Frontiers in health services最新文献

{"title":"The impact of DRG reimbursement system on appropriate techniques of traditional Chinese medicine-evidence from pilot cities with traditional Chinese medicine hospitals in China.","authors":"Jin Zhang, Yana Zhou, Dan Han, Chen Zhang, Yajuan Xiong","doi":"10.3389/frhs.2025.1441482","DOIUrl":"10.3389/frhs.2025.1441482","url":null,"abstract":"<p><strong>Introduction: </strong>Given the ongoing development and significant medical role of Traditional Medicine Hospital (TCM) techniques in Chinese TCM hospitals, it is imperative to conduct an assessment on the influence of the gradual implementation of the DRG reimbursement system in W City's three public hospitals on the utilization of appropriate techniques of TCM.</p><p><strong>Methods: </strong>This study uses the Difference-in-Difference method to analyze the economic impact of the DRG reimbursement system. It compares cost changes between the TCM techniques group and other groups before and after DRG implementation to reveal the actual influence on cost. Visualization tools show cost variations from 2019 to 2022, bolstering research credibility. A T-test analyzes cost disparities, validating prediction model accuracy. Finally, a parallel trend test ensures reliability of the DID model's results.</p><p><strong>Results: </strong>(1)The total cost of appropriate techniques of TCM group decreased significantly (<i>p</i> < 0.001), with a 14.27% reduction in cost-effective TCM techniques (<i>p</i> < 0.001) but no significant changes in surgical cost.(2) Cost analysis of various TCM techniques showed significant decreases in total cost for external treatment and acupuncture, by 4.78% and 8.06% respectively (<i>p</i> < 0.001). cost for external treatment, orthopedic treatment, acupuncture, and special therapies also decreased by 13.67%, 14.27%, 16.8%, and 9.3% respectively (<i>p</i> < 0.001).(3)After analyzing 8 departments with high discharge rates, the total cost of TCM techniques in cardiology decreased by 18.86% (<i>p</i> < 0.001) under the DRG reimbursement system, while acupuncture cost increased by 11.85% (<i>p</i> < 0.001). In orthopedics, TCM techniques cost decreased by 30.3% (<i>p</i> < 0.001), but acupuncture and stomach/spleen departments saw significant increases of 18.88% and 46.66% respectively (<i>p</i> < 0.001).(4)Overall, there has been a significant reduction in the cost of TCM techniques following DRG payment reform. Notably, cost changes varied across departments, and acupuncture and moxibustion have experienced substantial cost fluctuations.</p><p><strong>Conclusions: </strong>The DRG payment reform has had a significant impact on appropriate techniques of TCM utilization and medical expense control, reflecting hospitals' strategic adjustment in balancing service quality with the DRG policy. It is recommended that policymakers consider the compatibility of DRG with TCM methods to ensure fairness and efficiency.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1441482"},"PeriodicalIF":2.7,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12358404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons learnt in the response to COVID-19 in Mozambique: enabling readiness for the next pandemic.","authors":"Mariana E Posse, Grace Njeri Muriithi, Daniel Malik Achala, Elizabeth Naa Adukwei Adote, Chinyere Ojiugo Mbachu, Senait Alemayehu Beshah, Chijioke Osinachi Nwosu, John Ele-Ojo Ataguba","doi":"10.3389/frhs.2025.1612577","DOIUrl":"10.3389/frhs.2025.1612577","url":null,"abstract":"<p><strong>Introduction: </strong>The coronavirus disease 2019 (COVID-19) has led to a dramatic loss of human lives worldwide and caused economic and social disruptions. The risk of another pandemic occurring is ever-present requiring countries to document factors that influenced the response to COVID-19 to guide the response to future pandemics. This study documents lessons learnt from Mozambique's COVID-19 response, considering the perspectives of various stakeholders and examining different components of the response.</p><p><strong>Methods: </strong>We used a qualitative phenomenology research design and collected data using in-depth interviews. We used purposive sampling by selecting institutions with relevant experience and knowledge to inform the study objectives. We also used snowballing techniques by asking respondents for other potential informants. We interviewed 19 individuals indicated by the representatives of the institutions selected for the study. The institutions were mostly based in Maputo city, the country's capital. Participants were asked about their role in the organization; responsibility in vaccine distribution and delivery in Mozambique; their opinion on what worked well in the country's response to COVID-19, and what could be improved as preparation to future pandemics. Data was coded using a computer-assisted qualitative data analysis software Maxqda 2020 and analyzed using a deductive thematic approach. A validation meeting was held, in which research participants were asked to check the accuracy of the results and interpretations.</p><p><strong>Results: </strong>Key drivers of the COVID-19 response were strong leadership; a clear plan and strategies; a functional coordination mechanism; the use of evidence to make decisions; a careful consideration of priority groups; investments in the supply chain and surveillance systems; the utilization of pre-existing vaccination structures; and partnership between the government and several stakeholders. There is room for improvement including the development of a clear budget, a communication plan, creation of an emergency fund, accountability in the use of funds, decentralization of surveillance infrastructure and representation of vulnerable, marginalized, and hard-to-reach populations in the design and implementation of pandemic response.</p><p><strong>Conclusion: </strong>The lessons learned from the COVID-19 response in Mozambique, which could be considered when preparing for an effective and equitable response to future pandemics, are in essence the following: there should be government leadership, a response plan, adequate resources, use of data to inform decisions, constant vigilance, a prompt response, involvement of all stakeholders and documentation of actions for continuous learning. These lessons could improve pandemic preparedness nationally and globally.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1612577"},"PeriodicalIF":2.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12360260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Engaging community to co-design learning health systems: lessons from storytelling and Design Jam, a community case study from British Columbia, Canada.","authors":"Margaret Chen-Mei Lin, Krisztina Vasarhelyi, Karen Lok Yi Wong, Haruka Furuichi, Jim Mann, Annette Berndt, Kayoung Lee, Lori Benning, Lillian Hung","doi":"10.3389/frhs.2025.1620659","DOIUrl":"10.3389/frhs.2025.1620659","url":null,"abstract":"<p><p>Health and research systems produce vast amounts of data, yet only a fraction is used to improve healthcare delivery-especially for equity-deserving communities. In Canada, Learning Health Systems (LHS) are guided by the Quadruple Aim: improving population health, enhancing patient and provider experience, and reducing costs, with equity now recognized as a critical additional aim. As LHS evolve, advancing health equity has become a core driver, particularly in Canada. An equitable LHS prioritizes inclusion, accessibility, and co-creation, ensuring that historically marginalized communities are active partners in shaping healthcare solutions. Community engagement is foundational to LHS, where individuals, families, and communities collaborate with clinicians, researchers, and decision-makers to drive meaningful improvements. This community case study describes how a large health authority in British Columbia integrated design thinking and a participatory action research approach to co-develop a vision for a community-centered LHS. Fifty diverse partners participated, including individuals and families, clinicians, non-clinical health staff, health administrators, researchers, and students. The project team drew on a Canadian LHS framework, appreciative inquiry, and design thinking to guide engagement activities. Participants co-designed a vision for LHS, proposing actions across six key areas, including (1) Legal and Ethical, (2) Science and Research, (3) Data and Technology, (4) Policy, Process, and Resources, (5) Indigenous Leadership & Participation, (6) Social, Community, and Equity. Through the sessions, lived experiences helped surface barriers and community priorities. Storytelling and Design Jam methods were key tools for fostering meaningful engagement. We propose practical considerations (INSPIRE) that researchers and policymakers can apply to enhance participation, foster equity, and ensure that Learning Health Systems remain community-driven and responsive to diverse needs: Inclusion first, Nurture Trust, Show impact, Partner with lived experience experts, Institutionalize diverse engagement, Recognize ethical responsibilities, and Ensure sustainability. Future research should investigate how to overcome barriers to participation, embed participatory approaches, and consider design-thinking in health system transformation. By focusing on community engagement, this case study demonstrates how LHS can be co-developed as inclusive and equity-driven.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1620659"},"PeriodicalIF":2.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12339457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Equitable access to COVID-19 vaccines in Botswana: a scoping review.","authors":"John T Tlhakanelo, John Ele-Ojo Ataguba, Vincent Pagiwa, Nankie Ramabu, Khutsafalo Kadimo, Dintle Molosiwa, Grace Njeri Muriithi, Daniel Malik Achala, Elizabeth Naa Adukwei Adote, Chinyere Ojiugo Mbachu, Senait Alemayehu Beshah, Nyasha Masuka, Chijioke Osinachi Nwosu, James Akazili, Chikezie Ifeanyi","doi":"10.3389/frhs.2025.1609089","DOIUrl":"10.3389/frhs.2025.1609089","url":null,"abstract":"<p><strong>Introduction: </strong>Despite global market complexities, Botswana acquired about 2.6 million COVID-19 vaccine doses between March 2021 and March 2022, 76% of which were purchased while 24% were donations. Thus, the study was envisaged to aggregate evidence on the case of Botswana's COVID-19 vaccine access patterns, hesitancy, and uptake.</p><p><strong>Materials and methods: </strong>We conducted a scoping reviewof Botswana-based articles using a predetermined search strategy to search databases including Medline, CINAHL, Web of Science, PubMed, Scopus, and Google Scholar. The review included all the English-language written peer-reviewed and grey literature reporting on vaccination in Botswana, to broaden coverage in recognition of limited publications on COVID-19 vaccinartion in Botswana. Non-English articles were excluded due to limited translation resources. Due to the heterogeneity of studies, a narrative synthesis approach was used to collect, synthesize, and map the literature.</p><p><strong>Results: </strong>As of 31 December 2021, 80.6% of the Botswana national target of 1,390,856 people over 18 years had received at least one dose of a COVID-19 vaccine, while 71.9% were fully vaccinated. Various vaccine distribution channels were utilized, including public facilities and outreaches, to improve access and uptake of vaccines. COVID-19 vaccine acceptance was considered generally high (73.4% amongst adults), and found positively associated with the male gender, those with comorbidities, those with non-restrictive religious beliefs, and those aged 55-64 years who thought the vaccine was safe for use. COVID-19 vaccine delivery relied on existing Expanded Program on Immunization (EPI) structures and therefore experienced to existing EPI challenges including, lack of transport, shortage of human resources, and vaccine stock-outs.</p><p><strong>Conclusions: </strong>Under-performance of immunization programs at the district level, characterized by declining immunization coverage and inadequate outreach services, exacerbates disparities in vaccine access. Efforts to strengthen healthcare infrastructure and expand outreach services are essential for reaching populations with limited access to healthcare facilities, particularly in rural and hard-to-reach areas. Collaboration with other government entities and the private sector improved vaccine access.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1609089"},"PeriodicalIF":2.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12339540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Boost Team: transforming outreach for female veterans in rural communities.","authors":"Jenny Krause Cohen, Kara Zamora-Rogoski, Caitlin McLean, Mariam Jacob, Tara Stacker, Caroline Dancu, Jennifer Childers","doi":"10.3389/frhs.2025.1617105","DOIUrl":"10.3389/frhs.2025.1617105","url":null,"abstract":"<p><strong>Introduction: </strong>Prior studies show that rurality and sex act synergistically resulting in poor health outcomes for rural female Veterans in large part due to challenges utilizing timely and convenient health care services. We conducted a mixed-methods quality improvement evaluation of a novel outreach program within the Veterans Health Administration (VHA) that provides clinician-driven outreach to women Veterans served by rural VHA clinics. Our goal was to understand the impact the program has on rural female Veterans' access to and engagement in VHA care as well as the impact the program has on health system leaders and rural VHA clinic staff.</p><p><strong>Materials and methods: </strong>In 2022, we developed a clinician-driven outreach program known as The Boost Team. The Boost nurse practitioner (NP) \"cold called\" female Veterans within a regional VA health care system and provided real-time clinical care and linkage to VHA services. Outreach calls were completed with 543 Veterans and metrics on call attempts and services rendered were tracked. Of Veterans who received the outreach, 58 completed a telephone survey using the Patient Empowerment Engagement Activation Survey (PEEAS), and 21 completed a semi-structured interview. Interviews focused on experiences with the NP, Boost's impact on access to and experience of VHA care, and suggestions for program improvement. Health system leaders (HSLs; <i>n</i> = 11) and rural VHA clinic staff (<i>n</i> = 5) completed interviews focused on barriers and facilitators to wider implementation of the Boost Program.</p><p><strong>Findings: </strong>The most common needs addressed during outreach calls included new referrals to specialty care, completion of outstanding health care maintenance (e.g., age-appropriate cancer screening), coordination with primary and specialty care, assistance with medication management, and reviewing diagnostics (e.g., labs, imaging). PEEAS data demonstrated strong agreement across all categories (median = 5 or \"strongly agree\"). Veterans, HSLs, and clinic staff reported that Boost outreach increased trust in VHA among Veterans and provided necessary support for under-staffed clinics.</p><p><strong>Conclusions: </strong>Clinician-driven outreach is a powerful tool to improve access to and engagement in care for rural female Veterans and provides necessary support to rural VHA clinics. Future efforts include expanding geographic range of Boost and better characterizing populations of veterans that most benefit from clinician-driven outreach.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1617105"},"PeriodicalIF":2.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12339469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"I know I shouldn't but …\" the inevitable tension of using workarounds to be a \"good nurse\".","authors":"Deborah Debono, David Greenfield, Wendy Lipworth, David J Carter, Deborah Black, Reece Hinchcliff, Jane Ellen Carland, Jeffrey Braithwaite","doi":"10.3389/frhs.2025.1579265","DOIUrl":"10.3389/frhs.2025.1579265","url":null,"abstract":"<p><strong>Introduction: </strong>Rules, policies, and technologies are increasingly introduced in healthcare to reduce complexity and iatrogenic harm. One example is the implementation of Electronic Medication Management Systems (EMMS) to minimise medication errors. However, in hospitals where nurses primarily administer medications, research shows that nurses often adopt \"workarounds\" to overcome barriers in medication administration. This study explored how nurses experienced and perceived the use of workarounds in their daily medication administration practices. Understanding these feelings is crucial, as they are linked to both patient safety and staff retention.</p><p><strong>Methods: </strong>This ethnographic study was conducted in six wards in two Australian hospitals across 91 shifts, 46 interviews, seven focus groups, and member-checking sessions with nurses and EMMS stakeholders (<i>N</i> = 113 participants). Data analysis used a general inductive approach.</p><p><strong>Results: </strong>Nurses described positive, negative, ambivalent, and conflicting feelings about using workarounds. Some denied the use or tolerance of workarounds, despite them being routinely observed. Most reported a tension between the perceived necessity of workarounds, reluctance to deviate from policy, and the desire to be a good nurse. Workarounds were seen both as the trademark of an expert, mindful nurse and as deviations from the rules, unsafe for both patients and nurses.</p><p><strong>Discussion: </strong>This study demonstrates challenges to patient safety associated with the tension between the necessity of workarounds and the desire to adhere to policy. This can create stress and anxiety among nurses. They experience a tension at the intersection of the necessity of workarounds to deliver care, to be a good nurse, and the desire to adhere to policy. The associated stress and anxiety can lead to burnout, professional disengagement, and attrition. The study proposes solutions to manage challenges associated with workarounds.</p><p><strong>Conclusion: </strong>Workarounds are an inevitable aspect of healthcare delivery in response to standardisation. Negative perceptions of workarounds may inadvertently contribute to the very harm that standardisation seeks to prevent. A more open dialogue about their use is essential. Recognising their inevitability and equipping nurses to manage them constructively is key to reducing stress, preventing burnout, and enhancing patient safety.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1579265"},"PeriodicalIF":2.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12339508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators to COVID-19 testing and vaccination: a qualitative focus group study among Rhode Island's Latine/Hispanic community.","authors":"D Grace Smith, Yovanska Duarte-Velez, Elizabeth S Chen, Mario Bueno, A Rani Elwy, Indra Neil Sarkar","doi":"10.3389/frhs.2025.1473375","DOIUrl":"10.3389/frhs.2025.1473375","url":null,"abstract":"<p><strong>Introduction: </strong>Due to a combination of cultural, situational, social, and environmental factors, members of the Latine/Hispanic community experienced higher contagion and poorer outcomes amid the COVID-19 pandemic, and lower rates of testing and vaccination. Our aims were to use the frameworks of implementation science to identify barriers and facilitators impacting equitable access to COVID-19 testing and vaccination programs among Rhode Island's (RI's) Latine/Hispanic community.</p><p><strong>Methods: </strong>Between February and June 2021, we implemented a community-centered approach, empowering Promatoras, trusted community health leaders, to conduct eight focus groups among RI's Latine/Hispanic community (<i>n</i> = 55). To gain the perspectives of health delivery experts, we conducted six one-on-one interviews with healthcare professionals serving this community. Recordings were translated into English as applicable, transcribed, and analyzed using directed content analysis and thematic analysis, guided by theories of implementation science.</p><p><strong>Results: </strong>Latine/Hispanic community members made decisions about participation in testing and vaccination programs by considering factors primarily related to their communal, religious, interpersonal, and emotional contexts. The amount and sources of information they received, perceived accessibility of interventions, and their perceived agency (i.e., freedom to decide how/when/where to follow interventions) also shaped decisions. Many barriers identified by clinicians (e.g., structural determinants to access) were not discussed by Latine/Hispanic community members.</p><p><strong>Discussion: </strong>Facilitators and barriers to test/vaccine implementation were shaped by local communal and individual factors, generally supporting previous arguments on implementation among Latine/Hispanic communities, and revealing the importance of context-specific examinations. In public health pandemic preparedness work, we encourage community-based participatory approaches to identify priorities/barriers and involvement of community leaders to build trust, frame messaging, and disseminate information.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1473375"},"PeriodicalIF":2.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12339458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respite time-use among dementia caregivers.","authors":"Donald A Godfrey, Bob Wong, Amber D Thompson, Max E Coleman, Catharine Sparks, Rebecca L Utz","doi":"10.3389/frhs.2025.1598518","DOIUrl":"10.3389/frhs.2025.1598518","url":null,"abstract":"<p><p>Caregiving for family members with Alzheimer's disease and related dementias (ADRD) places significant burden on family members, leaving them at risk for a variety of mental and physical issues. While engaging in sufficient respite is generally considered an important resiliency factor for caregivers, recent research has demonstrated that caregivers are not satisfied with their respite and are not gaining much benefit during the limited respite time available to them.</p><p><strong>Objectives: </strong>The current study examines whether goal-oriented respite planning, facilitated by a mobile intervention, can improve caregivers' subjective experience of their respite time-use.</p><p><strong>Method: </strong>Caregivers (<i>N</i> <i>=</i> 85) used a mobile intervention to help them plan and evaluate their weekly respite time-use. Ecological Momentary assessments (weekly) monitored number of respite hours, respite goal achievement, and subjective assessment of their respite experience.</p><p><strong>Results: </strong>Respite goal achievement on a given week predicted improvements in participants' ratings of their respite time-use outcomes one week later. Specifically, one week after reporting improved respite goal achievement, caregivers' ratings on happiness with their respite activities, feeling that their respite made them a better caregiver, and feeling like they had enough respite all increased. These effects were independent of the number of respite hours they reported per week.</p><p><strong>Discussion: </strong>Engaging in weekly goal-setting and goal-review activities is associated with caregivers' subjective evaluation of their respite time-use. Interventions that help caregivers implement goal setting and achievement into their daily lives would likely benefit subjective evaluations and experiences with respite.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1598518"},"PeriodicalIF":2.7,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of chemotherapy for advanced and recurrent cervical cancer: a systematic review.","authors":"Katsuaki Inami","doi":"10.3389/frhs.2025.1616223","DOIUrl":"10.3389/frhs.2025.1616223","url":null,"abstract":"<p><strong>Introduction: </strong>Advanced and recurrent cervical cancer often requires palliative chemotherapy and is associated with poor prognosis. Recently, various systemic therapies-including cytotoxic drugs, anti-angiogenic agents, and immune checkpoint inhibitors-have been evaluated for their cost-effectiveness.</p><p><strong>Methods: </strong>We conducted a systematic review of English language-based research publications reporting incremental cost-effectiveness ratios (ICERs) for chemotherapy-based treatments in advanced or recurrent cervical cancer. Literature was retrieved from PubMed, Scopus, and Web of Science without date restrictions and screened based on predefined eligibility criteria. A total of 10 studies were included.</p><p><strong>Results: </strong>Traditional first-line platinum-based doublet chemotherapy (e.g., cisplatin plus paclitaxel) was consistently found to be cost-effective, with ICERs well below common willingness-to-pay (WTP) thresholds. The addition of bevacizumab improved survival but increased costs, yielding borderline or unfavorable ICERs (e.g., $155,000/QALY in the U.S.). Immunotherapy agents such as pembrolizumab and cadonilimab offered clinical benefits but often exceeded WTP thresholds, particularly in low- and middle-income settings. Cemiplimab had an ICER of $111,000/QALY as a second-line treatment, near the upper U.S. WTP threshold, while agents like tisotumab vedotin were not economically viable at current prices. Cost-effectiveness varied across regions depending on pricing, healthcare systems, and local WTP thresholds.</p><p><strong>Discussion: </strong>Although newer agents provide incremental survival benefits, their high costs often outweigh QALY gains. Policymakers and clinicians should consider the economic impact of adopting such therapies and prioritize value-based strategies, including price negotiations, biosimilar use, and biomarker-guided patient selection. Future research should promote evidence-based pricing and access models to support sustainable cancer care worldwide.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1616223"},"PeriodicalIF":2.7,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A policy-driven mental health and psychosocial support in African Union Peace Support Operations: the way forward in improving the psychosocial wellbeing of peace support personnel.","authors":"Joana Afful Larry-Afutu, Kenneth Abotsi","doi":"10.3389/frhs.2025.1465236","DOIUrl":"10.3389/frhs.2025.1465236","url":null,"abstract":"<p><strong>Background: </strong>To foster peace and security within Africa, the African Union Peace Support Operations (AUPSO) Division deploy personnel to volatile areas, predisposing them to physical and psychosocial problems. Though a lot is done to safeguard their physical health, their psychosocial problems have been relegated, predisposing them to mental health problems.</p><p><strong>Analysis: </strong>To address these mental health and psychosocial problems, the African Union, in collaboration with Kofi Annan International Peacekeeping Training Centre, Ghana developed and implemented a Mental Health and Psychosocial Support (MHPSS) course for AUPSO personnel. Implementing MHPSS in mission areas is bedeviled with challenges, because there are no policy guidelines for MHPSS in PSOs.</p><p><strong>Policy options: </strong>At the behest of WHO's Action Plan 2013-2020 which encourages institutions and organizations to prioritize mental health of personnel, the United Nations adopted a mental health and well-being strategy to enhance the psychosocial wellbeing of its mission's personnel in 2018.</p><p><strong>Conclusion: </strong>Feasibly, developing a MHPSS policy for PSOs would enhance the implementation of MHPSS programs in missionary areas to ensure that personnel are in a good psychosocial state to fulfil their missions' mandate.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1465236"},"PeriodicalIF":2.7,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}