Israel Journal of Health Policy Research最新文献

{"title":"Emotional resilience and sense of danger among doctors in hospitals during periods of heightened tensions and warfare in Israel.","authors":"Michael V Joachim, Dana Atia Joachim, Liat Korn, Yair Shapiro, Amir Laviv, Avi Zigdon","doi":"10.1186/s13584-024-00655-3","DOIUrl":"10.1186/s13584-024-00655-3","url":null,"abstract":"<p><strong>Background: </strong>The \"Iron Swords\" War beginning in October 2023 led to unprecedented levels of shock and trauma across Israel, significantly impacting the Israeli population and medical personnel. This study aimed to evaluate and compare the perceived personal resilience and sense of danger among physicians in hospitals located in different conflict zone proximities in Israel during this period.</p><p><strong>Methods: </strong>A quantitative, cross-sectional study was conducted from March to August 2024, during an active phase of the war, using a structured anonymous questionnaire. Participants were 161 physicians from three hospitals: one in southern Israel near the Gaza Strip, another in northern Israel near the borders with Lebanon, Syria, and Jordan, and a third in central Israel near Tel Aviv. The survey measured personal resilience using the Connor-Davidson Resilience Scale (CD-RISC-10) and sense of danger using the Solomon & Prager scale. Statistical analyses included Kruskal-Wallis H test, multiple linear regression, two-way analysis of variance (ANOVA), and Sobel test for mediation effects.</p><p><strong>Results: </strong>The final sample included 161 physicians (54 southern, 56 central, 51 northern). The mean resilience score was 31.14 ± 5.77, and the mean sense of danger score was 8.36 ± 4.15 (scales 0-40 and 0-20, respectively). Physicians in the southern hospital reported significantly higher sense of danger scores (p = 0.005). A trend towards lower resilience scores was noted among southern hospital physicians (p = 0.068) (p = 0.068). Two-way ANOVA revealed significant main effects of hospital location and gender on resilience (p = 0.046 and p = 0.003, respectively) and sense of danger (p = 0.005 and p = 0.062, respectively). Multiple regression analysis identified hospital location (β = -0.178, p = 0.023) and gender (β = 0.229, p = 0.004) as significant predictors of resilience. Mediation analysis indicated that personal resilience partially mediated the relationship between hospital location and sense of danger (indirect effect = 0.2896, p < 0.001).</p><p><strong>Conclusions: </strong>Physicians working near conflict zones report higher levels of perceived danger, though their resilience is comparable to peers in less threatened regions. Enhancing personal resilience is crucial to mitigate the heightened sense of danger. This could include regular resilience training, psychological support, and specific programs for single and childless physicians to improve safety perceptions. Additionally, fostering a supportive community with clear communication and robust emergency protocols is essential for enhancing staff resilience and safety in hospitals.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"13 1","pages":"68"},"PeriodicalIF":3.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Israeli dentists' knowledge, attitudes, and practices regarding smoking cessation care.","authors":"Tamar Vishnevsky, Tal Aperman-Itzhak, Itzhak Tayeb, Yael Bar-Zeev","doi":"10.1186/s13584-024-00653-5","DOIUrl":"10.1186/s13584-024-00653-5","url":null,"abstract":"<p><strong>Background: </strong>The 5A's model for brief smoking cessation care (SCC) is recommended for dentists to reduce the negative impacts of smoking on oral health. This study investigates Israeli dentists' adherence to the 5A's guidelines and explores factors influencing their knowledge, attitudes, and practices.</p><p><strong>Methods: </strong>An online cross-sectional survey was conducted among Israeli dentists during June-August 2020. The questionnaire included sociodemographic, smoking, and professional characteristics; knowledge (10 true/false statements); attitudes regarding SCC [based on the Theoretical Domains Framework (TDF)] using 13 statements (1-5 Likert scale), for a composite mean attitude score; and 5A's performance (1-5 Likert scale, never to always). Two primary outcomes were analysed: (1) performing all of the 5A's 'often or always'; and (2) performing 'always' the first two steps (\"Ask\" and \"Advise\"). Multivariable logistic regression explored the association between the various characteristics and the primary outcomes.</p><p><strong>Results: </strong>Overall, n = 410 responded. Mean knowledge score was 2.58 (SD = 1.51). Mean attitude score was 2.65 (SD = 0.60). Performance of all 5A's was low with 14.1% (n = 57) reporting completing all 5A's 'often or always', while 34.1% (n = 139) reported 'always' performing 'Ask' and 'Advise'. Specialists had better odds of 'often or always' performing the 5A's (adjusted OR = 2.01, p = .022) and 'always' performing 'Ask and Advise' (adjusted OR = 1.71, p = .022).</p><p><strong>Conclusions: </strong>This study highlights the insufficient performance of SCC among Israeli dentists, revealing gaps in knowledge and attitudes related to SCC. Various measures, such as training, automatic referral systems, and integrating SCC as quality measures, may improve SCC provision among Israeli dentists.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"13 1","pages":"66"},"PeriodicalIF":3.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Motivations of Israeli physicians to return, or not, to Israel after their fellowship abroad.","authors":"Lior Seluk, Daniel Weltsch, Gadi Segal, Mayan Gilboa","doi":"10.1186/s13584-024-00652-6","DOIUrl":"10.1186/s13584-024-00652-6","url":null,"abstract":"<p><strong>Background: </strong>Emigration of healthcare professionals, particularly physicians, is an unresolved \"pandemic\", influenced by various factors. In high-income countries, the training phase (fellowship) abroad is critical for career development, yet it poses challenges for the retention of these professionals upon their completion of training. This study aimed to identify the determinants influencing Israeli physicians' decisions to return to their home country after completing fellowship training abroad.</p><p><strong>Methods: </strong>This cross-sectional study conducted in early 2024, surveyed Israeli physicians with post-graduate training who pursued a fellowship abroad between 2013 and 2024. An anonymous survey included questions on demographics, training experience, and professional challenges. Analytical methods included descriptive statistics and regression analysis to explore factors associated with the decision to return.</p><p><strong>Results: </strong>Of the 323 individuals surveyed, 297 met the inclusion criteria. Among them, 141 (47.5%) have returned to Israel, while 156 (52.5%) currently reside abroad, 48 (31%) of them have completed their fellowship. Respondents identified several challenges, beginning with a complex application process prior to fellowship (47% stated this as a major challenge), substantial financial burdens averaging 35,546 USD in direct out-of-pocket expenses during, and job uncertainty, with only 55% having secured positions upon return. Of the 156 Israeli fellows still abroad, 107 (69%) reported medium to low confidence in returning. Factors associated with a higher likelihood of confidence in returning to Israel included a secured job position upon return (OR 8.6, 95% CI 3.1-28.9) and having an opportunity for a position that would utilize the skills gained during the fellowship (OR 3.5, 95% CI 1.3-10.2).</p><p><strong>Conclusion: </strong>The decision to return to Israel after a fellowship abroad is influenced by a mix of professional, personal, and geopolitical factors. To counteract the critical issue of brain drain, it is essential to enhance occupational certainty for returning physicians. These findings highlight the urgent need for healthcare policies that provide robust support for returning professionals and address their specific challenges.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"13 1","pages":"65"},"PeriodicalIF":3.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidnapping-Induced Trauma and secondary stress in armed conflicts: a comparative study among women in hostage families, volunteers, and the General Population.","authors":"Shahar Livne, Ilana Feldblum, Sara Kivity, Naama Shamir-Stein, Einat Brand, Shir Cohen, Eran Rotman, Hagai Levine, Mor Saban","doi":"10.1186/s13584-024-00650-8","DOIUrl":"10.1186/s13584-024-00650-8","url":null,"abstract":"<p><strong>Background: </strong>Exposure to armed conflict negatively impacts health. However, there is limited data on secondary stress from ambiguous loss contexts, such as kidnapping. In this study we aimed to quantify changes in modifiable health behaviors and well-being among women in hostage families and hostage crisis volunteers versus the general female population within the first two months of the 2023 Israel-Hamas war.</p><p><strong>Methods: </strong>A cross-sectional online survey was conducted on 318 Hebrew-speaking women aged 18-75 in Israel comparing: (1) a general population sample (n = 245); (2) hostage crisis volunteers (n = 40); and (3) hostage family members (n = 33). Participants provided demographic information, details on chronic illnesses, and responded to Likert-scale questions covering self-rated health, mental health, and lifestyle habits before the conflict and in current state.</p><p><strong>Results: </strong>Hostage family members reported the most severe health impacts, followed by volunteers. Fair/poor physical health status increased significantly in all groups during the war, with hostages' families reporting the highest rate (61.6%). Mental health deterioration was more pronounced among hostages' families, with 84% expressing a need for mental health support. Hostages' families also reported the highest rates of sleep problems, reduced adherence to a healthy lifestyle, and weight loss. Mental and physical health declined significantly across the exposed groups, as measured by multiple assessments, with hostage families experienced the most pronounced impairments across various domains of well-being.</p><p><strong>Conclusions: </strong>This period of conflict severely harmed the well-being of all women in the study population. Women from all three groups - hostage families, volunteers, and those from the general population - experienced health deterioration due to varying levels of stress and exposure to conflict-related factors. Hostage families faced the greatest impact with nearly all members of this group showing significant health damage. Long-term support is needed to help restore post-conflict health for all affected women. Further research may be needed to determine the most effective interventions for addressing these impacts across the different groups.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"13 1","pages":"64"},"PeriodicalIF":3.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11533335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A prediction model of PTSD in the Israeli population in the aftermath of october 7th, 2023, terrorist attack and the Israel-Hamas war.","authors":"Dana Katsoty, Michal Greidinger, Yuval Neria, Aviv Segev, Ido Lurie","doi":"10.1186/s13584-024-00644-6","DOIUrl":"10.1186/s13584-024-00644-6","url":null,"abstract":"<p><strong>Background: </strong>On October 7th, 2023, a mass terror attack was launched by Hamas militants, which was followed by the Israel-Hamas war. These events constitute a nationwide trauma with major ramifications for public mental health. This article presents an evidence-based model for the prediction of the prevalence of posttraumatic stress disorder (PTSD) related to the terrorist attack and the war.</p><p><strong>Main body: </strong>The creation of the model consisted of several steps. Firstly, the Israeli population was divided into six groups based on the intensity, context, and type of traumatic exposure (direct exposure to terror, close proximity to terror, soldiers in combat and support units, intense exposure to rocket attacks, moderate exposure to rocket attacks, and indirectly affected communities), and the population size of each group was assessed using official national databases. Secondly, an estimation of the expected prevalence of PTSD in each of the exposure groups was based on a review of the relevant literature. A random-effects meta-analysis of the prevalence rates was conducted separately per each exposure group. Finally, the predicted number of PTSD causalities in the population was calculated by multiplying the group size and the PTSD prevalence estimation. Based on population size and estimated PTSD prevalence within each exposure category, the model predicts that approximately 5.3% (N = 519,923) of the Israeli population (95% confidence interval, 1.64-9%), may develop PTSD as a result of the terrorist attack and the war.</p><p><strong>Conclusions: </strong>The predicted number of individuals with PTSD following mass trauma is expected to be considerable. The presented model can assist policymakers, clinicians, and researchers in preparing and devising adequate interventions for the mental health needs of large populations. Moreover, this model can be applied in other instances of mass-trauma exposure.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"13 1","pages":"63"},"PeriodicalIF":3.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Israeli clinical trials registration \"MyTrial\".","authors":"Anat Engel, Ornit Cohen","doi":"10.1186/s13584-024-00643-7","DOIUrl":"10.1186/s13584-024-00643-7","url":null,"abstract":"<p><strong>Background: </strong>Clinical trial registration is critical for research transparency and integrity. Since 2005, the Declaration of Helsinki has required prospective registration of trials before subject recruitment. In Israel, the MyTrial registry was established in 2015 to register interventional trials and became mandatory in 2016 for ethical approval. The study aimed to analyze the registration practices, challenges, and trends in clinical trial registration in Israel using the local registry \"MyTrial\".</p><p><strong>Methods: </strong>A total of 3,895 clinical trial records from 2011 to December 2022 were retrieved from the MyTrial platform and subjected to descriptive analysis.</p><p><strong>Results: </strong>A significant increase occurred from 2016 to 2021 due to mandated registration, with a peak in 2020 (733 trials) and a decrease in 2022 (462 trials), likely due to COVID-19. Most of the trials included drugs (56%) or medical devices (33%). Geographically, 53% were from central Israel. Only 39% of the patients were registered at both MyTrial and ClinicalTrials.gov. 65% had no blinding. 47% featured unregistered products. 56% had not started recruitment. Since 2016, the number of advanced therapy trials has steadily increased, reaching 19 in 2022. There are gaps between registered trials and official government reports.</p><p><strong>Conclusion: </strong>These findings provide valuable insights into the current landscape of clinical trial registration in Israel and highlight the need for improvements in compliance with prospective registration and adherence to the WHO-ICTRP standards.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"13 1","pages":"62"},"PeriodicalIF":3.5,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11515498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescription opioid use in Israel - the tide has risen, but it's not a tidal wave.","authors":"Yehuda Neumark, Paola Rosca","doi":"10.1186/s13584-024-00648-2","DOIUrl":"10.1186/s13584-024-00648-2","url":null,"abstract":"<p><p>The devastating human and financial costs of the ongoing global opioid crisis underscore the need for comprehensive public health strategies, effective treatment programs, and robust policy interventions to mitigate its impact. Regarding Israel, numerous reports highlight a steady increase since 2000 in prescription opioid use and the shift to more potent opioids particularly fentanyl, particularly among more marginalized population groups. In response to growing concern in the country about the rise in prescription opioid use and the consequential risk of opioid use disorder, the Israeli government, together with the country's health service providers, implemented a series of measures to monitor and regulate opioid prescriptions and balance the need for effective pain management with the prevention of opioid abuse and its associated harms. A national opioid data monitoring system is being established, alongside the provision of addiction training for health professionals, the integration of treatment services for opioid use disorder into the nationalized primary healthcare system, and the expansion of harm reduction strategies to mitigate the health risks associated with opioid use. Additional funding for opioid-related research, and for the broader fields of addictions and mental health, is vital. In conclusion, the sum of the evidence suggests that Israel is not facing an \"opioid crisis\" Continued commitment, resources, and innovative approaches will be crucial to ensure that the rising tide of opioid use in Israel, particularly during and in the aftermath of the ongoing war, will not become a tidal wave.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"13 1","pages":"60"},"PeriodicalIF":3.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11468429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"School health services in the Southern District of Israel-between privatization and nationalization.","authors":"Tzion Dadon, Ya'akov M Bayer, Anat Rosenthal, Michael Gdalevich","doi":"10.1186/s13584-024-00647-3","DOIUrl":"https://doi.org/10.1186/s13584-024-00647-3","url":null,"abstract":"<p><strong>Background: </strong>For decades, Israel's economic policy has favored either outsourcing or privatization of public services, including healthcare, generating an ongoing and prolonged debate of this approach. In 1997 school health services (SHS) for elementary and middle school pupils was outsourced to a sub-contractor firm, reducing budget, but also standards, for nurses and physicians. Consequently, the service has dwindled and was focused more and more on vaccinations. Between 2007 and 2012, under full private contractor delivery, SHS quality diminished substantially, leading to a significant decline in vaccination coverage in the Southern District. In 2012, a decision was made to return SHS to state control.</p><p><strong>Methods: </strong>This study analyzes the delivery parameters of SHS between the period when the service was operated by a private contractor from 2011to 2/2012, and the subsequent provision of the service directly by Ministry of Health (MoH) between 3/2012 and 2013. We compared the rates of vaccination coverage, screening tests and health education programs.</p><p><strong>Results: </strong>A statistically significant increase in SHS delivery for vaccinations and screening was observed in the Southern District of MoH after the transfer of service from contractor. The increase was variable in different population subgroups, and especially notable in the Bedouin schools of the District, where the MMRV vaccination rose from 19.3% to 96.8%. However, a substantial and significant reduction in health education activities was also noted, overall from 24.9% to 5.0%.</p><p><strong>Conclusions: </strong>The findings suggest that substantial benefits can be derived from direct provision of SHS by MoH and its regional offices, especially in the areas of reduced accessibility and lower socio-economic status. The case study of SHS in the Southern District of Israel can serve as an important example highlighting the impacts of privatization vs nationalization, with potential implications in other fields. These insights should be integral to future discussions of healthcare service provision.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"13 1","pages":"59"},"PeriodicalIF":3.5,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty; Time for Global Action : Commentary on \"Frailty and its Association with Long-Term Mortality among Community-Dwelling older adults aged 75 years and Over\".","authors":"Yotam Weiss, Idit Matot","doi":"10.1186/s13584-024-00646-4","DOIUrl":"10.1186/s13584-024-00646-4","url":null,"abstract":"<p><p>This commentary examines the study \"Frailty and Its Association with Long-Term Mortality Among Community-Dwelling Older Adults Aged 75 Years and Over\" by Lewis et al. The retrospective cohort study utilized data from a primary healthcare provider in Israel to investigate frailty using the Frailty Index (FI) and its correlation with long-term mortality. Nearly half of the older adult cohort was identified as frail, with a strong association between higher frailty levels and increased mortality risk. The commentary emphasizes the importance of routine frailty screening in clinical practice and health policy. Integrating FI calculations into electronic health records can facilitate timely care for high-risk individuals. However, presenting frailty data must be managed carefully and in conjunction with patients' preferences to avoid stigmatizing and negatively influencing clinical decisions. While the FI is a valuable tool, it should complement, not replace, other assessments that provide a more holistic view of the patient's health. Furthermore, the commentary strongly advocates for a more comprehensive approach to patient care, emphasizing that non-geriatricians must also be proficient in recognizing and managing frailty. Effectively addressing frailty can lead to significant cost savings for healthcare systems, reduced burden on healthcare facilities, and decreased need for long-term care.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"13 1","pages":"57"},"PeriodicalIF":3.5,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11451099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of legal representation on clinical measures in involuntarily admitted psychiatric patients: a retrospective study.","authors":"Yaacov Cohen, Ariel L Bendor, Roy Gilbar, Orly Cohen, Razek Khawaled, Arieh Dienstag, Amit Lotan, Omer Bonne","doi":"10.1186/s13584-024-00633-9","DOIUrl":"10.1186/s13584-024-00633-9","url":null,"abstract":"<p><strong>Background: </strong>Most western countries provide funded legal representation (LR) for involuntarily admitted psychiatric patients appearing before judicial committees. In 2004, an amendment to the Israeli Mental Health Act granted this right to involuntarily committed psychiatric patients. Psychiatrists then voiced concerns that LR may increase rates of premature discharge and compromise patients' safety and well-being. These worries have not been sufficiently addressed to date. This study aimed to provide answers to their concerns.</p><p><strong>Methods: </strong>This study included 3124 and 3434 inpatients involuntarily admitted to psychiatric facilities in 2000 and in 2010 (respectively), prior to and after the introduction of LR in Israel. Data were acquired from the Israeli National Psychiatric Hospitalization Registry. Clinical measures included percentage of discharges by the District Psychiatric Board (DPB), duration of involuntary hospitalization and rates of readmissions within thirty days and six months of discharge by treating psychiatrists (TP) or DPB.</p><p><strong>Results: </strong>The odds ratio (OR) of discharge by a DPB in 2010 (n = 221) compared to 2000 (n = 93) was 2.2 [95%CI 1.72-2.82]. The OR was similar for readmissions within thirty days or six months among patients discharged by TP and a DPB (OR = 1.08, p = 0.697 and OR = 0.92, p = 0.603, respectively) as well as between the two time points (p = 0.486 and p = 0.618). The duration of hospitalizations terminated by a DPB was significantly shorter than those terminated by TP, with no difference between the study time points. The mean hospitalization duration in 2010 was 21% shorter compared to 2000 among patients discharged by TP.</p><p><strong>Conclusions: </strong>The number of DPB proceedings and the number of involuntarily hospitalized psychiatric patients discharged by DPBs increased considerably after the advent of state-funded legal representation in 2004. We found that this did not compromise beneficence and non-malfeasance of patient care. Our results emphasize the feasibility of affording even the most severely mentally ill patients the rights to due process. These findings may relieve concerns about state-funded LR procedures in involuntary psychiatric hospitalizations.</p>","PeriodicalId":46694,"journal":{"name":"Israel Journal of Health Policy Research","volume":"13 1","pages":"58"},"PeriodicalIF":3.5,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11448244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}