Health Care Delivery System Research Articles

Quality and Safety in Nursing: Recommendations From a Systematic Review.

As a consistent 24-hour presence in hospitals, nurses play a pivotal role in ensuring the quality and safety (Q&S) of patient care. However, a comprehensive review of evidence-based recommendations to guide nursing interventions that enhance the Q&S of patient care is lacking. Therefore, the purpose of our systematic review was to create evidence-based recommendations for the Q&S component of a nursing professional practice model for military hospitals. To accomplish this, a triservice military nursing team used Covidence software to conduct a systematic review of the literature across five databases. Two hundred forty-nine articles met inclusion criteria. From these articles, we created 94 recommendations for practice and identified eight focus areas from the literature: (1) communication; (2) adverse events; (3) leadership; (4) patient experience; (5) quality improvement; (6) safety culture/committees; (7) staffing/workload/work environment; and (8) technology/electronic health record. These findings provide suggestions for implementing Q&S practices that could be adapted to many healthcare delivery systems.

Comparison of Short-Term Health Care Utilization Between Telemedicine-Delivered vs In-Person Care Visits for Heart Failure

BackgroundPatients with heart failure (HF) are a medically complex population with frequent hospitalizations. Downstream health care utilization following primary care delivered by telemedicine compared to in-person is unknown. ObjectivesThe purpose of this study was to understand differences in return in-person visits, emergency department (ED) encounters, and hospitalizations following a telemedicine vs an in-person primary care visit for patients with HF seen for a HF-related complaint. MethodsThis was an observational study of all primary care visits for HF from January 1, 2022, to December 31, 2022, in an integrated health care delivery system. We compared 7-day in-person follow-up visits, ED visits, and hospitalizations (all-cause and HF-specific) by index visit type. ResultsWe included 3,902 primary care visits with a primary diagnosis of HF. Most visits utilized telephone or video visits (58.4% total; 44.9% telephone, 13.5% video). After adjustment, telephone visits were associated with more in-person follow-up visits (6.14% vs 4.20%; adjusted OR: 1.08-2.21; P < 0.05) but fewer ED visits (6.12% vs 8.07%; adjusted OR: 0.55-0.97; P < 0.05) compared to in-person visits. Most hospitalized patients (74%) had an admitting diagnosis of HF. There was no difference between 7-day all-cause hospitalization following telephone or video visits compared to in-person visits. ConclusionsMost patients used telemedicine to address HF-specific primary care concerns. Telephone visits were associated with slightly higher short-term in-person primary care follow-up but lower ED utilization. Overall, downstream ED visits and hospitalizations were low. Telephone and video visits appear to offer safe alternatives to in-person care for HF-related primary care and are a promising health care delivery strategy

The Promises and Challenges toward Mass Customization of Healthcare Services

The healthcare industry is confronted with the challenge to offer an increasing variety of healthcare services while in the meantime controlling rapidly increasing healthcare costs. Mass customization has been proven to be an effective strategy to fulfill customers’ individual specific needs with high efficiency and low cost in the manufacturing industry. This paper investigates the theoretical feasibility and practical applicability of adopting mass customization as a conceptual framework for designing a healthcare service delivery system. The nature of healthcare delivery systems and their evolution are discussed relative to those of manufacturing systems. Recent research in personalized medicine, consumer-driven healthcare, consumer healthcare informatics, and integrated healthcare delivery is reviewed as enabling technologies towards mass customization of healthcare services. By synthesizing these scattered efforts in different streams of literature, this paper concludes that mass customization can contribute to the redesign of healthcare service systems, and delineates a roadmap for future research.

Update on advances in cystic fibrosis towards a cure and implications for primary care clinicians

During the past quarter century, the diagnosis and treatment of cystic fibrosis (CF) have been transformed by molecular sciences that initiated a new era with discovery of the cystic fibrosis transmembrane conductance regulator (CFTR) gene. The knowledge gained from that breakthrough has had dramatic clinical impact. Although once a diagnostic dilemma with long delays, preventable deaths, and irreversible pathology, CF can now be routinely diagnosed shortly after birth through newborn screening programs. This strategy of pre-symptomatic identification has eliminated the common diagnostic “odyssey” that was a failure of the healthcare delivery system causing psychologically traumatic experiences for parents. Therapeutic advances of many kinds have culminated in CFTR modulator treatment that can reduce the effects of or even correct the molecular defect in the chloride channel —the basic cause of CF. This astonishing advance has transformed CF care as described fully herein. Despite this impressive progress, there are challenges and controversies in the delivery of care. Issues include how best to achieve high sensitivity newborn screening with acceptable specificity; what course of action is appropriate for children who are identified through the unavoidable incidental findings of screening tests (CFSPID/CRMS cases and heterozygote carriers); how best to ensure genetic counseling; when to initiate the very expensive but life-saving CFTR modulator drugs; how to identify new CFTR modulator drugs for patients with non-responsive CFTR variants; how to adjust other therapeutic modalities; and how to best partner with primary care clinicians. Progress always brings new challenges, and this has been evident worldwide for CF. Consequently, this article summarizes the major advances of recent years along with controversies and describes their implications with an international perspective.

Economic Burden of Acute Gastroenteritis among Members of Integrated Healthcare Delivery System, United States, 2014-2016.

We conducted a large surveillance study among members of an integrated healthcare delivery system in Pacific Northwest of the United States to estimate medical costs attributable to medically attended acute gastroenteritis (MAAGE) on the day care was sought and during 30-day follow-up. We used multivariable regression to compare costs of MAAGE and non-MAAGE cases matched on age, gender, and index time. Differences accounted for confounders, including race, ethnicity, and history of chronic underlying conditions. Analyses included 73,140 MAAGE episodes from adults and 18,617 from children who were Kaiser Permanente Northwest members during 2014-2016. Total costs were higher for MAAGE cases relative to non-MAAGE comparators as were costs on the day care was sought and costs during follow-up. Costs of MAAGE are substantial relative to the cost of usual-care medical services, and much of the burden accrues during short-term follow-up.

Survey of plant species used in the treatment of common ailments in Hawul Local Government Area, Borno State, Nigeria

To record the locals' knowledge of some of the medicinal plant species in the area, a survey of plant species used for the treatment of common ailments was carried out in Hawul Local Government Area Borno State. A semi-structured questionnaire was used to collect the data. Numerous quantitative indices, including Informant Consensus Factor (ICF), Use Value (UV), Fidelity Level (FL), Shannon Weiner Index, Simpson Index, Relative Frequency of Citation (RFC), and Family Importance Value (FIV), were used to quantify the advantages, significance, and coverage of ethnomedicine. The Jaccard Index (JI) was used to assess the degree of homogeneity between the current study and earlier research as well as within indigenous tribes. A total of fifty-five (55) medicinal plants species, which were distributed under twenty-nine (29) families were documented from one hundred (100) informants. The majority of species that have been identified are tree species, and the most common plant portion used to make ethnomedicines is leaf material. The Fabaceae were the predominate families among the species that had been documented (11 species) Accacia nilotica, Piliostigma thonningii, Detarium microcarpum, Faidherbia albida, Sennia siamea, Prosopis Africana, Parkia baglobosa, Tamarindus indica, Pterocarpus erinaceus, Senna occidentalist, Senna obtusifolia, while the least represented was (1 species) Apocynacea. For digestive system problems, the highest ICF score was 0.77. According to the data gathered from the questionnaires, pile, yellow fever, malaria, typhoid, stomach ache, and ulcer were the most prevalent diseases, in that order. Based on UVs, the two most commonly cited ethnomedicinal plant species in the study area were Khaya senegalensis (0.40), Piliostigma thonningii (0.35) while the least was (0.01) Guinea senegalensis. The most common method of preparation was by decoction and the major route of administration was oral while least cited was sit bath. Phytochemical profiles demonstrated that flavonoids, alkaloids phenols, saponins and tannins were the major phytochemical component in Khaya. senegalensis and Piliostigma. thonningii leaves. This further justifies the frequent application of these plants in folklore medicine by the traditional herbal practitioners to treat different forms of illnesses. It is stated that due to their physiologically active ingredients and accessibility, herbal medicine will continue to play a significant role in the community's health care delivery system.

Reframing Fall Prevention and Risk Management as a Chronic Condition Through the Lens of the Expanded Chronic Care Model: Will Integrating Clinical Care and Public Health Improve Outcomes?

Falls are a leading cause of morbidity and mortality among adults aged 65 years and older (older adults) and are increasingly recognized as a chronic condition. Yet, fall-related care is infrequently provided in a chronic care context despite fall-related death rates increasing by 41% between 2012 and 2021. One of the many challenges to addressing falls is the absence of fall-focused chronic disease management programs, which improve outcomes of other chronic conditions, like diabetes. Policies, information systems, and clinical-community connections help form the backbone of chronic disease management programs, yet these elements are often missing in fall prevention. Reframing fall prevention through the Expanded Chronic Care Model (ECCM) guided by implementation science to simultaneously support the uptake of evidence-based practices could help improve the care of older adults at risk for falling. The ECCM includes seven components: (1) self-management/develop personal skills, (2) decision support, (3) delivery system design/re-orient health services, (4) information systems, (5) build healthy public policy, (6) create supportive environments, and (7) strengthen community action. Applying the ECCM to falls-related care by integrating health care delivery system changes, community resources, and public policies to support patient-centered engagement for self-management offers the potential to prevent falls more effectively among older adults.

Social Acceptance of Mobile Health Technologies Among the Young Population in Nigeria

Mobile devices are widely used in modernizing healthcare delivery because of their unique features related to accessibility, virtual interaction, and connectivity. While developing countries, with limited resources, strive to achieve high healthcare standards, and mobile health (mHealth) solutions could transform healthcare delivery systems in these countries, their functionality is currently limited. This study investigates the potential systematic introduction of mHealth services and their social acceptability in developing countries, with a particular focus on Nigeria. This cross-sectional study was conducted with a sample of university students. Structural equation modeling was used to test the study hypotheses, and descriptive statistics were used to analyze the sociodemographic characteristics of the participants. Psychological and personal characteristics, environmental characteristics, and conditions of use associated with mHealth technology adoption were examined based on eight constructs (health consciousness, trust, social influence, perceived risk, performance expectancy, facilitating conditions, effort expectancy, and behavioral intention). The results indicate that trust and performance expectancy are significant predictors of mHealth acceptance in the surveyed population. The future acceptance of mHealth among young people in developing countries holds great significance for improving healthcare delivery, addressing the unique challenges faced by developing countries, and leveraging the preferences of young individuals, which could contribute to the advancement of mHealth solutions and enhance healthcare accessibility. The findings shed light on the acceptance of mHealth technologies among the young populations of developing countries, with implications for future efforts to improve healthcare delivery and address the healthcare challenges of these countries.

Heterogeneity in the effect of type 2 diabetes on dementia incidence in a diverse cohort of Asian American and non-Latino White older adults.

Dementia incidence is lower among Asian Americans than among Whites, despite higher prevalence of type 2 diabetes, a well-known dementia risk factor. Determinants of dementia, including type 2 diabetes, have rarely been studied in Asian Americans. We followed 4846 Chinese, 4129 Filipino, 2784 Japanese, 820 South Asian, and 123 360 non-Latino White members of a California-based integrated health-care delivery system from 2002 to 2020. We estimated dementia incidence rates by race/ethnicity and type 2 diabetes status, and we fitted Cox proportional hazards and Aalen additive hazards models for the effect of type 2 diabetes (assessed 5years before baseline) on age of dementia diagnosis, controlling for sex/gender, educational attainment, nativity, height, race/ethnicity, and a race/ethnicity × diabetes interaction. Type 2 diabetes was associated with higher dementia incidence in Whites (hazard ratio [HR] = 1.46; 95% CI, 1.40-1.52). Compared with Whites, the estimated effect of diabetes was larger in South Asians (HR = 2.26; 95% CI, 1.48-3.44), slightly smaller in Chinese (HR = 1.32; 95% CI, 1.08-1.62) and Filipino (HR = 1.31; 95% CI, 1.08-1.60) individuals, and similar in Japanese individuals (HR = 1.44; 95% CI, 1.15-1.81). Heterogeneity in this association across Asian subgroups may be related to type 2 diabetes severity. Understanding this heterogeneity may inform prevention strategies to prevent dementia for all racial and ethnic groups.

Mapping the Geographic Inequalities in Psychiatrist Distribution across Madhya Pradesh, India: An Exploratory Study

Objective: The National Mental Health Survey identified a vast treatment gap across India. This treatment gap is partly attributed to the availability and accessibility of mental health services in different states. Accessibility to a psychiatrist in Madhya Pradesh (MP) is essential due to the significant disparity among urban, rural, and tribal regions across the state. The study attempted to identify the geographical disparity of psychiatrists in MP to improve future mental health service delivery. Methods: An online survey of practicing psychiatrists was conducted in December 2022 in the settings of public and private healthcare service delivery systems through offline and online accessibility/availability of psychiatrists practicing in MP, and the data were mapped using geo-locations of psychiatrists and were analyzed using ArcMap 10.8.1. Results: In total, 152 psychiatrists were practicing in MP across 195 locations, which amounts to 0.21 psychiatrists per 100,000 population with a concentration around big cities. Out of 54 districts, 24 districts did not have any practicing psychiatrists. A total of 155 health facilities were identified across 30 (55.6%) districts where at least one psychiatrist provided mental health services. The nearest-neighbor index for 152 points was –13.69. Conclusions: Combining psychiatrist geo-mapping data with population data comprehensively explains the MP state’s mental health service delivery needs. It could be wise to improve the spatial distribution of psychiatrists in each district rather than achieving the recommended ratio of doctors to patients per state. These data need to be supplemented with qualitative inquiry to help policymakers and health planners generate effective public–private partnerships in mental health service delivery in the coming time.

Lessons From the Field From a Volunteer Telehealth Ambassador Program to Enhance Video Visits Among Low-Income Patients: Qualitative Improvement Study.

The prevalence of telehealth video use across the United States is uneven, with low uptake in safety-net health care delivery systems, which care for patient populations who face barriers to using digital technologies. This study aimed to increase video visit use in an urban safety-net delivery system. We piloted a telehealth ambassador program, in which volunteers offered technical support to patients with access to digital technologies to convert primary care visits already scheduled as telehealth audio-only visits to telehealth video visits. We used a descriptive approach to assess the feasibility, efficacy, and acceptability of the pilot telehealth ambassador program. Feasibility was quantified by the percentage of eligible patients who answered calls from telehealth ambassadors. Program efficacy was measured in two ways: (1) the percentage of patients with access to digital technology who interacted with the navigators and were successfully prepared for a telehealth video visit, and (2) the percentage of prepared patients who completed their scheduled video visits. Program acceptability was ascertained by a structured telephone survey. Telehealth ambassadors attempted to contact 776 eligible patients; 43.6% (338/776) were reached by phone, among whom 44.4% (150/338) were provided digital support between March and May 2021. The mean call duration was 8.8 (range 0-35) minutes. Overall, 67.3% (101/150) of patients who received support successfully completed a telehealth video visit with their provider. Among the 188 patients who were contacted but declined video visit digital support, 61% (114/188) provided a reason for their decline; 42% (48/114) did not see added value beyond a telehealth audio-only visit, 20% (23/114) had insufficient internet access, and 27% (31/114) declined learning about a new technology. The acceptability of the telehealth ambassador program was generally favorable, although some patients preferred having in-real-time technology support on the day of their telehealth video visit. This high-touch program reached approximately one-half of eligible patients and helped two-thirds of interested patients with basic video visit capability successfully complete a video visit. Increasing the program's reach will require outreach solutions that do not rely solely on phone calls. Routinely highlighting the benefits of video visits, partnering with community-based organizations to overcome structural barriers to telehealth use, and offering in-real-time technology support will help increase the program's efficacy.

Artabotrys brachypetalus Benth.: Evaluation of its traditional uses, phytochemistry, and pharmacological properties

Background: Artabotrys brachypetalus is best known for its edible fruits, but today, it is a well-known medicinal plant. However, there are several uses of the species, some of them known since prehistoric times.Aim: This study compiles the existing information of the traditional uses, phytochemistry and pharmacological properties, and future potential applications of A. brachypetalus.Setting: This review provides an overview of uses and ethnopharmacological properties of A. brachypetalus.Method: Multiple searches on existing literature were carried out on the traditional, medicinal, phytochemistry, and pharmacological properties of A. brachypetalus in online databases such as Scopus, PubMed, Google Scholar, JSTOR, and Science Direct as well as using pre-electronic literature sources obtained from the university library.Results: This study showed that A. brachypetalus is a multipurpose species used as a food plant, source of fibre, firewood, timber, and herbal medicine. Artabotrys brachypetalus serves as a medicinal plant in five countries to treat human and animal diseases, accounting for 55.6% of the countries where the species is naturally found. The phytochemical evaluation of the plant revealed that it contains alkaloids, cyclohexane carboxylic acid, dicarboxylic acid, fatty acids, flavonoids, phenolics, sesquiterpenes, and sugars. The pharmacological assessments showed that the phytochemical compounds isolated from the species and crude extracts demonstrated antifungal, antidiabetic, antiplasmodial, and larvicidal activities.Conclusion: Further research should focus on elucidation of pharmacological, phytochemical, toxicological, in vitro, in vivo and clinical research of the species.Contribution: This study contributes to the existing knowledge about A. brachypetalus that could be useful in bio-prospecting for new health-promoting products required in the primary healthcare delivery system.

Factors associated with patients' healthcare-seeking behavior and related clinical outcomes under China's hierarchical healthcare delivery system.

The hierarchical healthcare delivery system is an important measure to improve the allocation of medical resources and promote equitable distribution of basic medical and health services. It is one of the key factors in the success or failure of China's medical reform. This study aims to analyze the factors influencing patients' healthcare-seeking behaviors, including socioeconomic and clinical outcomes, under China's hierarchical healthcare delivery system, and to provide potential solutions. Patients receiving outpatient treatment in the past 14 days and inpatient care in the past 1 year were investigated. The multivariate logistic regression was used to analyze the influencing factors of patient's medical treatment behavior selection, and to compare whether the clinical outcomes of primary medical institutions and grade A hospitals are the same. Nine thousand and ninety-eight person-times were included in the study. Of these, 4,538 patients were outpatients, 68.27% of patients were treated in primary medical institutions; 4,560 patients were hospitalized, 58.53% chose to be hospitalized in grade A hospitals. Provinces and cities, urban and rural areas, occupation, education level, medical insurance type, income, whether there are comorbid diseases, and doctors' medical behavior are the factors affecting the choice of medical treatment behavior. Patients who choose primary medical institutions and grade A hospitals have different control levels and control rate for the blood pressure, blood lipids, blood glucose. Under the hierarchical diagnosis and treatment system, the patients' choice of hospital is mainly affected by their level of education, medical insurance types, and the inpatients are also affected by whether there are comorbid conditions. Clinical outcomes of choosing different levels of hospitals were different.

Work and Environmental Factors on Job Burnout: A Cross-Sectional Study for Sustainable Work

In the context of sustainable development, the occupational sphere must be integrally considered within health promotion frameworks, ensuring an equitable work–life balance while recognizing and amplifying the capabilities of every employee. Concurrently, there is a notable trend of physicians transitioning from public to private healthcare sectors, with burnout frequently cited in scholarly discourse as a primary catalyst for this shift. The objective of our study was to examine the vulnerability of medical staff to burnout. To achieve this, we conducted a cross-sectional analysis involving 1084 physicians from various specialties, employed in urban hospital settings. This research was executed via the distribution of an anonymous questionnaire, utilizing the Google Forms platform during work hours. The questionnaire was based on the Maslach Burnout Inventory (MBI) scale, specifically adapted for medical professionals, requiring respondents to provide insights into their experiences. Analysis of the collected data from a total of 614 respondents indicated a moderate predisposition towards burnout among the sample. These findings underscore the necessity for interventions targeting organizational flexibility and, notably, the restructuring of remuneration practices. Salaries often do not reflect the terms of employment contracts across numerous EU jurisdictions, necessitating urgent reforms. In conclusion, the reinforcement of interpersonal dynamics within medical teams and between healthcare institutions and their practitioners emerges as a critical strategy. Enhancing these relationships is essential for revitalizing the healthcare delivery system, ensuring that medical professionals are adequately compensated in alignment with the principles of sustainable employment.

Telemedicine for emergency patient rescue.

This article summarizes recent developments in the application of telemedicine, specifically tele-critical care (TCC), toward enhancing patient care during various types of emergencies and patient rescue scenarios when there are limited resources in terms of staff expertise (i.e., knowledge, skills, and abilities), staffing numbers, space, and supplies due to patient location (e.g., a non-ICU bed, the emergency department, a rural hospital) or patient volume as in pandemic surges. The COVID-19 pandemic demonstrated the need for rapidly scalable and agile healthcare delivery systems. During the pandemic, clinicians and hospital systems adopted telemedicine for various applications. Taking advantage of technological improvements in cellular networks and personal mobile devices, and despite the limited outcomes literature to support its use, telemedicine was rapidly adopted to address the fundamental challenge of exposure in outpatient settings, emergency departments, patient follow-up, and home-based monitoring. A critical recognition was that the modality of care (e.g., remote vs. in-person) was less important than access to care, regardless of the patient outcomes. This fundamental shift, facilitated by policies that followed emergency declarations, provided an opportunity to maintain and, in many cases, expand and improve clinical practices and hospital systems by bringing expertise to the patient rather than the patient to the expertise. In addition to using telemedicine to maintain patient access to healthcare, TCC was harnessed to provide local clinicians, forced to manage critically ill patients beyond their normal scope of practice or experience, access to remote expertise (physician, nursing, respiratory therapist, pharmacist). These practices supported decades of literature from the telemedicine community describing the effectiveness of telemedicine in improving patient care and the many challenges defining its value. In this review, we summarize numerous examples of innovative care delivery systems that have utilized telemedicine, focusing on 'mobile' TCC technology solutions to effectively deliver the best care to the patient regardless of patient location. We emphasize how a 'paradigm of better' can enhance the entirety of the healthcare system.

Booster visits in the management of the acute musculoskeletal injuries: Transforming care to improve outcomes-A perspective review.

The current healthcare delivery system for patients with acute musculoskeletal injury is failing. Current rehabilitation management of acute musculoskeletal injury typically includes physical therapy, focused on management of impairments, with an eventual transition to functional activities and release to prior level of function. At that point, formal physical therapy is often discontinued, despite the knowledge that a high percentage of patients fail to maintain preinjury level of activity and often reduce participation in regular physical activity. Further, for those who attempt to return to prior levels of pivoting and cutting activities, there is a high second injury rate. The long-term human experience is compromised by the current model of care which terminates at the point of transition to activity. This model of care fails to meet the continued needs of these patients and may result in long term deficits and potential disability. Extended care models include intermittent follow up visits after discharge from an acute episode of care and have been efficacious and cost effective in some patient populations with musculoskeletal conditions. Specifically, a type of extended care model, labeled "booster sessions," represents an opportunity to provide structured, intermittent care to assist in a smooth transition back to function, following an acute episode of care and promote a healthier life outcome. This perspective review will discuss the opportunity to transform acute musculoskeletal care to booster visit care model in an attempt to develop a more efficacious and cost-effective system of care which could be generalizable to all musculoskeletal conditions.

Investigating perceptions and attitude toward telenursing among undergraduate nursing students for the future of nursing education: a cross-sectional study

BackgroundTelenursing is poised to emerge as a novel healthcare delivery system in the digital age. Hence, understanding nursing students' perspectives and readiness is pivotal for its effective implementation. This study investigated nursing students' perceptions regarding, and attitudes toward, telenursing and the factors that influenced their attitudes based on the technology acceptance model.MethodsThis study used a cross-sectional descriptive approach. The participants consisted of 188 nursing students (first to fourth year) enrolled in the College of Nursing in Korea. Differences in attitudes toward telenursing were analyzed using independent t-test and one-way analysis of variance. Pearson’s correlation coefficient was used to examine the correlations between the main variables. Factors that influenced attitudes toward telenursing were analyzed using multiple regression.ResultsOf the participants, 65.4% lacked substantial awareness of telenursing and 19.1% had prior telenursing experience. Although prospects on telenursing indicated that 90.4% had an optimistic view, face-to-face nursing was heavily preferred for both satisfactory and favored healthcare delivery. Many cited the Internet as their source of knowledge, and only 18.6% had received telenursing education. Attitude toward telenursing was significantly more positive among those with experience of telenursing, telenursing observation in clinical practice, and telenursing education exposure. The regression model was statistically significant (F = 67.445, p < .000). Factors, such as perceived usefulness, social influence, innovativeness, and self-efficacy, influenced attitudes toward telenursing.ConclusionsNursing students exhibited a lack of substantial awareness of telenursing; however, they simultaneously displayed a positive outlook. This lack of comprehensive understanding could stem from the absence of formal education in telenursing. Understanding and utilizing the potential of telenursing could be significantly aided by nursing students' education and knowledge. Thus, it is necessary to include telenursing education in the nursing curriculum. The skills and knowledge required for telenursing clinical practice can be developed through telenursing education. Such preparedness will affect nurses’ attitudes and intentions and the quality of telenursing offered to patients in the future.

Understanding key factors for strengthening Nepal’s healthcare needs: health systems perspectives

Background Nepal’s health policy environment and health-care delivery system has changed over the last 25 years, during which it witnessed a significant progress in improving citizens’ access to healthcare services. However, a combination of factors intrinsic to the nation continue to influence health service delivery producing variable health outcomes. Given the nation’s target towards achieving universal health coverage and sustainable development targets, there is a need to review and understand the functioning of Nepal’s health system, its strengths, challenges, and opportunities. The review aims to explore the key health system factors influencing health services and healthcare needs, and forge actionable recommendations for the future. # Methods The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for identifying the relevant literature between 2001 and 2023. A total of 300 articles were obtained from the initial search, out of which 42 full text articles were selected for an in-depth review. The literature was analysed to identify the broad themes relevant to Nepal’s health system, and the findings were synthesized narratively under each theme. # Results The review highlights various factors influencing health services and healthcare needs by describing the historical development of Nepal’s healthcare delivery system, its current scenario, health expenditure, health system challenges and opportunities ahead. The evolution of Nepal’s health system has been both significant and responsive. # Conclusions The change in the governance structure and adoption of primary healthcare approach present the nation with ample opportunities to further the scope of the nation’s existing health sector initiatives and outcomes.

Pilot study exploring the presence of leadership curricula in undergraduate medical education

IntroductionThe physician’s role in the healthcare delivery system extends beyond patient care to include numerous critical leadership roles in healthcare. In addition to treating patients, physicians manage multidisciplinary teams and...

A Re-evaluation of Global Financial Outlooks and Prospects in the Telehealth Industry Amidst the Transition to a Post-Pandemic Era

The onset of the COVID-19 pandemic propelled the telehealth sector into a period of rapid expansion, with web-based care emerging as a crucial tool for ensuring the safety of patients and healthcare providers alike. However, with the introduction of vaccines, the perceived need for telehealth services appeared to diminish, leading to a decline in value for telehealth companies. This shift prompted both existing players and newcomers in the telehealth space to innovate and redefine their value propositions in order to regain investor and customer confidence and stand out amidst increasing competition. The struggle to reshape the perception of telehealth from a pandemic-era necessity to a valuable complement to traditional in-person care has been reflected in the volatility of stock prices and declining valuations. This dynamic has underscored the need for telehealth companies to differentiate themselves through technological advancements and the convenience they offer. Analyzing the market through qualitative secondary research, incorporating insights from contemporary sources, financial data from platforms like Yahoo! Finance, and peer-reviewed literature, it becomes evident that the telehealth market experienced a surge in 2020, reaching $17.9 billion in the US alone, and is projected to grow to $140.7 billion by 2030. This growth was accompanied by a nearly twofold increase in digital health venture funding, reaching $14.1 billion in total funding. However, this rapid expansion led to an oversaturation of the market, with supply outpacing demand, resulting in a significant drop in valuations as vaccination rates rose in 2021. In response to this rebalancing, telehealth companies must chart a course for the post-pandemic era. The current role of suppliers in the telehealth space, whether they are established healthcare industry incumbents or innovative "telehealth-first" challengers, will influence the growth strategies they pursue. Moreover, identifying medical specialties and patient demographics that are best suited for web-based care will be critical for long-term success in the evolving healthcare delivery system. Looking ahead, investors should anticipate a bullish market characterized by growing share prices. Success in the telehealth industry is likely to hinge on fundamentally transforming care delivery models rather than simply transitioning traditional care to a web-based format. As the market consolidates, established telehealth giants capable of adapting to the changing landscape are expected to thrive, albeit amidst continued growth at a slower pace.