Health Policy and Technology最新文献

{"title":"Predicting the utilization of healthcare services during COVID-19 - forecasting models based on routine data","authors":"Marco Alibone,&nbsp;Marion Ludwig,&nbsp;Christina Simantiri,&nbsp;Josephine Jacob,&nbsp;Dirk Enders","doi":"10.1016/j.hlpt.2025.101030","DOIUrl":"10.1016/j.hlpt.2025.101030","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic has significantly impacted global healthcare systems through the prioritisation of COVID-19 cases and the reallocation of resources, leading, for example, to a postponement of elective procedures. This study quantifies the impact of the COVID-19 pandemic on healthcare utilization in 2020 and 2021.</div></div><div><h3>Methods</h3><div>Forecasting models were trained using data from the pre-pandemic years 2013 to 2019. The most suitable model was used to predict a trend in healthcare utilization unaffected by the pandemic in the two pandemic years. Deviations between observed and predicted utilization were interpreted as the pandemic impact on healthcare.</div></div><div><h3>Results</h3><div>During the COVID-19 pandemic, all-cause hospitalizations declined across the first three waves. The first drop occurred in April 2020, with hospitalization rates falling to 1.7 times below expected pre-pandemic levels. A second drop began in November 2020, reaching 1.4 times below expected levels by January 2021. Hospitalizations returned to pre-pandemic levels after strict lockdown measures eased. These declines affected elective procedures but also life-threatening conditions, such as myocardial infarctions (MI). In March and April 2020, admissions for these events were 1.29 times below expected levels. By July 2020, however, MI hospitalization increased, reaching 0.87 times higher than typical pre-pandemic rates.</div></div><div><h3>Discussion</h3><div>We investigate for the first time the impact of the pandemic on healthcare in Germany using modern forecasting methods showing delayed hospitalizations for acute conditions like MI. Findings highlight the need to protect vulnerable groups and underscore the importance of further research on long-term health impacts and improved public health responses.</div></div><div><h3>Lay summary</h3><div>The COVID-19 pandemic has significantly disrupted healthcare provision by prioritising COVID-19 cases over other conditions, leading to postponement of interventions and reduced care for serious problems such as myocardial infarctions (MI). This study examined healthcare utilization in Germany in 2020–2021 by comparing observed hospitalisations with predicted values based on pre-pandemic trends from 2013–2019. The results showed a sharp decline in hospitalisations during the first three pandemic waves. In April 2020, hospital admissions fell to almost half the expected level, with a second decline at the end of 2020. Normalisation only set in when the lockdown measures were lifted. Crucially, admissions for life-threatening conditions such as MI also fell temporarily, showing a time lag in hospital admissions. This analysis emphasises the importance of ensuring access to healthcare for critical illnesses, even in times of pandemic, to reduce negative health impacts and improve the resilience of healthcare in future crises.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 3","pages":"Article 101030"},"PeriodicalIF":3.4,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Red yeast rice supplement consumption and health hazards in Japan–what role is desired for community pharmacists?","authors":"Yosuke Nomura ,&nbsp;Yoshitaka Nishikawa ,&nbsp;Shota Suzuki ,&nbsp;Chiho Kaneko ,&nbsp;Hiroshi Okada","doi":"10.1016/j.hlpt.2025.101029","DOIUrl":"10.1016/j.hlpt.2025.101029","url":null,"abstract":"<div><div>Sales of health foods are soaring globally as health awareness increases. In Japan, health foods fall into four categories, including those with functional claims backed by scientific evidence. However, in March 2024, concerns about dietary supplements, notably the \"Beni-koji (Red Yeast Rice) choleste help^Ⓡ\" produced by KOBAYASHI Pharmaceutical Co., Ltd., sparked a loss of consumer confidence, linked to serious health issues, including five deaths. To prevent future incidents, enhanced health communication on supplement regulation, efficacy, and safety is crucial. Both the Japanese government and citizens need to reassess regulations, stressing the importance of adequate oversight in product development and evidence-based information maintenance. Moreover, healthcare professionals, particularly pharmacists, play pivotal roles in safeguarding the public against dietary supplement harms by offering empathetic support based on reliable information.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 3","pages":"Article 101029"},"PeriodicalIF":3.4,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dimensions and criteria of value assessment frameworks for generic drugs: A scoping review and thematic analysis","authors":"Zhisan He ,&nbsp;Xiaoyi Chen ,&nbsp;Shunlong Ou ,&nbsp;Qian Jiang ,&nbsp;Xiaoli Qin","doi":"10.1016/j.hlpt.2025.101025","DOIUrl":"10.1016/j.hlpt.2025.101025","url":null,"abstract":"<div><h3>Objectives</h3><div>Although generic drugs offer comparable patient benefits and cost advantages to original drugs and are widely utilized in emerging nations, concerns persist regarding their product quality, bioequivalence, and clinical outcomes. Additionally, there is a lack of consensus on the value assessment for generic drugs, particularly in determining whether lower prices correspond to equivalent value. Our objective is to systematically describe and contrast the prevailing tools, scales, frameworks and etc. for assessing generic drugs, while integrating their core dimensions and criteria as a reference for emerging nations. Methods: This study systematically reviewed evaluation tools, scales, and frameworks etc. for generic or off-patent drugs. Given that meta-analysis is limited to qualitative research, thematic analysis was employed to comprehensively synthesize the primary concepts of generic drug evaluation. The literature search was conducted using PubMed, EMbase, CNKI, and WanFang Data, with a cut-off date of July 25, 2024. Additionally, thematic analysis was conducted to identify themes and subthemes related to the evaluation of generics across the included records. Results: A total of nine evaluation tools, scales, and frameworks for generic drugs were included in this study. Variations were observed in their dimensions, criteria, application procedures, and methods of calculating criteria weights among participants. Ultimately, four core themes and 16 subthemes for the evaluation of generics were synthesized through thematic analysis. Conclusions: The four themes and sixteen subthemes can be regarded as primary dimensions and criteria for evaluating the value of generic drugs. They serve as a benchmark for value assessment frameworks, thereby promoting advancements in healthcare systems in regions where generic drugs are widely utilized.</div></div><div><h3>Public Interest Summary</h3><div>Although generic drugs provide comparable patient benefits and cost advantages to original drugs and are widely used in emerging nations, concerns persist regarding their product quality, bioequivalence, and clinical outcomes. Our objective is to systematically describe and contrast the prevailing tools, scales, frameworks, and other relevant methodologies for assessing generic drugs, while integrating their core dimensions and criteria. This study incorporates a total of nine evaluation tools, scales, and frameworks for generic drugs, synthesizing them into four core themes and 16 subthemes for the evaluation of generics. These four themes and sixteen subthemes can be regarded as primary dimensions and criteria for assessing the value of generic drugs. They serve as a benchmark for value assessment frameworks, thereby promoting advancements in healthcare systems in regions where generic drugs are widely utilized.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 3","pages":"Article 101025"},"PeriodicalIF":3.4,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appropriateness of the percutaneous coronary intervention technical fee in Japan","authors":"Satoru Hashimoto ,&nbsp;Yoshihiro Motozawa ,&nbsp;Burt Cohen ,&nbsp;Toshiki Mano","doi":"10.1016/j.hlpt.2025.101026","DOIUrl":"10.1016/j.hlpt.2025.101026","url":null,"abstract":"<div><h3>Objectives</h3><div>In Japan, reimbursements of technical fees for percutaneous coronary intervention (PCI) are not considered to reflect actual medical costs, since medical procedures frequently cost hospitals more than they make. This study evaluated the appropriateness of PCI technical fees in Japan as part of reimbursed medical fees.</div></div><div><h3>Methods</h3><div>We estimated the PCI technical fee’s validity from three approaches including 1) costing calculation, 2) survey-based cost estimation, and 3) lost profit methods.</div></div><div><h3>Results</h3><div>For the costing calculation method, we used the draft proposal that is evaluated by the Japanese Health Insurance Federation for Surgery (Gaihoren draft proposal). The proposal indicated PCI technical fees of ¥727,997 for acute myocardial infarction (AMI) and ¥596,397 for unstable angina (UA). For the survey-based cost estimation method, a survey of cardiologists showed the appropriateness of ¥814,600 and ¥554,825 for AMI-PCI and UA-PCI, respectively, while the lost profit method evaluated AMI-PCI at ¥812,210 and UA-PCI at ¥773,961. The average costs of technical fees calculated according to the three approaches were ¥772,186 for AMI-PCI and ¥566,688 for UA-PCI, which are higher than the existing reimbursements of ¥343,800 and ¥243,800, respectively.</div></div><div><h3>Conclusion</h3><div>The present study showed that technical fees for PCI did not reflect estimated costs in three approaches. The majority of hospitals in Japan are operating at a loss for medical profit, and these results call into question, the need for a review of the healthcare costs reimbursed by the government.</div></div><div><h3>Lay summary</h3><div>In Japan, reimbursement prices of percutaneous coronary intervention (PCI) technical fees are considered to be lower than the actual cost, which can translate to losses for hospitals, especially when complex PCI procedures are performed. We estimated the appropriateness of technical fees using three approaches including 1) costing calculation, 2) survey-based cost estimation, and 3) lost profit methods. The results confirmed that technical fees, which form the core of medical fees, do not reflect estimated costs. It was suggested that this discrepancy has led to a deficit in the structure of Japanese hospitals.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 3","pages":"Article 101026"},"PeriodicalIF":3.4,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness, use and implementation of telehealth solutions for CHF and COPD: A systematic review using the PRISMA method","authors":"Ofir Ben-Assuli","doi":"10.1016/j.hlpt.2025.101023","DOIUrl":"10.1016/j.hlpt.2025.101023","url":null,"abstract":"<div><h3>Background</h3><div>According to leading health organizations such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), telehealth applications have the potential to improve patients' health, particularly for the billions of patients suffering from chronic diseases such as Congestive Heart Failure (CHF) and Chronic Obstructive Pulmonary Disease (COPD). While telehealth solutions hold promise, there is currently inadequate clinical evidence supporting their use in public health surveillance and home-based care, making it difficult to draw decisive conclusions.</div></div><div><h3>Objective</h3><div>The objective of this work was to evaluate the cost-effectiveness, use, and implementation of telehealth solutions for patients with chronic diseases, specifically CHF and COPD, through a review of the current literature. This narrative review examined studies presenting cost-effectiveness analyses, use, and implementation of telehealth for these patients.</div></div><div><h3>Methods</h3><div>This work implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In order to receive recency and to examine recent and innovative telehealth solutions, articles published in English from 2010 to 2023 were included in the search. The inclusion criteria were papers on telehealth tools employed for CHF and COPD patients that assessed their cost-effectiveness.</div></div><div><h3>Results</h3><div>The majority of the studies were conducted in Europe. Approximately half had an adequate sample size and tracked patients prospectively for a sufficient duration. The most frequently used telehealth method was distance monitoring, with only a few studies incorporating home visits or phone calls. The parameters monitored included blood pressure, oxygen saturation, heart rate, and spirometry, among others. General statistical analyses and regression models were the most frequently used methods, although several studies incorporated Markov models and simulations.</div></div><div><h3>Discussion</h3><div>The majority of the papers (20 out of 26) concluded that the tools implemented led to either cost-effectiveness, cost-savings or strongly dominance. This promising result shows that telehealth is an important topic that deserves further research on its effectiveness as well as cost-effectiveness for chronic disease management.</div></div><div><h3>Limitations</h3><div>One key limitation of this PRISMA review is that the literature search was restricted to two major diseases, and the language of the publications was exclusively English. Thus, the generalizability of the findings to other chronic diseases is subject to caution.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 3","pages":"Article 101023"},"PeriodicalIF":3.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The challenge of telemedicine – using SWOT methodology and value-based assessment to analyze barriers, incentives and opportunities: Opening the digital doors to expand access and health equity","authors":"Yigal Chechik ,&nbsp;Michal Bitan ,&nbsp;Orna Tal","doi":"10.1016/j.hlpt.2025.101022","DOIUrl":"10.1016/j.hlpt.2025.101022","url":null,"abstract":"<div><h3>Objective</h3><div>Telemedicine can enhance efficiency and accessibility to high-quality care. Moreover, it can improve satisfaction by increasing the responsiveness of medical professionals, expert consultation and multidisciplinary meetings, especially in an era of a pandemic. During 2020, ambulatory care was dramatically reduced, and while telemedicine emerged as the only method of delivering care, we witnessed variability among physicians in the implementation of telemedicine. In order to identify leading themes to assess the successful implementation of telemedicine, we used SWOT (strengths, weaknesses, opportunities and threats) methodology that enables management of positions on the assimilation of technology.</div></div><div><h3>Materials and Methods</h3><div>A structured questionnaire was distributed in a controlled manner to all the teams that were involved in hospital ambulatory clinics (HAC).</div></div><div><h3>Results</h3><div>Out of 306 workers directly involved in HAC telemedicine, 146 replied (48 % response rate). The professional distribution of the responders was: 75 physicians (56 % specialists, 40 % medical directors), 51 nurses (51 % of them in managerial positions) and 20 administrators. Using SWOT analysis, we identified that the most positive influential factor to telemedicine implementation was improving accessibility, and the main barrier was the lack of sufficient physical examination. Nurses and administrators scored higher on telemedicine opportunities (<em>P</em> = 0.048), threats (<em>P</em> &lt; 0.001) and technological added value (<em>P</em> = 0.001). The multivariable model showed that when the participant was more experienced, telemedicine was less perceived as a weakness and considered less threatening.</div></div><div><h3>Conclusions</h3><div>We found significant differences in perceptions toward telemedicine regarding threats and opportunities. Improving access to care, bridging the digital technology gap and preventing infections were all scored as the most important factors to accelerate implementation. SWOT analysis offers a wise methodology to assess the impact of change while many factors and stakeholders are involved. Additional analysis by value-based assessment elements (VBAE) revealed that &gt;40 % of the users declared that improving \"professionalism\" was a major principle that added value and incentive to favor telemedicine.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 3","pages":"Article 101022"},"PeriodicalIF":3.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volume-cost relationship in Pancreatic Surgery: A scoping review","authors":"Nashmil Ghadimi ,&nbsp;Alireza Olyaeemanesh ,&nbsp;Ali Akbar Fazaeli ,&nbsp;Rajabali Daroudi ,&nbsp;Sara Kaveh","doi":"10.1016/j.hlpt.2025.101020","DOIUrl":"10.1016/j.hlpt.2025.101020","url":null,"abstract":"<div><h3>Objectives</h3><div>To synthesize evidence on the volume-cost relationship (VCR) in pancreatic surgery, focusing on the impact of hospital and surgeon volumes on economic indicators.</div></div><div><h3>Methods</h3><div>A scoping review was conducted using PubMed, Web of Science, and Scopus to identify studies published from inception to November 30, 2024, to ensure a comprehensive and unbiased review of all relevant studies. The PRISMA-ScR framework guided data extraction, focusing on hospital and surgeon volumes in relation to costs, length of stay (LOS), resource utilization, and readmissions. The metrics included cost definitions, volume thresholds, and economic indicators. Studies that analyzed the economic impact of centralization in pancreatic surgery were included.</div></div><div><h3>Results</h3><div>Twenty-two studies (1996–2024), primarily from the United States, were included. Pancreaticoduodenectomy was the most studied procedure. High-volume Hospitals (HVHs) consistently demonstrated reduced costs, shorter LOS, lower resource utilization, and higher discharge-to-home rates compared to low-volume hospitals (LVHs). Cost reductions were attributed to enhanced efficiency and fewer complications. However, there was significant variability in volume thresholds and limited use of cost-effectiveness analyses (CEAs). Few studies addressed broader societal costs, such as productivity losses or caregiver burden.</div></div><div><h3>Conclusions</h3><div>Centralizing pancreatic surgeries in HVHs offers clear economic impact through improved efficiency and outcomes. Addressing gaps in standardized volume definitions, incorporating socioeconomic factors, and expanding CEAs are critical for optimizing resource allocation and ensuring equitable and cost-effective care. Future research should focus on these areas to inform better health policies.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 3","pages":"Article 101020"},"PeriodicalIF":3.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143943148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Societal preferences for prioritizing patients suffering from breast cancer, deafness, or knee arthrosis for scarce surgical capacity","authors":"Vivian Reckers-Droog ,&nbsp;Anouk van Alphen ,&nbsp;Saskia Knies ,&nbsp;Robert Baatenburg de Jong ,&nbsp;Thomas Reindersma","doi":"10.1016/j.hlpt.2025.101021","DOIUrl":"10.1016/j.hlpt.2025.101021","url":null,"abstract":"<div><h3>Objective</h3><div>Constraints on surgical capacity due to budgetary and workforce shortages necessitate prioritization. Lessons learned from the COVID-19 pandemic emphasize the societal debate around these decisions and stress the need to align decisions with societal preferences. This study examines societal preferences for prioritizing patients with three conditions—breast cancer, deafness, or knee arthrosis—for scarce surgical capacity.</div></div><div><h3>Methods</h3><div>We conducted a labelled discrete choice experiment among 1,046 members of the Dutch public. Respondents completed 14 choice tasks in which they prioritized patients for surgery, based on their condition, age, health-related quality of life (HRQOL) before and after surgery, and waiting time until surgery. We used conditional logit, multinomial logit, and latent class models to examine (heterogeneity in) respondents’ preferences.</div></div><div><h3>Results</h3><div>Respondents were more likely to prioritize patients suffering from breast cancer over those with knee arthrosis or deafness. They also prioritized patients with lower levels of HRQOL before surgery, larger surgery-related increases in HRQOL, and longer waiting times. They were less likely to prioritize patients who were older, except in the case of deafness. Observed preference heterogeneity largely resulted from differences in preference strength, rather than direction.</div></div><div><h3>Conclusions</h3><div>Our results provide insight into societal preferences for prioritizing patients with different conditions for surgery. This insight aids in understanding public outcry that may follow deviating decisions. Aligning prioritization decisions with societal preferences may increase the legitimacy of such decisions. Further research may examine the relevance of these preferences for physicians and their willingness to be guided by evidence on societal preferences.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 3","pages":"Article 101021"},"PeriodicalIF":3.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143918345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The psychology of vaccine uptake: Beyond information to action","authors":"Y. Tony Yang","doi":"10.1016/j.hlpt.2025.101019","DOIUrl":"10.1016/j.hlpt.2025.101019","url":null,"abstract":"","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 3","pages":"Article 101019"},"PeriodicalIF":3.4,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The facilitating and hindering factors of pre-implementation phase in establishment of clinical decision support systems: A systematic review and meta synthesis","authors":"Erfan Shakibaei Bonakdeh ,&nbsp;Amrik Sohal ,&nbsp;Vida Kardan Moghadam ,&nbsp;Koorosh Rajabkhah ,&nbsp;Daniel Prajogo ,&nbsp;Angela Melder ,&nbsp;Quy Nguyen ,&nbsp;Gordon Bingham ,&nbsp;Erica Tong","doi":"10.1016/j.hlpt.2025.101014","DOIUrl":"10.1016/j.hlpt.2025.101014","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Clinical decision support systems (CDSS) are increasingly adopted in healthcare; however, their success and uptake among healthcare workers vary significantly across different contexts. This systematic review aims to identify and synthesise literature on the facilitating and hindering factors influencing the establishment of CDSS during the pre-implementation phase in hospital settings.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Five major databases were searched for relevant studies published from January 2010 to July 2024. All steps, including screening, data extraction, quality appraisal, and synthesis, were conducted independently by two authors. The quality appraisal used the JBI checklist for qualitative studies [&lt;span&gt;&lt;span&gt;1&lt;/span&gt;&lt;/span&gt;]. Data on study characteristics and determinant factors were extracted, and a deductive meta-synthesis categorised these determinants into five dimensions of the Consolidated Framework for Implementation Sciences (CFIR). The grey literature was also searched for prospective studies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 12,010 papers were identified from the databases, of which 21 papers were systematically reviewed and synthesised. The data from the included studies were organised into five main themes based on the CFIR framework: Inner Setting, Intervention Process, Intervention Characteristics, Individual Characteristics, and Outer Setting.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Despite the longstanding existence of CDSS and extensive literature in this area, there is limited evidence on the determinants of CDSS from an implementation science perspective, particularly in less digitally developed healthcare systems. Moreover, existing literature lacks a focused analysis of the different phases of CDSS establishment (Adoption, Pre-implementation, Implementation, Maintenance, and Promotion). Future research should aim to develop a more granular understanding of the determinants influencing CDSS establishment across various contexts and phases.&lt;/div&gt;&lt;div&gt;Public summary&lt;/div&gt;&lt;div&gt;The healthcare sector is transitioning from paper-based medical records to the digitalisation of not only medical records but also all patient journey pathways. Clinical Decision Support Systems (CDSS) are one of the digital solutions designed to assist clinicians by reminding them of critical information essential for decision-making. However, many CDSS implementations have failed to achieve their intended purpose, resulting in minimal impact on expected outcomes.&lt;/div&gt;&lt;div&gt;In exploring the reasons for this, we found that the willingness and capacity of clinicians, managers, hospitals, and the healthcare sector as a whole are crucial determinants of CDSS success. The pre-implementation stage is particularly critical before rolling out any selected technology. During this phase, it is essential to customise the CDSS to align with internal processes, enhance IT capacities, engage clinicians in the ","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 3","pages":"Article 101014"},"PeriodicalIF":3.4,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}