Peter C. Coyte

Background: Telemedicine has expanded rapidly in recent years, with particularly pronounced growth following the COVID-19 pandemic. By improving access to care and offering greater flexibility in service delivery, it has become an important component of health care. Although the benefits of telemedicine for patients are well documented, its effects on physician job satisfaction remain insufficiently understood. Given the importance of job satisfaction for workforce stability, physician well-being, and quality of care, further examination of how telemedicine affects physician job satisfaction is warranted. Objective: This study aims to examine the association between telemedicine adoption and physician job satisfaction and to assess whether the physician-patient relationship mediates this association. Methods: A cross-sectional survey was conducted among health care professionals in Xi’an, China. Data were collected between November 7 and December 8, 2023, via an online questionnaire administered using the REDCap (Research Electronic Data Capture; Vanderbilt University) platform. A total of 12,052 physicians were included in the analysis. Physician job satisfaction was measured using a validated 6-point Likert scale. Telemedicine adoption was assessed through self-report. A partial proportional odds model was used to examine the association between telemedicine adoption and job satisfaction, adjusting for a comprehensive set of potential confounders. Additionally, the Karlson-Holm-Breen (KHB) decomposition method was used to explore the mediating role of physician-patient relationship quality in this association. Results: Among 12,052 surveyed physicians, 1642 (13.62%) reported adopting telemedicine, whereas 10,410 (86.38%) did not. After adjusting for demographic characteristics, work-related factors, psychological factors, and physician-patient relationship, telemedicine adoption was significantly associated with higher job satisfaction (odds ratio [OR] 1.17, 95% CI 1.05‐1.30). Findings were robust across multiple sensitivity analyses. Subgroup analyses indicated that the association did not vary across physician subgroups, and no significant interaction effects were observed. Mediation analysis revealed a total effect of telemedicine on job satisfaction of 0.33 (95% CI 0.17‐0.50), with an indirect effect of 0.10 (95% CI 0.07‐0.13) through improved physician-patient relationships, accounting for 30.30% of the total effect. Conclusions: These findings suggest that telemedicine adoption is positively associated with physician job satisfaction, partially mediated by the physician-patient relationship. Policies should promote telemedicine adoption while prioritizing platform designs that support effective physician-patient interactions to enhance provider well-being and care outcomes.

The literature has demonstrated that the Diagnostic Related Group (DRG) payment model has been effective in controlling healthcare expenditures. However, t

Management of non-communicable diseases (NCDs), including hypertension (HT) and diabetes mellitus (DM), was significantly impacted by the COVID-19 pandemic. Many institutions adopted alternative care pathways, e.g. pharmacy at home (PAH), and the deferred care (DC). While PAH has been studied for clinical outcomes, evaluation of the DC remains limited. Consequently, this study evaluates both the clinical and economic outcomes of the PAH and DC as alternatives to usual care. A retrospective study was conducted at a tertiary care hospital in Thailand from 1 July 2021, to 30 June 2023. Data from outpatients with HT and DM were classified into PAH, DC, or discharged home with follow-up at the hospital. Clinical outcomes included changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting blood sugar (FBS), calculated from baseline to follow-up. Economic outcome was the cost of illness (COI) per patient visit. Multivariate multilevel mixed-effects linear regression assessed clinical outcomes, while log-linear regression evaluated economic outcome. There were 3,518 patients in the pandemic period and 4,135 patients in the post pandemic period. There was no statistically significant impact of PAH and DC on changes in SBP, DBP, and FBS. However, both care pathways significantly reduced COI during both periods (p < 0.001). During the pandemic period, COI reductions were 32.3% in PAH and 93.5% in DC compared to usual care. Similar trends were observed in the post pandemic period, with COI reductions of 40.0% for PAH and 96.1% for DC. PAH and DC pathways did not worsen the clinical outcomes and reduced costs during and following the pandemic. As a result, these two pathways, developed during the COVID-19 pandemic, can be adapted for regular use. When these pathways are integrated into regular use, they can be promptly and fully reactivated in future emergencies.

Background: Acupuncture has been used for pain relief for thousands of years in China, and could be an alternative to drug prophylaxis for migraine prevention. Recently, promising clinical data on acupuncture for migraine prevention has emerged. However, few studies have investigated the economic impact of acupuncture on migraine prevention in Taiwan. Methods: This study aims to assess the lifetime economic impact of acupuncture in migraine prevention from both a Taiwanese healthcare payer and a societal perspective. An economic cost–benefit evaluation was constructed to compare acupuncture with drug prophylaxis and with no active treatment among patients with episodic migraine and chronic migraine over their lifetime in Taiwan. Epidemiological and clinical inputs were collected from the published literature. Healthcare costs and utilization were based on a retrospective longitudinal analysis of the National Health Insurance Research Database. Productivity loss was derived from a labor economic study. Health gains were valued at 3× average national income. All costs were adjusted to 2023 New Taiwan dollars using the consumer price index in Taiwan and reported as the present value with a discount rate of 3%. Results: From both health system and societal perspectives, acupuncture treatment was associated with significantly more lifetime net economic gains than no active treatment ($1,248,464 and $1,321,994, respectively). Similarly, there was a net lifetime economic gain when acupuncture was compared to drug prophylaxis: $909,571 (health system) and $963,510 (societal), respectively. The economic gain of acupuncture was driven by cost savings from reducing productivity loss and increased value from quality-adjusted life-year gain from fewer migraine days. Lifetime economic gain was greatest among young, female, and chronic migraine patients. Conclusion: Acupuncture was associated with greater lifetime net economic gains in migraine prevention compared to no active treatment or drug prophylaxis. Decision-makers in Taiwan should consider increasing reimbursements for acupuncture sessions to encourage its utilization.

Background: The demand for long-term care is increasing as the elderly population continues to grow, prompting a critical examination of care modalities. Methods: This study employs data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) to assess the relationship between informal and formal care for older people with disabilities in Beijing. The analysis employs the Probit model and incorporates the application of instrumental variable techniques and propensity score matching to ensure robustness in the results. Results: The findings highlight the important role of informal care. Conclusions: Policymakers should incorporate support policies for informal care into the overall design of the system, provide support to informal caregivers, and reduce their burden. Our research conclusions provide empirical reference for cities with similar characteristics to Beijing.

Cultural beliefs play an important crucial role in shaping individuals’ decision-making and behavior. This study uses data from the 2011 and 2013 waves of the China Household Financial Survey to investigate the impact of a specific Chinese spiritual belief, known as the “zodiac year”, on individual risk aversion behavior. The findings reveal a significant correlation between the zodiac year and individuals’ risk attitudes, indicating that people tend to adopt more risk-averse behaviors during their zodiac year. Additionally, we explore the influence of Eastern religions and education on the relationship between the zodiac year and individuals’ risk aversion behavior. The results indicate that Eastern religions amplify the impact of the zodiac year, whereas educational attainment has the potential to mitigate the influence of this superstitious belief. This study contributes to the growing body of literature examining the influence of spiritual beliefs on individual economic behavior, providing empirical support for the hypothesis that spiritual beliefs can shape individuals’ risk aversion behavior.

Introduction: The global demographic shift towards an aging population has created an urgent need for high-quality elderly care services. This study focuses on “elder services” within the framework of sustainable development, addressing seniors with intensive care needs and independent seniors. Methods—Social Governance: To understand the social governance aspects, we employ a qualitative methodology, analyzing policy documents, novel care methods, and successful case studies. Sustainable Development: Simultaneously, our study investigates sustainable development, examining the methods used to promote sustainability in geriatric care. Research Question: Our research question centers on identifying strategies that foster inclusivity and sustainability in elder services, considering diverse needs, housing, community involvement, and the role of technology. Results: We identified innovative models aimed at improving the well-being of older individuals, including community-driven initiatives, technology-assisted solutions, holistic wellness programs, intergenerational interaction programs, and the integration of traditional and modern care methods. We explored stakeholder perspectives, providing insights into the complexities of implementing effective elderly care solutions. Our study evaluated the efficiency of diversified social governance models in geriatric care, highlighting their benefits compared to traditional models. We presented specific concerns and suggestions from stakeholders regarding sustainable development in geriatric care. Discussion: Our findings underscored the importance of collaboration among various stakeholders to enhance elderly care. Our study summarizes key insights from current policies and anticipated future trajectories in geriatric care, providing a foundation for developing sustainable elderly care facilities.

Background: Pediatric cancer patients in China often present at an advanced stage of disease resulting in lower survival and poorer health outcomes. One factor hypothesized to contribute to delays in pediatric cancer has been the online health information–seeking (OHIS) behaviors by caregivers. Objective: This study aims to examine the association between OHIS behaviors by caregivers and delays for Chinese pediatric cancer patients using a mixed methods approach. Methods: This study used a mixed methods approach, specifically a sequential explanatory design. OHIS behavior by the caregiver was defined as the way caregivers access information relevant to their children’s health via the Internet. Delays in pediatric cancer were defined as any one of the following 3 types of delay: patient delay, diagnosis delay, or treatment delay. The quantitative analysis methods included descriptive analyses, Student t tests, Pearson chi-square test, and binary logistic regression analysis, all performed using Stata. The qualitative analysis methods included conceptual content analysis and the Colaizzi method. Results: A total of 303 pediatric cancer patient-caregiver dyads was included in the quantitative survey, and 29 caregivers completed the qualitative interview. Quantitative analysis results revealed that nearly one-half (151/303, 49.8%) of patients experienced delays in pediatric cancer, and the primary type of delay was diagnosis delay (113/303, 37.3%), followed by patient delay (50/303, 16.5%) and treatment delay (24/303, 7.9%). In this study, 232 of the 303 (76.6%) caregiver participants demonstrated OHIS behaviors. When those engaged in OHIS behaviors were compared with their counterparts, the likelihood of patient delay more than doubled (odds ratio=2.21; 95% CI 1.03-4.75). Qualitative analysis results showed that caregivers’ OHIS behaviors impacted the cancer care pathway by influencing caregivers’ symptom appraisal before the first medical contact and caregivers’ acceptance of health care providers’ diagnostic and treatment decisions. Conclusions: Our findings suggest that OHIS among Chinese pediatric caregivers may be a risk factor for increasing the likelihood of patient delay. Our government and society should make a concerted effort to regulate online health information and improve its quality. Specialized freemium consultations provided by health care providers via online health informatic platforms are needed to shorten the time for caregivers’ cancer symptom appraisal before the first medical contact.