bluuebunny/crossref_metadata_2025_split huggingface dataset:
Making integration happen: managers’ views on multidisciplinary work in Finnish health system
Authors: Karreinen S , Paatela S , Huhtakangas M , Paananen H , Satokangas M , Tynkkynen L K 
Published: October 2024

Abstract

Background
In Finland, a large-scale health and social service reform was implemented in 2023. The structural reform centralised the organising of health and social services from some 200 organisations to 22 wellbeing services counties (WBSC). One goal of the reform was to promote service integration between and within health and social services. The reform offers a unique opportunity for investigating how such change unfolds. This study addresses the integration aspirations of those who are responsible for implementing the change, that is middle managers in WBSCs. We focus on micro and meso levels and explore how the aim of multidisciplinary collaboration is interpreted as part of advancing service integration by middle managers in one newly formed WBSC.

Methods
The data for this qualitative study were derived from 11 semi-structured interviews with senior and middle managers responsible for various fields of health and social care services in a single WBSC between October 2022 and June 2023. Inductive thematic analysis was applied.

Results
The managers framed multidisciplinary collaboration very positively and easier to achieve in the new organisation with health and social services united under the same management. The managers acknowledged the need to form collaborative structures (e.g. meetings) and processes at all levels of organisation. Leadership plays a crucial role in creating space for the professionals to form an experience of a shared every-day work. However, previous structures and patterns of work still seemed to limit these endeavours. Tensions between, for example, professional groups or units were left essentially untouched. Multidisciplinary collaboration will serve especially persons with complex and multiple needs and was framed key to cost savings.

Conclusions
While the structural reform opens a window of opportunity to new collaborative patterns, competing logics and interests as well as power imbalances may hamper the development if not addressed.

Key messages
• Middle managers had high hopes for multidisciplinary work after the health system reform, including effects on the difficult issues concerning costs and health workforce availability.
• While the managers were prepared to promote multidisciplinary work, the prior organisational boundaries and logics hindered integration. Different tensions between stakeholders need more attention.
Behavioral incentives on pay-for-performance schemes in primary health care: a scoping review
Authors: Alves J , Dias C V , Perelman J , Gonçalves I , Moiane I , Morgado V 
Published: October 2024

Abstract

Background
Incentivizing healthcare professionals through pay-for-performance (P4P) schemes has become an essential strategy to enhance healthcare quality and efficiency. In Portugal, a P4P framework was put in place in Primary Health Care (PHC). Understanding how these incentives influence healthcare delivery is crucial for optimizing P4P effectiveness.

Objectives
This scoping review aims to compare the impacts of intrinsic and extrinsic incentives of P4P schemes within PHC teams.

Methods
We are conducting a comprehensive scoping review following the PRISMA-ScR guidelines. The databases PubMed/MEDLINE, Scopus, Web of Science, and PsycINFO are being searched to identify experimental and quasi-experimental studies. Eligible studies focused on PHC providers organized in teams, examining the role of intrinsic and extrinsic incentives under both public and private healthcare settings.

Results
Preliminary findings include a Dutch study demonstrating significant improvements in adherence to prescribing guidelines through electronic health records based P4P indicator. In Ethiopia, performance-based non-financial incentives led to enhanced data quality and evidence utilization among health workers. Conversely, a study from Burkina Faso highlighted mixed results in antenatal care quality improvement despite incentive implementation. In Scotland, studies on the removal of financial incentives indicated potential declines in certain quality care metrics, suggesting the complexities involved in the direct and indirect effects of incentive withdrawal.

Conclusions
The preliminary evidence indicates that both intrinsic and extrinsic incentives can significantly impact the effectiveness of P4P schemes, though the nature and magnitude of these impacts vary considerably. The findings underscore the necessity of a nuanced approach to designing and implementing incentive mechanisms in PHC to foster sustainable improvements in healthcare quality.

Key messages
• Intrinsic and extrinsic incentives significantly influence P4P scheme effectiveness in PHC.
• Designing P4P incentives requires nuanced consideration of varying impacts on healthcare quality.
The determinants of oral health in Turkish elderly: an analysis of Turkey Health Survey (THS) 2022
Authors: Şevik I , Davas A 
Published: October 2024

Abstract

Background
Oral health is an integral part of health and wellbeing; however, the use of dental care by the elderly is lower compared to other services. Considering the relationship between oral health and chronic diseases, along with healthcare use patterns, evaluating oral health in the elderly is crucial. This study aims to assess the oral health status and individual, socioeconomic and healthcare related factors in people aged 65 and over in Turkey.

Methods
This cross-sectional study was based on THS 2022 micro dataset. Participants aged 65 and over constituted the population of this study, with 3144 participants included. Data analysis was performed using SPSS 28.0 and included descriptive statistics, Pearson’s chi-square and logistic regression.

Results
The mean age of participants was 72.57 with 54% being women.Self-reported poor oral health was noted in 25.8%, and 75.2% did not receive dental care in the past year. Individual factors such as older age, obesity, and multimorbidity, as well as social factors like female gender, being single, and language barrier, were associated with worse oral health. Education and social support were also associated with oral health. Among economic factors, employment showed a significant association. Concerning healthcare-related factors, not using oral care in the past year, unmet dental care needs due to financial constraints, appointments, and transportation were associated with worse oral health. Logistic regression revealed significant associations between oral health and age, multimorbidity, gender, language, education, social support, employment, dental care use, unmet dental care needs due to financial constraints and transportation.

Conclusions
Addressing barriers and risk factors is needed to improve oral health among Turkey’s elderly. Efforts should focus on enhancing access to dental care and addressing socioeconomic determinants of oral health.

Key messages
• Identifying and addressing barriers and individual, socioeconomic and health-care related risk factors associated with poor oral health among the elderly in Turkey is important.
• It is needed to prioritize efforts aimed at enhancing access to oral care for the elderly in Turkey by both improving physical access and addressing social determinants to ensure better oral health.
Organization of Vaccination Sites in Quebec: Perception of Users, Employees and managers
Authors: Lanthier-Veilleux M , Pépin E M , Ezin Aloffan LND , Loslier J , Nour K , Guay M 
Published: October 2024

Abstract

Since late 2020, vaccination sites have emerged rapidly in order to protect the population against COVID-19. Health services in Montérégie (Québec) are provided by three organizations. Each adopted a different approach to immunization. The Regional Public Health Department took this opportunity to describe, compare, and explain these three approaches. A mixed methods design through a multiple case study was conducted. Users, employees and managers were interviewed at the end of 2021 on several performance-related topics. Individual interviews with employees and managers in mid-2022 further explored these topics. 38 managers, 360 employees, and 946 users participated in the survey. 9 managers and 10 employees were interviewed. Most participants were satisfied with vaccination organization regardless of the model used, mainly because of high geographic and temporal accessibility of the sites. Further signage to indicate directions could optimize accessibility. High adaptability was essential for managers and employees. Training strategies such as people to refer to and pairing allowed to better deal with frequent changes and staff rotation. The addition of ongoing training could be beneficial. Rapid changes in employee schedules were identified as a challenge. The use of technology-based scheduling tools, accessible to all, brought added flexibility, which was appreciated. Several ideas were used to communicate updates on a daily basis. However, timely implementation of new recommendations remained an ongoing challenge. Dedicated clinics for specific clienteles were successful. Community partnerships were generally beneficial, although establishing more of them could potentially reach other vulnerable communities. To improve accessibility and minimize health social inequities, a greater investment in local partnerships might reach more vulnerable clienteles. Regular communication and innovative employee support are key elements to improve fluidity of operations.

Key messages
• Reaching out for vulnerable clienteles is essential to minimize health social inequities.
• Rapid changes in services needs underlign fluidity communication importance.
Long-term Survival After Cancer: A Scoping Review of the Health Care Landscape in Germany
Authors: Messer S , Cryns N , Ernst M , Dirksen U , Gruenwald V , Skoetz N 
Published: October 2024

Abstract

Background
Cancer remains a global health concern, with a significant increase in new cases projected in the coming years. Although cancer treatment and diagnosis have advanced, leading to improved survival, survivors often face complex physical, emotional, and cognitive challenges. The objective of this scoping review is to provide an overview of the current landscape of specialized long-term survivorship care services in North Rhine-Westphalia (NRW) with a focus on vulnerable groups.

Methods
The scoping review involves two search approaches: a manual search performed by two review authors and a systematic search performed by an information specialist following Scoping Review guidance. The protocol was published on the OSF platform. The systematic search was conducted in databases such as LIVIVIO, MEDLINE and Scopus. The manual search involves identifying key categories of survivorship services and conducting online searches based on these categories in duplicate. Data extraction and synthesis is conducted using EPPI-Reviewer software, and focuses on services characteristics, patient demographics, program format, and accessibility.

Results
The study has identified more than 300 survivorship care services across North Rhine-Westphalia. According to preliminary results some services offer comprehensive care, while others have significant gaps, particularly in addressing the needs of vulnerable groups. One example of these gaps is the lack of tailored services specifically designed for people with a migration background. Most of the services are not available in multiple languages or gender-specific oriented. The results will be presented on the congress in detail.

Conclusions
This scoping review underscores the importance of tailored survivorship care, especially for vulnerable groups. Public health actions should focus on addressing disparities in access to survivorship services, enhancing existing programs, and developing new policies to support cancer survivors.

Key messages
• Effective survivorship care requires attention to vulnerable groups.
• The care of long-term cancer survivors should receive more attention in research.
Rethinking electronic health records implementation in Germany: a value-based health system approach
Authors: Schmitt T 
Published: October 2024

Abstract

Problem
The Digital Act (Digital-Gesetz) in Germany stipulates that electronic health records (elektronische Patientenakte; ePA) will be set up for all persons under the statutory health insurance (SHI) in 2025; those who do not wish to use ePA can object. This opt-out approach aims to increase the coverage of ePA among the SHI population to 80%, which has been ca. 1.5% since its launch in 2021. According to law, ePA is managed solely by the patient and does not replace the conventional patient file stored in the medical practice management system. Without appropriate measures, it is likely that multiple parallel patient files are created, with the risk of ePA being side-lined over time.

Description
The Ministry of Health aims to make ePA the central platform for patients’ healthcare provision throughout their life. With ePA, patients should receive useful information about their healthcare as well as reminders and tailor-made medical advice. For healthcare providers, ePA should become an essential part of the healthcare process with containing reliable information and supporting the treatment. However, understanding ePA as more than a digital health solution, factors beyond technical interoperability must be considered for its successful implementation.

Results
The full potential of ePA and its positive impact on healthcare to tackle the fragmentation issue can only be realised when it is viewed as a helpful tool of collaboration for all involved parties. The existing regulatory frameworks in Germany create disincentives for greater integration, coordination, and interconnection, with each sector following its own reimbursement system and reinforcing the division between them. This contradicts with the idea of ePA fostering patient-centredness and inter-sectoral collaboration.

Lessons
How a health system functions and how health services are governed and remunerated have a substantial impact on the healthcare providers’ acceptance of digital services.

Key messages
• Changes in the governance of health systems may be necessary when implementing electronic health records to bring person-centred care and overcome the separation of in-patient and out-patient sectors.
• Rather than a paternalistic approach, the relationship between the patient and healthcare provider should move towards a partnership model, based on the motivation of keeping individuals healthy.
The association between health literacy and colorectal cancer screening uptake in Taiwan
Authors: Hsu C W , Lin Y J , Shen Y C , Wang Y R 
Published: October 2024

Abstract

Background
Population-based cancer screening programs have been confirmed as a cost-effective strategy for early detection of colorectal cancer, leading to reduced mortality and morbidity. In Taiwan, the government has provided an immunochemical fecal occult blood test (iFOBT) every two years to all citizens aged 50 to 74 years since 2013. The study aims to determine the association between iFOBT uptake and health literacy (HL).

Methods
Data from the National Health Interview Survey (NHIS), a population-based cross-sectional survey conducted in 2021-22 in Taiwan, were applied. The European Health Literacy Survey Short Form (HLS-EU-Q16), self-reported iFOBT participation within the past 2 years, and covariates assessed by face-to-face interview. The present analysis included those age-eligible for screening (n = 3,871) and applied the survey-weighted multivariable logistic regression to estimate odds of iFOBT uptake between HL skill levels, controlling for age, education attainment, socioeconomic status, health status, and household urbanicity level.

Results
In general, 44.6% of participants had utilized the iFOBT, and 79.9% had adequate HL skills which reported higher iFOBT uptake rates (45.9%) than their counterparts (39.4%). Multivariable analysis showed that having adequate HL was associated with greater odds of iFOBT utilization (adjusted odds ratio [aOR] = 1.79; 95% CI: 1.29-2.49). Additionally, compared to those households registered in the township, participants in higher urbanicity levels had lower iFOBT uptake: city (aOR = 0.62; 95% CI: 0.47-0.82). Other predictors that contributed significantly were participants’ gender and having 2 or more chronic diseases.

Conclusions
Inadequate HL skills and urban residency may reduce participation in the CRC screening program, despite its free availability. More efforts should include literacy-friendly designed materials and the provision of tailored support in urban settings.

Key messages
• HL skills are significantly associated with the CRC screening uptake in Taiwan. Improving HL could have positive effects on people’s participation.
• Urbanicity levels are also predictors associated with screening utilization. Disseminating health service information in localized ways should be a potential option.
Validating weight optimization’s Impact on participants via Social Impact Bonds
Authors: Haga C , Bang E , Jeong S , Inoue Y , Kondo K 
Published: October 2024

Abstract

Background
To promote health for everyone, even the health-unconcerned, Okayama City has established the Social Impact Bond (SIB), which funds and executes social programs for defined outcomes, with third-party assessment. This study examined the normalization of participants’ physiques three years later to verify the effectiveness of SIB.

Methods
We conducted a study of a quasi-experimental design, non-randomized controlled trial. A total of 8,251 eligible people applied for the program. Of these, 1,599 were enrolled in the National Health Insurance System (NIH), and 731 of them were included in the intervention group in 2018. Among 705 non-participating matched members and randomly selected, 170 were used as the control group. Whether or not the standard physique in the endpoint (EP) FY2021, was used as the dependent variable, and the participation as the independent variable. Age, gender, and physique at baseline (BL) were used as covariates for logistic regression analysis.

Results
A total of 532 patients underwent health checkups for both BL and EP, and the follow-up rate was 60.5% in the intervention group and 52.9% in the control group. Examination of between-group differences in BL revealed that the mean age was 66.7 years significantly higher in the males’ intervention group and 60.6 years in the control group (p &lt; 0.01). The crude odds ratio (OR) of maintaining or achieving standard BMI in the participating group was 0.90, and the adjusted OR was 1.23 and 1.31 after propensity score matching, both were not significant. On the other hand, when restricted to people with thinness, the pre-adjusted OR was 5.00 and the adjusted OR was 12.43.

Conclusions
Participation in the project contributed about 20% to 30% to weight optimization, and it could not be denied that it was brought about by chance. However, when limited to thin physiques, project participation was about twelve times higher, and the probability of having an appropriate physique was increased.

Key messages
• SIB might affect the BMI optimization for older people in improving thinness.
• Efforts will be needed to encourage participation among younger age groups.
What if we could eradicate cervical cancer?
Authors: De Luca A , Capitani E , Limaj S , Taddeini F , Cosimi A , Turillazzi R , D’Amato M G , Montomoli E , Nante N , D’Urso A 
Published: October 2024

Abstract

Introduction
WHO wants to achieve the elimination of Cervical Cancer: all countries must achieve and maintain an incidence rate of less than 4 per 100,000 women. Three key pillars: 90% of girls fully vaccinated against HPV by 15 years of age; 70% of women aged 35-45 years screened; 90% of women with pre-tumour lesion and invasive tumour treated. Our study assessed the position of the Tuscany South East Local Health Authority(LHA TSE) with respect to these three pillars and how to improve it.

Methods
A retrospective observational study was conducted. The following were used: ISTAT data of incidence of cervical cancer standardised by age from 2013 to 2017;data from ISPRO on screening(PAP and HPV test)from 2013 to 2022;data of vaccination coverage taken from the Health Information System of Collective Prevention(SISPC) from 2012 to 2023 for children&lt;12 years,

Results
The incidence rate of cervical cancer in LHA TSE is 9.4 per 100 thousand. About HPV vaccine coverage by age 12, for girls it has been rising from 80.5% in 2012 to a peak of 84.8% in 2019 and then progressively decreasing to 76.3% in 2023.Coverage for boys has also been progressively increasing from 0.8% in 2012 to a peak in 2019 of 74.9% and then decreasing to 69.8% in 2023. A total of 52 thousand children are vaccinated. As for the adjusted adherence to screening, we started from an average adherence of 51.8% in 2013 (75 thousand women invited with 102% coverage) to 53.2% in 2022 (54 thousand women invited with 107% coverage). In 2013, ASC-US+ lesions were found in 6.4 % of women by PAP Test and in 2022 in 6.3 % of women. In the examined period, more than 90% of women with pre-tumour lesion and more than 90% with invasive tumour were treated.

Conclusions
LHA TSE will have to implement actions to increase vaccination coverage and screening adherence rates through awareness campaigns and open days, also considering whether a change in the age range for starting screening is necessary as vaccination coverage increases.

Key messages
• Cervical cancer is one of the most preventable cancers, but too few young women are vaccinated against HPV infection, the main causative factor.
• Prevention through adherence to screening enables early identification of lesions caused by HPV virus.