Demand For Care Research Articles

L’activité odontologique hospitalière dans l’offre de soins en zone sous-dotée : exemple en Basse-Normandie

Demand for dental care in Basse-Normandie has been severely affected by the reduced availability of local services. One of the missions of hospital dental services is to respond to these difficulties in accessing care. The objective of this study is to determine how hospital activity fits into the local dental care offer. To do this, we compared the activity of the dental service of the Caen hospital with that of private practices. The proportion of young patients, particularly those under fifteen, was greater at the university hospital than in private practice (20.9 percent vs 12.9 percent, p < 1.10 -5). The activity of private practices included a higher proportion of fixed prosthetic care and oral prophylaxis procedures, in contrast to surgical procedures, direct restorative care, and consultations, which account for a higher proportion of hospital activity (10 percent vs 22.5 percent, p < 1.10-5). The dental service at Caen hospital differs from private practices in Basse-Normandie in that its activity is oriented toward primary care or emergency care. This activity seems to reflect a high individual caries risk, probably associated with social vulnerability. The unit therefore seems to respond to a need for primary care.

Too many cooks could spoil the broth: choice overload and the provision of ambulatory health care

Patient empowerment calls for an intensified participation of (informed) patients with more treatment opportunities to choose from. A growing body of literature argues that confronting consumers with too many opportunities can lead to a choice overload (CO) resulting in uncertainty that the selected alternative dominates all other options in the choice set. We examine whether there is a CO effect in the demand for ambulatory health care in Germany by analyzing the association of medical specialists supply on so-called patients’ health uncertainty. Further, we investigate if the CO effect is smaller in areas with a higher density of general practitioners (GPs). We find that patients who live in an area with a large supply of specialists are subject to a CO effect that is expressed by an increased health uncertainty. The coordinating role of GPs seems to be effective to reduce the CO effect, while preserving free consumer choice.

General practitioners’ perspectives on relocating care: a Dutch interview study

BackgroundHealthcare systems around the world are facing significant challenges because higher costs and an increase in demand for care has not been matched by a corresponding growth in the health workforce. Without reform, healthcare systems are unsustainable. Relocating care, such as from hospitals to general practices, is expected to make a key contribution to ensuring healthcare remains sustainable. Relocating care has a significant impact upon general practitioners (GPs). Therefore, we investigated which care, according to GPs, could be relocated and under which conditions.MethodGPs were recruited through Nivel’s GPs network on eHealth and innovation, located in the Netherlands. One exploratory focus group and 12 in-depth interviews were conducted. Interview transcripts were analyzed using the qualitative research principles of thematic analysis.ResultsAccording to the participants, some diagnostic and follow-up care could be relocated from hospitals to GPs once certain prerequisites are fulfilled. An important condition of relocating care from the hospital to the GP is that GPs have sufficient time to take over these tasks. The types of care that can be relocated from the GP to other settings are those questions where the medical knowledge of the GP can offer nothing extra or where problems in navigating the health system cause patients to either turn to, or stay with, their GP.ConclusionCare should first be relocated from the GP to other settings before attempting to organize the relocation of care from the hospital to the GP. When this, and other conditions are met, some diagnostic and follow-up care can be relocated from the hospital to the GP.

Collaboration between the French TMAS and CRAPEM on the management of psychiatric emergencies at sea

Doctors at the French Telemedical Assistance Service (TMAS) provide support to ship captains via teleconsultation for the management of medical emergencies during navigation. In response to this emerging demand for psychological or psychiatric care, TMAS doctors have been calling as and when required on a specialised platform known as the Resource Center for Psychological Assistance at Sea (CRAPEM), based in Saint Nazaire, France, since 2020. The study objective was to compare the management of psychiatric emergencies at sea by TMAS doctors alone versus TMAS doctors assisted by CRAPEM. We conducted a retrospective, descriptive epidemiological study between 1 January 2020 and 31 December 2021. We extracted data from AppliCCMM on patient characteristics, ship characteristics, management characteristics including final decision (treatment on board, disembarkation, diversion, evacuation or death) from previously identified diagnostic coding. Decisions were compared for “case” versus “control” using Chi-2 tests. Differences were considered significant if the P value was below 0.05. The analysis therefore focused on 21 patient cases and 63 patient controls. A comparison of the final decisions shows that patients in the CRAPEM group receive significantly (p < 0.001) less treatment on board. This difference is probably related to the fact that the patients for whom TMAS doctors seek advice from CRAPEM have more serious conditions. CRAPEM is a new organization aimed at improving the management of psychiatric illnesses in seafarers and, in our case, acute-phase psychological and psychiatric emergencies. Given the specific characteristics of the maritime environment, its intervention improves the management of patients at sea.

Delivering Integrated Community Care for the Elderly: A Qualitative Case Study in Southern China.

The rapid aging and increasing care demands among the elderly population present challenges to China's health and social care system. The concept of aging in place has prompted the implementation of integrated community care (ICC) in the country. This study aims to provide empirical insights into the practices of integrated care policies and approaches at the community level. Data for this study were collected through six months of participatory observations at a local community health service center in a southern Chinese city. Semi-structured interviews were conducted with the multidisciplinary community care team to gather frontline formal caregiver perceptions of ICC, thereby facilitating a better understanding of the obstacles and opportunities. Qualitative analysis revealed four themes: the ICC delivery model and development strategies within the community care scheme, the person-centered guiding principle, and the challenges and struggles encountered by formal caregivers within China's current ICC system. The case study presented herein serves as a notable example of the pivotal role of primary care in the successful implementation of elderly care within a community setting. The adoption of a private organization-led approach to medico-social integration care in the community holds significant potential as a service delivery model for effectively addressing a wide range of elderly care issues.

P.031 SMILES: Sunnybrook-St. Michael’s Integrated Leadership/QI in Endovascular Stroke care – enhancing hyperacute stroke protocols for optimized door-to-intervention times

Background: Hyperacute stroke care demands rapid, coordinated care. Traditional metrics like Door-to-Needle time are pivotal but insufficient for capturing the complexity of endovascular stroke interventions. The SMILES collaboration aims to standardize and optimize protocols for door-to-intervention times, incorporating Crew Resource Management (CRM). Methods: The multidisciplinary initiative integrates both hospitals, ED, neurology, and QI teams. We employed a comprehensive approach: stakeholder engagement, simulation-based learning, process mapping, and literature review. Emphasis was placed on enhancing situational awareness, triage and prioritization, cognitive load management, role clarity, effective communication, and debriefing. Results: The collaboration led to PDSA cycles and development of refined stroke protocols. Interventions included: 1) A ’zero point survey’ for team pre-arrival briefings, enhancing situational awareness and role clarity; 2) Streamlined patient registration to reduce cognitive load and improve triage efficiency; 3) Direct transfer of patients to imaging. Additionally, digital tools were implemented to facilitate communication. Simulation sessions reinforced CRM principles, leading to improved team cohesion and operational performance. Conclusions: The SMILES initiative is grounded in CRM principles by standardizing protocols and emphasizing non-technical skills crucial for high-stakes environments. This improves outcomes but also fosters a culture of safety and efficiency. Future directions include an evaluation of these protocols’ impact on patient factors.

#2739 Determinants of well-being of spousal caregivers of CKD patients: a directed qualitative content analysis

Abstract Background and Aims Informal caregivers are essential to patients with chronic kidney disease (CKD) in all stages of the disease. They provide, most often unpaid, practical and emotional support to someone with whom they have a personal relationship, mostly spouses, family members and friends. Support from caregivers helps CKD patients adjust to their disease and increase treatment adherence. However, CKD puts a large burden on both patients themselves and their caregivers. Overburdening is especially seen in spousal caregivers, as they are more often older, co-residents, perform longer hours of care, and suffer more from relational stress compared to other types of informal caregivers. Although previous studies show high levels of caregiver burden, a comprehensive understanding of caregiver role, caregiver burden, and factors that may relieve this burden is lacking. Therefore, our aim was to explore both the contributing and alleviating determinants of well-being of spousal caregivers of patients with CKD in a qualitative way. Method A qualitative interview study was performed among spousal caregivers of patients with CKD. Informal caregivers were recruited by the Dutch Kidney Patients Association to assist in the development of an informal caregiver module with interviews for the Kidney Guide (Nierwijzer.nl). Fifteen face-to-face interviews were held between December 2021 and April 2022 at participants’ homes. Interviews lasted approximately 1 to 1.5 hours. All participants were adults and able to speak and understand Dutch. A directed qualitative content analysis was performed, using the stress-appraisal model as a framework. The model proposes that the care demand (primary stressors) leads to the actual provision of care by the informal caregiver (primary appraisal). Consequently, the provision of care leads to consequences for the caregiver's own life (secondary stressors), leading to burden (secondary appraisal). Finally, the experienced burden leads to the outcome, namely caregivers’ well-being. Moderators change the effect of stressors (e.g., social support may alleviate burden by sharing care tasks). Results Of the fifteen participating spousal caregivers, nine were female. Caregivers’ age ranged from 34 to 82 years. Duration of informal caregiving ranged from approximately 4 to 37 years. Most patients were on a type of kidney replacement therapy (KRT). In this study, we extended the stress-appraisal model to the context of CKD, providing a disease-specific model for practice (Fig. 1). Through this model, we describe the impact of care provision on all aspects of spousal caregivers’ lives and the burden associated with it, and identify possible modifiable factors to prevent overburdening of spousal caregivers. CKD-specific determinants included, amongst others, the impact of kidney disease and KRT on patients themselves as well as the associated caregiver tasks, for example adjusting to dietary restrictions and attending dialysis appointments. KRT options and flexibility (e.g., the choice for home or in-center dialysis) were CKD-specific moderators that alleviated burden. The care for someone on dialysis led to additional tasks (e.g., transportation to the dialysis center or assisting with home dialysis), negative impact on caregivers’ personal and social lives, and additional burden, emphasizing a distinction with caring for a CKD patient not on dialysis. Conclusion To our knowledge, this is the first study that gives a comprehensive overview of the contributing and alleviating determinants of the well-being of spousal caregivers of CKD patients. A disease-specific version of the stress-appraisal model for use in practice was provided, with evidence for all paths in the model. Moreover, we underline the need for acknowledgement of spousal caregivers in four areas: (1) personal and relational, (2) social environment, (3) healthcare, and (4) work and legislation (Fig. 2). This acknowledgement is of great importance to support and facilitate informal care within nephrology.

The impact of long-term care insurance on family care for older adults: The mediating role of intergenerational financial support.

Rapid population aging has been placing heavy tolls on Chinese family caregivers. Previous empirical evidence from multiple countries have shown that establishing national long-term care insurance was effective in reducing family care burdens. Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS) wave 2011 to 2018, this study examined the effects of implementing the pilot long-term care insurance program on family care received by the Chinese older adults, by using a time-varying Difference-in-Differences (DID) method. The results showed that: (1) the implementation of the pilot long-term care insurance program has led to a 17.2% decline in general for family care received by the Chinese older adults. (2) The effect of participating in the pilot program on family care received differed by respondent's household registration, health status, marital status, and possesion of retirement pension, and were specifically pronounced among those who were urban residents, having spouse, living with disabilities, and living with no retirement pension. (3) Further results from the mechanism analyses showed that the pilot long-term care insurance program decreased the level of family care by reducing the dual intergenerational financial support between older adults and their adult children. (4) Although participating in the pilot program decreased older adult's dependence on their adult children, their physical and mental health status were not negatively affected. This study contributes to the existing literature by evaluating the effects of implementing the pilot long-term care insurance program on family care received by the Chinese older adults, and lends supports to the previous studies that participating in long-term care insurance significantly reduces old adults' demand for family care, but not in sacrifice of their physical and mental well-being.

Dermatology workforce projections in the United States, 2021 to 2036.

There has been a growing imbalance between supply of dermatologists and demand for dermatologic care. To best address physician shortages, it is important to delineate supply and demand patterns in the dermatologic workforce. The goal of this study was to explore dermatology supply and demand over time. We conducted a cross-sectional analysis of workforce supply and demand projections for dermatologists from 2021 to 2036 using data from the Health Workforce Simulation Model from the National Center for Health Workforce Analysis. Estimates for total workforce supply and demand were summarized in aggregate and stratified by rurality. Scenarios with status quo demand and improved access were considered. Projected total supply showed a 12.45% increase by 2036. Total demand increased 12.70% by 2036 in the status quo scenario. In the improved access scenario, total supply was inadequate for total demand in any year, lagging by 28% in 2036. Metropolitan areas demonstrated a relative supply surplus up to 2036; nonmetropolitan areas had at least a 157% excess in demand throughout the study period. In 2021 adequacy was 108% and 39% adequacy for metropolitan and nonmetropolitan areas, respectively; these differences were projected to continue through 2036. The findings suggest that the dermatology physician workforce is inadequate to meet the demand for dermatologic services in nonmetropolitan areas. Furthermore, improved access to dermatologic care would bolster demand and especially exacerbate workforce inadequacy in nonmetropolitan areas. Continued efforts are needed to address health inequities and ensure access to quality dermatologic care for all.

Retrospective study on the emotional status of healthcare workers in a COVID-19 field hospital in Oman.

To combat the overwhelming demand for medical services and care during the COVID-19 Pandemic, the Sultanate of Oman launched the COVID-19 Field Hospital in 2020, designed to respond and alleviate the burden on the medical infrastructure. Several studies globally and from the Middle East suggested that frontline healthcare workers (HCW) were at risk of developing markers of psychological distress. It was further understood through research findings that HCW were resilient during times of crisis. However, there is a dearth in studies evaluating the emotional status of frontline HCW posted in the COVID-19 field hospitals in Gulf Countries, including Oman. This study attempts to shed light on the emotional status of HCW that were on the frontlines in the field hospital in the Sultanate of Oman. This study aims to quantify and evaluate the emotional status of HCW in the frontline field hospital by screening for symptoms of depression, anxiety, and sleep quality. The data was collected by a local private mental healthcare facility as part of digital feedback to design and implement supportive strategies. Data was collected between September 2021 and October 2021 from 121 HCW in the COVID-19 Field hospital in Oman via 'WhatsApp'. Chi square and binary logistic regression tests were administered to evaluate the data. The participants comprised of 63.6% females and 79.3% were between 30 and 39 years of age. Majority of the participants (65.2%) described themselves as 'financially unstable' and possess an average of 7.5 years of work experience. Of the participants 73.6% of the HCW were based solely in the field hospital for 6-9 months at the time of the survey. Majority of the participants denied the presence of emotional distress expressed through depression (92.6%), anxiety (92.6%) and poor quality of sleep (59.5%). The findings of the present study reflect the HCW ability to cope during challenging situations likely owing to a variety of environmental, social and personal protective factors. The findings of this study can translate into further research on identifying and addressing stressors and targeting the enhancement of protective factors to safeguard the well-being of HCW.

Who responds to longer wait times? The effects of predicted emergency wait times on the health and volume of patients who present for care

Healthcare is often free at the point-of-care so that price does not deter patients. However, the dis-utility from waiting for care that often occurs could also lead to deterrence. I investigate responses in the volume and types of patients that demand emergency care when predicted waiting times quasi-randomly change. I leverage a discontinuity to compare emergency sites with similar predicted wait times but with different apparent wait times displayed to patients. I use impulse response functions estimated by local projections to estimate effects of predicted wait times on patient demand for care. An additional thirty minutes of predicted wait time results in 15% fewer waiting patients at urgent cares and 2% fewer waiting patients at emergency departments within three hours of display. Patients that stop using emergency care are also triaged as healthier. However, at very high predicted wait times, there are reductions in demand for all patients including sicker patients.

Workforce thresholds and the non-linear association between registered nurse staffing and care quality in long-term residential care: A retrospective longitudinal study of English care homes with nursing

BackgroundCare needs amongst 425,000 dependent older residents in English care homes are becoming more complex. The quality of care in these homes is influenced by staffing levels, especially the presence of registered nurses (RNs). Existing research on this topic, often US-focused and relying on linear assumptions, has limitations. This study aims to investigate the non-linear relationship between RN staffing and care quality in English care homes using machine learning and administrative data from two major care home providers. MethodsA retrospective observational study was conducted using data from two English care home providers. Each was analysed separately due to variations in data reporting and care processes. Various care quality indicators and staffing metrics were collected for a 3.5-year period. Regression analysis and machine learning (random forest) were employed to identify non-linear relationships. Ethical approval was obtained for the study. ResultsUsing linear methods, higher skill mix – more care provided by RNs – was associated with lower incidence of adverse outcomes, such as urinary tract infections and hospitalisations. However, non-linear skill mix–outcome relationship modelling revealed both low and high skill mix levels were linked to higher risks. The effects of agency RN usage varied between providers, increasing risks in one but not the other. DiscussionThe study highlights the cost implications of increasing RN staffing establishments to improve care quality, suggesting a non-linear relationship and an optimal staffing threshold of around one-quarter of care provided by nurses. Alternative roles, such as care practitioners, merit exploration for meeting care demands whilst maintaining quality. This research underscores the need for a workforce plan for social care in England. It advocates for the incorporation of machine learning models alongside traditional regression-based methods. Our results may have limited generalisability to smaller providers and experimental research to redesign care processes effectively may be needed. ConclusionRNs are crucial for quality in care homes. Contrary to the assumption that higher nurse staffing necessarily leads to better care quality, this study reveals a nuanced, non-linear relationship between RN staffing and care quality in English care homes. It suggests that identifying an optimal staffing threshold, beyond which increasing nursing inputs may not significantly enhance care quality may necessitate reconsidering care system design and (human) resource allocation. Further experimental research is required to elucidate resource-specific thresholds and further strengthen evidence for care home staffing. Tweetable abstractHow much nursing care is needed to assure quality in care homes? Evidence from 2 English care home providers shows that nurse sensitive outcomes (an indicator of quality) are better when ~25 % of care is provided by nurses. Nurse shortages increase risks for residents.

The Fiscal Space for Health in Vietnam: Challenges from Population Aging

Vietnam's population is aging, leading to a higher proportion of elderly individuals. Despite significant health financing reforms, But changes in epidemiology, demographics, and growing demand for health care will continue to put pressure on health spending. This paper examines the fiscal space for health in Vietnam amidst population aging by analyzing data from 2009 to 2020. Findings reveal that healthcare resources have not kept pace with the escalating demands due to the aging of Vietnam's population faster than forecast. Total health expenditure as a percentage of GDP shows this clear increase. Private healthcare spending, particularly out-of-pocket expenses, is on the rise. Spending from the health insurance fund also increases every year,, placing future burdens on young workers. In addition, the State budget allocations for healthcare have also grown, but economic growth will compensate for this shortfall.

The Vital Role of Pharmacists in Diabetes Self-care

The number of people affected by diabetes is projected to rise significantly by 2030. As of 2021, 537 million people were living with diabetes with the numbers projected to rise to 643 million by 2030. The growing number of patients living with diabetes means that the demand for care will likely go up. Healthcare providers provide diabetes care more so the regular follow-up required by patients living with the disease. They also work together with the patients in facilitating self-care. Diabetes self-care is instrumental for patients living with diabetes. It ensures patients achieve glycemic control and have a lower risk of having complications. However, for most patients, practicing self-care can be a challenge. Most lack the knowledge and skills that are required to practice self-care confidently. Involving healthcare providers in diabetes self-care can lead to better disease outcomes. Pharmacists can provide the regular follow-ups and other services that lead to effective self-care such as health literacy. Pharmacists-led diabetes management interventions have been shown to lead to good outcomes including better glycemic control and reduced likelihood of having high blood pressure. Therefore, the aim of this review is to explore the role of pharmacists in diabetes self-care. Keywords: diabetes, diabetes self-care, diabetes complications, pharmacists, glycemic control

Follow-up after major traumatic injury: a survey of services in Australian and New Zealand public hospitals

BackgroundIncreased survival from traumatic injury has led to a higher demand for follow-up care when patients are discharged from hospital. It is currently unclear how follow-up care following major trauma is provided to patients, and how, when, and to whom follow-up services are delivered. The aim of this study was to describe the current follow-up care provided to patients and their families who have experienced major traumatic injury in Australia and New Zealand (ANZ).MethodsInformed by Donabedian’s ‘Evaluating the Quality of Medical Care’ model and the Institute of Medicine’s Six Domains of Healthcare Quality, a cross-sectional online survey was developed in conjunction with trauma experts. Their responses informed the final survey which was distributed to key personnel in 71 hospitals in Australia and New Zealand that (i) delivered trauma care to patients, (ii) provided data to the Australasian Trauma Registry, or (iii) were a Trauma Centre.ResultsData were received from 38/71 (53.5%) hospitals. Most were Level 1 trauma centres (n = 23, 60.5%); 76% (n = 16) follow-up services were permanently funded. Follow-up services were led by a range of health professionals with over 60% (n = 19) identifying as trauma specialists. Patient inclusion criteria varied; only one service allowed self-referral (3.3%). Follow-up was within two weeks of acute care discharge in 53% (n = 16) of services. Care activities focused on physical health; psychosocial assessments were the least common. Most services provided care for adults and paediatric trauma (60.5%, n = 23); no service incorporated follow-up for family members. Evaluation of follow-up care was largely as part of a health service initiative; only three sites stated evaluation was specific to trauma follow-up.ConclusionFollow-up care is provided by trauma specialists and predominantly focuses on the physical health of the patients affected by major traumatic injury. Variations exist in terms of patient selection, reason for follow-up and care activities delivered with gaps in the provision of psychosocial and family health services identified. Currently, evaluation of trauma follow-up care is limited, indicating a need for further development to ensure that the care delivered is safe, effective and beneficial to patients, families and healthcare organisations.

Improving large animal practice efficiency with credentialed veterinary technicians

Large animal veterinary practice faces many challenges, in­cluding competitive markets, labor shortages, increasing costs of goods, and more. One major concern that our profession currently recognizes is a decrease in the total number of large animal veterinarians available to service producers despite increased demand for large animal veterinary care in many re­gions.1,2,3 Recent data from the AVMA states that less than 4% of veterinarians are employed in food-animal practice.1 There has also been a 15% decline in the total number of veterinar­ians who practice food animal or mixed animal medicine.1,3 This makes it extremely difficult for livestock to get adequate veterinary care to keep herds and flocks healthy. The lack of veterinary care and oversight creates a significant concern for animal welfare and food safety. As this shortage continues, the scarcity of large animal veterinarians for foreign animal dis­ease surveillance becomes a significant concern in securing the business continuity of our food supply.

Actionability and familial uptake following opportunistic genomic screening in a pediatric cancer cohort

The care for patients with serious conditions is increasingly guided by genomic medicine, and genomic medicine may equally transform care for healthy individual if genomic population screening is implemented. This study examines the medical impact of opportunistic genomic screening (OGS) in a cohort of patients undergoing comprehensive genomic germline DNA testing for childhood cancer, including the impact on their relatives. Medical actionability and uptake after cascade testing in the period following disclosure of OGS results was quantified. A secondary finding was reported to 19/595 (3.2%) probands primarily in genes related to cardiovascular and lipid disorders. After a mean follow up time of 1.6 years (Interquartile range (IQR): 0.57-1.92 yrs.) only 12 (63%) of these variants were found to be medically actionable. Clinical follow up or treatment was planned in 16 relatives, and as in the probands, the prescribed treatment was primarily betablockers or cholesterol lowering therapy. No invasive procedures or implantation of medical devices were performed in probands or relatives, and no reproductive counseling was requested. After an average of 1.6 years of follow-up 2.25 relatives per family with an actionable finding had been tested. This real-world experience of OGS grants new insight into the practical implementation effects and derived health care demands of genotype-first screening. The resulting health care effect and impact on demand for genetic counseling and workup in relatives extends beyond the effect in the probands.

The impact of the bottleneck to entry into ophthalmology specialty training

Seventy-nine per cent of those living with visual impairment are over 60 and increased longevity will increase the prevalence of eye diseases by more than 50%. To meet the escalating demand for eye care, more ophthalmologists must be trained. Changes to the application in 2024 have been aimed at facilitating this. Aim: To evaluate the opinions of aspiring and current ophthalmology trainees regarding the recent changes. A survey-based questionnaire of 11 questions was developed and distributed amongst medical students and junior doctors. We received responses from 17 medical students (17.6%), foundation doctors (5.9%), junior doctors out of training (17.6%), and ophthalmology trainees (58.9%), with 76.5% trained in the UK. Demographically, 41.2% were Black, 11.8% White, 29.4% Asian, and 5.9% Arab. Among current trainees, 60% had been unsuccessful in their first application, and an additional 10% on their second attempt. Despite 88.2% being aware of the competition, all found securing a training post challenging. Over half disagreed with the sufficiency of ST1 positions, and none supported the elimination of the ST3 application route. Applicants are applying multiple times, each with progressively more competitive portfolios and higher entry exam scores. For this reason, the recruitment process may be missing out on good ophthalmologists who did not have the necessary privileges to excel relatively early on in their professional careers. Such candidates may have fared better as ST3 candidates. To service the widening and complex demographic of patients, changes may need to be made to meet the demand with a diverse workforce.

Therapies go digital. What drives physicians' acceptance?

National healthcare systems face multiple challenges, including the increasing demand for care and decreasing availability of healthcare professionals. Digital health technologies represent opportunities that offer improved efficiency, accessibility, and patient care. In this scenario, Digital Therapeutics are technological advancements to treat or alleviate a disease and deliver a medical intervention with evidence-based therapeutic impacts and regulatory approval. Digital Therapeutics are a paradigm shift for physicians, who exercise caution in terms of trust and wide usage. Digital Therapeutics represents an opportunity and a challenge in healthcare system integration. The research investigates the factors explaining physicians' acceptance of Digital Therapeutics. A research model that combines organizational mechanisms derived from Institutional Theory and rational factors derived from the Technology Acceptance model was developed. The model was tested through 107 responses from a survey distributed to the members of the leading Italian scientific society in Diabetology. Literature-based hypotheses were empirically tested through Structural Equation Modelling. The analysis confirmed the influence of Perceived Ease of Use on Perceived Usefulness and Perceived Usefulness on the Intention To Use Digital Therapeutics. Rules and norms impact Perceived Usefulness when considering the influence of the scientific society. Culture and mindset towards innovation within the hospital positively affect Perceived Ease of Use. The readiness of hospital facilities enhances the extent to which physicians perceive the ease of employing Digital Therapeutics in their daily practice. Instead, esteemed colleagues' opinions and guidelines from the scientific society reveal to physicians the value of Digital Therapeutics in patients' care pathways. Institutions should prioritize cultural, normative, and regulative aspects to accelerate physicians' endorsement of Digital Therapeutics. Findings advance the theoretical knowledge around clinicians' adoption of innovative digital health technologies, unveiling the interaction between rational and institutional factors. The results highlight practical implications for healthcare institutions and Digital Therapeutics manufacturers willing to promote their adoption.

Palliative Care Research and Clinical Practice Priorities in the United States as Identified by an Interdisciplinary Modified Delphi Approach.

Background: Palliative care demands in the United States are growing amid a comparatively small workforce of palliative care clinicians and researchers. Therefore, determining research and clinical practice priorities is essential for streamlining initiatives to advance palliative care science and practice. Objectives: To identify and rank palliative care research and clinical practice priority areas through expert consensus. Design: Using a modified Delphi method, U.S. palliative care experts identified and ranked priority areas in palliative care research and clinical practice. Priorities were thematically grouped and analyzed for topic content and frequency; univariate analysis used the median of each priority item ranking, with a cutoff median of ≤8 indicating >76% agreement for an item's ranking. Results: In total, 27 interdisciplinary pediatric and adult palliative care experts representing 19 different academic institutions and medical centers participated in the preliminary survey and the first Delphi round, and 22 participated in the second Delphi round. The preliminary survey generated 78 initial topics, which were developed into 22 priority areas during the consensus meeting. The top five priorities were (1) access to palliative care, (2) equity in palliative care, (3) adequate financing of palliative care, (4) provision of palliative care in primary care settings, and (5) palliative care workforce challenges. Conclusions: These expert-identified priority areas provide guidance for researchers and practitioners to develop innovative models, policies, and interventions, thereby enriching the quality of life for those requiring palliative care services.