Israel Journal of Health Policy Research最新文献

Background: A recent call has been made in Israel to address the needs of citizens inflicted by multiple adversities such world pandemic, internal conflicts, events of mass trauma and ongoing war. Nonetheless, public's and mental health professional's view regarding these needs and their prioritization is not well understood. This study aims to bridge this gap in knowledge, by assessing mental health service users and professionals' views regarding the future of mental health in Israel.

Methods: Two surveys were distributed to mental health professionals and service users. Responders (286 professionals and 522 service users) were asked about their vision for future mental health services and their views regarding the integration of technology and innovation, using a close-ended measure developed by mental health professionals to address local challenges.

Results: The top-rated category among professionals and service users was improving accessibility, with 75% of the service users and 82% of the professionals ranking this item as one of top-three items. Individuals with less experience with the mental healthcare system tended to rank personalized care as second-ranked priority (OR = 0.48, p = 0.04), whereas highly experienced individuals were more likely to rank alternatives to psychiatric hospitalization as third-ranked priority (OR = 2.99, p < 0.001). Professionals ranked the level of innovation in Israel's mental healthcare as 3.37 (SD = 1.82), and service users ranked 3.18 (SD = 2.12) out of 10. Among mental health professionals, lack of resources was rated as the predominant challenge in implementing technology and innovation.

Conclusions: Policy and decision-makers in Israel should consider addressing the issue of mental healthcare accessibility as top priority when planning a mental health reform, as well as routes to improve personalized care and alternative to psychiatric admissions. Steps should be taken to improve innovation and technology as means to improve the quality of mental healthcare in Israel.

Background: The COVID-19 pandemic has transformed healthcare, affecting the diagnosis and management of common diseases. Our study aimed to assess the effect of the changes in reasons for primary care visits on primary care physicians' (PCPs') workload from 2019 to 2023, focusing on non-COVID-related diseases.

Methods: A cross-sectional study of electronic medical records conducted at Leumit Health Services between 2019 and 2023, approximately 510,000 patients who had at least one consultation with a PCP were included. The study categorized visits using ICD-9 codes and calculated the number of visits and the accumulated annual duration of time (AADT) for each code group.

Results: In 2023, there was a significant 38.9% increase in administrative visits compared to 2019, with these visits accounting for 21.8% of AADT. Additionally, a consistent rise in visits for hyperlipidemia, obesity, and diabetes was noted. Conversely, the AADT for respiratory tract infections and sexually transmitted diseases markedly declined. A lesser, yet still notable, decrease was observed in other infectious diseases, injuries, heart diseases, and pulmonary diseases.

Conclusions: COVID-19 altered the distribution of primary care visit reasons and subsequently impacted the burden on PCPs. Notably, there was an increase in visits for bureaucratic issues and a concerning reduction in follow-ups for cardiovascular risk factors, alongside a rise in metabolic conditions. These trends persisted even after the pandemic waned, despite the removal of social restrictions. Policymakers should evaluate how to optimize the utilization of PCPs' time and explore methods to regulate demand for improved efficiency.

Background: Nurses play a vital role in disaster response during emergencies. Nevertheless, limited attention has been paid to factors that influence nurses' responses and challenges in prehospital settings. These issues became evident during the October 7, 2023, terror attack on Israel, when nurses heroically provided medical treatment, but there was no organized nurse-led initiative to provide emergency care in a prehospital setting.

Aims: (1) To examine the factors associated with nurses' intentions to provide prehospital emergency reponse during disasters; and (2) To understand multilevel determinantsof nurses' prehospital emergency response to inform health policy recommendations.

Methods: This study employed an explanatory sequential mixed-methods design. Between February and December 2024, a self-reporting questionnaire was distributed to Israeli nurses (n = 315), followed by a qualitative phase involving an open-ended questionnaire completed by 20 healthcare professionals involved in medical care during the attack or in senior emergency preparedness roles. Descriptive and inferential statistics and qualitative content analysis were employed. We applied the socioecological framework to organize the results from both phases.

Results: High personal resilience, readiness and self-efficacy, along with positive attitudes, low hesitancy, and residence in a rural-type settlement significantly predicted nurses' intention to provide prehospital emergency care. Qualitative analysis revealed four key themes related to nurses' prehospital roles: (1) individual barriers and facilitators, (2) interprofessional relationships and teamwork, (3) nurses' roles within the community, and (4) organizational and policy challenges. Findings from both phases were synthesized using the socioecological framework for analysing prehospital nursing care during emergencies.

Conclusion: Nurses' prehospital emergency response intentions are shaped by personal, professional, and policy-level factors. Beyond education, targeted health policies must clearly define nurses' roles, strengthen interprofessional collaboration, and integrate nursing into disaster preparedness frameworks to improve system resilience and patient outcomes, particularly in the face of escalating environmental crises globally.

Background: Accessibility and availability are critical components of quality healthcare, particularly for dialysis patients requiring tri-weekly treatments. Inconveniently placed or oversubscribed dialysis centers contribute to widening healthcare disparities. This study aims to enhance equity in dialysis care by utilizing Geographic Information Systems (GIS) to optimize facility placement through data-driven decision-making.

Methods: This cross-sectional study analyzed national data from 5,961 hemodialysis patients across 76 dialysis centers in Israel. Geographic accessibility was assessed using GIS to measure travel distances between patients' residences and their treating dialysis centers. For utilization rate, active hemodialysis patient count was compared to estimated maximum capacity for each center. Statistical comparisons across districts were conducted using chi-square, ANOVA, or Kruskal-Wallis tests, with Bonferroni corrections. Findings were visualized using ArcGIS software.

Results: The median travel distance to dialysis centers varied significantly by district (p < 0.001), with the longest distance in the North district (10.9 km) and the shortest in the South district (3.4 km). The mean utilization rate was 73.3%, with the highest in the North district (82.5%) and the lowest in the Jerusalem district (64.3%). No significant differences in utilization rates were found between districts (p = 0.38.

Conclusions: To our knowledge, this is the first study to apply GIS to national patient-based data for assessing dialysis center accessibility and utilization. Our findings demonstrate how GIS integration with national registries can inform equitable healthcare planning and facility allocation. This approach offers policymakers a scalable, technology-driven strategy to optimize resource distribution, correct healthcare inequities, and improve accessibility for dialysis patients.

In their previously published article in the Israel Journal of Health Policy Research, Rose and colleagues describe and advocate for greater use of implementation science in Israel. As a discipline, implementation science seeks to traverse the last steps in bringing new science from research to clinical practice, which are often the most difficult of the entire process. Implementation science in general faces substantial challenges, including the extraordinary heterogeneity of the dissemination process, and the obstacles represented by established practices, singular preferences, and questions about generalizability. In our view, implementation science complements classic epidemiology as part of a continuum of population health research that warrants greater attention and funding. For now, however, implementation science will need to show that it can consistently achieve sizable, durable, and widespread results if it is to traverse its own last mile and establish itself as a successful and permanent component of biomedicine in Israel.

On October 7th, 2023, a deadly attack was launched on southern Israel from the Gaza Strip followed by major clashes along the Israel-Lebanon border. In the following days, approximately 2.5% of the Israeli population was evacuated from their homes, many of whom were directly affected by the violence Many evacuees were housed in Eilat, a small geographically peripheral city known for its holiday atmosphere in the southernmost part of Israel. The horrors of the terror attacks and the war, the unprecedented number of evacuees, and the highly limited mental health resources available in this remote city have combined to create an overwhelming demand for mental health services, which required the deployment of special measures. In this report from the field, we discuss our experiences in sending the first organized, organic teams to provide primary mental health support to the evacuees, with the supervision of Shalvata Mental Health Center, located over 300 km away from Eilat. Our experience highlights the need for proper preparation, planning, and practice for large-scale mental health support intervention in mass evacuation events and points to several successful and suboptimal practices for future deployment.