Background: Technical assistance (TA) is increasingly recognized as a strategy to improve substance use disorder (SUD) treatment. This literature review examines the role of TA in strengthening SUD treatment in the United States, on provider needs, barriers, and investment areas to improve access to quality care in California. Methods: A literature review was conducted using six online databases (PubMed, Web of Science, JSTOR, Science Direct, PsycINFO, and Cochrane Library) and manual searching. Eligibility criteria prioritized peer-reviewed studies on TA and SUD treatment outcomes in the United States within the past 15 years from January 2010 to May 2025. The established inclusion and exclusion criteria prioritized peer-reviewed studies focused on improving TA and SUD treatment outcomes in the United States, and included a comprehensive list of search terms. Deductive thematic analysis was used to identify key challenges and recommendations related to TA needs. Results: The initial search yielded 85 articles, which were then narrowed to 18 based on the inclusion criteria. Thematic analysis of 18 relevant articles revealed five overarching TA needs themes: client acuity & access challenges, organizational needs, staffing challenges, treatment & training efficiency support, and workforce development. Key challenges identified included limited funding, workforce shortages, and training gaps, while recommendations emphasized increased funding, expanded training, and integrated care models. Conclusions: TA holds promise for building capacity in SUD treatment, particularly in addressing workforce development, enhancing funding mechanisms, and improving integrated care. In California, a robust and equity-informed TA framework is essential for fostering a more resilient and responsive treatment system for small to medium-sized providers serving vulnerable populations.
Background: Although previous studies have explored the factors that influence therapeutic compliance, research on the interaction between psychosocial variables, educational strategies, and patient behaviors is limited. This study addresses this gap by aiming to propose a model to explain the barriers to adherence to prescribed therapies by health professionals. Methods: A quantitative study of descriptive and explanatory scope was conducted, the data was collected by means of a self-administered questionnaire distributed among 137 participants during the first semester of the year 2023, using a non-probabilistic convenience sampling. A confirmatory factor analysis (CFA) was performed, and the relationship between the previously defined constructs was identified by means of Results: The main variables for understanding the factors that influence medical adherence are: individual variables, perception of disease severity, adherence to medical treatment, probability of taking preventive actions, and educational strategies. Significant associations were found between perception of disease severity and adherence to treatment (R=0.393, Cramer's V=0.363), adaptation to the medical regimen and the probability of taking preventive actions (R=0.234, Cramer's V=0.374), as well as between educational strategies and the probability of taking preventive actions (R=0.304, Cramer's V=0.304). Conclusions: This study provides a quantitative structural model that enhances our understanding of the factors influencing adherence to medical treatment. The strong association between the perception of disease severity, educational strategies, and the likelihood of taking preventive actions suggests that future interventions should focus on these aspects.
Effective medical response in emergency situations requires meticulous preparedness, including in maintaining critical diagnostic services. This study examines the rapid activation and operation of clinical laboratory services at the Fortified Underground Hospital (FUH) in the Rambam Health Care Campus, during times of crisis. The study explores the facility's infrastructure, emergency protocols, and the adaptive strategies employed by the laboratory to ensure continuity of care under extreme conditions. The FUH's laboratory services, which are vital for timely diagnoses, are designed to function seamlessly during emergencies, offering key insights into the resilience of healthcare systems. Emphasis is placed on the importance of flexibility, robust training, and integrated communication networks in maintaining laboratory operations during high-pressure scenarios. Since Rambam Hospital has continued nearly all of its clinical activities during this emergency situation, including trauma care, elective surgeries, oncology and hematology clinics, our laboratory infrastructure has been required to support both routine diagnostics and specialized testing to meet the hospital's diverse needs. In our setup, we utilized the same routine laboratory equipment rather than relying on separate, stored devices designated only for emergencies. Regularly maintained systems provide greater reliability and consistency, thereby reducing the risk of analytical errors. Moreover, this approach enabled us to maintain the same high quality of service, including with respect to turnaround times. The findings highlight valuable lessons for global emergency preparedness, emphasizing the need for adaptable healthcare infrastructure, strategic partnerships, and equitable access to diagnostic services. This research underscores the significance of preparedness and adaptability in safeguarding the continuity of care, even in the most challenging medical emergencies.
Background: Antimicrobial resistance (AMR) poses a major public health challenge, with dentists contributing significantly through inappropriate prescribing. This study assessed the knowledge, attitudes, and practices (KAP) of dentists in Al-Ahsa, Saudi Arabia, regarding antibiotic use and AMR. Methods: A cross-sectional survey was conducted over six months period among 424 licensed dentists working in public and private dental clinics in Al-Ahsa, Saudi Arabia. A clinic-bast, near census recruitment approach was used, and eligible dentist present during data collection period were invited to participate. Data were collected using structured, self-administered questionnaire distributed in google form. Content validity was established by three subject-matter experts, and internal consistency was confirmed using Cronbach's alpha. KAP scores were derived from predefined item domains and categorized as poor (<= 40%), fair (41-80%), or good (>80%). Descriptive statistics, Chi-squared test, and multinomial logistic regression analyses were applied. Results: Among the 242 participants dentists were male 283 (66.75%) and general practitioners 271 (63.91%). Overall, 270 (63.7%) demonstrated poor knowledge, 187 (44.1%) exhibited fair attitudes, and 249 (58.7%) showed poor prescribing practices. While 361 (85.1%) acknowledged AMR as a global concern, misconceptions persisted regarding prophylactic use and first-line drug selection for penicillin-allergic patients. Continuing dental education (CDE) attendance and prescribing frequency were significant predictors of knowledge (P=0.03) and attitudes (P=0.008). Workload 195 (45.99%) and patient pressure influenced prescriptions in 227 (53.54%) of cases. Conclusions: Dentists in Al-Ahsa displayed suboptimal knowledge and variable attitudes toward antibiotic use. Improving dental antibiotic stewardship may require strengthened, standardized CDE supported by system-level interventions (e.g., prescribing protocols and audit-feedback).
Background: Non-attendance at hospital outpatient appointments wastes valuable resources and delays patient care. Strategies addressing transportation, cultural considerations, and flexible scheduling have been proposed to mitigate missed appointments. The objective of the review was to identify types of reminder interventions and evaluate their effectiveness in improving outpatient attendance rates, along with associated costs wherever reported. Methods: A systematic search was conducted in Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and Web of Science with no date restrictions applied. All records available in each database up to October 2023 were included. The primary outcome assessed was patient attendance rates, while the secondary outcome, where reported, included the cost associated with intervention reminder systems. Two independent reviewers screened studies and evaluated methodological quality using the Cochrane RoB 2 tool. Data were synthesised using the Mantel-Haenszel method with a random-effects model to compute pooled risk ratios (RRs), and heterogeneity was assessed using I-squared (I2) statistics. Subgroup and sensitivity analyses were done, and publication bias was evaluated using Egger's test. Results: Twelve studies from nine countries fulfilled the inclusion criteria; ten contributed to the meta-analysis, while two were synthesised narratively. Three reminder types were used in the included studies: short message service (SMS), telephone reminders, and postal reminders. Across all reminder types in meta-analysis, a statistically significant improvement in attendance was observed compared to usual care [RR 1.11, 95% confidence interval (CI): 1.05-1.19, I2=83%, 10 studies, 8,236 participants]. Subgroup analyses showed that SMS reminders improved (RR 1.14, 95% CI: 0.99-1.31, 4 studies, 4,636 participants) and telephone reminders significantly improved attendance (RR 1.11, 95% CI: 1.04-1.19, 5 studies, 3,369 participants). Only one study explored the impact of postal reminder letters on attendance and found improved attendance in structured environments (from 64.7% to 73.0%). Three studies reported costs of delivering reminders, but none conducted a cost-effectiveness analysis. No significant publication bias was detected. Conclusions: This review demonstrates that overall reminders and particularly telephone reminders are effective interventions for enhancing patient attendance rates in hospital outpatient settings. Future studies may consider exploring the role of reminder timing and contextual influences on attendance outcomes.
Background: Health professionals experience distress when unable to provide patient care in alignment with personal values and professional commitments. Most recently, Executive Orders (EO) in the USA have resulted in institutions adjusting practice on factors not based on scientific evidence, clinical recommendations, or the best interests of patients. This study describes how an institution's response to EO was felt by healthcare professionals. Methods: An anonymous and voluntary mixed-methods survey was distributed within a single institution. Survey topics included demographics, personal values, professional fulfillment, and feelings about external political pressures and institutional response. Qualitative data were reviewed, analyzed, coded, and clustered into themes through an iterative process. Results: A total of 164 participants responded to the survey, the majority nurses (38.4%) and physicians (15.7%). Participants expressed concern that external political pressures would impact the care of vulnerable patients and had already affected their own professional fulfillment. Nearly all participants felt it was important that their institution share their values and described these as providing quality health care for all (n=88, 53.7%), compassionate care (n=28, 17.1%), and ethical care (n=13, 7.9%). When responding to future external political pressures, healthcare professionals would like open discussion, greater communication, and transparency. Conclusions: Participants in this study described their work as motivated by values of equity and compassion and see the institution as the conduit through which they provide this care. Participants asked that the institution advocate in alignment with expressed values. When decisions are made that do not align with these values, participants asked the institution for greater opportunities for communication and transparency in decision-making.
Background: The transformation of healthcare to support population health includes designing community strategies using a network of external partners, including patients. Such a transformation must be patient-centric and employ a service-oriented lens to create practices that address population health needs. While providers have extended their engagement with patients to support their care journeys and recognize the role of external partners and social determinants in helping patients gain access to care and overcome barriers, their community strategies have been narrowly focused. These strategies have been unable to quickly adapt to changing patient conditions, as seen during the coronavirus disease 2019 (COVID-19) pandemic. We characterize community strategy as consisting of services designed to support three distinct a patient's health needs. The value fulfillment network designs services to help patients gain access to care and overcome barriers. The value-in-use (or patient feedback) network is designed to gather feedback on changes in patient health conditions or barriers within the ecosystem, enabling adaptation of any or all parts of the value networks. Such segmentation of services supporting the patient care journey provides a modular approach to community strategy and builds agility among respective actors to adapt the strategy as needed. Methods: Recent research in Public Health 3.0 suggests the need for community strategies to use systemic action that leverages cross-sector collaboration among diverse actors (providers, partners, and patients) to support population health. However, it does not suggest any methodology to address the evolving needs of patients. In this research, we propose a three-step methodology using inter-organizational dynamic capabilities (IDC) research. The first step involves selecting an appropriate IDC model to define the roles of each actor in supporting patient needs. The second step applies network theory to align the goals of actors as they govern their relationships. The third step uses communication theory to orchestrate resources among the actors via digital platforms as they support the patient care journey. Results: We illustrate the methodology through three use cases. The first applies an IDC model moderated by a provider, the second by partners, and the third by an actor representing a network of organizations. These examples highlight the methodology's flexibility, showing how actors can adapt the IDC model to support inter-sector collaboration as patient needs evolve. Conclusions: We discuss how community strategy adaptation can be made more dynamic with the use of AI tools as part of future research and offer concluding remarks.
As associations between climate change and human health continue to receive greater focus, so too is recognition of the need to coordinate and harmonize mitigation work across adjacent sectors such as healthcare and urban planning. In 2022, the U.S. Department of Health and Human Services issued a voluntary Health Sector Pledge, encouraging health systems to make public commitments toward addressing climate risks, including developing and releasing a climate resilience plan for continuous operations, anticipating the needs of groups in their community that experience disproportionate risk of climaterelated harm. As a new expectation of health systems, little prior research is available to offer frameworks for their development. Urban planning, in contrast, has a longer history of incorporating climate resilience planning into its work, and may therefore offer insights relevant to the health sector. Through a search of public websites, we identified the health systems that have released plans and analyzed the contents of these plans using the "smart cities" framework. Elements of this framework include management, infrastructure, materials, energy, water, waste, pollution, and community resilience. The results showed an emphasis among health systems on measures to reduce pollution and lower energy consumption, but there has been less focus on describing community resilience goals and management changes, as the Health Sector Pledge wanted. Results of this analysis are discussed in the context of both city planning and community benefit planning.
Background: Electronic health records (EHRs), which collect patient health data from various healthcare settings, are integral to modern healthcare systems, influencing patient care and clinical outcomes. Their widespread use has raised concerns about the wellbeing of healthcare professionals. This study aimed to investigate how ConnectCare, the EHR system in Alberta, Canada, impacts clinician perspectives about their wellbeing. Methods: A qualitative research approach was employed, using pre-focus group discussion with 5 physicians and two focus group discussions with 11 physicians from various specialties at a large academic teaching hospital. This sample was selected to gauge the sentiment of specialists and not to explore in depth physicians' experiences. A focus group guide, developed based on the United Kingdom's (UK) National Health Service (NHS) health and wellbeing framework, was used to facilitate the sessions. This framework offers a comprehensive structure for understanding factors that influence physician wellbeing. The physicians shared their experiences with EHRs, discussing both the benefits and challenges. The discussions were recorded, transcribed, and analyzed through thematic analysis to identify key themes. Results: Participants described feeling more stressed due to constant pressure to be available and respond quickly within ConnectCare. Physicians struggled with adapting to new technology and managing the added administrative workload, which negatively impacted their work-life balance. However, clinicians identified meaningful improvements in contemporaneous communication amongst the healthcare team using the EHR, though not all aspects of team communication were helpful. The study identified gaps in support systems and issues with software and hardware, leading to inefficiency and frustration. There was also skepticism about using ConnectCare for real-time wellbeing assessments, calling for more transparent and thoughtful approaches to addressing physician wellbeing. Healthcare organizations were advised to establish robust follow-through processes to ensure that collected wellbeing data leads to tangible improvements. Despite the challenges, physicians expressed a preference for the current EHR rather than reverting to paper charting. Conclusions: The impact of EHRs on physician wellbeing is both positive and negative. The extent of acceptability of EHR appears to depend on specialists' personal experiences and what they value. It also depends on the available support and the operational healthcare setting.
Background: Although health systems are pivotal in improving population health, they also contribute a sizable amount of greenhouse gas emissions. As multiple countries strive to achieve environmentally friendly and sustainable healthcare delivery, attention has shifted to reducing greenhouse gas emissions at a rate consistent with international benchmarks. In 2022, the U.S. Department of Health and Human Services encouraged private-sector health systems to join federal health systems in pledging to cut greenhouse gas emissions by 50 percent by 2030 and achieve net-zero emissions by 2050, also known as the Health Sector Climate Pledge. This study aimed to explicate the characteristics of U.S.-based health systems that were early adopters of emissions reduction goals. Methods: For this exploratory cross-sectional study, health system-related data were obtained from the Agency for Healthcare Research and Quality (2022), while data on Climate Pledge signatory status were obtained from the Department of Health and Human Services website (2023). Descriptive, bivariate, and binary logistic regression analyses were conducted to examine the relationship between health system characteristics (e.g., structural, reputational, financial, socio-political context) and pledge status. Results: Health systems with at least one major teaching hospital had significantly higher odds of being Climate Pledge signatories [odds ratio (OR) =2.3753; 95% confidence interval (CI): 1.1590, 4.9925; P=0.02]. In addition, higher hospital net revenue (OR =1.0052; 95% CI: 1.0022, 1.0086; P=0.001) and smaller system bed size (OR =0.9994; 95% CI: 0.9989, 0.9998; P=0.005) were significantly associated with pledge status. Being headquartered in a state in which the majority of the population identified as politically liberal was also significantly associated with higher odds of pledge adoption (OR =7.8354; 95% CI: 2.1525, 28.1049; P=0.002). Conclusions: Our findings emphasize that health system characteristics and context significantly influence the adoption of emissions reduction goals. Specifically, our study highlights how health system capacity, teaching intensity, and political context influence pledge adoption. To accelerate wider adoption, early adopters should actively engage peers to reinforce broader commitments to climate resiliency. Researchers should also examine how executive leaders from subdisciplines such as information systems, finance, and supply chain interoperate in sustainability decision-making.
Background: The recently published Climate Vulnerability Index (CVI) gives us a comprehensive overview of the counties that are most vulnerable to the effects of climate change. Understanding the health care delivery characteristics in these vulnerable communities may help to anticipate and mitigate the negative impacts of climate change. In this setting, we sought to assess hospital characteristics in the most climate-vulnerable counties in the United States. Methods: We conducted a cross-sectional study using county-level data from the CVI [2017-2019] to stratify counties into quintiles of climate vulnerability. These data were linked with hospital characteristics from the American Hospital Association survey [2016] and population characteristics from the American Community Survey [2021]. We analyzed the hospital and demographic characteristics of the most climate vulnerable counties. Results: Hospitals in the most climate-vulnerable counties are significantly more likely to be located in rural areas (34% vs. 24%, P<0.001), smaller in bed size (mean 135 vs. 167 beds, P<0.001), more often classified as rural referral centers (7.2% vs. 4.0%, P<0.001) or sole community providers (11% vs. 6.9%, P<0.001), and more likely to be private equity-owned (6.2% vs. 3.8%, P<0.001). They employ fewer full-time personnel, including physicians (mean 110 vs. 336, P<0.001) and nurses (mean 187 vs. 267, P<0.001), and have reduced diagnostic capabilities, with lower availability of magnetic resonance imaging (75% vs. 79%, P=0.008) and advanced computed tomography scanners (52% vs. 64%, P<0.001). The populations in these counties have a higher proportion of non-Hispanic Black residents (24% vs. 10%, P<0.001), lower education levels (18% vs. 28% with bachelor's degree, P<0.001), a higher percentage of individuals with disabilities (18% vs. 14%, P<0.001), and significantly higher poverty rates (20% vs. 14%, P<0.001) compared to national averages. Conclusions: Our results indicate that hospitals in the most climate-vulnerable counties in the United States are smaller and less well-resourced, with fewer beds, intensive care units, and clinical staff. Targeted investments are needed to strengthen their infrastructure and capacity, ensuring they can effectively respond to climate-related emergencies and support health equity in the face of climate change.
