Influence Health Care Research Articles

Canadian Physiotherapists’ Perspectives about Core Professional Values and Associated Behaviours: A Qualitative Descriptive Study

Relevance: Core values influence health care professionals' behaviours and decision-making. Research has yet to examine Canadian physiotherapists’ views about core professional values (CPVs). Purpose: To explore physiotherapists’ views about CPVs and associated behaviours (ABs). Methods: A qualitative descriptive approach was undertaken. Narrative text data collected from members of the Canadian Physiotherapy Association (CPA), including physiotherapists, physiotherapist assistants, retired and student members, regulators, and executives and members in leadership roles during three rounds of e-Delphi surveys, conducted as part of the CPA Core Professional Values and Associated Behaviours document development process, were analyzed using descriptive content analysis by teams of two researchers. Results: Three categories (Integral … A Given; Perhaps, It's Debatable; Conflicting, Competing and Differing Tensions and Perspectives) and two sub-categories (In Part, Maybe, But … I'm Not Sure I Completely Agree With What You Are Proposing; I Beg to Differ … I'm Not on Board with What You are Proposing) emerged. Accountability, Integrity, and Respect were perceived most positively. Wavering views regarding Advocacy, Client/Patient-Centredness, Compassion/Caring and Excellence were evident. Altruism, Equity, and Social Accountability had the most contentious and divergent perspectives. Conclusion: Views about CPVs varied on a continuum from wholly positive/agreement to more neutral to ambivalent to wholly negative/disagreement. Future research, utilizing different theoretical approaches, can further our understanding about the role CPVs play in the practice of Canadian physiotherapists.

Implementasi Business Process Re-Engineering pada Pengelolaan Perbekalan Farmasi pada Rumah Sakit Ibu dan Anak (RSIA) Kota Malang

The availability of pharmaceutical supplies in hospitals is a basic requirement must be maintained, because medicine and pharmaceutical supplies are one of the factors that influence health care in hospitals. Pharmaceutical product management is a complex process. Inefficient management has a negative impact on hospital operational costs. Business Process Reengineering (BPR) is an effort to improve or refinement strategies by utilizing technology in the form of SIM- RS to increase productivity, effectiveness and efficiency in managing pharmaceutical supplies. This study aims to determine the implementation of BPR in the management of pharmaceutical supplies in pharmaceutical installations in hospitals. The method used is descriptive qualitative by conducting natural observations and interviews. The interview results were then reduced, analyzed and the data were presented in narrative form accompanied by tables and graphs. The size of the population consists of eight informants included director of the hospital, pharmaceutical procurement staff, finance managers, IT staff, pharmacist and nursing service staff, pharmaceutical procurement staff of external hospital as an informer triangulation. The results showed that the implementation of BPR can reduce the costs of managing pharmaceutical supplies by up to 70%, linear purchase and sales graphs, and researchers can find out the success factors in implementing BPR. It is important for organizations to have specific and detailed standard operating procedures so that BPR can implemented according to vision and goals.

Neighborhoods, Networks, and HIV Care Among Men Who Have Sex With Men: Proposal for a Longitudinal Study.

The majority of people living with HIV in the United States are men who have sex with men (MSM), with race- and ethnicity-based disparities in HIV rates and care continuum. In order to uncover the neighborhood- and network-involved pathways that produce HIV care outcome disparities, systematic, theory-based investigation of the specific and intersecting neighborhood and social network characteristics that relate to the HIV care continuum must be engaged. Using socioecological and intersectional conceptual frameworks, we aim to identify individual-, neighborhood-, and network-level characteristics associated with HIV care continuum outcomes (viral suppression, retention in care, and antiretroviral adherence) among MSM living with HIV in New York City. In the longitudinal cohort study, we assess 3 neighborhoods of potential influence (residential, social, and health care access activity spaces) using Google Earth. We investigate the influence of neighborhood composition (eg, concentrated poverty and racial segregation) and four neighborhood-level characteristics domains: (1) community violence, physical disorder, and social disorganization (eg, crime rates and housing vacancy); (2) alcohol and other drug use; (3) social norms (eg, homophobia and HIV stigma); and (4) community resources (eg, social services and public transit access). We test theoretical pathways of influence, including stress or coping, stigma or resilience, and access to resources, across the different neighborhoods in which MSM live, socialize, and receive HIV care. At each visit, we locate each participant's reported activity spaces (ie, neighborhoods of potential influence) and collect individual-level data on relevant covariates (including perceptions of or exposure to neighborhoods) and social network inventory data on the composition, social support, and perceived social norms. The outcomes are HIV viral suppression, retention in care, and antiretroviral adherence. These data are combined with an existing, extensive geospatial database of relevant area characteristics. Spatial analysis and multilevel modeling are used to test the main theory-driven hypotheses and capture independent neighborhood-level and network-level effects and changes over time. The study began enrollment in March 2019 and concluded visits in December 2023, with a total of 327 participants enrolled. The median age was 44.1 (SD 11.5) years. Almost all participants self-identified as cisgender men (n=313, 98.1%) and as gay, homosexual, or bisexual (n=301, 94.4%). Overall, 192 (60.1%) participants identified as non-Hispanic Black, and 81 (25.3%) identified as Hispanic. Most (n=201, 63%) reported at least occasional difficulty in meeting basic needs (eg, rent and food) in the past 6 months. The mean number of years living with HIV was 15.4 (SD 10.1). This study will have direct implications for the design of multilevel interventions, addressing factors at the neighborhood, network, and individual levels. Results may inform urban planning and program design to improve HIV care outcomes for MSM, particularly for Black and Latino MSM living in urban areas. PRR1-10.2196/64358.

The Right ICD Code, Right Now: A Call to Action for Pragmatic Language Disorders After Right Hemisphere Stroke.

Diagnosis of language impairments after stroke is important to optimizing stroke outcomes. After right hemisphere brain damage (RHD), apragmatism can impact the comprehension and production of pragmatic language. However, despite decades of empirical evidence, there is no International Classification of Diseases (ICD) code for RHD pragmatic language impairments. The absence of an ICD code has far reaching ramifications that impact patient outcomes, including reduced clinical and public awareness, limited curricular content, and underdiagnosis. This viewpoint justifies the need to appropriately classify the pragmatic language symptomology after RHD with an ICD code. An ICD code can positively influence health care practitioner knowledge, education, and practice while informing public health considerations vital to epidemiological analyses.

FACTORS INFLUENCING HEALTH CARE PROVIDER IN CODUNCTING PREECLAMPSIA SCREENING

Background: Preeclampsia is responsible for maternal health globally due to its high morbidity and maternal mortality rates, especially in low-income countries such as Indonesia. Primary care providers, including general practitioners, midwives, and nurses, have a crucial role to play in the early assessment of preeclampsia screening. It was noted that factors affecting mortality were the lack of preparedness of officers in managing and responding to pregnancy emergencies, delayed recognition of worsening clinical signs of preeclampsia, as well as inadequate assessment and treatment for preeclampsia. This study aims to analyze the driving factors that influence health care provider in conducting preeclampsia screening in Gresik District. Methods: This research was an observational analytical study with a cross-sectional approach. The population in this study consisted of all doctors and midwives at the primary health facilities in the Gresik Regency area. The sample was taken from 159 respondents who were service providers in 20 primary health facilities in Gresik using simple random sampling. The variables in this study were the knowledge and attitudes of healthcare workers toward implementing preeclampsia screening. Data collection in this study used an online questionnaire conducted after issuing the Ethical Approval Letter until October 2023, which was then analyzed using a chi-square test with a significance level of 0.05. Results: Only 27% of respondents demonstrated a good level of knowledge about preeclampsia, which affected the effectiveness of preeclampsia screening (p-value 0.04). A total of 86.2% of respondents showed a high level of attitude toward preeclampsia screening. However, this study found no significant relationship between healthcare workers' attitudes and preeclampsia screening (p-value 0.171). Conclusion: There is a significant link between the knowledge of the healthcare provider and the optimization of preeclampsia screening so new methods of training are needed that are assessed as effective and accompanied by rigorous monitoring and evaluation to enhance healthcare provider knowledge, especially concerning preeclampsia screening.

Tapping into Gen Z Ways to Enhance E-learning and Meaningful Connections

Generation-Z born 2000-2009 (Australian Bureau of Statistics 2024) are comfortable with digital technology and connecting with one another using social media platforms. Regardless of this proficiency they may still experience challenges engaging with online learning especially around social cohesion, wellbeing and learning success. Other challenges they may encounter are communicating and interacting face-to-face in the workplace, which is a vital 21st Century graduate attribute. A growing societal concern is staff shortages and unfilled vacancies within the health sector. There are many factors influencing health care workforce shortages, but Generation-Z may be a good fit due to their growing awareness of societal concerns and willingness to upskill. This study seeks to investigate the enablers and barriers impacting Generation-Z nursing students’ ability to successfully engage with e-learning and to communicate effectively in face-to-face interactions within the workplace environment. Furthermore, this study seeks to explore the ways Generation- Z nursing students communicate and interact with each other on social media. The study will use a qualitative, social constructionism (making meaning in a social context) methodology. Methods include three focus group discussions with students aged 18-24 years, enrolled external/online in an undergraduate nursing program, with a minimum of one clinical placement completed or attempted. Data will be analysed using thematic analysis process proposed by Braun and Clarke (2022). Findings will inform e-learning design strategies that address the identified barriers and use the enablers to help Generation-Z successfully transfer their social media communication knowledge and skills to better engage with online learning, leading to higher satisfaction and completion rates. These strategies include supporting the transference of their fluent online social media communication skills to build and use meaningful connections relevant to the healthcare workplace that further supports the enablement of the graduate attribute, effective communicator.

History in context: teaching the history of dentistry with rare materials.

History and health humanities instruction offers a framework for professional students to examine the arc and development of their profession as well as develop cultural competencies. Exploring ideas, themes, and health care practices and approaches through historical instruction can show students how culture influences health care and practice, therefore providing a context for further development of cultural competence skills. This case report describes a collaboration among a dentistry course instructor, a liaison librarian, and curators of a rare book collection. Working together, this team offers an active learning class that examines the historical arc of the dental profession. We aim to have students use primary source materials to examine the experiences, research, and narratives of their profession. Using a World Cafe with thematic tables allows students to safely examine rare materials and artifacts and have meaningful conversations about themes that are critical to dentistry's past, present, and future. Students reported that engaging with artifacts and historical materials provided a different way to understand history and enhanced their learning experience. Engaging students in this work builds critical thinking skills that are essential to evidence-based practice.

Cultural Humility in Nursing: A Concept Analysis.

The ability of nurses to deliver culturally mindful health care may be vital to improving the patient-clinician relationship and subsequent health outcomes for marginalized populations. Continuing education in cultural training should be designed to enhance a nurse's cultural humility. This study explores the concept of nurse cultural humility using the methods outlined by Walker and Avant (2018): define the attributes, offer a model case exemplifying the attributes, discuss the antecedents and consequences, and determine empirical referents. The defining attributes of cultural humility in nursing are a lifelong process of reflexivity, an understanding and appreciation that the cultural backgrounds of both nurse and patient influence health care encounters, and a commitment to redress and mitigate power imbalances in the patient-clinician relationship. By clearly defining nurse cultural humility, leaders will be able to develop cultural training interventions to enhance nurse cultural humility and measure the concept accurately. [J Contin Educ Nurs. 202x;5x(x):xx-xx.].

An empirical study of job crafting and employees’ loyalty in the Nigerian healthcare system

Many factors have contributed to the continuous departure of workers from the Nigerian healthcare system since the COVID-19 outbreak. Therefore, this study aimed at examining the effect of job crafting on the loyalty of healthcare workers in public hospitals in Lagos, Nigeria. The study population was 11,084, comprising all the doctors and nurses in public hospitals in Lagos, with a sample size of 725 using the Morgan Sample Size Determination table. We collected primary data using a well-structured questionnaire and conducted analysis using structural equation modeling. The findings revealed a significant positive relationship between job creation and healthcare workers' loyalty in the public healthcare system. This implies that job creation influences health care workers' loyalty. This study suggests that the management of the public healthcare system should encourage and support job crafting while also building and encouraging positive relationships among healthcare workers to ensure their loyalty and effective service delivery.

Impact of an Electronic Health Record-Based Interruptive Alert Among Patients With Headaches Seen in Primary Care: Cluster Randomized Controlled Trial.

Headaches, including migraines, are one of the most common causes of disability and account for nearly 20%-30% of referrals from primary care to neurology. In primary care, electronic health record-based alerts offer a mechanism to influence health care provider behaviors, manage neurology referrals, and optimize headache care. This project aimed to evaluate the impact of an electronic alert implemented in primary care on patients' overall headache management. We conducted a stratified cluster-randomized study across 38 primary care clinic sites between December 2021 to December 2022 at a large integrated health care delivery system in the United States. Clinics were stratified into 6 blocks based on region and patient-to-health care provider ratios and then 1:1 randomized within each block into either the control or intervention. Health care providers practicing at intervention clinics received an interruptive alert in the electronic health record. The primary end point was a change in headache burden, measured using the Headache Impact Test 6 scale, from baseline to 6 months. Secondary outcomes included changes in headache frequency and intensity, access to care, and resource use. We analyzed the difference-in-differences between the arms at follow-up at the individual patient level. We enrolled 203 adult patients with a confirmed headache diagnosis. At baseline, the average Headache Impact Test 6 scores in each arm were not significantly different (intervention: mean 63, SD 6.9; control: mean 61.8, SD 6.6; P=.21). We observed a significant reduction in the headache burden only in the intervention arm at follow-up (3.5 points; P=.009). The reduction in the headache burden was not statistically different between groups (difference-in-differences estimate -1.89, 95% CI -5 to 1.31; P=.25). Similarly, secondary outcomes were not significantly different between groups. Only 11.32% (303/2677) of alerts were acted upon. The use of an interruptive electronic alert did not significantly improve headache outcomes. Low use of alerts by health care providers prompts future alterations of the alert and exploration of alternative approaches.

DATOS-CAT: OMOP-Common Data Model for the Standardization, Integration and Analysis of Population-Based Biomedical Data in Catalonia.

Transforming the population based biomedical cohort into the Common Data Model (OMOP-CDM) empowers researchers to access direct sources of information, enabling a deeper understanding of how genetic profiles relate to clinical outcomes and providing new knowledge that can significantly influence health care practices around the world.

Predictors of Health Care Practitioners' Intention to Use AI-Enabled Clinical Decision Support Systems: Meta-Analysis Based on the Unified Theory of Acceptance and Use of Technology.

Artificial intelligence-enabled clinical decision support systems (AI-CDSSs) offer potential for improving health care outcomes, but their adoption among health care practitioners remains limited. This meta-analysis identified predictors influencing health care practitioners' intention to use AI-CDSSs based on the Unified Theory of Acceptance and Use of Technology (UTAUT). Additional predictors were examined based on existing empirical evidence. The literature search using electronic databases, forward searches, conference programs, and personal correspondence yielded 7731 results, of which 17 (0.22%) studies met the inclusion criteria. Random-effects meta-analysis, relative weight analyses, and meta-analytic moderation and mediation analyses were used to examine the relationships between relevant predictor variables and the intention to use AI-CDSSs. The meta-analysis results supported the application of the UTAUT to the context of the intention to use AI-CDSSs. The results showed that performance expectancy (r=0.66), effort expectancy (r=0.55), social influence (r=0.66), and facilitating conditions (r=0.66) were positively associated with the intention to use AI-CDSSs, in line with the predictions of the UTAUT. The meta-analysis further identified positive attitude (r=0.63), trust (r=0.73), anxiety (r=-0.41), perceived risk (r=-0.21), and innovativeness (r=0.54) as additional relevant predictors. Trust emerged as the most influential predictor overall. The results of the moderation analyses show that the relationship between social influence and use intention becomes weaker with increasing age. In addition, the relationship between effort expectancy and use intention was stronger for diagnostic AI-CDSSs than for devices that combined diagnostic and treatment recommendations. Finally, the relationship between facilitating conditions and use intention was mediated through performance and effort expectancy. This meta-analysis contributes to the understanding of the predictors of intention to use AI-CDSSs based on an extended UTAUT model. More research is needed to substantiate the identified relationships and explain the observed variations in effect sizes by identifying relevant moderating factors. The research findings bear important implications for the design and implementation of training programs for health care practitioners to ease the adoption of AI-CDSSs into their practice.

What is the cure for absolute infertility? Biomedicalisation and routinisation of surrogacy and uterus transplantation in Nordic medical journals

AbstractThis article investigates 20 years of discursive struggles in Nordic medical journals around the process of legitimating and routinising gestational surrogacy and uterus transplantation in Finland and Sweden. The comparative analysis through critical discourse analysis suggests that influential health care professionals have contributed to different levels of legal and cultural adaptation of the methods, prioritising non-commercial gestational surrogacy in Finland and uterus transplantation in Sweden. The article identifies central discursive turning points in the medical journal discussions by interpreting them against the background of medical and policy developments in Finland and Sweden during the analysed twenty-year period. Legitimation and routinisation of surrogacy and uterus transplantation were developed through biomedicalisation by representing them as infertility treatments and emphasising the relational dynamics between donors and recipients—a connection that in the Nordic context is often based on kinship or close relationships. The diagnosis of absolute uterine factor infertility was central to representing women as on the boundary between fertile and infertile, as they may have functioning ovaries. Through the biomedicalised rhetoric of equal opportunities for biogenetic motherhood, the diagnosed women’s ambiguous reproductive status was used to legitimise the two methods as cures for absolute infertility, thereby reinforcing hegemonic family and kinship norms.

Narrative review and call to action on reporting and representation in orthobiologics research for knee osteoarthritis.

Osteoarthritis affects a significant portion of U.S. adults, and knee osteoarthritis contributes to 80% of disease burden. Previous data have shown that non-White patient populations often report worse symptoms and less favorable outcomes following arthroplasty, a definitive treatment for knee osteoarthritis. There is a lack of demographics data on race/ethnicity, as well as socioeconomic status (SES) and social determinants of health (SDOH), in knee osteoarthritis treatment guidelines and knee arthroplasty research. In addition, there is underrepresentation of non-White patient populations in the existing treatment guidelines for knee osteoarthritis. Over the past decade, orthobiologics have emerged as an alternative to surgical intervention. Our hypothesis is that there would be a similar lack of reporting of demographics data and underrepresentation of non-White populations in studies pertaining to orthobiologics, including evaluating differences in outcomes. This study reviewed U.S.-based research in orthobiologics as a treatment option for knee osteoarthritis. We identified a lack of demographics reporting in terms of race/ethnicity, and none of the studies reported SES or SDOH. Non-White populations were underrepresented; White patients contributed to 80% or more of all study populations that reported race/ethnicity. None studied the correlation between symptoms and outcome measures, and the race/ethnicity, SES, and SDOH of the patients. Based on a review of existing literature, we strongly advocate for ongoing research encompassing patients of all races/ethnicities, SES, and SDOH, and an exploration into potential variations in symptoms and outcomes among distinct population subgroups. Furthermore, SES barriers may influence health care delivery on orthobiologics for disadvantaged populations.

Educational Debt and Income Among Pharmacists and Other Health Professionals

ObjectiveGiven the substantial increases in student educational loan debt in recent years, the objective was to assess trends in educational debt-to-income ratios for graduates of pharmacy, medicine, dentistry, optometry, and veterinary medicine programs in the United States in the 2017–2022 period. MethodsA retrospective analysis of 2017–2022 data for educational debt and income for select health professions was conducted. Annual income data were collected from the American Community Survey, and educational debt data were collected from health professions organizations. Educational debt-to-income ratios for each health profession were calculated, as was the mean change per year in debt-to-income ratio. ResultsWith the exception of medicine, educational debt consistently exceeded income across the selected health professions in the 2017–2022 period. Debt-to-income ratios of pharmacists and the remaining health professionals decreased on average per year between 2017 and 2022. Physicians had the lowest debt-to-income ratios and dentists had the highest debt-to-income ratios in the study period. ConclusionDebt-to-income ratios fell below the 2017 levels for the health professions of interest, suggesting that average growth in income outpaced that of debt for the study period. Regardless, debt remains high and may influence health care professionals’ postgraduate training and career decisions, and in turn affect access to health care. Therefore, a call to action is proposed to address educational debt burden. Several strategies are suggested, including federal policy changes, implementing tuition reductions or minimal increases, facilitating financial aid options, and reducing underlying costs of health professions programs.

Territorial control by non-state armed groups and gendered access to healthcare in conflict using a new complex adaptive systems framework

The growing prevalence and influence of non-state armed groups (NSAGs) in armed conflict requires a deeper understanding of how their territorial control and contestation affect sub-national healthcare availability and outcomes, particularly with regards to gender dynamics. However, there are gaps in existing research in understanding how NSAG governance influences health care outcomes. Furthermore, a disconnect exists between the literature on international humanitarian interventions, NSAG governance and national health systems. Each perspective tends to prioritise a specific health service provider—whether NSAGs, State actors, or international humanitarian organisations—and often treats populations as homogenous. To address these gaps, we propose a complex adaptive system framework centred on the influence of territorial control for health services in intra-state conflict settings, with a gender lens. This systems framework accounts for the influence of all parties significant for health service delivery. It recognises that those governing the localised health system may differ from those physically delivering health services. Our framework enables empirical examination of health service delivery and outcomes. We apply the framework to three conflict-affected settings (Colombia, Iraq, Mali) using publicly available data and offer recommendations for policymakers and practitioners targeting health service provision in intra-state conflict contexts.

Identifying potential LGBTQIA+ competencies for genetic counseling student training.

The LGBTQIA+ community faces considerable health disparities. Developing and integrating LGBTQIA+ competencies into healthcare provider training programs is one way to promote inclusive high-quality care to potentially improve this community's health. Currently, there are no established LGBTQIA+-specific competencies for genetic counseling graduate programs (GCPs), so training across GCPs likely varies. This qualitative focus group-based study aimed to explore current topics related to genetic counseling (GC) for LGBTQIA+ patients covered in North American GCPs, their learning objectives, and LGBTQIA+-specific competencies that GC students (GCSs) should achieve by graduation. Eligible participants were program leaders at ACGC-accredited GCPs and/or faculty who taught LGBTQIA+-related content in at least one GCP over the last 5 years. A semistructured interview guide was used to conduct virtual focus groups that were recorded and transcribed. Transcripts were analyzed using reflexive thematic analysis and an inductive iterative approach that generated themes regarding what content is taught and what knowledge, attitudes, and skills GCSs should demonstrate as a result. Thirteen people participated, including nine LGBTQIA+ people. They represented 12 GCPs (22% of current GCPs) across the United States and Canada. Focus groups ran 73-90 min. Transcript analysis identified six themes, framed as learning objectives (LOs), and 24 subobjectives. These included recognizing the breadth of the LGBTQIA+ community and their lived experience with the healthcare system, demonstrating respect for and responding to patient identities to provide inclusive GC, employing strategies to mitigate social aspects that influence health care, and assessing personal biases and the impact of socialization. Participants used several teaching methods including didactic lectures, simulation, written activities, reflections, and fieldwork experiences. The six identified LOs may be a starting point for GCPs looking to develop or refine their LGBTQIA+ curricula. Competency-based education may enhance GCSs' abilities to provide inclusive GC to the LGBTQIA+ community.

New diagnostic technologies in laboratory medicine: potential benefits and challenges.

Laboratory tests play a central role in medicine, as they help to make diagnoses, assess prognosis and risk of disease, and monitor therapies, thus contributing to 70% of all medical decisions. This cross‑sectional function offers great potential for technologic and organizational innovation to influence health care as a whole. In recent years, a variety of technologies have emerged and entered the field of medical research, or even medical care. A new generation of biosensors enables laboratory tests to be carried out at the point of care and allows for faster medical decisions. Modern devices allow for patient‑centric blood sampling, which eliminates the need for painful blood draws, patient traveling, and limits the workload of health care professionals. Analytical techniques, such as metabolomics, lipidomics, or proteomics can identify biomarkers extremely sensitively, even down to individual cells. Pharmacogenomics allows for determination of genetic polymorphisms that predict a response to chemotherapeutic agents. Machine‑learning approaches can handle large amounts of multilayered data for diagnostic applications. However, this enormous diagnostic potential is far from being utilized and only very few applications have been implemented in clinical practice. Why is this the case? In this article, we describe the key technologic fields, discuss their medical potential, and list obstacles to their implementation. In addition, we present a methodologic framework to support researchers, clinicians, and authorities in development and implementation of novel diagnostic approaches.

Which factors influence health services utilization in Bulgaria? Results of a cross-sectional survey.

Research on the factors influencing health care services utilization in Bulgaria does not apply a particular model to analyze these determinants. To fill this gap, we apply the Andersen's Behavioural Model, a commonly used framework, to determine the factors that impact the utilization of health care services in our country. Data are collected in an online survey conducted in Bulgaria in 2023 among consumers. The standardized questionnaire includes questions on the utilization of health care services used by the respondent during the preceding 12 months. We apply binary logistic regressions to analyze predictors of visits to general practitioners and medical specialists, as well as hospitalizations. The results of the regression analysis show that the factors of self-reported health status and the presence of a chronic disease influence the utilization of health care services except for general practitioner visits. Greater trust in general practitioners and hospitals is associated with an increased probability of undergoing examinations and hospitalizations. Predisposing and enabling characteristics appear as significant determinants of health care utilization. The study confirms the relevance of the Behavioural Model for the use of health care services in the Bulgarian context. Further research on health outcomes and their impact on utilization can help determine the most efficient level and appropriateness of the use of health care services.

Potential of Large Language Models in Health Care: Delphi Study.

A large language model (LLM) is a machine learning model inferred from text data that captures subtle patterns of language use in context. Modern LLMs are based on neural network architectures that incorporate transformer methods. They allow the model to relate words together through attention to multiple words in a text sequence. LLMs have been shown to be highly effective for a range of tasks in natural language processing (NLP), including classification and information extraction tasks and generative applications. The aim of this adapted Delphi study was to collect researchers' opinions on how LLMs might influence health care and on the strengths, weaknesses, opportunities, and threats of LLM use in health care. We invited researchers in the fields of health informatics, nursing informatics, and medical NLP to share their opinions on LLM use in health care. We started the first round with open questions based on our strengths, weaknesses, opportunities, and threats framework. In the second and third round, the participants scored these items. The first, second, and third rounds had 28, 23, and 21 participants, respectively. Almost all participants (26/28, 93% in round 1 and 20/21, 95% in round 3) were affiliated with academic institutions. Agreement was reached on 103 items related to use cases, benefits, risks, reliability, adoption aspects, and the future of LLMs in health care. Participants offered several use cases, including supporting clinical tasks, documentation tasks, and medical research and education, and agreed that LLM-based systems will act as health assistants for patient education. The agreed-upon benefits included increased efficiency in data handling and extraction, improved automation of processes, improved quality of health care services and overall health outcomes, provision of personalized care, accelerated diagnosis and treatment processes, and improved interaction between patients and health care professionals. In total, 5 risks to health care in general were identified: cybersecurity breaches, the potential for patient misinformation, ethical concerns, the likelihood of biased decision-making, and the risk associated with inaccurate communication. Overconfidence in LLM-based systems was recognized as a risk to the medical profession. The 6 agreed-upon privacy risks included the use of unregulated cloud services that compromise data security, exposure of sensitive patient data, breaches of confidentiality, fraudulent use of information, vulnerabilities in data storage and communication, and inappropriate access or use of patient data. Future research related to LLMs should not only focus on testing their possibilities for NLP-related tasks but also consider the workflows the models could contribute to and the requirements regarding quality, integration, and regulations needed for successful implementation in practice.