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The Veterans Health Administration (VHA) is the United States' largest integrated health care delivery system, serving over 9 million enrollees at nearly 1300 health care facilities. In addition to providing health care to the nation's military veterans, the VHA has a research and development program, trains thousands of medical residents and other health care professionals, and conducts emergency preparedness and response activities. The VHA has been celebrated for delivering high-quality care to veterans, early adoption of electronic medical records, and high patient satisfaction. However, the system faces challenges, including implementation of an expanded community care program, modernization of its electronic medical records system, and providing care to a population with complex needs. The position paper offers policy recommendations on VHA funding, the community care program, medical and health care professions training, and research and development. [ABSTRACT FROM AUTHOR]

Purpose: Health in low-income countries has become associated with the provision of minimum guaranteed public health services though Essential Health Packages (EHPs). How far do EHPs deliver the human right to health for all? This study addresses this question through qualitative research into access to health care for vulnerable communities, using Malawi as a case study. This study shows that there are significant accountability gaps and perceptions of weak service provision in Malawi's EHP in relation to some particularly marginalised (and stigmatised) groups that limit the right to health and the promise of "health for all". Design/methodology/approach: This study extends the body of qualitative work on EHPs in general and on Malawi in particular by exploring the perceptions of key stakeholders in relation to inclusivity and the delivery of health policies to particularly vulnerable groups. To do so, this study adopted an approach based on interpretive epistemologies (Scott, 2014). This study conducted largely unstructured interviews with a range of health stakeholders, speaking to stakeholders individually, rather than through focus groups due to the potentially sensitive nature of the topic. Findings: The findings of this study are as follows: limited inclusion of civil society actors and local communities; local communities and local policymakers feel frustration with the gap between the promises of consultation in the EHP and the reality, and the difficulties of not having effective channels of communication; and exclusionary health practices for particularly vulnerable groups. Research limitations/implications: There are limitations based on the qualitative methodology, and in terms of the particularly vulnerable groups – the authors studied two such groups (people with disabilities and those who identify as LBTQ) but a wider survey of vulnerable groups is needed to extend and confirm the findings. Practical implications: Greater attention to the health rights of vulnerable groups would improve access and services, even in the context of resource restrictions. This study suggests that a deeper engagement with human rights-based approaches would pay dividends in terms of increasing access to health in Malawi, even within the constraints of the EHP process. Furthermore, without this, there is the risk that discrimination and exclusion will become more embedded in health policies, rather than progressively minimised. Social implications: Without addressing these issues, there is the risk that discrimination and exclusion will become more embedded in health policies, rather than progressively minimised. Originality/value: This paper makes an important contribution to the growing literatures on EHP in sub-Saharan Africa and Malawi in particular and to the importance of listening to stakeholder perceptions. It provides original data on stakeholder perspectives of the challenges associated with universalising health care in resource-constrained countries. To the best of the authors' knowledge, it is one of the first papers to focus on the rights of disabled and LBTQ people in relation to EHPs. [ABSTRACT FROM AUTHOR]

The humanitarian crisis precipitated by the ongoing conflict in Sudan poses profound risks to the health and welfare of the country's children. This paper explores essential policy interventions to safeguard child mental health services under these challenging circumstances. Crucial strategies include enhancing healthcare accessibility for children and their caregivers, promoting education, and improving household living conditions. Additionally, it is vital to provide improved access to information about nutritious food and strengthen health systems in areas directly exposed to conflict. Cooperation with international aid organizations is paramount to delivering medical supplies to functioning health facilities. The paper also recommends partnerships with local non-governmental and humanitarian organizations to execute public health programs effectively. These multi-faceted policy measures underscore the importance of a comprehensive response to ensure the health and well-being of children amid the turmoil in Sudan. Through these strategies, we aim to provide a blueprint for policymakers and humanitarian organizations to mitigate the devastating impacts of the conflict on the country's most vulnerable population. [ABSTRACT FROM AUTHOR]

Women are disproportionately impacted by the COVID-19 pandemic worldwide. Based on the Australian context, we highlight how women from Culturally and Linguistically Diverse (CALD) communities are vulnerable to Domestic and Family Violence (DFV). During the pandemic, CALD women experienced inequality in relation to DFV support and services. In this paper, our methodology is based on a case study from a rapid review of academic and grey literature that privileged the lived experience of CALD women affected by the pandemic. From a critical social work perspective, we explored the newly emerging literature highlighting DFV for CALD communities during the pandemic. Our research highlights an increase in DFV incidents, frequency and severity of incidents against CALD women, limited access to DFV services, and that women on Temporary and Humanitarian Visas (THV) were more likely to be subjected to DFV. We support the urgent need to include women's services in developing appropriate policy responses to address the specific issues facing women, particularly those on THV. Critical social work perspectives can be utilised to build on and support the response of services during the COVID pandemic to promote social and policy change, and increased access to services. This support can be implemented by workforce initiatives, dedicated resources and community engagement. [ABSTRACT FROM AUTHOR]

This paper presents current information on policy developments, service design, best practices, and approaches to empower the users of health and medical care services for people with intellectual disabilities in Poland. Polish regulations allow systemic support to be provided for all people with disabilities. However, Polish patients with intellectual disabilitiy (PwID) and their caregivers face many barriers. Although a key obstacle is the lack of a standard definition that approaches disability in an interdisciplinary way, PwID are also more likely to experience difficulties in personal communication in medical settings and less likely to encounter specialists prepared to work with this group. There is also a need to pay greater attention to the expectations of PwID. To facilitate a holistic approach to diagnosis and therapy, there needs to be coordination between different specialists, including medical staff, paramedics, psychologists, and teachers. Providing personal communication training for medical personnel, as well as developing dedicated procedures for PwID in primary health care, clinics and hospitals, will improve equal access to health and health literacy for all in Poland. Even so, it is important to respect the autonomy of PwID and the commitment of caregivers. [ABSTRACT FROM AUTHOR]

Irish health and social care policy has undergone a significant evolution in recent years to address inequalities, improve standards and update models of care to incorporate a rights‐based approach. The following account describes the Irish health and social care system, as delivered in the Republic of Ireland, and details how it operates for those with intellectual and developmental disabilities. The paper is informed by government policy, legislation, reviews, national plans, parliamentary reports, and population data. Clear progress has been made in shifting from a service‐led to a rights‐based, service‐user led model of care; however, resourcing this fundamental transition in approach to service provision poses challenges for the Irish State. [ABSTRACT FROM AUTHOR]

Purpose: Transitional care (TC) models emerged to ensure healthcare coordination and continuity, as at-risk patients transfer between different settings or different levels of care within the same setting. TC models have been developed in many countries as well as within different healthcare service delivery models and organizations. This paper aims to focus on a TC model developed in Italy called Operating Centre for Transition (OCT), in order to (1) explore its distinctive features by establishing a framework of analysis, (2) apply the framework to study two OCTs and (3) provide recommendations on how to use the framework to evaluate and develop new OCTs in the future. Design/methodology/approach: The authors adopted a grounded theory method to develop and validate the framework of analysis. The authors employed several qualitative methods following four iterative and recursive steps: (1) desk analysis of relevant documents, (2) in-depth interviews to key informants, (3) three meetings of an expert working group and (4) application of the framework to two case studies. Findings: The framework of analysis identifies three core dimensions that are always present in any OCT: the service model, the functions and the organizational features. Moreover, for every dimension several variables that capture and understand OCTs' nature, role and development level are identified. Originality/value: The results of the study highlight the key elements of the OCT model in Italy and show that the proposed framework can be useful both to analyse existing OCTs and to support health managers and policy makers to create new OCTs or develop those already active. [ABSTRACT FROM AUTHOR]

Background The coronavirus disease 2019 (COVID-19) pandemic impacted cancer services worldwide. We examined the effect of the first three pandemic waves on the number of electronic (e)-referrals to rapid access clinics (RACs) for breast, lung and prostate cancer in Ireland. Methods This study used a retrospective, repeated cross-sectional design. The predicted weekly number of e-referrals by suspected cancer types from March 2020 to May 2021 was calculated using the Holt-Winters seasonal smoothing method, based on the observed numbers from a representative pre-pandemic period (01 January 2019 to 01 March 2020) and compared this with the observed number across the first three pandemic waves (02 March 2020 to 09 May 2021). Percentage differences were calculated between observed and predicted numbers of e-referrals for the three RACs and patterns were examined in each wave. Results Observed e-referrals were lower than predicted for all three RACs in the first wave of the pandemic (15.7% lower for breast, 39.5% lower for lung and 28.1% lower for prostate) with varying levels of recovery in the second and third waves for the three e-referral types. Conclusions The COVID-19 pandemic impacted patterns of e-referrals to RACs in the first three pandemic waves in Ireland. Early identification of changes in engagement with health services, such as a decrease in primary care presentations with a resultant decrease in e-referrals to RACs can allow for a rapid response from cancer control programmes. Continued surveillance of the impact of service disruption on cancer services allows policy makers and strategic leaders in cancer control programmes to respond rapidly to mitigate the impact on cancer outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Conduct six systematic reviews investigating for-profit private sector roles in NCD prevention and management in low- and middle-income countries (LMICs) through our a priori framework's pillars. Methods: Six systematic reviews and thematic syntheses were performed between March- August 2021, Six databases, websites of relevant organizations, and references lists of included studies were comprehensively searched. Studies published in English from 2000 onwards involving the pillar of interest, for-profit private sector, NCD prevention/management, and LMIC context were included. Results were synthesized using an inductive thematic synthesis approach. Results: Ultimately, 25 articles were included in the PPP review, 33 in Governance and Policy, 22 in Healthcare Provision, 15 in Innovation, 14 in Knowledge Educator, and 42 in Investment and Finance. The following themes emerged: PPPs (coordination; financial resources; provision; health promotion; capacity building; innovation; policy); Governance/Policy (lobbying; industry perception; regulation); Healthcare Provision (diagnosis/treatment; infrastructure; availability/accessibility/affordability); Innovation (product innovation; process innovation; marketing innovation; research; innovation dissemination); Knowledge Educator (training; health promotion; industry framework/guideline formation); Investment and Finance (treatment cost; regulation; private insurance; subsidization; direct investment; collaborative financing; innovative financing; research). Conclusion: These findings will be instrumental for LMICs considering private sector engagement. Potential conflicts of interest must be considered when implementing private sector involvement. [ABSTRACT FROM AUTHOR]

Introduction: Health, social care, charitable and justice sectors are increasingly recognising the need for trauma‐informed services that seek to recognise signs of trauma, provide appropriate paths to recovery and ensure that services enable people rather than retraumatise. Foundational to the development of trauma‐informed services is collaboration with people with lived experience of trauma. Co‐production principles may provide a useful framework for this collaboration, due to their emphasis on lived experience, and intent to address power imbalances and promote equity. This article aims to examine trauma‐informed and co‐production principles to consider the extent to which they overlap and explore how to tailor co‐production approaches to support people who have experienced trauma. Methods: Bridging Gaps is a collaboration between women who have experienced complex trauma, a charity that supports them, primary care clinicians and health researchers to improve access to trauma‐informed primary care. Using co‐production principles, we aimed to ensure that women who have experienced trauma were key decision‐makers throughout the project. Through reflective notes (n = 19), observations of meetings (n = 3), interviews with people involved in the project (n = 9) and reflective group discussions on our experiences, we share learning, successes and failures. Data analysis followed a framework approach, using trauma‐informed principles. Results: Co‐production processes can require adaptation when working with people who have experienced trauma. We emphasise the need for close partnership working, flexibility and transparency around power dynamics, paying particular attention to aspects of power that are less readily visible. Sharing experiences can retrigger trauma. People conducting co‐production work need to understand trauma and how this may impact upon an individual's sense of psychological safety. Long‐term funding is vital to enable projects to have enough time for the establishment of trust and delivery of tangible results. Conclusions: Co‐production principles are highly suitable when developing trauma‐informed services. Greater consideration needs to be given as to whether and how people share lived experiences, the need for safe spaces, honesty and humility, difficult dynamics between empowerment and safety and whether and when blurring boundaries may be helpful. Our findings have applicability to policy‐making, funding and service provision to enable co‐production processes to become more trauma‐informed. Public Contribution: Bridging Gaps was started by a group of women who have experienced complex trauma, including addiction, homelessness, mental health problems, sexual exploitation, domestic and sexual violence and poverty, with a general practitioner (GP) who provides healthcare to this population, alongside a support worker from the charity One25, a charity that supports some of the most marginalised women in Bristol to heal and thrive. More GPs and healthcare researchers joined the group and they have been meeting fortnightly for a period of 4 years with the aim of improving access to trauma‐informed primary care. The group uses co‐production principles to work together, and we aim to ensure that women who have experienced trauma are key decision‐makers throughout our work together. This article is a summary of our learning, informed by discussion, observations and interviews with members of the group. [ABSTRACT FROM AUTHOR]

Background: Behvarzs are the backbone of primary healthcare services in the Iranian health system and play a key role in providing efficient, responsive, and equitable services at the first level of service provision. This study aimed to identify the challenges of Behvarzs to provide a perspective for policymakers and managers to help them formulate future programs to enhance the efficiency of the health system. Methods: Following a qualitative design, an inductive content analysis approach was used to analyse the data. The healthcare network of the Alborz province (Iran) was considered as the study context. A total of 27 interviews were conducted with policymakers, development managers, managers of Behavrz training centres, and Behvarz workers in 2020. All interviews were audio-taped and transcribed, followed by data analysis using MAXQDA ver. 10. Results: Five themes were identified: service provision (scope of services, ambiguity of roles, non-compliance with the referral system, the quality of data entry, quality of services), access to equipment (quantity, quality), administrative issues (macro planning, micro planning), training (appropriateness of information, quality of training, recruiting related staff), perceived equity and fairness (balance between workload, income, and benefits, job satisfaction, job promotion). Conclusion: Occupational challenges affect the performance of Behvarzs in responding to society's needs because they not only play a major role in the health system, but also contribute to addressing the communication gap between local communities and high-level institutions, leading to the alignment of policy implementation. Therefore, strategies that emphasise the role of Behvarzs should be followed to promote community engagement. Behvarz workers or community health workers not only play a major role in the health system, but also contribute to filling the gap between communities and high-level institutions by delivering basic healthcare services and for more complicated needs they can refer people to receive appropriate services, leading to more homogeneity in policies. Therefore, strategies are needed to emphasise Behvarz workers' role, with a special focus on engaging local communities. The identified challenges can provide valuable information for health policymakers and the experiences of Behvarz workers can be used to inform international community health workers' programs, which in turn provides better outcomes for treated patients. [ABSTRACT FROM AUTHOR]

Health care transition is an expanding field of health care practice and research focused on facilitating adolescents and emerging adults with long-term conditions to transfer uninterruptedly from pediatric to adult health care services and to transition successfully into adulthood and beyond. There is a widespread need to develop and implement service models as approximately one million adolescents and emerging adults with long-term conditions transfer their care into the adult system and enter adulthood. The purpose of this article is to explore major issues associated with the current state of health care transition practice, research and ultimately policymaking and systems change. The prominent issues addressed in this article include the following. Defining clearly what constitutes models of health care transition practice as ambiguity exists with terminology used with concepts integral to health care transition. The indistinct meanings of health care transition terminology commonly used, such as transition, transfer, readiness, and preparation, need to be operationalized for widespread application. Furthermore, questions remain as to what goal-directed outcomes are expected within this field of practice and science. [ABSTRACT FROM AUTHOR]

Purpose: It can be said that the most important function of the health system is to provide health-care services. This directly affects society's health and justice. To the best of the authors' knowledge, this study is the first study that has meta-analyzed the percentage of health services utilization among Iranians to answer this question "How much is the percentage of health-care services utilization in Iran?" Design/methodology/approach: This study is a systematic review and meta-analysis conducted in 2020. The literature review was done by searching the databases of Google Scholar, Scopus, PubMed, Web of Science, Science Direct, SID, Magiran and Irandoc from January 2010 to August 2020. Pooled utilization percentage (UP) was estimated by STATA 15 through random-effects meta-analysis with 95% confidence interval. The I2 statistic was used to investigate the possibility of heterogeneity of articles (I2 ≥ 50% indicate heterogeneity). A forest plot was applied to report the results. A funnel plot exploited due to publication bias assessment. Findings: Approximately 22% of the reviewed articles have been done at the national level of Iran. Most studies have examined the utilization of outpatient and inpatient services. Based on the random effects method, the pooled value of UP was obtained at 47.82%, (95% CI: 39.33–56.31). Also, the pooled percentage of utilization was statistically significant (Test of UP = 0, Z = 456.44, p = 0.000). Practical implications: Policymakers can improve the level of utilization from health services by expanding universal coverage, expanding insurance coverage and removing direct and indirect barriers. Originality/value: To the best of the authors' knowledge, this is the first systematic review and meta-analysis on health services utilization in Iran that completely considers the utilization rate in all health services and states the practical solutions to cope with utilization deficiencies and barriers. [ABSTRACT FROM AUTHOR]

This article examines the legal and ethical challenges for the provision of healthcare in the metaverse. It proposes that the issues arising in the metaverse are an extension of those found in telehealth and virtual health communities, albeit with greater complexity. It argues that international collaboration between policymakers, lawmakers, and researchers is required to regulate this space and facilitate the safe and effective development of meta-medicine. [ABSTRACT FROM AUTHOR]

For virtual care models to be able to improve the safety and quality of care, it is essential to identify the strengths and weaknesses of virtual care. In this Scoping review, literature published on virtual care was identified using international databases. The results of the included studies were summarized using a predefined taxonomy. In total, 20 studies were included in the present review. Extracting the findings of the articles showed four main topics, including "virtual care delivery models," "Video conference software platforms to provide virtual care," "virtual care delivery challenges," and "virtual care implementation facilitators." Therefore, with the development of emerging digital technologies, unique opportunities to provide virtual care and improve the provision of health services have been created in the health care system worldwide. Multifunctional video conference software platforms using specific models for each scope of care practice should be considered. [ABSTRACT FROM AUTHOR]

To explore gym staff perspectives on the inclusion of people with disability in the gym setting. Semi-structured interviews were conducted with 16 staff at four urban gym facilities, exploring perspectives on disability inclusion. An interpretive descriptive approach was adopted with reflexive thematic analysis of interview data and subsequent mapping of themes to the socioecological model. Consistent with the socioecological model, the themes identified were "people with disability benefit from participation in gym settings" (personal); "positive interactions with people with disability" (interpersonal); "managing expectations of other gym users" (interpersonal); "inclusion is supported by a positive ethos, staff training and accessible facilities" (organisational); "people with disability lack awareness of inclusive exercise opportunities" (community); "desire to increase collaboration with healthcare professionals" (community); "access to transport can facilitate gym attendance" (community) and "local gym policy" (policy). Although an overall ethos of inclusion was apparent, areas identified for enhancement were: awareness of gym services in the community; inter-sectoral collaboration with healthcare and disability organisations; comprehensive disability inclusion training; transport systems and accessibility; engaging people with disability in gym service planning. Gym staff value collaboration with healthcare and rehab professionals to support inclusion of people with disability in exercise. Standardised disability inclusion training for gym staff is recommended. Individuals with disability should be empowered to contribute to the development of inclusive gym facilities and services. Rehab professionals have a role to play in raising awareness and advocating for inclusive exercise opportunities. [ABSTRACT FROM AUTHOR]

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This report assesses the competencies and technology needed for the provision of Telehealth Peer Support by Peer Support Specialists. The online survey assessed access to technology, core competencies required for the delivery of ThPS, and resources needed by the workforce to deliver ThPS. Responses from 313 PSS and 164 managers/supervisors of PSS from New York State were analyzed. Findings indicate nearly one-quarter of the PSS workforce continues to need access to technology and one-third need training in the delivery of ThPS. Perceptions of the important, critical, and most frequently used competencies for the delivery of ThPS were rated similarly by PSS and managers/supervisors. The broad implementation of effective ThPS requires additional resources and training for the PSS workforce. Further research to validate the ThPS competencies identified in the study will enhance training programs and resources. Policy makers and those who have advocated for the continued delivery of ThPS post-stay at home orders should ensure programs delivering ThPS provide access to technology and skills training in the competencies of ThPS. The use of ThPS post COVID-19 may address some persistent service barriers such as rural access and areas with fewer available services. [ABSTRACT FROM AUTHOR]

In recent years 'social enterprises' have become important partners in the delivery of key public services such as healthcare. However, little is known about how healthcare social enterprises contribute to public service provision in the health sector. We analyzed 172 social enterprises from four continents involved in healthcare to assess the types of interventions, processes, and roles they play responding to rapidly evolving healthcare systems. We found that they are engaged broadly in three dimensions of health service provision: improving access to health services; improving the quality of health services; and building public health capacity. We contribute to social policy theory by enhancing understanding of the micro-level interventions of social enterprises in the healthcare sector and articulating new dimensions of NPG that include co-innovation, co-lobbying, and co-integration in the context of healthcare. [ABSTRACT FROM AUTHOR]

The article offers insights on building rural health service research in Australian rural communities in 2022. Topics discussed include the rural town Colac Area Health's successful building of health research capacity, a research project's provision of increased research skill development among staff and networking with local researchers, and the challenge of funding for sustaining research efforts. Also noted is the importance of collaboration with regional health centers and staff.

This article examines the political economy of health inequalities and inequities in the public health care system in India and identifies potential areas for interventions to promote equal and equitable health care for marginalized people. Drawing on the Political Economy of Health Model of Research, this article reiterates the inadequacy of policy frameworks and programs in ensuring accessible, affordable, and quality public health care services to all. We argue that for policies to be successful, policymakers should consider the diverse social registries of class, caste, religion, gender, region, ethnicity, and age, as well as their intersections. We also argue that health care policies and programs need to be: (a) dynamic and flexible, (b) intersectional and backed up by sufficient grassroots research, and (c) equitable at every stage of policy formulation, implementation, and evaluation. [ABSTRACT FROM AUTHOR]