still, they were similar across wealth quintiles and ethnic groups ( p > 0.05), despite persistent differences in absolute coverage. Conclusion Vietnam has achieved substantial improvements in both ANC contacts and service content, yet important inequalities remain. Monitoring both service contacts and essential ANC content, using complementary measures such as the Complete ANC Coverage Index, provides a more comprehensive assessment of effective ANC coverage and may better inform policies to promote equitable maternal healthcare.
Background Despite its life-saving potential, cesarean delivery (CD) remains a major concern due to its increased risk of intra/post-operative complications. This study therefore evaluated adverse maternal outcomes following cesarean section (CS) and identified correlated factors among women who delivered at Yirgalem General Hospital. Methods A retrospective cross-sectional study was conducted from March 4 to 25, 2024, involving 372 mothers. Data were collected using a structured checklist through a review of medical records of women who gave birth by CS between February 6, 2022 and January 5, 2024. The data were entered into EpiData 3.1, and then exported to SPSS version 21 for analysis. Association between outcome variable and its predictors was examined using bivariable and multivariable logistic regression analysis. Statistical significance was defined as a p-value ≤0.05, with adjusted odds ratios (AORs) and 95% confidence intervals reported. Results The overall prevalence of maternal adverse outcome following CS was 27.7% (95% CI: 23.3%, 32.4%). Significant factors of adverse outcome encompassed rural residence (AOR = 2.05, 95% CI: 1.09 - 3.86), lack of antenatal care follow-up (AOR = 2.26, 95% CI: 1.22 - 4.21), and a history of pre-existing medical illness (AOR = 2.31, 95% CI: 1.26 - 4.23). Conclusion The occurrence of maternal adverse outcome following CS in the study setting was notably high. Rural residence, lack of ANC, and pre-existing medical conditions were significant determinants. Strengthening healthcare access in rural areas, improving antenatal care coverage, and ensuring early diagnosis and management of medical conditions are essential to reducing complications associated with cesarean delivery.
Background Communication breakdowns in perioperative settings are a major contributor to elevated stress, heightened anxiety, and emotional vulnerability among patient caregivers, thus highlighting the need for reliable communication practices. This qualitative study investigated communication practices through the perceptions and experiences of patient caregivers and healthcare providers across the perioperative stages, exploring the benefits and challenges of both verbal and digital communication methods. Methodology A qualitative research design was adopted, involving semi-structured in-depth interviews with 23 purposively selected participants from a tertiary hospital in Coastal Karnataka. The interview guides were pilot tested and validated to ensure accuracy and comprehensiveness. The interviews were audio-recorded, transcribed, and analyzed using ATLAS. ti 8 software for thematic analysis. A two-cycle coding process was employed to analyze the data from the participants’ perspectives, resulting in eleven different codes that were further organized into six emerging themes. Results The study revealed existing communication practices in surgical settings, with verbal communication practices characterized by direct updates and mic announcements emerging as more prominent. However, limited intraoperative updates intensified patient caregiver anxiety and uncertainty. The participants perceived the benefits of digital adoption of communication tools to bridge the communication gaps in surgical settings, although concerns remained about digital literacy, data privacy, and over-reliance on technology. Conclusions The successful implementation of digital communication practices depends on overcoming structural, socio-ethical, and technological limitations. Alternatively, a tailored communication approach that reflects stakeholder needs in peri-operative contexts would be more effective in sustainable communication delivery.
Background:Health information systems are a cornerstone for assessing health system performance, particularly for leading conditions contributing to disease burden, such as hypertension, making effective monitoring indispensable. In October 2023, Mexico initiated the federalisation of public health services for the population without social security, creating an integrated national public health care provider and increasing the need for system-level monitoring tools capable of supporting longitudinal assessment across heterogeneous settings. Objective:To describe the development and early application of an integrative monitoring platform using routinely collected clinical data to support system-level oversight of hypertension care within Mexico's federalised public health care provider. Design:Descriptive health services research study based on secondary analysis of routinely collected clinical data. Methods:An integrative monitoring platform was developed to organise data into a structured indicator framework covering four domains: care engagement and continuity; clinical care processes; intermediate clinical outcomes; and case-mix and clinical complexity. The platform enables longitudinal and subnational analyses across selected indicators presented as illustrative use cases. Institutional reach was assessed using an overall monitoring period from January 2024 to September 2025, while clinical process and intermediate outcome indicators, including blood pressure control, were calculated within a predefined active six-month monitoring cohort using the September 2025 reporting date. Results:From January 2024 to September 2025, a total of 486,044 individuals received hypertension-related care within primary care services across participating states. The active six-month cohort included 322,661 individuals, with 67.2% (95% CI, 67.04-67.37) achieving blood pressure control (<140/90 mmHg), and 36.8% (95% CI, 36.62-36.96) achieving strict control (<130/80 mmHg). For those with sub-optimal control, 63% had timely clinical follow-up and 48% underwent treatment intensification. A high proportion of individuals presented high risk features including obesity (36.4%; 95%CI, 36.2-36.5), diabetes (48.7%; 95%CI, 48.5-48.8) or high cardiovascular risk characteristics (81.7%, 95%IC, 81.5-81.8). Conclusion:Transforming routinely collected clinical data into an integrative monitoring platform is feasible within a newly federalised public health care provider. Routine monitoring of relevant indicators across multiple dimensions of care provides a structured basis for system-level oversight, longitudinal assessment, data-informed decision-making, and continuous learning within large public service delivery systems.
Background In a context of rapid population ageing, most countries face major challenges to prepare their long-term care systems to meet rising demands. It is vital that research examines how systems can adapt to these demographic changes. International comparisons between long-term care systems can support the identification of shared lessons on the advantages and disadvantages of different systems and associated outcomes. Objective To analyse and compare the long-term care systems in Norway and in England and identify lessons from this comparison. Method Using Donabedian’s structure-process-outcome framework, this comparative overview analysed the commonalities and differences between the two systems. Data were identified from Government websites, relevant publications, and websites from key national sector organisations from the time period in which the study was conducted (2021-2025). Results The Norwegian and English systems exhibit more similarities than differences. The most notable differences emerged in the structure component, particularly in terms of funding mechanisms and the degree of care integration. Differences were also evident in the outcome component, where national outcome measures are less systematically embedded in the Norwegian system. In contrast, the process component revealed that both countries have implemented similar initiatives to address shared challenges within their services. Conclusion We argue that to build a system fit for the future, we need to confront elements currently unaddressed and to understand the interdependence within the triad of care (care recipient-informal carer-workforce), as well as its gendered nature.
Artificial intelligence (AI) and machine learning (ML) are rapidly transforming the healthcare landscape, enhancing diagnostic accuracy, personalising treatments, and improving operational efficiency. However, alongside these advancements comes a critical concern: the potential for AI models to perpetuate, or even exacerbate, health inequities. This paper examines the complex potential of AI in health, and how it can both improve and undermine equity. The key to addressing these challenges lies not only in developing advanced algorithms but in fostering responsible and inclusive development. We argue that to operationalise inclusion in AI systems, research co-design should be prioritised in order to integrate the perspectives of diverse knowledge users, including patients, clinicians, and community partners, shown through worked examples in TRIPOD+AI and PROBAST+AI. This approach encourages future work to rethink the role of knowledge users in the development of AI for healthcare.
Background Community-based health insurance (CBHI) is essential for improving access to affordable healthcare and protecting vulnerable populations from catastrophic health expenditures in developing countries such as Ethiopia. Ensuring continued membership in CBHI is critical to maintaining these benefits and sustaining the financial viability of the scheme. Therefore, this study examined factors associated with women’s intention to continue membership in CBHI in Sidama National Regional State, Ethiopia, in 2024. Methods A community-based cross-sectional study was conducted among 640 women enrolled in CBHI. A pretested structured questionnaire was utilized to conduct face-to-face interviews using the Open Data Kit (ODK) mobile devices. Multilevel logistic regression analysis was employed to assess both individual and community-level factors of women’s intention to maintain membership. The 95% confidence intervals (CIs) and p-values less than 0.05 were used to determine the association between the dependent and independent variables. Results The analysis showed that women living in high-literacy communities had 3.27 times higher odds of intention to continue CBHI membership compared to those in low-literacy areas (AOR = 3.27, 95% CI: 1.02–10.51). Likewise, women perceiving CBHI as improving the quality of care were 4.22 times more likely to intend to continue membership (AOR = 4.22, 95% CI: 2.45–7.28). Additionally, perception of the premium as fair (AOR = 2.20, 95% CI: 1.10–4.43) and transparency in CBHI decisions (AOR = 1.87, 95% CI: 1.06–3.28) were positively associated with the odds of intention to remain in CBHI membership. Furthermore, each additional health facility visit was associated with increased odds of intention by 28% (AOR = 1.28, 95% CI: 1.03–1.59), and higher healthcare satisfaction was also associated with increased intention to continue CBHI membership (AOR = 1.17, 95% CI: 1.02–1.34). Conclusion Both community-level literacy and individual-level factors, particularly perceptions of quality of care, fairness of premiums, transparency, frequency of health facility visits, and satisfaction, were associated with women’s odds of intending to remain in CBHI membership. Policy efforts that strengthen service quality, promote transparent governance, and enhance community literacy may support sustained CBHI membership and contribute to more resilient health financing systems in Sidama, Ethiopia.
Background This article examines the demographic ageing of physicians and nurses in Czechia between 2012 and 2022, a critical issue amid widespread healthcare professional shortages across Europe. The study applies standard and alternative indicators of demographic ageing to working life tables to identify trends and intensity in the ageing structure of the Czech healthcare workforce. Methods Aimed at analysing the intensity of the ageing and attrition of healthcare professionals in the system, single-decrement working life tables were constructed employing individual anonymised data obtained from the largest Czech health insurance company, which has concluded contracts with practically all the country’s healthcare providers. Standard and alternative indicators of demographic ageing were subsequently applied to the working life tables in an adapted form (e.g. the constant prospective age, ageing index, etc.). Results In addition to the most important finding that the healthcare workforce in Czechia is ageing, the results highlight that nearly one-third of female physicians in outpatient care (OC) had only 10 years of working life remaining in the period 2020–2022. A similar situation was observed concerning nurses across all three monitored intervals within the studied period. Overall, the healthcare system has failed to respond to the ageing of large older cohorts either by extending their professional careers or, more importantly, through generational renewal. Conclusions Alternative aging indicators reveal that the demographic aging of the Czech health workforce is highly heterogeneous, with nurses posing a more critical threat than physicians due to their lower participation in the workforce after reaching retirement age. Standard workforce planning methods fail to capture these shifting retirement thresholds and dynamics between inpatient and outpatient care. To prevent personnel shortfalls, healthcare policymakers must transition from generic recruitment strategies to creating age-friendly working environments that prolong the professional careers of aging healthcare staff.
