Health Services Insights最新文献

{"title":"Sociocultural Factors Affecting Chronic Disease Management Among the Hispanic/Latino Ethnic Group in Texas: A Qualitative Study.","authors":"Camilla Ortega, Yong Ju Cho, Gabriel Vidal, Grace E Brannon, Christian E Vazquez, Yeonwoo Kim","doi":"10.1177/11786329261445200","DOIUrl":"https://doi.org/10.1177/11786329261445200","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to explore Hispanic/Latinos' sociocultural experiences of dealing with chronic diseases as first-generation immigrants.</p><p><strong>Methods: </strong>Through purposive sampling, 12 Hispanic/Latino adults with limited English proficiency participated in in-person, semi-structured interviews and provided in-depth insights on lived experiences regarding managing chronic diseases. Interviews were conducted between October 2023 and February 2024 in the Dallas-Fort Worth Metropolitan area, Texas. Interviews were analyzed using the thematic constant comparative method supported by Atlas.ti software to understand participants' experiences with managing chronic diseases, employing the Sociocultural Health Belief Model as a theoretical lens.</p><p><strong>Results: </strong>Participants' experiences reflected on how sociocultural factors, such as socioculturally-informed health norms and beliefs, cultural adaptation and health literacy, and family influence, contributed to disease management, sometimes as barriers or as resources. Seven themes identified from the responses included: (1) I do not trust the doctor's treatment and efficacy, so I avoid or delay going to the doctor; (2) I only go to the doctor when I am symptomatic; (3) Structural barriers further complicate cultural health norms and beliefs; (4) I do not know how to change my traditional meals to include healthier food options; (5) Language is a crucial key to healthcare; (6) I rely on Spanish-language health resources, but I have concerns about reliability; and (7) Family is a major source of instrumental emotional and motivational support.</p><p><strong>Conclusions: </strong>The findings highlight the interconnectedness of these sociocultural factors and recognize the need for cultural competence in chronic disease management to enhance effective care and improve chronic health outcomes among Hispanic/Latino adults with limited English proficiency.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"19 ","pages":"11786329261445200"},"PeriodicalIF":2.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13145014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Children's Palliative Care Knowledge, Attitudes, and Learning Preferences Among Healthcare Professionals Working in Humanitarian Crisis and Emergency Settings.","authors":"Zachary Blatman, Spandana Rayala, Kathryn Richardson, Mohammed Ilias Kamal Risat, Rachel Yantzi, Megan Doherty","doi":"10.1177/11786329261445187","DOIUrl":"https://doi.org/10.1177/11786329261445187","url":null,"abstract":"<p><strong>Background: </strong>Palliative care has been recognized as an essential component of a humanitarian response; however, it remains unavailable in most humanitarian crisis settings. Globally, healthcare workforce capacity represents a major barrier to implementing children's palliative care, and there is limited evidence to guide educators on the learning needs and preferences of healthcare professionals working in humanitarian settings.</p><p><strong>Objective: </strong>The primary objective of this study was to explore the extent of training, experience, and confidence in children's palliative care among healthcare professionals working in humanitarian settings. Secondary objectives were to identify perceived educational needs, including priority learning topics and preferred methods of palliative care education.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey of healthcare professionals with experience working in humanitarian settings. The survey assessed participants' self-reported knowledge, confidence, attitudes, prior training experiences, and learning preferences related to children's palliative care.</p><p><strong>Results: </strong>One hundred thirty four healthcare professionals participated, including nurses (37%), physicians (17%), and clinical officers (15%). Most participants provided clinical care (n = 82, 64%) and were locally recruited staff (83%). More than 70% of respondents reported having some palliative care training, either during their professional training (n = 52) or through continuing medical education (n = 41). Despite this, many participants reported discomfort with key palliative care situations, including forming a therapeutic relationship with families of dying children (61%) and discussing impending death with parents (61%). Nearly all respondents (98%) expressed interest in further training, with preferred learning modalities including online teaching sessions and web-based certificate courses.</p><p><strong>Conclusions: </strong>There is strong interest and awareness for children's palliative care training amongst humanitarian healthcare professionals. Despite prior exposure to palliative care education, many participants report limited confidence and skill in providing children's palliative care, particularly in communication and psychosocial domains. Health educators should consider developing online training programs on children's palliative care to meet the educational needs of healthcare professionals in humanitarian settings.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"19 ","pages":"11786329261445187"},"PeriodicalIF":2.5,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Qualitative Study of a Pilot of Clinician Perspectives on the Delivery of Medicare Annual Wellness Visits for Patients with Dementia in an Academic Health Science Center in Texas.","authors":"Huey-Ming Tzeng, Yong-Fang Kuo, Monique R Pappadis, Elizabeth A Hennessy, Maribel M Marquez-Bhojani, Samuel V David, Elise Passy, Mukaila A Raji","doi":"10.1177/11786329261432894","DOIUrl":"https://doi.org/10.1177/11786329261432894","url":null,"abstract":"<p><strong>Background: </strong>Little is known about clinicians' perspectives on the process and outcomes of Medicare Annual Wellness Visits (AWVs) in Medicare beneficiaries with mild cognitive impairment (MCI) or Alzheimer's Disease and Related Dementias (ADRD).</p><p><strong>Objectives: </strong>We sought clinicians' opinions on the impact of AWVs on health outcomes and disparity reduction for beneficiaries with MCI/ADRD.</p><p><strong>Design: </strong>Institute for Healthcare Improvement's 4Ms framework of an age-friendly health system informed the design of this qualitative study of a pilot.</p><p><strong>Methods: </strong>We used convenience sampling and recruited clinicians from a single academic-health-science center's catchment area in Texas, who billed for at least 1 AWV to participate in a one-time, one-on-one, semi-structured interview conducted via phone/Zoom. Participants verbally agreed to participate. This study met the federal regulations for a Quality Assessment project.</p><p><strong>Results: </strong>We interviewed 26 clinicians (17 female; 26 non-Hispanic, 12 White, 10 Asian, 4 Black; 16 in family medicine and 5 in internal medicine). Most agreed AWVs improve health outcomes (n = 23, 88.5%) and reduce health disparities for Medicare beneficiaries with MCI/ADRD (n = 20, 76.9%). The top three \"what works\" themes were: (1) non-primary care providers (eg, wellness nurses) streamline AWV delivery by screening patients, providing resources/support, and sharing abnormal findings with primary care providers (PCPs); (2) PCPs do AWVs themselves to be in alignment with issues identified; and (3) sufficient time allotted to learn what matters most to patients and caregivers. The top three \"what does not work\" themes were: (1) clinicians desire having a family caregiver present; (2) clinicians need the full hour for in-depth screenings and holistic care; and (3) clinics need on-site social workers to address nonmedical issues.</p><p><strong>Conclusions: </strong>Clinicians agreed that AWVs helped improve health outcomes and reduce health disparities. Tailoring AWV components by MCI/ADRD stage will optimize the visit, maximize health outcomes, and decrease disparities in access to care.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"19 ","pages":"11786329261432894"},"PeriodicalIF":2.5,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13039569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Economic Costs of Congenital Hearing Loss in a South African Cohort.","authors":"Winfrida Tombe-Mdewa, Claudine Storbeck, Alys Young, Aisha Moolla, Susan Goldstein, Evelyn Thsehla","doi":"10.1177/11786329251401414","DOIUrl":"10.1177/11786329251401414","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of congenital hearing loss in South Africa is estimated to be 6 per 1000 live births, which is higher than most high-income countries but consistent with rates observed in other parts of Africa. While policymakers typically focus on direct healthcare-related costs, many of the broader societal and economic impacts of congenital hearing loss remain hidden, including educational, vocational, and social consequences. Understanding the full economic burden is essential for informed policy and healthcare planning.</p><p><strong>Objectives: </strong>To assess the full economic burden of congenital hearing loss, including indirect and intangible costs in South Africa.</p><p><strong>Design: </strong>A cost-of-illness model from a societal perspective in 2022.</p><p><strong>Methods: </strong>We constructed a cohort-survival model to estimate the societal lifetime costs of congenital hearing loss. Cost components included direct medical expenses (diagnostics, devices, surgeries), non-medical costs (special education), indirect costs (lost productivity, reduced earnings) and the monetary value of disability adjusted life years lost due to hearing loss. Model inputs were derived from published literature and consultation with experts.</p><p><strong>Results: </strong>Total economic cost for the cohort was ZAR 16.4 billion (USD 1 billion per lifetime or ZAR 256 million (USD 15.9 million) per year. Productivity losses made up the largest proportion of societal costs with losses of approximately ZAR 2.4 billion (52% of total costs). Total discounted cost per person with hearing loss was ZAR 1.1 million (USD 70 thousand) per lifetime.</p><p><strong>Conclusion: </strong>Congenital hearing loss has far-reaching implications beyond immediate healthcare expenses, including significant societal and economic costs. Early childhood interventions such as newborn screening and early identification, assistive devices and speech and language therapy interventions may reduce the high costs associated with congenital hearing loss and may provide substantial returns on investment.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"19 ","pages":"11786329251401414"},"PeriodicalIF":2.5,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147511561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Women's Satisfaction with Midwifery-Led Continuity of Care: Insights from Antenatal, Intrapartum, and Postnatal Experiences in the Sidama Region, Ethiopia. A Non-Randomized Control Trial.","authors":"Rekiku Fikre, Sanne Gerards, Wondwosen Teklesilasie, Jessica Gubbels","doi":"10.1177/11786329251404113","DOIUrl":"https://doi.org/10.1177/11786329251404113","url":null,"abstract":"<p><strong>Background: </strong>Evidence from high-income countries indicates that midwifery-led continuity of care improves maternal satisfaction and health outcomes throughout pregnancy and postpartum. In Ethiopia, low maternal satisfaction with care indicates systemic problems, including ineffective communication and substandard service quality. This study aimed to evaluate how midwifery-led continuity care impacts maternal satisfaction during antenatal, intrapartum, and postpartum care in the Sidama region's general hospitals in Ethiopia.</p><p><strong>Methods: </strong>A prospective non-randomized controlled trial was conducted from October 2023 to June 2024 in four general hospitals in the Sidama region of Ethiopia. A total of 478 low-risk women were allocated into two groups: midwifery-led continuity of care (n = 239 and shared care n = 239). Quantitative data were gathered through face-to-face interviews to evaluate maternal satisfaction, and average satisfaction scores between groups were analyzed using bootstrapping linear regression.</p><p><strong>Results: </strong>Women in the midwifery-led continuity of care reported significantly higher satisfaction with continuity of care compared to shared care, with an adjusted mean difference of 0.28 (95% CI 0.13-0.40; <i>P</i> < .001). Specifically, during antenatal care, the adjusted mean difference was 0.20 (95% CI 0.06-0.33; <i>P</i> < .003), intrapartum care was 0.31 (95% CI 0.17-0.45; <i>P</i> < .001), and postnatal care was 0.44 (95% CI 0.29-0.59; <i>P</i> < .001).</p><p><strong>Conclusion: </strong>Women receiving midwifery-led continuity of care reported higher satisfaction levels, making this model a viable alternative for improving satisfaction in maternity services by offering a more personalized and supportive approach to care.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"19 ","pages":"11786329251404113"},"PeriodicalIF":2.5,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12936368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147325843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging Strategy and Local Reality: First-Line Managers' Experiences in Leading Large-Scale Implementation.","authors":"Lisa Viktorsson, Janna Skagerström, Christine Gustafsson, Petra Dannapfel","doi":"10.1177/11786329261419275","DOIUrl":"https://doi.org/10.1177/11786329261419275","url":null,"abstract":"<p><strong>Background: </strong>Implementation of eHealth technologies has the potential to improve healthcare delivery, but is complex. Successful adoption depends on organizational readiness, effective change management and active involvement of healthcare professionals. Leadership plays a critical role in fostering a supportive climate for digital transformation. However, many managers lack the tools, knowledge and clarity needed to lead implementations effectively. This study explores how middle managers in primary care in Sweden prepare for and lead a large-scale, top-down implementation of a digital service system (1177 Direct) for symptom assessment, triage, referral and chat.</p><p><strong>Objectives: </strong>By examining middle managers' experiences, the study aims to identify best practices, barriers and enabling factors that support successful digital transformation.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with 26 middle managers within primary healthcare. Interviews were conducted 2 weeks before each unit launched the digital service system. The data were analysed using conventional content analysis.</p><p><strong>Results: </strong>The analysis yielded four categories describing the managers' experiences of preparing for implementation of the digital service at their workplace: (1) how the managers navigated their role when driving top-down organizational change, having the responsibility to lead the change no matter their thoughts about it; (2) the importance of preparing tailored strategies for the implementation; (3) important preconditions for leadership in change; (4) the ability to adjust the innovation and implementation process to the local setting.</p><p><strong>Conclusion: </strong>Middle managers have a pivotal role in preparing for and leading implementation. Managers' efforts focused on supporting staff, navigating uncertainty, and applying local strategies to foster readiness and engagement. When leading change, there is a need for clear communication, contextual adaptation and bidirectional feedback to ensure sustainable implementation. Strengthening these preconditions can enhance middle managers' capacity to lead complex digital transformations effectively and promote long-term success.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"19 ","pages":"11786329261419275"},"PeriodicalIF":2.5,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12929841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147305008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Financial and Workforce Impact of Medication Errors in the Finnish Public Healthcare System: A Pilot Study.","authors":"Jonna-Carita Kanninen, Raimo Ojala, Jouni Ahonen, Hannu Kautiainen, Anu Holm, Ville Valkonen","doi":"10.1177/11786329261427522","DOIUrl":"https://doi.org/10.1177/11786329261427522","url":null,"abstract":"<p><strong>Background: </strong>Medication errors (MEs) pose a significant challenge to patient safety and healthcare efficiency. In addition to clinical consequences, MEs contribute to increased healthcare expenditures and resource utilization. However, comprehensive cost assessments of MEs, including staff time and service costs, remain limited.</p><p><strong>Objectives: </strong>The aim of this pilot study is to examine the costs associated with MEs regionally and nationally in Finland.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Methods: </strong>This study assessed the financial and resource burden of MEs in the Finnish public healthcare system using a survey conducted in the wellbeing services county of North Savo in Eastern Finland. The study perspective is economic and healthcare system-focused. Healthcare professionals in charge of patient safety reporting estimated the workforce impact of MEs by assessing the time spent, the corrective measures taken, and the additional interventions required to manage these events. Cost calculations were based on salary data from the 2023 financial administration statistics and service costs from the Finnish Institute for Health and Welfare (THL) database, adjusted to 2023 monetary value. An estimator, derived from regional data, was applied to extrapolate the nationwide economic burden of MEs.</p><p><strong>Results: </strong>Medication errors (MEs) impose a substantial financial burden, with an estimated mean cost of €138 per event and a total annual cost of €686 274 in the wellbeing services county of North Savo. Extrapolated to the national level, the annual impact was estimated at €15.5 million. The main cost drivers were the work time expenditures of nurses and physicians involved in managing these events.</p><p><strong>Conclusion: </strong>Managing MEs demands extra work of healthcare personnel, which is a considerable waste of resources. Most of the events are preventable. That is why effective safety strategies are needed, and prompt action taken to improve quality of care and reduce unnecessary costs.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"19 ","pages":"11786329261427522"},"PeriodicalIF":2.5,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12929818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147289838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Vulnerability to Resilience: Community-Based Insights on Adolescent and Youth Depression in Underserved Communities in Mexico.","authors":"Natalia Bautista-Aguilar, Lina Díaz-Castro, Christian Díaz de León-Castañeda, Héctor Cabello-Rangel, Blanca Estela Pelcastre-Villafuerte, Jose Carlos Suarez-Herrera","doi":"10.1177/11786329261419279","DOIUrl":"https://doi.org/10.1177/11786329261419279","url":null,"abstract":"<p><strong>Background: </strong>Adolescents and youth from socially and culturally underserved communities face a disproportionate burden of depression, exacerbated by systemic barriers to accessing timely and culturally appropriate mental health care. In contexts where health systems are under-resourced, community-based initiatives may offer promising strategies for promoting youth mental well-being.</p><p><strong>Objective: </strong>This study explores how adolescents and youth from underserved communities in Mexico perceive and cope with depressive symptoms, with the aim of identifying community-informed strategies that can inform culturally relevant mental health promotion and prevention initiatives.</p><p><strong>Methods: </strong>Using an exploratory qualitative design, the study combined participant observation with focus group discussions involving people aged 15 to 25. A thematic analysis guided by resilience and participatory frameworks was conducted to examine youths' emotional experiences, stressors, and coping mechanisms within their family, school, and social environments.</p><p><strong>Results: </strong>Participants reported depressive symptoms such as sadness, social withdrawal, fatigue, and hopelessness. Key stressors included family conflict, exposure to violence, and school-based pressures like bullying and academic demands. Although many youth used positive coping strategies-such as seeking social support and participating in recreational activities-some also exhibited maladaptive responses, including avoidance and silence. Focus groups emerged as empowering spaces for youth to articulate emotions and co-develop potential solutions.</p><p><strong>Conclusions: </strong>Findings highlight the urgent need for holistic interventions that integrate family and school-based programs with youth-centered, community-led mental health initiatives. Participatory methods are proposed as culturally sensitive, scalable approaches to address service gaps in under-resourced settings. These community-driven responses not only support individual coping but also contribute to the resilience of local health systems by aligning services with the lived realities of underserved populations.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"19 ","pages":"11786329261419279"},"PeriodicalIF":2.5,"publicationDate":"2026-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12926534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147283500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of Palliative Care Decision on Secondary Health Care Utilization and Cancer Treatment at the End of Life Among Patients with Head and Neck Cancer: A Single-Center Retrospective Study.","authors":"Martti Merikari, Tiina Saarto, Riikka-Leena Leskelä, Antti Mäkitie, Timo Carpén, Outi Akrén","doi":"10.1177/11786329251412688","DOIUrl":"10.1177/11786329251412688","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of studies concerning the end of life (EOL) of patients with head and neck cancer (HNC).</p><p><strong>Objectives: </strong>To investigate whether the timing of palliative care decision (PCD), that is, decision to terminate life-prolonging anticancer treatments, is associated with reduced secondary health care utilization and medical procedures at the EOL among patients with head and neck cancer.</p><p><strong>Design and methods: </strong>A total of 108 patients with HNC treated at the Helsinki University Hospital Comprehensive Cancer Center were reviewed retrospectively. Three study groups were formed according to the timing of PCD: (1) the early PCD group (PCD >30 days prior to death), (2) the late PCD group (⩽30 days prior to death), and (3) the no PCD group.</p><p><strong>Results: </strong>PCD was made for 78 patients (72%), of which 57 (73%) were considered as early PCD and 21 (27%) as late. The median interval between PCD and death was 71 days (IQR 108). During the last month of life, a significantly smaller proportion of patients with an early PCD was hospitalized (19% vs 67%, OR = 0.12, CI [0.04-0.37], <i>P</i> < .001 and 19% vs 47%, OR = 0.27, CI [0.10-0.72], <i>P</i> = .007) and readmitted (5% vs 29%, OR = 0.14, CI [0.03-0.62], <i>P</i> = .004 and 5% vs 20%, OR = 0.22, CI [0.05-0.96], <i>P</i> = .032) in secondary health care compared with the patients with late or no PCD. Early PCD also associated with less ED visits (28% vs 52%, OR = 0.36, CI [0.126-0.997], <i>P</i> = .045) compared with the late PCD in the last month of life. Compared with the late PCD group, early PCD group was more likely to receive palliative radiotherapy (42% vs 14%, OR 4.36, 95% CI [1.15-16.51], <i>P</i> = .022).</p><p><strong>Conclusion: </strong>Early PCD associated with reduced utilization of secondary health care and emergency services at the EOL. The disease trajectories for patients with HNC should warrant more attention to the earlier timing of PCD.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"19 ","pages":"11786329251412688"},"PeriodicalIF":2.5,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12833134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146062440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Policy Meets Reality: Municipal Leaders' Views Amid Rising LTC Expenditure.","authors":"Trond Tjerbo, Terje P Hagen, Jon Helgheim Holte","doi":"10.1177/11786329251410041","DOIUrl":"10.1177/11786329251410041","url":null,"abstract":"<p><strong>Background: </strong>Long-term care (LTC) expenditure in Norway has increased by a far higher rate than GDP. While aging is still seen as the predominant challenge, younger users (<60 years) are disproportionately represented among the top-5% high-cost users, who accounted for 39% of LTC costs in 2019.</p><p><strong>Aim: </strong>This study investigates how municipal leaders perceive the main drivers of LTC expenditure growth and what they consider to be the most pressing challenges.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with 13 municipal leaders between November 2023 and February 2024. Using thematic analysis, we explored their perspectives on expenditure growth, causes, and challenges. Municipalities were selected across KOSTRA groups to ensure variation in demographics and finances.</p><p><strong>Results: </strong>Three main themes emerged. Municipal leaders identified younger users with complex mental health needs requiring intensive services, workforce shortages forcing reliance on expensive purchased services, and expanding rights creating gaps between expectations and capacity. These pressures are compounded by fiscal asymmetries-national policies expand mandates while implementation costs fall on municipalities with constrained budgets and labor markets.</p><p><strong>Conclusions: </strong>Expenditure growth stems from both demographic drivers and governance challenges. While young users and workforce shortages directly increase costs, fiscal asymmetry makes these pressures difficult for municipalities by removing their flexibility to adapt services to available resources.</p><p><strong>Implications for health services management: </strong>Managers need tools to manage fiscal asymmetries between national policy and local implementation.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"19 ","pages":"11786329251410041"},"PeriodicalIF":2.5,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12811556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145997929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}