Health Policy and Technology最新文献

{"title":"Willingness to pay for remote and self-monitoring: Comparing patients and non-patients in gestational hypertensive care","authors":"Marie-Lien Gerits,&nbsp;Samantha Bielen","doi":"10.1016/j.hlpt.2025.101071","DOIUrl":"10.1016/j.hlpt.2025.101071","url":null,"abstract":"<div><h3>Objectives</h3><div>Contingent valuation (CV) is widely used in health economics, as it enables the quantification of diverse benefits within a single monetary measure. However, a key methodological debate that remains underexplored is whether patients or non-patients should complete the CV task and how this choice may influence willingness to pay (WTP) estimates. This study aimed to investigate that question in the context of two home blood pressure (BP) monitoring approaches for pregnant women at risk of gestational hypertensive disorders, remote monitoring (RM) and patient self-monitoring (PSM). We also examined the role of patient status and treatment experience in shaping WTP.</div></div><div><h3>Methods</h3><div>The WTP of 199 patients and 222 non-patients was examined using a CV survey, combining a payment card and open-ended question. Propensity score matching analysis with regression adjustment assessed WTP differences between patients and non-patients. Subgroup analyses explored whether these differences were driven solely by being a patient or also by home BP monitoring experience.</div></div><div><h3>Results</h3><div>The mean WTP was €130 for RM and €85 for PSM. Patients exhibited a €31 higher WTP for RM compared to non-patients, a difference that was marginally significant at the 10 % level. This effect was driven by treatment experience status. We found no significant difference in WTP PSM between patients and non-patients.</div></div><div><h3>Conclusions</h3><div>Simply being a patient does not affect WTP for home BP monitoring. When patients have treatment experience, this can increase WTP compared to non-patients, but not for approaches for which the potential benefits are apparent without experiencing them, like PSM.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 6","pages":"Article 101071"},"PeriodicalIF":3.4,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144665891","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":"From accuracy to comprehensibility: Evaluating large language models for myopia patient queries","authors":"Ezgi Karataş ,&nbsp;Ceren Durmaz Engin","doi":"10.1016/j.hlpt.2025.101073","DOIUrl":"10.1016/j.hlpt.2025.101073","url":null,"abstract":"<div><h3>Objectives</h3><div>This study evaluated the accuracy and comprehensibility of responses from three large language models (LLMs)—ChatGPT-4, Gemini, and Copilot—when addressing patient queries about myopia. Accurate, understandable information is crucial for effective patient education and management of this common refractive error.</div></div><div><h3>Methods</h3><div>Sixty questions across six categories (definition, etiology, symptoms and diagnosis, myopia control, correction, and new treatments) were presented to ChatGPT-4, Gemini, and Copilot. Responses were assessed for accuracy by two experienced ophthalmologists using a 3-point Likert scale. Quality and reliability were evaluated using the DISCERN and EQIP scales, while readability was measured with the Flesch Reading Ease Score, Flesch-Kincaid Grade Level, and Coleman-Liau Index. Statistical analyses were conducted using SPSS version 25.</div></div><div><h3>Results</h3><div>ChatGPT-4 provided the most accurate responses in the defsinition, symptoms, and diagnosis categories, with a 75 % overall success rate. Copilot had a similar success rate of 73.3 % but the highest inaccuracy rate (6.7 %). Gemini had a 71.7 % success rate. Copilot scored highest in reliability (DISCERN 76) and readability (Flesch Reading Ease 46.74), followed by ChatGPT-4 and Gemini. No significant differences in accuracy were found among the LLMs across categories.</div></div><div><h3>Conclusions</h3><div>All three LLMs performed well in providing myopia-related information. Copilot excelled in readability and reliability despite a higher inaccuracy rate. ChatGPT-4 and Copilot outperformed Gemini, likely due to their advanced architectures and training methodologies. These findings highlight the potential of LLMs in patient education and the need for ongoing improvements to ensure accurate, comprehensible AI-generated health information.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 6","pages":"Article 101073"},"PeriodicalIF":3.4,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144696805","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":"Contributing factors of sentinel events involving medical devices: A cross-sectional retrospective human factors analysis","authors":"Mees Casper Baartmans ,&nbsp;Steffie Marijke Van Schoten ,&nbsp;Cordula Wagner","doi":"10.1016/j.hlpt.2025.101068","DOIUrl":"10.1016/j.hlpt.2025.101068","url":null,"abstract":"<div><h3>Background and objective</h3><div>Although most medical device applications in hospitals are safe and effective, in a small number of cases devices are involved in patient safety events causing serious unintended patient harm. These so-called sentinel events are thoroughly investigated by hospitals, with detailed event descriptions filed in reports. Studying these reports may help fill the knowledge gap on the latent contributing factors of sentinel events involving medical devices. This study aims to identify the contributing factors of sentinel events involving medical devices and how these factors lead to unintended patient harm.</div></div><div><h3>Design</h3><div>A cross-sectional retrospective analysis of 20 sentinel event reports involving medical devices from Dutch general hospitals, using a human factors approach and specific classification system for medical device related events.</div></div><div><h3>Results</h3><div>A total of 105 contributing factors were identified. For most events, factors relating to the operator (e.g., flaws in setting up and checking devices before use), device (e.g., design issues), infrastructure (e.g., poor environmental ergonomics) and patient (e.g., complicating anatomy) mutually contributed and interacted. Jointly these factors triggered events causing unintended patient harm.</div></div><div><h3>Conclusions</h3><div>In-depth analysis of reports of sentinel events using a human factors approach, showed the underlying patterns of interacting contributing factors leading to unintended patient harm. Sentinel events involving medical devices are triggered by an interplay of factors related to the operator, device, infrastructure, and patient. To prevent future patient harm, an integral approach addressing all these elements is needed.</div></div><div><h3>Public Interest Summary</h3><div>Medical devices can be involved in events leading to unintended patient harm in hospitals. We know little about the underlying factors contributing to such events. Therefore, 20 reports of events involving a medical device that led to serious patient harm were analysed in depth. In most events, the patient harm was triggered by factors relating to the operator of the device, the device itself, the organisation and environment in which the device was applied, and the patient to whom the device was applied. Jointly, these factors prompted the events and led to patient harm. The insights from this study can be used to further improve the safe application of medical devices in hospitals.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 6","pages":"Article 101068"},"PeriodicalIF":3.4,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144696804","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":"Use of standardised measurement instruments and technology among Flemish physiotherapists: a cross-sectional online survey on current practices, attitudes, and barriers","authors":"Jorn Ockerman ,&nbsp;Anke Van Bladel ,&nbsp;Jelle Saldien ,&nbsp;Hilde Van Waelvelde ,&nbsp;Lynn Bar-On","doi":"10.1016/j.hlpt.2025.101051","DOIUrl":"10.1016/j.hlpt.2025.101051","url":null,"abstract":"<div><h3>Objectives</h3><div>The aim of this study was to investigate the current levels of use and attitudes towards standardised measurement instruments and (rehabilitation) technology among physiotherapists in Flanders, Belgium.</div></div><div><h3>Methods</h3><div>This cross-sectional study used an open, online survey, accessible to physiotherapists working in Flanders.</div></div><div><h3>Results</h3><div>305 completed records were retrieved. Most respondents were female (73,8 %), had &gt;11 years of clinical experience (54,1 %), and treated &gt;10 patients per day (82,6 %). Less than half of the respondents (47,5 %) reported frequent use of standardised measurement instruments. Treating &lt;15 patients per day and working in a rehabilitation centre were significantly associated with frequent use of measurement instruments. Lack of time and added value were most often reported as perceived barriers for systematic implementation. Regarding technology, respondents reported to lack sufficient knowledge (40,7 %), with 36,7 % using no technology in their clinical practice. Having between 3–10 years of clinical experience and frequently treating neurological disorders were significantly associated with an increased use of technology. Lack of finances, knowledge, time and skills were the most frequently perceived barriers to the use of (rehabilitation) technology.</div></div><div><h3>Conclusion</h3><div>Frequent use of measurement instruments among Flemish physiotherapists appears to be relatively low and one in ten frequently alters the standardised administration. Though attitudes toward (rehabilitation) technology are positive, its adoption in clinical practice appears to be relatively low. Identified barriers include financial constraints, lack of knowledge, time and skills.</div></div><div><h3>Public interest summary</h3><div>This study investigated how frequently physiotherapists in Flanders, Belgium use standardized measurement instruments (which assess a patient’s health status) and technology during their patients’ treatment. We surveyed 305 physiotherapists and found that fewer than half regularly use measurement instruments. Those who treated fewer patients and worked in rehabilitation centres used these tools more often. Lack of time was most often reported as a barrier for frequent use of measurement instruments.</div><div>Concerning (rehabilitation) technology, many physiotherapists felt they didn't have enough knowledge about such devices and more than one in three used no technology in their clinical practice. Those with 3–10 years of professional experience and those who often treated neurological disorders were more likely to use technology. The biggest barriers to using technology were lack of money, knowledge, time, and skills.</div><div>Stimulating the use of both standardised measurement instruments and rehabilitation technology could yield benefits for both therapist and patient.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 5","pages":"Article 101051"},"PeriodicalIF":3.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604773","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 economic value of virtual primary healthcare services for rural populations: A systematic review","authors":"Digby Simpson ,&nbsp;Kabir Ahmad ,&nbsp;Md Parvez Mosharaf ,&nbsp;Bushra Farah Nasir ,&nbsp;Srinivas Kondalsamy-Chennakesavan ,&nbsp;Matthew McGrail ,&nbsp;Katharine A Wallis ,&nbsp;Khorshed Alam","doi":"10.1016/j.hlpt.2025.101067","DOIUrl":"10.1016/j.hlpt.2025.101067","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Virtual healthcare services are increasingly overcoming geographical barriers and improving access to primary healthcare, especially for rural populations. This systematic review evaluates the economic value of virtual healthcare interventions in rural primary healthcare settings.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocol guidelines. The search strategy included databases such as MEDLINE, PubMed, CINAHL, PsycINFO, and ECOLIT, covering studies published between January 31, 2010, and January 31, 2024. The quality of included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Fifteen studies met inclusion criteria. Studies were classified into cost–benefit analyses (&lt;em&gt;n&lt;/em&gt; = 2), cost analysis (&lt;em&gt;n&lt;/em&gt; = 4), and cost-effectiveness/cost-utility (&lt;em&gt;n&lt;/em&gt; = 9) studies. Five studies met over 70 % of CHEERS 2022 reporting criteria. Key findings include significant cost savings and improved cost-effectiveness for interventions targeting elderly populations, Indigenous populations, war veterans, and adults in general.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;The review highlights the economic value of virtual healthcare in rural primary healthcare settings, derived from cost savings and cost-effective service provision. However, inconsistencies in defining ‘virtual healthcare’, limited stakeholder engagement, and incomplete reporting of economic outcomes were identified. Future research should further consider the long-term sustainability, inclusion of younger populations, and wider stakeholder consultation in economic evaluations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Virtual healthcare is a cost-effective and sustainable solution for strengthening rural primary healthcare systems. Policymakers and healthcare providers are encouraged to scale up rural virtual healthcare models to bridge healthcare disparities and enhance equity in access to healthcare in rural settings.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Public Interest Summary&lt;/h3&gt;&lt;div&gt;This systematic review critically examined the economic value of virtual healthcare interventions within rural primary healthcare settings. Synthesis of evidence reveals the substantial cost savings and cost-effectiveness of rural virtual healthcare services, particularly for interventions targeting older adults, Indigenous communities, war veterans, and the general adult population.&lt;/div&gt;&lt;div&gt;The findings underscore the major economic advantages of integrating virtual healthcare into rural primary care services. However, it also highlights limitations, such as inconsistent definitions for ‘virtual healthcare’, insufficient engagement with diverse stakeholders, and incomplete reporting of economic outcomes. Future research should prioritise long-term sustainability, include younger ","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 5","pages":"Article 101067"},"PeriodicalIF":3.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144595675","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":"Enhancing in-hospital cardiac arrest outcomes through the Tele-ICU Model: A novel approach to CPR quality improvement in India","authors":"Sidney Hilker ,&nbsp;Vishwanath Koppad ,&nbsp;Lokesh MB ,&nbsp;Carl Britto ,&nbsp;Ryan CL Brewster","doi":"10.1016/j.hlpt.2025.101062","DOIUrl":"10.1016/j.hlpt.2025.101062","url":null,"abstract":"<div><h3>Introduction</h3><div>In-hospital cardiac arrest is a substantial cause of morbidity and mortality in low- and middle-income countries. Telemedicine intensive care units (Tele-ICUs) may expand critical care capacity, however their impact on cardiac arrest management and outcomes has not been well-defined.</div></div><div><h3>Methods</h3><div>A tele-ICU network established in India provides 24/7 multidisciplinary monitoring and management via real-time audiovisual technology. Between September 2022-November 2023, six partner hospitals underwent tele-ICU implementation and participated in a spaced advanced cardiac life support (ACLS) curriculum, tailored to tele-ICU workflows. The study period spanned from three months prior to the bedside ACLS training (“pre-intervention”) to six months following completion (“post-intervention”). The impact of the intervention on return of spontaneous circulation (ROSC) rates and overall hospital mortality was assessed with multivariable logistic regression and interrupted time series analysis.</div></div><div><h3>Results</h3><div>Among a total of 163 cardiac arrest events (<em>n</em> = 52 pre-intervention, <em>n</em> = 111 pre-intervention), most took place within 5 days of ICU admission (83.4 %) and asystole (61.3 %) was the most common precipitating rhythm. Tele-ICU sites achieved significantly greater ROSC rates during the post-intervention (38.7 %) versus the pre-intervention (19.2 %) periods (adjusted odds ratio [aOR] 3.65 [95 % confidence interval [CI] 1.40–9.53]). This corresponded with an immediate 16.1 % (95 % CI 0.7 %-31.5 %) level increase without a significant trend change (-0.10 % [-0.97 %-0.77 %]). Overall hospital survival remained similar (4.5 % vs. 3.8 %; aOR 0.69 [95 % CI 0.08–5.72]) between study periods.</div></div><div><h3>Conclusions</h3><div>Tele-ICU implementation coupled with targeted ACLS training was associated with improvements in immediate in-hospital cardiac arrest outcomes, highlighting the potential of low-cost, technology-enabled care delivery models to optimize resuscitation performance in LMICs.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 5","pages":"Article 101062"},"PeriodicalIF":3.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571212","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 effectiveness of mobile health applications on the quality of life of hypertension patients: A systematic review and meta-analysis","authors":"Nouran Hamza ,&nbsp;Wael Hafez ,&nbsp;Sara Adel Abdelkader Saed ,&nbsp;Marina Raouf ,&nbsp;Nesma Magdi ,&nbsp;Sahar Allam ,&nbsp;Rahma Sweedy ,&nbsp;Dina Alaraby ,&nbsp;Marwa Muhammed Abdeljawad ,&nbsp;Nouran A. Taha","doi":"10.1016/j.hlpt.2025.101064","DOIUrl":"10.1016/j.hlpt.2025.101064","url":null,"abstract":"<div><h3>Background</h3><div>The complexity and burden of hypertension management necessitate innovative strategies to improve care quality and patient outcomes. Our meta-analysis aimed to evaluate the impact of e-health interventions on hypertension patients' quality of life and medication adherence.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis were conducted using medical electronic databases for literature published before June 30, 2023. Studies investigating the efficacy of mobile health applications on the quality of life of hypertension patients were included. We extracted the studies’ characteristics, patient descriptions, and efficacy outcomes of mobile health applications. Quality assessment was done using ROB 2 and ROBINS-I V2. A meta-analysis was conducted using RevMan software.</div></div><div><h3>Results</h3><div>The intervention significantly decreased the standardized mean difference of the systolic blood pressure (SBP) measures compared to the control (SMD=-0.43; 95 % CI= -0.52, -0.17; <em>p</em> &lt; 0.01). Additionally, it significantly increased the odds of blood pressure control (OR=3.05; 95 %CI=1.42, 6.54; <em>p</em> &lt; 0.01). The heterogeneity was high; therefore, sensitivity and subgroup analyses were conducted: The intervention significantly increased the quality of life score of hypertension patients compared to the control (SMD=0.19; 95 % CI=0.04, 0.33; <em>p</em> = 0.01). It also significantly decreased the SMD of the SBP change from baseline and the diastolic blood pressure change from baseline compared to the control [(SMD=-4.29; 95 % CI= -5.05, -3.52; <em>p</em> &lt; 0.01), (SMD=-2.75; 95 % CI= -4.06, -1.45; <em>p</em> &lt; 0.01), respectively].</div></div><div><h3>Conclusion</h3><div>Our study demonstrates the efficacy of e-health interventions in promoting hypertension self-management, highlighting their potential as a scalable and accessible tool among the mobile phone-using population.</div></div><div><h3>Public Interest Summary</h3><div>Hypertension is a serious disease with severe complications if left uncontrolled. Our goal was to collect all available data on using mobile health applications in hypertension patients to facilitate their medication adherence and thus improve their quality of life. Our results show a noticeable enhancement in blood pressure control and increased patients’ quality of life after using these mobile health applications. This synthesized evidence can help patients and their healthcare providers recognize the strong efficacy and promising outcomes of these applications across multiple studies, which can ultimately lead to widespread utilization and more benefits to patients.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 5","pages":"Article 101064"},"PeriodicalIF":3.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144595837","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":"Benefits and challenges of high-density microarray patches for vaccination among older adults: A qualitative study","authors":"Matthew N. Berger ,&nbsp;Sara L. Knox ,&nbsp;Ben Baker ,&nbsp;Benjamin G. Stewart ,&nbsp;Charles Ross ,&nbsp;Erin Mathieu ,&nbsp;Angus H. Forster ,&nbsp;S.Rachel Skinner ,&nbsp;Cristyn Davies","doi":"10.1016/j.hlpt.2025.101065","DOIUrl":"10.1016/j.hlpt.2025.101065","url":null,"abstract":"<div><h3>Objectives</h3><div>Microarray Patches (MAPs) deliver vaccines to the upper dermis and epidermis, rich in immune cells. This study explored the perceived safety, usability, and acceptability of High-Density Microarray Patches (HD-MAPs) among older adults aged 50+.</div></div><div><h3>Methods</h3><div>This was a single-centre, single-arm, open-label study using excipient-coated HD-MAPs. A trained user administered two HD-MAPs to each participant’s dominant arm, and participants self-administered to their non-dominant arm. Semi-structured interviews were conducted on days 0 and 28. Thematic analysis was used to explore participant experiences.</div></div><div><h3>Results</h3><div>Forty-four older adults were recruited. Themes explored the benefits and challenges of HD-MAPs. Benefits included (1) mass distribution and administration, (2) reduced healthcare burden, and (3) convenience, particularly in low-resource settings due to thermostability and potential for self-administration. Participants felt that use of trained users and self-administration could reduce burden on healthcare resources. Challenges highlighted were (1) safety of unsupervised use, (2) proof of vaccination, and (3) user confidence and cost. Concerns about adverse events and correct dosage were raised, though participants felt reassured by the sensation, applicator sound, and mark after application.</div></div><div><h3>Conclusion</h3><div>HD-MAPs may ease healthcare burdens and improve convenience and acceptability among older adults, offering an alternative to needles and syringes, especially for vulnerable populations.</div></div><div><h3>Lay summary</h3><div>This study explored how older adults (aged 50+) perceived the safety, usability, and acceptability of High-Density Microarray Patches (HD-MAPs), a new, needle-free vaccine delivery method. Participants received the HD-MAP from a trained user and also tried self-administering it. Most found HD-MAPs convenient and easy to use, appreciating their potential for home use and application in remote areas without refrigeration. Participants liked the idea of reducing the burden on healthcare systems and found the HD-MAPs less intimidating than needles. However, some concerns were raised, including safety when used unsupervised, confirming successful vaccine delivery, and cost. Participants suggested using telehealth or supervised settings to enhance confidence. Overall, HD-MAPs were considered a promising vaccination alternative, especially during pandemics and in low-resource settings. The technology may help increase vaccination rates in older adults by offering more accessible, less painful options.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 5","pages":"Article 101065"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144581157","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":"Adverse events involving medical devices in Dutch hospitals: A patient record review study","authors":"Mees.C. Baartmans ,&nbsp;Steffie.M. van Schoten ,&nbsp;Bo Schouten ,&nbsp;Linda van Eikenhorst ,&nbsp;Renske M. Hoeben ,&nbsp;Henk Asscheman ,&nbsp;Cordula Wagner","doi":"10.1016/j.hlpt.2025.101063","DOIUrl":"10.1016/j.hlpt.2025.101063","url":null,"abstract":"<div><h3>Objectives</h3><div>To report the incidence of potentially preventable Adverse Events involving a Medical Device (AEMD) and provide an overview of specific topics on how devices were involved in causing patient harm.</div></div><div><h3>Methods</h3><div>A retrospective nationwide patient record review study using randomly selected records of 2998 patients deceased during their admission in 20 Dutch hospitals in 2019.</div></div><div><h3>Results</h3><div>63 potentially preventable AEMDs were identified, corresponding to a weighted incidence of 1.9 % (95CI 1.5 %-2.5 %). Medical devices were involved in about half of all potentially preventable adverse events. Consequences for patients were often severe. Themes in how medical devices were involved in causing patient harm were: Endoscopes causing perforations and hemorrhages, bleedings and infections after placement of heart- and vascular implants, and respiratory harm related to naso- and orogastric tube application. In most cases, the role of the device in causing adverse events was that of prompting a known complication. Preventability in these cases often lied in the subsequent management of the bleeding, perforation or infection.</div></div><div><h3>Conclusions</h3><div>AEMDs occur in a small percentage of patients admitted and deceased in Dutch hospitals, but do represent a substantial part of all potentially preventable adverse events identified amongst the old and severely comorbid patient group in this study. An additional analysis of the data, provided a more thorough understanding of how the use of medical devices contributes to patient harm. Other study designs are necessary to learn more about technical and organizational issues that might trigger AEMDs.</div></div><div><h3>Public interest summary</h3><div>Most medical device applications are safe and effective. Though in a small number of cases an Adverse Event involving a Medical Device (AEMD) occurs. This study found that in 1.9 % (95CI 1.5 %-2.5 %) of patients deceased during their admission in 20 Dutch hospitals in 2019 a potentially preventable AEMD occurred. Identified topics in these AEMDs were perforations, bleedings, and infections after application of endoscopes, heart- and vascular implants, and tubes for enteral feeding or drainage. The role of the devices in these AEMDs was often that of prompting a known complication and considered non-preventable. Preventability in most cases lied in the subsequent management of the perforation, bleeding or infection.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 5","pages":"Article 101063"},"PeriodicalIF":3.4,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604772","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":"Lowering inequality in access to emergency contraception: The effect of a Chilean public policy","authors":"Sebastián Lavanderos ,&nbsp;Andrea Morales ,&nbsp;Camilo Riquelme ,&nbsp;Juan Haase","doi":"10.1016/j.hlpt.2025.101066","DOIUrl":"10.1016/j.hlpt.2025.101066","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the impact of legal changes, specifically Law 20.418, on reducing inequality in emergency contraception (EC) access in Chile between 2008 and 2013.</div></div><div><h3>Methods</h3><div>A longitudinal, retrospective analysis was conducted using data from the Monthly Statistical Record (REM) of the Chilean Ministry of Health. EC consultation rates were calculated for ambulatory and total consultations, including rape-related cases, across communes. Inequality was assessed using Lorenz curves and four inequality indicators: Gini index, Theil index, coefficient of variation, and 75/25 ratio.</div></div><div><h3>Results</h3><div>The study found a significant reduction in communal inequality in EC consultations after the implementation of Law 20.418 in 2010. Between 2008 and 2013, the Gini index for ambulatory consultations decreased by 41 %, while for total consultations, it dropped by 20 %. Other inequality indicators also showed substantial decreases, with the 75/25 ratio decreasing by 73 % for ambulatory consultations. Regional analysis revealed a consistent downward trend in inequality, with the most significant improvements occurring in areas with higher consultation rates.</div></div><div><h3>Conclusions</h3><div>The findings indicate that the legal reforms introduced by Law 20.418 contributed to reducing disparities in EC access across communes. Despite improvements, some residual inequalities persist, highlighting the need for further research to identify and address remaining barriers to equitable EC access in certain regions.</div></div><div><h3>Lay Summary</h3><div>This study evaluates the impact of Chile's Law 20.418, which mandated the provision of emergency contraception (EC) in the public health system, on reducing access inequality. Data from 2008 to 2013 show a significant decrease in inequality in EC consultations across communes. The Gini index and other inequality indicators revealed improvements, with a 41 % reduction in inequality for ambulatory consultations and a 20 % reduction for total consultations. These changes are linked to the law's implementation, which expanded EC access, particularly in rural and underserved areas. Despite the progress, some disparities remain, suggesting that while policy interventions have made access more equitable, further efforts are needed to address residual barriers. This study highlights the importance of legal frameworks in promoting health equity, particularly in reproductive healthcare.</div></div>","PeriodicalId":48672,"journal":{"name":"Health Policy and Technology","volume":"14 5","pages":"Article 101066"},"PeriodicalIF":3.4,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549378","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}