Inquiry-The Journal of Health Care Organization Provision and Financing最新文献

{"title":"Assessment of Health Insurance's Role in Reducing Financial Barriers to Health Service Access: Perspective from a Resource Limited Setting.","authors":"Bereket Alemayehu Admasu, Mahlet Yigeramu Gebremariam","doi":"10.1177/00469580251333636","DOIUrl":"https://doi.org/10.1177/00469580251333636","url":null,"abstract":"<p><p>In Ethiopia, Community-Based Health Insurance (CBHI) schemes aim to enhance healthcare accessibility and reduce financial barriers to health care access by providing protection against out-of-pocket (OOP) expenses. However, evidence on the institutional experience of insured patients remains limited. This study explores the financial implications of CBHI membership among inpatients at St. Paul's Hospital Millenium Medical College. A cross-sectional study was conducted in St. Paul's Hospital Millenium Medical College Inpatient Departments. After stratifying across different wards, the study participants were chosen by systematic random sampling. Data on socio-demographics and payment related factors were collected with a structured questionnaire. Ethical approval and informed consent were obtained. About 260 respondents, of whom 168 (64.6%) were CBHI members and 92 (35.4%) were non-members, had participated in the study. The result reveals that both CBHI members and non-members continue to bear OOP expenses, undermining the financial protection intended by the scheme. Among CBHI members, self-sponsored out-of-pocket payments along with health insurance (65, 38.7%) were the major source of financing. The significant reduction in reported difficulty in paying for basic necessities among CBHI members compared to non-members (<i>P</i> = .034) does suggest that the insurance offers some level of financial relief. While CBHI provides some financial relief, gaps in coverage need more in-depth exploration.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"62 ","pages":"469580251333636"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027036","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":"High Medication Non-Adherence Rates and its Drivers in the General Population: A Cross-sectional Study Using the OMAS-37 Adherence Survey Tool.","authors":"Rønnaug Eline Larsen, Ala Karimi, Tonje Krogstad, Cecilie Johannessen Landmark, Lene Berge Holm","doi":"10.1177/00469580251321596","DOIUrl":"10.1177/00469580251321596","url":null,"abstract":"<p><p>Substantial variability in patients' medication adherence underscores the key significance of pharmacists and other healthcare providers proactively aiding individuals in achieving optimal medication outcomes. Medication-taking behaviours, barriers, and beliefs varies significantly among medication users. It is crucial to ascertain these factors when designing adherence interventions. The OsloMet Adherence-to-medication Survey tool (OMAS-37) is designed to quantify the degree of adherence, and to assess 37 unique causes for non-adherence. The aim of this study was to assess non-adherence among medication users in the general population utilising the OMAS-37 tool. A cross sectional study among medication users in Norway was conducted in 2021. The features of the general population and three patient subgroups-cardiovascular, pain, and mental health disorders-were characterized and compared using Kruskal-Wallis tests. Of the 812 participants, with a median age of 50 (IQR 37-59) and 91% (n = 736) identifying as female, 64% (n = 517) exhibited high non-adherence scores indicating poor medication. Main reasons included forgetfulness (42%, n = 343), perceived improvement in health (40%, n = 326), and fear of adverse drug reactions (39%, n = 320). Statistically significant positive adherence factors encompassed increasing age, higher education, medication decision involvement, and pill organiser usage. The cardiovascular subgroup exhibited significantly better adherence than the pain and mental health disorders subgroups. The total sample and all three subgroups demonstrated some variation in the main causes for non-adherence. This first study employing OMAS-37 reveals high non-adherence levels and varying causes of non-adherence among different patient groups, emphasizing the need for targeted adherence interventions.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"62 ","pages":"469580251321596"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11851734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494556","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":"Exploring Barriers, Facilitators, and Needs Related to Mental Health Promotion for Police Officers: A Qualitative Approach.","authors":"Gi Wook Ryu, Ji Yeon Lee","doi":"10.1177/00469580251317931","DOIUrl":"10.1177/00469580251317931","url":null,"abstract":"<p><p>Police officers are vulnerable to psychological distress and trauma since they are constantly exposed to significant physical and mental violence. Poor mental health can lead to increased healthcare costs for individuals, organizations, and nations and negatively impacts public safety. Mental health interventions tailored to the nature of police work are needed; however, a research gap exists regarding understanding the mental health of police officers. This study aimed to explore the barriers, facilitators, and needs for mental health promotion among police officers. This study adopted a qualitative approach in South Korea. Twelve police officers working in a metropolitan city were recruited using purposive sampling methods. One-on-one interviews were conducted with open-ended questions regarding barriers, facilitators, and needs for improving mental health. Content analysis was used to derive relevant themes. The participants included 3 women and 9 men, with an average age of 37.8 years and working experience of 12.6 years. Three themes and 9 subcategories emerged. The theme related to barriers was \"difficulty accessing resources\"; the theme related to facilitators was \"supportive environment for mental health prevention and management\"; and the theme related to needs was \"education and policies to promote mental health.\" Considering the occupational and organizational characteristics of the police profession, individual and organizational interventions and policies are needed to adequately manage the mental health of police officers.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"62 ","pages":"469580251317931"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082315","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":"Medicaid Home and Community Based Services Spending and Nursing Home Use by Individuals Under the Age of 44.","authors":"Seiyoun Kim, Ziwei Pan, Nurah Koney-Laryea, Hye-Young Jung, Sophia Jan, Kira L Ryskina","doi":"10.1177/00469580251323779","DOIUrl":"10.1177/00469580251323779","url":null,"abstract":"<p><p>Prior studies of the role of state spending on home and community-based services (HCBS) in nursing home use focused on adults over the age of 65. However, medically complex children and adults under 50 years old represent a small (about 5%) but highly vulnerable subset of nursing home patients. We measured the impact of HCBS spending on short-term and long-term nursing home stays by children and adults under 44 years old and compared the impact between Non-Hispanic White (NHW) individuals and Black, Indigenous, and People of Color (BIPOC). We used the Minimum Data Set to measure nursing home stays in each state per year in 2012 to 2019. The Medicaid Long Term Services and Supports annual expenditure reports were used to measure HCBS expenditures per state resident with a disability. Our outcome was nursing home use by children (<18 years old) and adults (18-43 years old) associated with a change in HCBS expenditures per state resident with a disability (measured in $1000 increments) estimated using linear regression. Higher HCBS expenditures per resident were associated with fewer short-term and long-term nursing home stays among NHW children. We did not find statistically significant association between changes in HCBS expenditures and nursing home stays among BIPOC children. Investments in HCBS are necessary to reduce nursing home use among younger adults. However, to mitigate racial disparities in nursing home use among children, HCBS spending alone may not be sufficient.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"62 ","pages":"469580251323779"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606822","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":"Acceptability and Efficacy of an Adapted School-Based Dialectical Behavioral Therapy Skills Group for Adolescents: A Qualitative Perspective.","authors":"MacKenzie Whitener, Shirin Khazvand, Ian Carson, Anna Martin, Michelle Salyers, Melissa Cyders, Matthew Aalsma, Tamika Zapolski","doi":"10.1177/00469580251314279","DOIUrl":"10.1177/00469580251314279","url":null,"abstract":"<p><p>Adolescence is characterized by heightened emotion dysregulation, impulsivity, and engagement in high-risk behaviors, such as substance use, violence, and unprotected sexual activity. Dialectical Behavioral Therapy for Adolescents (DBT-A) is an evidence-based intervention that targets emotion regulation and impulsivity among adolescents, proven effective at decreasing high-risk behaviors. However, limited research exists on adolescents' perceptions of DBT-A, particularly in schools. The current study aimed to understand adolescents' perspectives on a DBT-A skills group delivered within urban high schools in a midwestern state. The study sample of 18 youth (mean age 14.7; 66.7% male; 38.9% Black) completed individual semi-structured qualitative interviews assessing their perspectives on the DBT-A skills group. Interview topics included the program's impact on youths' daily lives, risk-taking behaviors, skill acquisition, and general feedback about the group. Fifteen of the eighteen participants (86%) reported acceptability of the program, expressing that they enjoyed the content and would recommend the group to peers. Participants observed positive impacts on their daily lives, including self-reported enhanced ability to regulate their emotions, communicate with teachers, effectively adapt their mindsets and motivations, and make healthy relationship decisions. Additionally, some noted an increased feeling of connection to their peers following the group. Delivering the DBT-A skills group in schools was shown to have high rates of acceptability among youth and resulted in improved emotion regulation and reduced impulsivity. Further research is needed to assess long-term effects of this program and to identify best training practices for school staff to implement and sustain the program long-term.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"62 ","pages":"469580251314279"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030407","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":"Examples from US Policies to Reduce Oversupply and Overutilization: Lessons for the Japanese Health Care System.","authors":"Jared Lane K Maeda","doi":"10.1177/00469580241310757","DOIUrl":"10.1177/00469580241310757","url":null,"abstract":"<p><p>The Japanese health care system provides universal coverage with relatively low cost sharing and patients have a free choice of providers. Although Japan's government price controls have helped to restrain the growth in health care spending, the country's rapidly growing elderly population and adoption of new drugs and technologies have placed increased fiscal pressures on its health care system. Additionally, the Japanese health care system does not have the infrastructure in place to restrain utilization, which may be a key driver of increases in health care spending. Although the US health care system has many shortcomings, such as the highest health care prices among developed countries and a significant uninsured population, it has been able to manage utilization by using various tools, such as prior authorization and gatekeeping. The US health care system might be able to offer Japan some lessons on ways to reduce unnecessary utilization and supply to create greater value in its health care system.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"62 ","pages":"469580241310757"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11705337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933333","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":"Acceptability and Future Considerations for Telegenetic Counseling After the COVID Pandemic: Interviews with Genetic Counselors, Clinicians, and Patients.","authors":"Meghan C Martinez, Nina Szwerinski, Su-Ying Liang, Sharon Chan, Monique de Bruin, Cheryl D Stults","doi":"10.1177/00469580251314747","DOIUrl":"10.1177/00469580251314747","url":null,"abstract":"<p><p>While telegenetic counseling has increased substantially since the start of the COVID-19 pandemic, previous studies reported concerns around building rapport, nonverbal communication, and the patient-counselor relationship. This qualitative evaluation elicited feedback from genetic counselors, referring clinicians, and patients from a single healthcare organization to understand the user-driven reasons for overall satisfaction and experience. We conducted 22 in-depth, semi-structured interviews with participants from all 3 groups between February 2022 and February 2023. Interview recordings were transcribed and analyzed using a pragmatic thematic approach. Participants across all groups felt the style and content of the genetic counseling visit lent itself perfectly to telegenetics specifically because of no physical exam component. Most patient and counselor participants expressed having the genetic counseling over phone or video had no impact on the patient-counselor relationship or the amount of trust and emotional connection they were able to achieve remotely. Preference for visit type can be influenced by in-person masking requirements impeding full facial expressions or expressing strong emotions over phone. All respondents expressed strong support for all modalities going forward. Counselors with broad experience across platforms should be the focus of future recruitment as should patient education around the nature of the genetic counseling visit and the accuracy of various testing options. Telegenetic programs should consider perspectives from all 3 groups to ensure that specific needs of each are addressed.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"62 ","pages":"469580251314747"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030410","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":"How Individuals Seeking Help for Substance Use Disorder Adjusted to Virtual 12-Step Meetings During the COVID-19 Pandemic.","authors":"Connie Hassett-Walker","doi":"10.1177/00469580251320767","DOIUrl":"10.1177/00469580251320767","url":null,"abstract":"<p><p>Technology-based online support services are emerging as a resource for people recovering from substance abuse. This study presents findings on how individuals seeking help for a substance use disorder through 12-step fellowship meetings (Alcoholics Anonymous, Narcotics Anonymous) adjusted to virtual rather than in-person meetings during the COVID-19 pandemic. Fifty individuals (50) were interviewed, recruited primarily from 12-step meetings in 3 locations in a rural New England state in the United States. Subjects were asked about whether they had attended virtual meetings during the pandemic, how online meetings compare to in-person meetings, and if they encountered any obstacles when attending virtual meetings (eg, Internet connectivity). More individuals preferred in-person meetings for a variety of reasons, although many participants were willing to give virtual meetings a try. Some participants continued to attend virtual meetings, even after in-person meetings returned. Positives of virtual recovery meetings included convenience and the fact that they could be accessed from anywhere. Internet connectivity and technical difficulties presented a challenge for some. Some individuals were unable to focus in virtual meetings and got easily distracted. Digital recovery support services should continue to be offered as some recovering individuals find them helpful. Virtual meetings are a resource, particularly for those individuals living in rural areas without many in-person resources readily available, or access to adequate transportation. Treatment providers working in rural states may consider advocating to policymakers for quality Internet services (eg, high-speed broadband access), to sufficiently meet residents' treatment and other healthcare needs.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"62 ","pages":"469580251320767"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525267","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":"Improving Clinical Pharmacist Performance in Oncology Care Through Education on Pharmaceutical Care Plans Documentation: A Pre-post Interventional Study.","authors":"Tasbiha Ali, Adeel Siddiqui, Omar Akhlaq Bhutta, Saba Mazhar, Aleeshba Usman, Irfan Raza, Nabin Pathak, Sunil Shrestha","doi":"10.1177/00469580251335819","DOIUrl":"10.1177/00469580251335819","url":null,"abstract":"<p><p>Clinical pharmacists are vital in oncology care as they are involved in optimizing pharmaceutical care plans (PCPs). Their involvement in medication management and accurate documentation assists in the care of cancer patients. This study aims to evaluate the impact of a targeted educational intervention for clinical pharmacists on both the quantity and quality of PCP documentation, providing insights into optimizing pharmaceutical care within an oncology setting. A descriptive pre-post study was done at Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore. Data on admitted patients' PCPs from November 2023 to March 2024 were collected from the Hospital Information System. PCP documentation was evaluated following the educational intervention on clinical pharmacy staff, and the improvement in the documentation among the specialties section was analyzed using a one-tailed <i>t</i>-test. The study assessed a total of 120 patients during the pre-intervention phase and 382 patients post-intervention. In the pre-intervention phase, the mean ± SD age of patients was 36.1 ± 20.1 years, with males constituting 57.5% and females 42.5%. Post-intervention, the mean ± SD age slightly increased to 37.3 ± 20.7 years, with a similar gender distribution of 58.9% males and 41.1% females. The intervention significantly increased the number of PCPs from 130 in the pre-intervention phase to 516 in the post-intervention phase, particularly in Adult Oncology (<i>P</i> = .0115) and Palliative Care (<i>P</i> = .0095). Post-intervention, a substantial enhancement in the documentation and management of PCPs was observed. The study demonstrates that structured educational interventions significantly enhance the clinical pharmacists' documentation of PCPs. By integrating targeted training with continuous reinforcement strategies, healthcare institutions can optimize pharmaceutical care processes, improve interdisciplinary collaboration, and ultimately enhance patient safety in oncology settings.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"62 ","pages":"469580251335819"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053434","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":"Caring for Caregivers Within Age-Friendly Health Systems: An Organizational Case Study of National Scale and Spread.","authors":"Ellen Carbonell, Diane Mariani, Robyn Golden","doi":"10.1177/00469580251325660","DOIUrl":"https://doi.org/10.1177/00469580251325660","url":null,"abstract":"<p><p>The bulk of care for older adults who need assistance but do not require hospitalization or skilled nursing care typically falls to families and friends due to the lack of comprehensive long-term care services for older adults in the United States. To assist with the needs of these key members of the care team who are not typically included in the electronic medical record of the older adult, and to provide them with the care they need to live healthy lives of their own while providing care for an older adult, Caring for Caregivers (C4C) was created by RUSH University System for Health. The goal of the model is to provide information and support for family caregivers due to the extraordinary level of stress they experience, and to do this within a structure that gathers data and addresses the lack of research on caregivers for older adults within health systems. This case study demonstrates the benefits of a customizable model that focuses on What Matters to the caregiver and the care recipient, while adapting to the needs of the staff, the health system, and the community.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"62 ","pages":"469580251325660"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056076","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}