Background In May 2022, during the Omicron surge, Taiwan implemented a strict "triage policy for mild and severe cases", directing severe cases to hospital care and mild cases to community-based telemedicine. Unlike permissive deregulation elsewhere, the policy combined mandatory, population-scale case separation with full National Health Insurance reimbursement and a defined activation date. Objective To evaluate implementation of Taiwan's community triage policy and telemedicine adoption, focusing on procedural challenges and enabling factors. Methods We conducted a convergent mixed-methods study. Cross-sectional citizen surveys were conducted before (January-March 2022) and after (October-December 2022) policy implementation and analyzed using multivariable logistic regression. Two physicians were interviewed retrospectively in May 2023, using a semi-structured guide prepared in advance, about discussions in three professional physician groups during April 2022-April 2023. Findings were integrated at the interpretation and reporting stages using MAST, TAM2, and Kingdon's policy-window theory. Results Among 797 survey respondents, telemedicine use was 8.8% before the policy and 34.5% after it (adjusted OR 5.90, 95% CI 3.70–9.41). In-person visits for administrative procedures remained common among users and unchanged across periods (30.0% vs. 31.2%, p = 0.889), while fewer users reported three or more consultations in Survey 2 (26.3% vs. 51.1%, p = 0.005). Interviewees described increased administrative burden and operating costs without proportional reimbursement. Conclusions Telemedicine use expanded rapidly during the policy period, but persistent administrative barriers indicate that rapid adoption did not amount to institutional integration. The design does not permit causal attribution. Sustainable implementation is likely to depend on end-to-end workflow digitization and adequate reimbursement. Public interest summary In May 2022, during a large COVID-19 outbreak, Taiwan asked people with mild illness to consult a doctor by video or telephone in their own community, so that hospitals could concentrate on severely ill patients. These consultations were fully paid for by the national health insurance system.We surveyed 797 members of the public before and after this policy, and interviewed two doctors about what colleagues had discussed in their professional groups.Telemedicine use was nearly four times higher after the policy than before. However, about one in three users still had to travel to a clinic afterward to pay, present an insurance card, or collect medicine, and this did not improve over time. Doctors reported more paperwork and higher running costs without extra payment.Moving the consultation online is not enough on its own. The steps around it must move online too.
Objectives Type 2 diabetes, cardiovascular disease, and chronic obstructive pulmonary disease are common chronic conditions that often co-occur with one another and with other chronic diseases, leading to poorer health outcomes and higher healthcare costs. In the Netherlands, single-disease management programmes are widely used in primary care but may not fully meet the needs of these patients. A person-centred integrated care (PC-IC) approach introduced a generic, person-centred disease management programme. The aim of this study is to evaluate its cost-effectiveness compared to usual care. Methods We conducted a 12-month cluster-randomised controlled trial in 22 general practitioner (GP) practices in the Netherlands, including 420 patients in the PC-IC approach and 415 receiving usual care. A trial-based cost-utility analysis was performed from the healthcare and societal perspectives. Healthcare and informal care costs were measured with the iMTA Medical Consumption Questionnaire, productivity losses with the iMTA Productivity Cost Questionnaire, and Quality Adjusted Life Years (QALYs) were derived from the EQ-5D-5 L. Costs and effects were analysed using constrained linear mixed models, with uncertainty assessed through 1000 bootstrap replications. Exploratory subgroup analyses were performed to examine heterogeneity in effects. Results Over 12 months, mean incremental costs were €258 (95% CI –€774 to €1301) from the societal perspective and €436 (95% CI –€471 to €1461) from the healthcare perspective, with negligible differences in QALYs 0.008 (95% CI –0.003 to 0.018), leading to incremental Net Monetary Benefits close to €0. Conclusion In this study, it is not demonstrated that the PC-IC approach was cost-effective within 12 months considering the absence of differences between the intervention and control groups in health-related quality of life, medical consumption and productivity. Yet, the Dutch primary care is moving towards PC-IC. As such, careful monitoring and further research are needed to assess the added value of this shift over a longer time horizon.Trial registration number: ID NCT05495230Public Interest Summary: Many people with chronic conditions such as type 2 diabetes, cardiovascular disease, chronic obstructive pulmonary disease, and asthma, have multiple chronic diseases. Dutch primary care is increasingly moving towards person-centred and integrated care, which focuses on the patient rather than treating each disease separately. In this study, we compared a new person-centred and integrated care approach with usual care in the Netherlands. After one year, the new approach did not clearly show improvement in patients’ health-related quality of life or reduced costs compared with usual care. These findings suggest that while person-centred and integrated care may not yet provide clear overall value for money, further research and careful monitoring are important as healthcare systems continue to adopt this approach.
Objectives Digital maturity is increasingly promoted as a cornerstone of digital health policy, yet its implications for affective commitment among primary healthcare managers remain insufficiently understood. This study examines whether digital maturity can be interpreted as a policy-relevant organisational capability associated with affective commitment in primary healthcare (PHC), and whether organisational trust helps explain this association. We also assess whether these associations differ across European healthcare systems. Methods A cross-sectional survey was conducted between January and June 2024 among 600 PHC managers in Poland, England, and the Netherlands (200 per country). Validated scales were used to measure digital maturity (DM), identification-based organisational trust (OTID), and affective commitment (AFC). Data were analysed using confirmatory factor analysis and structural equation modelling (SEM). Mediation was tested with bootstrapping, and moderated mediation by country was examined using the Hayes PROCESS macro. Results Digital maturity showed a small but statistically significant negative association with affective commitment. It was also positively associated with identification-based organisational trust, which in turn was positively associated with affective commitment. Organisational trust partially mediated the association between digital maturity and affective commitment, indicating the presence of direct and indirect associations in opposite directions. The conditional indirect association differed across countries and was strongest in England, moderate in the Netherlands, and weakest in Poland. Given the lack of full metric and structural invariance, these cross-country differences should be interpreted cautiously as exploratory contextual patterns. Conclusions Digital maturity was associated with affective commitment through a small negative direct association and a positive indirect association via organisational trust. These findings suggest that digital maturity should be understood as a policy-relevant organisational capability embedded in governance arrangements, institutional support, organisational processes, and trust-building practices. Public interest summary This study shows that digital maturity is related to affective commitment through two different pathways. It has a small negative direct association with commitment, but it is also positively associated with organisational trust, which in turn is positively associated with affective commitment. The positive indirect association through trust was strongest in England, moderate in the Netherlands, and weakest in Poland, although these cross-country differences should be interpreted cautiously because full measurement and structural invariance were not established. Using data from Poland, England, and the Netherlands, we found that the positive organisational associations of digital maturity appear to be closely linked to organisational trust. These findings highlight that successful digital transformation requires not only investment in technology but also attention to organisational culture, trust, and system-level support. Policymakers and health system leaders should therefore treat digital maturity as a broader policy-relevant organisational capability that combines technology with human-centred and governance-focused approaches
Introduction Medication non-adherence remains a major challenge in hypertension management among middle-aged and older adults. Reminder systems can support timely medication use, but many existing tools lack usability and healthcare workflow integration. REM, derived from the word ‘reminder’, was developed as an integrated medication adherence support system connecting patients, physicians, and pharmacists through a mobile application, smart pillbox, and wearable device. This study explored stakeholders’ perceived usefulness, ease of use, behavioral intention to use REM, and recommendations for improvement. Methods This qualitative formative study used semi-structured interviews with hypertensive middle-aged and older adult patients (n = 20), physicians (n = 10), pharmacists (n = 10), and information technology (IT) experts (n = 10). The interview guide was informed by the Technology Acceptance Model and examined perceptions of system usefulness, ease of use, intention to use, feasibility, and recommended refinements. Data were coded and organized using MAXQDA. Results Participants perceived the REM system as useful and easy to use for supporting medication adherence and patient monitoring. Most participants were willing to use or recommend REM, although acceptance depended on physician endorsement, affordability, insurance coverage, and workflow compatibility. Suggested refinements included secure communication, improved portability, offline functionality, and enhanced data security. Conclusion REM was perceived as a useful and easy-to-use digital health intervention with potential to support medication adherence among middle-aged and older adults with hypertension. Findings highlight the importance of user-centered design, stakeholder integration, affordability, workflow compatibility, and robust data security in promoting future adoption and implementation. Public interest summary Middle-aged to older adults with high blood pressure often forget to take their medication on time. To address this, the REM system was developed to improve their medication compliance. REM was derived from the word "reminder". The system consists of a mobile application, a smart pillbox, and a wearable device that work together to help patients remember their medication. Physicians and pharmacists can also access patients’ prescriptions and medication intake schedules to monitor their progress and compliance. In this study, patients, physicians, and pharmacists, including IT experts, were interviewed to express their thoughts about REM. Most participants were also willing to use and recommend REM for its usefulness. Suggested improvements included chat support, offline accessibility, portability, and stronger privacy and security features. In conclusion, the REM system shows potential as a user-friendly tool for improving medication adherence and supporting better health outcomes.
Objectives Everyday life is increasingly mediated by digital technologies. These systems improve access and convenience but can also replace movement, sleep-protective routines and in-person participation. We examined whether the activity-cognition index changed gradually or showed a rapid transition as digital mediation expanded, and whether the proposed three-parameter model performed better than simpler alternatives. Methods We analysed global annual data for 2000–2024. An activity-cognition index combined adult mobility, metabolic integrity (inverse obesity), cognition-related health burden and international learning performance. A digitality index combined Internet and mobile-broadband access, digital payments and remote work/education anchors. We compared the study-specific quartic benchmark with linear, quadratic, spline, segmented, logistic, calendar-time and autoregressive models, and examined annual changes, serial dependence and detrended early-warning indicators. Results The digitality index increased from 0.060 to 0.680. The benchmark fold was 0.456, first crossed in 2016; observed A first became negative in 2017, and the 2024 benchmark equilibrium was -0.220. A digitality-based logistic transition fitted best (RMSE 0.063; leave-one-year-out RMSE 0.074), but a calendar-time logistic model fitted nearly as well (leave-one-year-out RMSE 0.082), and digitality correlated 0.998 with year. Raw variance and autocorrelation increased around the transition period but weakened after detrending. Conclusions The series shows a marked nonlinear change in the mid-2010s, but it does not establish a causal or universal digitality threshold. The framework should serve as an exploratory monitoring tool that makes scale, model and temporal uncertainty visible and can be tested with national, local and service-specific data.
