medRxiv - Health Policy最新文献

{"title":"Shouldering our Way into a More Meaningful Research Agenda for Atraumatic Shoulder Pain: A Priority Setting Study","authors":"Kristian Damgaard Lyng, Torben Krejberg Boersting, Mikkel Bek Clausen, Annelene Houen Larsen, Behnam Liaghat, Kim Gordon Ingwersen, Marcus Bateman, Amar Rangan, Karen Toftdahl Bjoernholdt, David Hoeyrup Christiansen, Steen Lund Jensen, Janus Laust Thomsen, Kristian Thorborg, Connie Ziegler, Jens Lykkegaard Olesen, Michael Skovdal Rathleff","doi":"10.1101/2024.08.22.24312355","DOIUrl":"https://doi.org/10.1101/2024.08.22.24312355","url":null,"abstract":"IMPORTANCE: Atraumatic shoulder pain significantly burdens society and the individual. There is a growing need for involving patients and other stakeholders in setting the research agenda. OBJECTIVE: To use the voices of people with atraumatic shoulder pain, healthcare practitioners, and their relatives to establish research questions. DESIGN, SETTING, AND PARTICIPANTS: This priority-setting study followed a modified approach originally formulated by the James Lind Alliance (JLA). The process consisted of six phases (initiation, consultation, collation, prioritization, validation, and reporting) and included two e-surveys and two separate virtual workshops. Data collection started on June 2021 until June 2023. We included people with atraumatic shoulder pain, relatives, healthcare practitioners managing shoulder pain, and researchers conducting research within the field. EXPOSURES: The first e-survey included basic demographic questions and the possibility to submit at least one and a maximum of five potential research questions. Based on a thematic analysis, questions were arranged into themes and related questions. In the second e-survey, participants were asked to prioritize the questions. Finally, two priority-setting partnership workshops were used to formulate a top-10 list. MAIN OUTCOMES AND MEASURES: A top-25 and top-10 list of research questions related to atraumatic shoulder pain. RESULTS: Initially, 297 participants submitted 1080 potential research questions. In the second e-survey, 290 participants prioritized these questions resulting in a compilation of the top 25. Based on discussions from the workshops with 21 participants, a top 10 list was created. CONCLUSIONS AND RELEVANCE: In the final top 10 list, the three research questions with the highest ranking concerned 1) translating the best available knowledge into clinical practice, 2) preventing shoulder pain, and 3) identifying who benefits from surgery. These questions inform future research funding and projects relating to atraumatic shoulder pain.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142188810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What do the Welsh public understand about NHS dental services, what do they think they could look like, and what are their priorities? A qualitative study","authors":"Natalie Joseph-Williams, Abubakar Sha'aban, Francesca Mazzaschi, Anthony Cope","doi":"10.1101/2024.08.14.24311616","DOIUrl":"https://doi.org/10.1101/2024.08.14.24311616","url":null,"abstract":"NHS General Dental Services in Wales are undergoing reform. To ensure dental services meet the needs of those who use them, we explored what the public think these services could look like and what their priorities for are.\u0000The aim of this study was to consult with the Welsh public to understand their views on NHS dental services to help inform dental reform plans in Wales. Specific objectives were to explore: What do the public think Welsh NHS dental services could look like? What do the public understand about dental services and the dental team? What are their views on skill mix in dentistry?\u0000What are their attitudes towards and needs for oral health self-management?\u0000What are their priorities for dental care services in Wales? We used qualitative methods (interviews and focus group style workshops) across two phases between November 2023 and May 2024 to explore the study objectives. Thematic analyses were performed on the data to identify key themes. Forty four participants with diverse backgrounds from all seven local health boards in Wales took part.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142188807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"″Implementing a policy is something else″: Governance of complex health information systems in Tanzania","authors":"Regine Unkels, Elibariki Mkumbo, Ntuli Kapologwe, Fatuma Manzi, Claudia Hanson, Helle Molsted Alvesson, Andrea B. Pembe","doi":"10.1101/2024.08.15.24312044","DOIUrl":"https://doi.org/10.1101/2024.08.15.24312044","url":null,"abstract":"Introduction: Health management information systems are crucial for a country′s health service planning and monitoring. Research indicates that generated data is often of low quality or not used for decision-making in low-resource settings. Digitalization potentially alleviates these problems, but scale-up in these countries is hampered by unreliable availability of resources.\u0000We aimed to understand how health policymakers perceive and experience working with data, data systems and the introduction of digital technology related to the governance of health management information systems in Tanzania.\u0000Methods: We conducted 16 interviews with national, regional and district health care managers experienced in using health information systems in Tanzania. Reflexive thematic analysis was used. Themes were developed underpinned by complexity theory and M. Lipsky′s theory of street-level bureaucracy. Results: Health care managers experienced challenges in health management information system governance in an unpredictable environment. Different power practices for system governance and implementation were used: Institutional power was applied to areas with existing international guidance and strategic examples. Subnational managers contextualized implementation through discretionary power practices where uncertainties prevailed. This led to transformed agendas in some cases, but also allowed for innovations to make policies work. Conclusions: Acknowledging the complexity of health management information system governance with constant adaptation can allow policymakers and senior managers to direct discretionary power where policy implementation would otherwise fail in the Tanzanian context. This can be achieved by identifying a set of social values around data processes that resonates with all actor groups and may support governance of this complex system.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142188774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Syncing Strategy and Execution: A Systematic Review of Public Health Preparedness Policy Implementation","authors":"Jennifer Swint, Wei Zhang, Amanda Marrison, Sandra Gabriel","doi":"10.1101/2024.08.05.24311490","DOIUrl":"https://doi.org/10.1101/2024.08.05.24311490","url":null,"abstract":"Background: The gap between public health preparedness and response policies and their practical implementation remains a critical challenge in global health security. This systematic review synthesizes evidence on barriers to effective policy implementation and identifies strategies for bridging this policy-practice gap.\u0000Methods: We systematically searched six electronic databases for peer-reviewed studies published between 2000 and 2023 focusing on the implementation of public health preparedness and response policies. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT) and AMSTAR-2.\u0000Results: Of 2,456 initially identified studies, 87 met the inclusion criteria. Studies addressed various public health emergencies, including infectious disease outbreaks (n=41, 47.1%), natural disasters (n=23, 26.4%), and man-made disasters (n=8, 9.2%). Key barriers to policy implementation included organizational factors (76 studies, 87.4%), resource constraints (72 studies, 82.8%), and communication challenges (68 studies, 78.2%). Promising strategies for bridging the gap included adaptive management approaches (38 studies, 43.7%), participatory policy development (35 studies, 40.2%), and integrated information systems (31 studies, 35.6%). Only 23 studies (26.4%) were assessed as high quality, with limited quantitative evidence on strategy effectiveness.\u0000Conclusions: While several promising strategies for bridging the policy-practice gap have been identified, there is a critical need for more rigorous evaluations of their effectiveness. Future research should focus on organizational reforms, flexible resource allocation, and leveraging emerging technologies to enhance policy implementation in public health preparedness and response.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141935048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does household income predict health and educational outcomes in childhood better than neighbourhood deprivation?","authors":"Ieva Skarda, Richard Cookson, Ruth Gilbert","doi":"10.1101/2024.07.25.24310986","DOIUrl":"https://doi.org/10.1101/2024.07.25.24310986","url":null,"abstract":"Background Public health research and prevention policies often use the small area Index of Multiple Deprivation (IMD) at neighbourhood level to proxy individual socio-economic status because it is readily available. We investigated what household income adds to IMD in early childhood for predicting adverse health in adolescence. Methods Using data from the Millennium Cohort Study, we analysed IMD and self-reported equivalised household income (ages 0-5) to predict outcomes at age 17: poor academic achievement, psychological distress, poor health, smoking, and obesity. Predictions were compared using IMD quintiles alone, household income alone, and both together. Results Household income was a stronger and more consistent predictor of age 17 outcomes than IMD and revealed inequalities within neighbourhoods. Decreasing household income showed steep gradients in educational attainment and smoking across all IMD quintiles, and moderate gradients in obesity, psychological distress, and poor health in most quintiles. IMD did not predict smoking or psychological distress within any income group, or educational attainment within the poorest income group. Conclusion Household income is associated with inequality gradients within all quintiles of neighbourhood IMD. Early childhood public health strategies should consider household income in combination with neighbourhood deprivation.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141775049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"We Are on the Verge of Breakthrough Cures for Type 1 Diabetes, but Who Are the 2 Million Americans Who Have It?","authors":"Rebecca A Smith, Samara Eisenberg, Aaron Turner-Pfifer, Jacqueline Le Grand, Sarah Pincus, Yousra Omer, Fei Wang, Bruce Pyenson","doi":"10.1101/2024.07.24.24310877","DOIUrl":"https://doi.org/10.1101/2024.07.24.24310877","url":null,"abstract":"Two million Americans have Type 2 Diabetes. Innovative treatments have standardized insulin delivery and improved outcomes for patients, but patients' access to such technologies depends on social determinants of health, including insurance coverage, proper diagnosis, and appropriate patient supports. Prior estimates of US prevalence, incidence, and patient characteristics have relied on data from select regions and younger ages and miss important determinants. By contrast, our research leveraged nationally representative administrative claims datasets to build a nuanced picture of the population with T1DM. Our work also supports future policy and research efforts with 2025, 2029, and 2035 projections of demographic and insurance coverage for people with T1DM.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141775098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rapid review of the effectiveness of smoking cessation interventions for people with anxiety and/or depression living within the community","authors":"Jordan Everitt, Toby Ayres, Alesha Wale, Chukwudi Okolie, Amy Fox-McNally, Helen Morgan, Hannah Shaw, Jacob Davies, Rhiannon Tudor Edwards, Alison Cooper, Adrian Edwards, Ruth Lewis","doi":"10.1101/2024.07.23.24310849","DOIUrl":"https://doi.org/10.1101/2024.07.23.24310849","url":null,"abstract":"Abstract\u0000The Welsh Government aims to reduce smoking prevalence from the current rate of 13% to below 5% of the population by 2030. People with mental health conditions have a higher rate of smoking prevalence and are less likely to access smoking cessation services. Evidence shows that smoking cessation in this population decreases symptoms, improves positive mood and quality of life. This rapid review aimed to identify and synthesise the evidence for the effectiveness of smoking cessation interventions in people with anxiety and/or depression living in the community.\u0000Results\u0000The literature searches were conducted in March 2024, the included study reports were published between 2008 and 2023, nine were published since 2019. Eleven primary studies from 15 reports were included in the rapid review: 10 RCTs, two of which were pilot RCTs, and one quasi-experimental pilot study. Studies were conducted in the USA (n=6), Spain (n=1), France (n=1), Netherlands (n=1), and two studies were conducted across the EU and USA.\u0000Research Implications and Evidence Gaps\u0000No UK studies were identified therefore it is unclear whether findings are generalisable to the UK. No studies applying interventions at critical touchpoints within smoking cessation or mental health services were identified. Only one study assessed the cost-effectiveness of a smoking cessation intervention. Only one study assessed a smoking cessation intervention in participants with anxiety. Most studies included in this review were judged to be of low quality. Most studies recruited participants from the general population, therefore it is unclear whether participants were engaged with mental health services. Further high-quality UK-based research is needed to better understand the effectiveness of smoking cessation interventions for people with anxiety and depression.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141775096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid review of Allied Health Professionals working in neonatal services","authors":"Nathan Bromham, Leona Batten, David Jarrom, Elizabeth Gillen, Juliet Hounsome, Jacob Davies, Rhiannon Tudor Edwards, Alison Cooper, Adrian Edwards, Ruth Lewis","doi":"10.1101/2024.07.23.24310638","DOIUrl":"https://doi.org/10.1101/2024.07.23.24310638","url":null,"abstract":"Background\u0000This review aimed to quantify the impact of allied health professionals (AHPs) embedded in neonatal services on outcomes by asking the following review questions:\u0000Q1. What is the effectiveness of neonatal services with embedded allied health professionals compared to neonatal services without embedded allied health professionals?\u0000Q2. What is the effectiveness of early interventions provided by allied health professionals in neonatal units? Research Implications and Evidence Gaps\u0000There was very little directly relevant evidence on AHPs embedded in neonatal services. Most of the evidence related to multidisciplinary team working or early interventions provided by AHPs. Few early intervention trials were from the UK, leading to uncertainty about the availability and applicability of interventions in the UK setting. Further UK-based research is needed to better understand the best way to integrate allied health professionals in neonatal services. Economic considerations There is no published evidence on the cost of AHPs working within neonatal units. There is marked variability in the reporting of cost estimates for neonatal care units in the UK, making the evaluation of cost implications of adopting AHP recommendations difficult. Subsequent economic evaluations could explore the Budget Impact to the NHS of increasing AHP presence in neonatal units to align with recommendations from AHP professional bodies and Royal Colleges.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141775097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardizing and Scaffolding Healthcare AI-Chatbot Evaluation","authors":"Yining Hua, Winna Xia, David W. Bates, Luke Hartstein, Hyungjin Tom Kim, Michael Lingzhi Li, Benjamin W Nelson, Charles Stromeyer, Darlene King, Jina Suh, Li Zhou, John Torous","doi":"10.1101/2024.07.21.24310774","DOIUrl":"https://doi.org/10.1101/2024.07.21.24310774","url":null,"abstract":"The rapid rise of healthcare chatbots, valued at $787.1 million in 2022 and projected to grow at 23.9% annually through 2030, underscores the need for robust evaluation frameworks. Despite their potential, the absence of standardized evaluation criteria and rapid AI advancements complicate assessments. This study addresses these challenges by developing a the first comprehensive evaluation framework inspired by health app regulations and integrating insights from diverse stakeholders. Following PRISMA guidelines, we reviewed 11 existing frameworks, refining 271 questions into a structured framework encompassing three priority constructs, 18 second-level constructs, and 60 third-level constructs. Our framework emphasizes safety, privacy, trustworthiness, and usefulness, aligning with recent concerns about AI in healthcare. This adaptable framework aims to serve as the initial step in facilitating the responsible integration of chatbots into healthcare settings.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141737682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic Review of Health Disparities in Access and Delivery of Care for Geriatric Diseases in the United States","authors":"Muhammad R. Hussein, Mony Thomas, Sonia Utterman, Jackline Jushua","doi":"10.1101/2024.07.18.24310621","DOIUrl":"https://doi.org/10.1101/2024.07.18.24310621","url":null,"abstract":"Background: The U.S. population continues to age, and the identification of disparities in geriatric care -so that they may be understood and solutions addressed - is ever more critical. A systematic review is presented on current disparities found in access to care for geriatric diseases as well as in the delivery of care within the United States.\u0000Methods: A comprehensive search for the available literature from 2010 to 2024 was carried out through the PubMed, CINAHL, and Scopus databases in peer-reviewed journals. Studies that focused on disparities in access and provision of geriatric care for adults aged 65 years and above within the U.S. health system were included in this study. The Joanna Briggs Institute critical appraisal tools were used in the quality appraisal of studies included.\u0000Results: Of the total number of 5,218 studies that were identified initially, 132 studies were eligible for inclusion. Our analysis uncovered continued inequity in geriatric care across racial, ethnic, socioeconomic, and geographic lines. Findings include: (1) low rates of early diagnosis and delayed treatment of dementia and Alzheimer's among minority seniors, who were found to be 2.3 times more likely for African Americans and 1.9 times more likely for Hispanics than their white counterparts; (2) inability to access high-level geriatric care in regions outside of metropolitan areas, where it was identified that older adults had to commute, on average, 3.2 times farther to the nearest provider; (3) socioeconomic factors found to present obstacles to home health and long-term care, with seniors from a lower income bracket 1.8 times more likely to be placed in a poor-quality nursing home; and (4) disparities in the quality of end-of-life care for elders of lower socioeconomic status, with African Americans and Hispanics being respectively 38% and 51% less likely to use hospice care.\u0000Conclusion: This review has demonstrated that important and persistent disparities exist in the availability and delivery of geriatric care in the United States. Of the 132 studies, 34 directed their efforts toward reducing interventions to have such disparities with salutary results coming from culturally tailored community-based approaches. Multipronged interventions that include policy revision, workforce development, and community-based initiatives hold promise for reducing these disparities. This should be an area of focus for future targeted interventions, which should, therefore, be evaluated for effectiveness in reducing disparities in health outcomes for all older adults.\u0000Keywords: health disparities, geriatric care, access to care, care delivery, systematic review","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141745708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}