Patient survey on cancer genomic medicine in Japan under the national health insurance system.

In Japan, comprehensive genomic profiling (CGP) tests have been reimbursed under the national health care system for solid cancer patients who have finished standard treatment. More than 50,000 patients have taken the test since June 2019. We performed a nation-wide questionnaire survey between March 2021 and July 2022. Questionnaires were sent to 80 designated Cancer Genomic Medicine Hospitals. Of the 933 responses received, 370 (39.7%) were web based and 563 (60.3%) were paper based. Most patients (784, 84%) first learned about CGP tests from healthcare professionals, and 775 (83.1%) gave informed consent to their treating physician. At the time of informed consent, they were most worried about test results not leading to novel treatment (536, 57.4%). On a scale of 0-10, 702 respondents (75.2%) felt that the explanations of the test result were easy to understand (7 or higher). Ninety-one patients (9.8%) started their recommended treatment. Many patients could not receive recommended treatment because no approved drugs or clinical trials were available (102/177, 57.6%). Ninety-eight patients (10.5%) did not wish their findings to be disclosed. Overall satisfaction with the CGP test process was high, with 602 respondents (64.5%) giving a score of 7-10. The major reason for choosing 0-6 was that the CGP test result did not lead to new treatment (217/277, 78.3%). In conclusion, satisfaction with the CGP test process was high. Patients and family members need better access to information. More patients need to be treated with genomically matched therapy.

Survival among lung cancer patients: comparison of the U.S. military health system and the surveillance, epidemiology, and end results (SEER) program by health insurance status.

PURPOSE: The U.S. military health system (MHS) provides beneficiaries with universal health care while health care access varies in the U.S. general population by insurance status/type. We divided the patients from the U.S. general population by insurance status/type and compared them to the MHS patients in survival. METHODS: The MHS patients were identified from the Department of Defense's Automated Central Tumor Registry (ACTUR). Patients from the U.S. general population were identified from the Surveillance, Epidemiology, and End Results (SEER) program. Multivariable Cox regression analysis was conducted to compare different insurance status/type in SEER to ACTUR in overall survival. RESULTS: Compared to ACTUR patients with non-small cell lung cancer (NSCLC), SEER patients showed significant worse survival. The adjusted hazard ratios (HRs) were 1.08 [95% Confidence Interval (CI) = 1.03-1.13], 1.22 (95% CI = 1.16-1.28), 1.40 (95% CI = 1.33-1.47), 1.50 (95% CI = 1.41-1.59), for insured, insured/no specifics, Medicaid, and uninsured patients, respectively. The pattern was consistently observed in subgroup analysis by race, gender, age, or tumor stage. Results were similar for small cell lung cancer (SCLC), although they were only borderline significant in some subgroups. CONCLUSION: The survival advantage of patients receiving care from a universal health care system over the patients from the general population was not restricted to uninsured or Medicaid as expected, but was present cross all insurance types, including patients with private insurance. Our findings highlight the survival benefits of universal health care system to lung cancer patients.

Evaluation of the diagnostic accuracy of exome sequencing and its impact on diagnostic thinking for patients with rare disease in a publicly funded health care system: A prospective cohort study.

PURPOSE: To evaluate the diagnostic utility of publicly funded clinical exome sequencing (ES) for patients with suspected rare genetic diseases. METHODS: We prospectively enrolled 297 probands who met eligibility criteria and received ES across 5 sites in Ontario, Canada, and extracted data from medical records and clinician surveys. Using the Fryback and Thornbury Efficacy Framework, we assessed diagnostic accuracy by examining laboratory interpretation of results and assessed diagnostic thinking by examining the clinical interpretation of results and whether clinical-molecular diagnoses would have been achieved via alternative hypothetical molecular tests. RESULTS: Laboratories reported 105 molecular diagnoses and 165 uncertain results in known and novel genes. Of these, clinicians interpreted 102 of 105 (97%) molecular diagnoses and 6 of 165 (4%) uncertain results as clinical-molecular diagnoses. The 108 clinical-molecular diagnoses were in 104 families (35% diagnostic yield). Each eligibility criteria resulted in diagnostic yields of 30% to 40%, and higher yields were achieved when >2 eligibility criteria were met (up to 45%). Hypothetical tests would have identified 61% of clinical-molecular diagnoses. CONCLUSION: We demonstrate robustness in eligibility criteria and high clinical validity of laboratory results from ES testing. The importance of ES was highlighted by the potential 40% of patients that would have gone undiagnosed without this test.

Hyper-Acute Stroke Systems of Care and Workflow.

PURPOSE OF REVIEW: Recent stroke treatment advances have necessitated agile, broad-scale healthcare system redesign, to achieve optimal patient outcomes and access equity. Optimised hyperacute stroke care requires integrated pre-hospital, emergency department, stroke specialist, radiology, neurosurgical and endovascular neurointervention services, guided by a population-wide needs analysis. In this review, we survey system integration efforts, providing case studies, and identify common elements of successful initiatives. RECENT FINDINGS: Different regions and nations have evolved varied acute stroke systems depending on geography, population density and workforce. However, common facilitators to these solutions have included stroke unit care as a foundation, government-clinician synergy, pre-hospital pathway coordination, service centralisation, and stroke data guiding system improvement. Further technological advantages will minimize the geographical distance disadvantages and facilitate virtual expertise redistribution to remote areas. Continued treatment advances necessitate an integrated, adaptable, population-wide trans-disciplinary approach. A well-designed clinician-led and government-supported system can facilitate hyperacute care and scaffold future system enhancements.

The impact of the 2021 flood on the outpatient care in the North Rhine region, Germany: a cross-sectional study.

BACKGROUND: In the summer of 2021, heavy precipitation led to extreme flooding across Western Europe. In Germany, North Rhine-Westphalia and Rhineland-Palatinate were particularly affected. More than 180 people lost their lives, and over 700 were left injured and traumatized. In the North Rhine district alone, more than 120 practices were only able to operate to a limited extent or had to close their practices completely. The aim of this study was to assess the impact of the 2021 flood on the outpatient care in the North Rhine region. METHODS: The cross-sectional study was conducted in January 2022 in practices affected by the flood in the North Rhine region. For this purpose, 210 affected practices were identified using a list of the Association of Statutory Health Insurance Physicians for North Rhine (KVNO) and via telephone and/or e-mail. These practices were forwarded a questionnaire that addressed, among other things, the local accessibility of the practices before and after the flood, possibilities of patient care in different premises and received support. RESULTS: A total of 103 practices (49.1%) returned the completed questionnaire, of which 1/4 were general practitioners. 97% of the practices reported power failure, more than 50% water supply damage and nearly 40% the loss of patient records. 76% of the participating practices stated that they needed to close their practice at least temporarily. 30 doctors took up patient care in alternative premises. The average number of patients seen by doctors per week before the flood was 206.5. In the first week working in alternative premises, doctors saw an average of 66.2 patients (-50.3%). Especially elderly/geriatric patients and patients with disabilities were identified as particularly vulnerable in terms of access to health care after the flood. CONCLUSIONS: The flood had a significant negative impact on outpatient care. We determined not only a high number of closed practices and a large decrease in patient numbers but also differences in patient care assessment depending on the type of alternative premises. To address outpatient care disruptions after extreme weather events more effectively, appropriate measures should be implemented pre-emptively.

Assessment of care provision integration in a community-based mental health system: balanced care model implementation in Andalusia (Spain).

BACKGROUND: Andalusia is the second largest region in Spain, and it has developed a comprehensive mental health (MH) plan that encourages the consolidation of the balanced care model. However, its geographical and socioeconomic disparity is a great challenge for a community-based MH system. Both the assessment of the implementation of the MH plan and the development of new tools to support decision-making can be considered critical. OBJECTIVES: The present study aims (i) to assess how the integration of different types of MH care may influence system performance and (ii) to check the performance evolution of the integration process geographically regarding the small MH areas of Andalusia. METHODS: The performance of the Andalusian MH system was assessed by combining Monte Carlo simulation, fuzzy inference and data envelopment analysis. The relative technical efficiency was the main performance indicator. RESULTS: A correct integration of appropriate types of MH care, according to population needs, increases the performance of the Andalusian MH system both from global and regional perspectives. The spatial representation (based on small MH areas) of the results highlights how the performance depends on specific geographical characteristics. By analyzing the identified spatial clusters, defined by different management patterns depending on user and socioeconomic characteristics, benchmark areas and areas for improvement can be studied to design evidence-informed policies and interventions. CONCLUSIONS: A global analysis of MH system performance was carried out, including both the successive integration of different types of care and its spatial evolution. Although an appropriate integration of different types of MH care has a positive effect on the Andalusian MH system, this process has different profiles depending on specific geographically based user and socioeconomic characteristics. The balanced care model can be considered the paradigm for assessing the performance of a large and populated territory such as Andalusia, which has a community-based MH system. This methodological approach (performance assessment and spatial analysis) may be used as a guide for developing future evidence-informed policies and managerial interventions.

Global trends and partial forecast of adverse effects of medical treatment from 1990 to 2019: an epidemiological analysis based on the global burden of disease study 2019.

BACKGROUND: The possibility of adverse effects of medical treatment (AEMT) is increasing worldwide, but little is known about AEMT in China. This study analyzed the health burden of AEMT in China in recent years through the Global Burden of Disease Study (GBD) 2019 and compared it with the worldwide average level and those in different sociodemographic index (SDI) regions. METHODS: We calculated the age-standardized rate (ASR) of deaths, disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs), incidence and prevalence attributed to AEMT in China, worldwide and countries with different sociodemographic indices during 1990-2019 using the latest data and methods from the GBD 2019. RESULTS: From 1990 to 2019, the global age-standardized death rate (ASDR), DALYs, and YLLs for AEMT showed a significant downward trend and were negatively associated with the SDI. By 2040, the ASDR is expected to reach approximately 1.58 (95% UI: 1.33-1.80). From 1990 to 2019, there was no significant change in the global incidence of AEMT. The occurrence of AEMT was related to sex, and the incidence of AEMT was greater among females. In addition, the incidence of AEMT-related injuries and burdens, such as ASR of DALYs, ASR of YLLs and ASR of YLDs, was greater among women than among men. Very old and very young people were more likely to be exposed to AEMT. CONCLUSIONS: From 1990 to 2019, progress was made worldwide in reducing the harm caused by AEMT. However, the incidence and prevalence of AEMT did not change significantly overall during this period. Therefore, the health sector should pay more attention to AEMT and take effective measures to reduce AEMT.

Strategies to strengthen the resilience of primary health care in the COVID-19 pandemic: a scoping review.

BACKGROUND: Primary Health Care (PHC) systems are pivotal in delivering essential health services during crises, as demonstrated during the COVID-19 pandemic. With varied global strategies to reinforce PHC systems, this scoping review consolidates these efforts, identifying and categorizing key resilience-building strategies. METHODS: Adopting Arksey and O'Malley's scoping review framework, this study synthesized literature across five databases and Google Scholar, encompassing studies up to December 31st, 2022. We focused on English and Persian studies that addressed interventions to strengthen PHC amidst COVID-19. Data were analyzed through thematic framework analysis employing MAXQDA 10 software. RESULTS: Our review encapsulated 167 studies from 48 countries, revealing 194 interventions to strengthen PHC resilience, categorized into governance and leadership, financing, workforce, infrastructures, information systems, and service delivery. Notable strategies included telemedicine, workforce training, psychological support, and enhanced health information systems. The diversity of the interventions reflects a robust global response, emphasizing the adaptability of strategies across different health systems. CONCLUSIONS: The study underscored the need for well-resourced, managed, and adaptable PHC systems, capable of maintaining continuity in health services during emergencies. The identified interventions suggested a roadmap for integrating resilience into PHC, essential for global health security. This collective knowledge offered a strategic framework to enhance PHC systems' readiness for future health challenges, contributing to the overall sustainability and effectiveness of global health systems.

Temporal trends analysis of emergency obstetric and newborn care availability and readiness index of healthcare facilities in Burkina Faso.

BACKGROUND: Ensuring healthcare services are equipped to offer; emergency obstetric and newborn care (EmONC) is crucial for improving the quality of maternal and newborn care in low- and middle-income countries. We assessed the temporal trends of the availability and readiness of the healthcare system to provide EmONC in Burkina Faso. METHODS: We analyzed the data from three national health facilities surveys, conducted in 2014, 2016 and 2018, using the WHO Service Availability and Readiness Assessment tool. We performed multivariable linear regression models to examine the trends. RESULTS: Between 2014 and 2018, the percentage of healthcare facilities providing delivery service and blood transfusion significantly decreased (88.1% to 75.4% for delivery services and 67.3% to 50.2% for blood transfusion, p < 0.001). The readiness index of healthcare facilities to provide basic EmONC showed a negative trend according to public healthcare, primary healthcare, and Centre-Nord, Centre-sud, Hauts-Bassins, Nord, Plateau Central and Sud-ouest health regions. CONCLUSIONS: We observed multiple indications of a decline in the readiness of healthcare services to offer EmONC in Burkina Faso from 2014 to 2018. As such, bolstering the capabilities of health facilities to deliver EmONC is essential for hastening the decrease in maternal mortality.

Envisioning the Future of Personalized Medicine: Role and Realities of Digital Twins.

Digital twins have emerged as a groundbreaking concept in personalized medicine, offering immense potential to transform health care delivery and improve patient outcomes. It is important to highlight the impact of digital twins on personalized medicine across the understanding of patient health, risk assessment, clinical trials and drug development, and patient monitoring. By mirroring individual health profiles, digital twins offer unparalleled insights into patient-specific conditions, enabling more accurate risk assessments and tailored interventions. However, their application extends beyond clinical benefits, prompting significant ethical debates over data privacy, consent, and potential biases in health care. The rapid evolution of this technology necessitates a careful balancing act between innovation and ethical responsibility. As the field of personalized medicine continues to evolve, digital twins hold tremendous promise in transforming health care delivery and revolutionizing patient care. While challenges exist, the continued development and integration of digital twins hold the potential to revolutionize personalized medicine, ushering in an era of tailored treatments and improved patient well-being. Digital twins can assist in recognizing trends and indicators that might signal the presence of diseases or forecast the likelihood of developing specific medical conditions, along with the progression of such diseases. Nevertheless, the use of human digital twins gives rise to ethical dilemmas related to informed consent, data ownership, and the potential for discrimination based on health profiles. There is a critical need for robust guidelines and regulations to navigate these challenges, ensuring that the pursuit of advanced health care solutions does not compromise patient rights and well-being. This viewpoint aims to ignite a comprehensive dialogue on the responsible integration of digital twins in medicine, advocating for a future where technology serves as a cornerstone for personalized, ethical, and effective patient care.

Comparison of the Response to an Electronic Versus a Traditional Informed Consent Procedure in Terms of Clinical Patient Characteristics: Observational Study.

BACKGROUND: Electronic informed consent (eIC) is increasingly used in clinical research due to several benefits including increased enrollment and improved efficiency. Within a learning health care system, a pilot was conducted with an eIC for linking data from electronic health records with national registries, general practitioners, and other hospitals. OBJECTIVE: We evaluated the eIC pilot by comparing the response to the eIC with the former traditional paper-based informed consent (IC). We assessed whether the use of eIC resulted in a different study population by comparing the clinical patient characteristics between the response categories of the eIC and former face-to-face IC procedure. METHODS: All patients with increased cardiovascular risk visiting the University Medical Center Utrecht, the Netherlands, were eligible for the learning health care system. From November 2021 to August 2022, an eIC was piloted at the cardiology outpatient clinic. Prior to the pilot, a traditional face-to-face paper-based IC approach was used. Responses (ie, consent, no consent, or nonresponse) were assessed and compared between the eIC and face-to-face IC cohorts. Clinical characteristics of consenting and nonresponding patients were compared between and within the eIC and the face-to-face cohorts using multivariable regression analyses. RESULTS: A total of 2254 patients were included in the face-to-face IC cohort and 885 patients in the eIC cohort. Full consent was more often obtained in the eIC than in the face-to-face cohort (415/885, 46.9% vs 876/2254, 38.9%, respectively). Apart from lower mean hemoglobin in the full consent group of the eIC cohort (8.5 vs 8.8; P=.0021), the characteristics of the full consenting patients did not differ between the eIC and face-to-face IC cohorts. In the eIC cohort, only age differed between the full consent and the nonresponse group (median 60 vs 56; P=.0002, respectively), whereas in the face-to-face IC cohort, the full consent group seemed healthier (ie, higher hemoglobin, lower glycated hemoglobin [HbA1c], lower C-reactive protein levels) than the nonresponse group. CONCLUSIONS: More patients provided full consent using an eIC. In addition, the study population remained broadly similar. The face-to-face IC approach seemed to result in a healthier study population (ie, full consenting patients) than the patients without IC, while in the eIC cohort, the characteristics between consent groups were comparable. Thus, an eIC may lead to a better representation of the target population, increasing the generalizability of results.

Methodological Frameworks and Dimensions to Be Considered in Digital Health Technology Assessment: Scoping Review and Thematic Analysis.

BACKGROUND: Digital health technologies (dHTs) offer a unique opportunity to address some of the major challenges facing health care systems worldwide. However, the implementation of dHTs raises some concerns, such as the limited understanding of their real impact on health systems and people's well-being or the potential risks derived from their use. In this context, health technology assessment (HTA) is 1 of the main tools that health systems can use to appraise evidence and determine the value of a given dHT. Nevertheless, due to the nature of dHTs, experts highlight the need to reconsider the frameworks used in traditional HTA. OBJECTIVE: This scoping review (ScR) aimed to identify the methodological frameworks used worldwide for digital health technology assessment (dHTA); determine what domains are being considered; and generate, through a thematic analysis, a proposal for a methodological framework based on the most frequently described domains in the literature. METHODS: The ScR was performed in accordance with the guidelines established in the PRISMA-ScR guidelines. We searched 7 databases for peer reviews and gray literature published between January 2011 and December 2021. The retrieved studies were screened using Rayyan in a single-blind manner by 2 independent authors, and data were extracted using ATLAS.ti software. The same software was used for thematic analysis. RESULTS: The systematic search retrieved 3061 studies (n=2238, 73.1%, unique), of which 26 (0.8%) studies were included. From these, we identified 102 methodological frameworks designed for dHTA. These frameworks revealed great heterogeneity between them due to their different structures, approaches, and items to be considered in dHTA. In addition, we identified different wording used to refer to similar concepts. Through thematic analysis, we reduced this heterogeneity. In the first phase of the analysis, 176 provisional codes related to different assessment items emerged. In the second phase, these codes were clustered into 86 descriptive themes, which, in turn, were grouped in the third phase into 61 analytical themes and organized through a vertical hierarchy of 3 levels: level 1 formed by 13 domains, level 2 formed by 38 dimensions, and level 3 formed by 11 subdimensions. From these 61 analytical themes, we developed a proposal for a methodological framework for dHTA. CONCLUSIONS: There is a need to adapt the existing frameworks used for dHTA or create new ones to more comprehensively assess different kinds of dHTs. Through this ScR, we identified 26 studies including 102 methodological frameworks and tools for dHTA. The thematic analysis of those 26 studies led to the definition of 12 domains, 38 dimensions, and 11 subdimensions that should be considered in dHTA.

Problems and Barriers Related to the Use of mHealth Apps From the Perspective of Patients: Focus Group and Interview Study.

BACKGROUND: Since fall 2020, mobile health (mHealth) apps have become an integral part of the German health care system. The belief that mHealth apps have the potential to make the health care system more efficient, close gaps in care, and improve the economic outcomes related to health is unwavering and already partially confirmed. Nevertheless, problems and barriers in the context of mHealth apps usually remain unconsidered. OBJECTIVE: The focus groups and interviews conducted in this study aim to shed light on problems and barriers in the context of mHealth apps from the perspective of patients. METHODS: Guided focus groups and individual interviews were conducted with patients with a disease for which an approved mHealth app was available at the time of the interviews. Participants were recruited via self-help groups. The interviews were recorded, transcribed, and subjected to a qualitative content analysis. The content analysis was based on 10 problem categories ("validity," "usability," "technology," "use and adherence," "data privacy and security," "patient-physician relationship," "knowledge and skills," "individuality," "implementation," and "costs") identified in a previously conducted scoping review. Participants were asked to fill out an additional questionnaire about their sociodemographic data and about their use of technology. RESULTS: A total of 38 patients were interviewed in 5 focus groups (3 onsite and 2 web-based) and 5 individual web-based interviews. The additional questionnaire was completed by 32 of the participants. Patients presented with a variety of different diseases, such as arthrosis, tinnitus, depression, or lung cancer. Overall, 16% (5/32) of the participants had already been prescribed an app. During the interviews, all 10 problem categories were discussed and considered important by patients. A myriad of problem manifestations could be identified for each category. This study shows that there are relevant problems and barriers in the context of mHealth apps from the perspective of patients, which warrant further attention. CONCLUSIONS: There are essentially 3 different areas of problems in the context of mHealth apps that could be addressed to improve care: quality of the respective mHealth app, its integration into health care, and the expandable digital literacy of patients.

eHealth Literacy and the Use of NHS 111 Online Urgent Care Service in England: Cross-Sectional Survey.

BACKGROUND: Many health care systems have used digital technologies to support care delivery, a trend amplified by the COVID-19 pandemic. "Digital first" may exacerbate health inequalities due to variations in eHealth literacy. The relationship between eHealth literacy and web-based urgent care service use is unknown. OBJECTIVE: This study aims to measure the association between eHealth literacy and the use of NHS (National Health Service) 111 online urgent care service. METHODS: A cross-sectional sequential convenience sample survey was conducted with 2754 adults (October 2020-July 2021) from primary, urgent, or emergency care; third sector organizations; and the NHS 111 online website. The survey included the eHealth Literacy Questionnaire (eHLQ), questions about use, preferences for using NHS 111 online, and sociodemographic characteristics. RESULTS: Across almost all dimensions of the eHLQ, NHS 111 online users had higher mean digital literacy scores than nonusers (P<.001). Four eHLQ dimensions were significant predictors of use, and the most highly significant dimensions were eHLQ1 (using technology to process health information) and eHLQ3 (ability to actively engage with digital services), with odds ratios (ORs) of 1.86 (95% CI 1.46-2.38) and 1.51 (95% CI 1.22-1.88), respectively. Respondents reporting a long-term health condition had lower eHLQ scores. People younger than 25 years (OR 3.24, 95% CI 1.87-5.62) and those with formal qualifications (OR 0.74, 95% CI 0.55-0.99) were more likely to use NHS 111 online. Users and nonusers were likely to use NHS 111 online for a range of symptoms, including chest pain symptoms (n=1743, 70.4%) or for illness in children (n=1117, 79%). The users of NHS 111 online were more likely to have also used other health services, particularly the 111 telephone service (χ12=138.57; P<.001). CONCLUSIONS: These differences in eHealth literacy scores amplify perennial concerns about digital exclusion and access to care for those impacted by intersecting forms of disadvantage, including long-term illness. Although many appear willing to use NHS 111 online for a range of health scenarios, indicating broad acceptability, not all are able or likely to do this. Despite a policy ambition for NHS 111 online to substitute for other services, it appears to be used alongside other urgent care services and thus may not reduce demand.

Key Considerations for Designing Clinical Studies to Evaluate Digital Health Solutions.

Evidence of clinical impact is critical to unlock the potential of digital health solutions (DHSs), yet many solutions are failing to deliver positive clinical results. We argue in this viewpoint that this failure is linked to current approaches to DHS evaluation design, which neglect numerous key characteristics (KCs) requiring specific scientific and design considerations. We first delineate the KCs of DHSs: (1) they are implemented at health care system and patient levels; (2) they are "complex" interventions; (3) they can drive multiple clinical outcomes indirectly through a multitude of smaller clinical benefits; (4) their mechanism of action can vary between individuals and change over time based on patient needs; and (5) they develop through short, iterative cycles-optimally within a real-world use context. Following our objective to drive better alignment between clinical evaluation design and the unique traits of DHSs, we then provide methodological suggestions that better address these KCs, including tips on mechanism-of-action mapping, alternative randomization methods, control-arm adaptations, and novel end-point selection, as well as innovative methods utilizing real-world data and platform research.

Perception and Acceptance of Telemedicine Use in Health Care Among the General Public in China: Web-Based Cross-Sectional Survey.

BACKGROUND: The COVID-19 pandemic is bringing about substantial changes in health care systems, leading to a significant shift toward telemedicine for the delivery of health care services. OBJECTIVE: This study aims to examine the relationship between perceived usefulness and ease of use of telemedicine services and their association with the behavioral intention to use telemedicine. METHODS: An anonymous cross-sectional survey was conducted in China. Partial least squares structural equation modeling was used to determine significant predictors of intention to use telemedicine consultation. Types of illnesses that favored seeking telemedicine consultation, as well as the most preferred platform for conducting telemedicine consultations, were also investigated. RESULTS: In total, 1006 participants completed the survey. A total of 44.3% (n=446) reported being very likely and 49.3% (n=496) reported being likely to seek telemedicine consultation. Overall, the majority of participants expressed strong agreement or agreement regarding the perceived usefulness of telemedicine. Likewise, the majority indicated strong agreement or agreement when it came to their perception of the ease of using telemedicine. In the partial least squares structural equation modeling, perceived usefulness (ß=0.322; P<.001) and perceived ease of use (ß=0.118; P=.01) were significantly associated with a higher likelihood of seeking telemedicine consultation. A considerable number of participants expressed willingness to use telemedicine services for various medical conditions, particularly respiratory (n=340, 33.8%), skin (n=316, 31.4%), and musculoskeletal issues (n=316, 31.4%) while showing less interest in seeking telemedicine consultations for reproductive health (n=44, 4.4%) and cancer (n=64, 6.4%). The majority preferred video chat (n=443, 44%) and text chat (n=317, 31.5%) as their most preferred platforms for telemedicine consultation, while a smaller proportion preferred telephone (n=193, 19.2%) and email (n=53, 5.3%). CONCLUSIONS: Telemedicine has the potential to play a larger role in China's health care system. The preferences for certain platforms over others may influence service design and implementation.

System's Crisis Resilience as a Societal Crisis: Knowledge Structure and Gaze of the Finnish Health Care System.

The crisis resilience of vital social systems is currently the target of constant development efforts in Finland, as their drifting into crisis would weaken societies' functional abilities, safety, and security. This is also the case regarding the Finnish health care system. In an attempt to move beyond existing frameworks of crisis imagination, this article takes an unconventional stance by elucidating endogenous crisis dynamics present in the Finnish health care system. Delphi process was conducted for top experts in Finnish health care and crisis management. With a dissensus-seeking orientation, our aim was to fertilize disagreements among panelists to reveal key vulnerabilities in the health system. Despite our efforts to evoke dissensus, the panelists ended up generating a consensus that aims to protect the underlying assumptions of the health system's knowledge structure. Through inductive analysis of expert discourses, the data was analyzed through our research question "what constitutes a crisis-proof health system and a crisis-prone health system". What is framed as a strength of the system by our panelists, namely the ability to maintain legitimacy, improve efficiency, and guarantee continuity, can still have questionable implications that are left ungrasped. A system's theory approach illustrates how such effects can develop and escalate beyond the reach of social interventions, and thus be predisposed to cause objectionable yet concealed social crises. The discussion illustrates how these endogenous crisis dynamics could be seen to materialize in real-life cases.

The oral health care system in Libya: a case study.

BACKGROUND: This study aims to describe the Libyan oral health care system in terms of its structure, function, workforce, funding, reimbursement and target groups. METHODS: A single descriptive case study approach and multiple sources of data collection were used to provide an in-depth understanding of the Libyan oral health care system. A purposeful sample of the key informants (Managers of oral health centers, dentists of various specialties with experience in the field, dentists, nurses, dental technicians, and officials in the affairs of medical insurance) was recruited. The case and its boundaries were guided by the study's aim. Both qualitative and quantitative analyses were conducted. Descriptive statistics were used for quantitative data. Framework analysis, informed by the study objectives, was used to analyze interviews and documents. RESULTS: The analysis showed that oral health services are integrated into medical services. The provision of dental care is mainly treatment-based, in the private sector. The oral health services in the public sector are mainly emergency care and exodontia. The dental workforce included in the study were mostly dentists (89% General Dental Practitioners (GDPs), 11% specialists), with a marked deficiency in dental technicians and nurses. Around 40% of dentists work in both the private and public sectors. The government provides the funding for the public sector, but the private sector is self-funded. No specific target group(s) nor clear policies were reported. However, the system is built around primary health care as an overarching policy. Dental caries is the most common oral problem among Libyan preschool children affecting around 70% and is the most common cause of tooth loss among adults. CONCLUSION: The oral health care system in Libya is mainly privatized. The public health services are poorly organized and malfunctioning. There is an urgent need to develop policies and plans to improve the oral health care system in Libya.

International Standards and Features of Financing in the Field of Health Care and Provision of Medical Services.

The relevance of this article is due to the fact that international standards in the field of health care and medical services are central to the field of world principles of functioning and development of medical law. The aim of the article is to conduct research on the peculiarities of international standards in the field of health care and medical services, as well as to study the prospects of their implementation in Ukraine. Leading research methods are general and special research methods, including methods of logic, analysis, comparison. The results of this study are to outline recommendations for the use of international standards in the field of health care and medical services in Ukraine and to summarize the legal framework on this issue. The significance of the results is reflected in the fact that this study can serve as a basis for outlining future changes in current legislation of Ukraine on the functioning of the health care system and implementation of world practices in health care. Within the framework of this study, systematized the main international and European documents that reflect the main international standards in the field of health care and medical services and ratified in Ukraine and have a direct impact on the legal framework for this area.

[The comparative analysis of health care systems].

Within the framework of the national development goal of the Russian Federation "preservation of population, health and well-being of people" the target indicator "the increase of life expectancy up to 78 years" is to be achieved by 2030. The achievement of this value is also directly affected by functioning of of health care system. In 2015, the United Nations, within the framework of the Sustainable Development Goals for the period up to 2030, formulated the task that implies ensuring of universal health services coverage "including financial risk security, access to qualitative essential medical and sanitary services and access to safe, effective, qualitative and inexpensive essential medications and vaccines for all". In the course of the study, methodology was developed that permitted to calculate values of performance indicators of main health care systems (financial support and infrastructure development) and to conduct comprehensive comparative analysis with values of particular public health indicators. The study results confirmed possibility of such comparisons. The stable direct relationship between such indicators as "current health expenditure (CHE) per capita", "current health expenditure (CHE) as percentage of gross domestic product (GDP)", "UHC Service Coverage Index", "life expectancy" was revealed. The inverse dependency between such indicators as "out-of-pocket expenditure as percentage of current health expenditure (CHE)" and "UHC Service Coverage Index" as well as between "UHC Service Coverage Index" and "total NCD mortality rate" and "probability of premature dying from non-infectious diseases" was determined.