Background Private equity (PE) investment in U.S. nursing homes has increased significantly over the past two decades. The emergence of this novel ownership model has prompted concerns regarding its effects on nursing home performance, especially quality. Objective This systematic review examined the impact of PE ownership on U.S. nursing homes, focusing on quality of care and financial performance. The review was conceptually informed by agency theory and the structure-process-outcome (SPO) framework. Methods Following PRISMA guidelines, a systematic search across five databases identified 12 studies published between 2000 and 2024. Eligible studies examined the effects of PE ownership on nursing home quality or financial performance. Data were extracted and synthesized across these two dimensions. Results Across studies, PE ownership was linked to higher number of deficiencies, increased hospitalization rates, and higher mortality, although some improvements in care processes were noted. Financial outcomes showed initial financial gains but long-term challenges, primarily due to high debt loads. Conclusions Findings suggest that PE strategies may prioritize short-term profitability, which may compromise quality of care in some instances. These findings highlight the need for financial transparency, and reimbursement models that incentivize long-term quality.

The primary focus of this research is the evolving landscape of telemedicine policies and practices across various countries, with particular attention to recent initiatives in South Korea. This study is crucial for understanding the implications of institutionalizing telemedicine, especially following the coronavirus disease 2019 (COVID-19) pandemic. It aims to ensure the delivery of quality medical services through remote healthcare systems. The objectives include analyzing changes in international telemedicine policies post-COVID-19, comparing these changes with South Korea's policies, and identifying best practices for the domestic institutionalization of telemedicine. The research examines telemedicine policies and practices in South Korea, the United States, Canada, the United Kingdom, France, Japan, and Australia. Key variables analyzed are eligibility for telemedicine, types of diseases treated, telemedicine platforms, drug prescriptions, drug delivery, responsibility for telemedicine, and cost. Data were collected from policy documents, legal frameworks, and pilot project outcomes and were analyzed to identify trends, differences, and potential areas for policy development. Telemedicine policies vary significantly among countries, with different approaches to patient eligibility, disease types treated, platforms used, prescription and delivery of drugs, legal responsibilities, and costs. South Korea's telemedicine policy is in its early stage, recently expanding to include all patients with prior face-to-face treatment within six months. The initial hypotheses that telemedicine policies are rapidly evolving and that there is no one-size-fits-all approach were supported. The findings suggest that telemedicine is a complex and multifaceted issue that requires careful consideration of various medical, legal, and technological aspects. South Korea's approach to telemedicine should be customized to its unique healthcare environment, focusing on patient health and alignment with national healthcare priorities. Future research should explore the development of a comprehensive system for telemedicine that addresses patient needs, provider capabilities, and regulatory requirements, with an emphasis on creating a global benchmark for personalized telemedicine.

Objectives: A recent meta-analysis of high-quality randomized trials casts doubt on the effectiveness of triclosan-coated sutures in reducing surgical site infection (SSI). This economic analysis is aimed at assessing whether triclosan-coated sutures, compared with uncoated sutures, can reduce costs from a healthcare perspective. Design: This was a model-based economic analysis mainly informed by baseline SSI rates, effect size CIs from a recent meta-analysis of high-quality trials (OR 0.90, 95% CI 0.74 to 1.09, p=0.29), and country-specific cost data. Setting: This was a worldwide analysis that estimated average cost savings aggregated for high, middle, and low Human Development Index (HDI) countries and country-specific cost savings for the 193 countries on the HDI list. Participants: Participants were patients undergoing abdominal surgery. The analysis was informed by baseline SSI rates from an international cohort study (12 539 patients). Main outcome measures: Results are reported in 2022 US dollars as average cost differences associated with SSI between coated and uncoated sutures. Deterministic sensitivity analyses examined variations in suture cost, hospital stay costs, and effect size, with best and worst-case scenario analyses. Results: SSI-related cost differences per patient ranged from -$466 to $171 in high-HDI, -$23 to $18 in middle-HDI, and -$34 to $22 in low-HDI countries when triclosan-coated sutures were used. The largest potential savings and expenditure occurred in contaminated-dirty wounds. Similar results were observed at the national level in 184 of 193 countries. Best-case to worst-case analyses showed a range of -$533 to $192 in high-HDI, -$57 to $49 in middle-HDI and -$69 to $52 in low-HDI countries. Conclusions: This analysis highlights significant uncertainty regarding cost savings with routine use of triclosan-coated sutures, emphasizing the need for high-quality data and CI-based economic analysis in policy making.

Background: The global push to scale up telemedicine services is challenged by complex, multilevel, multifaceted implementation and a lack of consensus on what the evidence-based essential building blocks of implementation are. Objective: We aimed to evaluate the evidence base supporting telemedicine implementation knowledge tools; identify shared conceptual constructs and outliers; and formulate recommendations to guide the design, development, and optimization of telemedicine services. Methods: We conducted implementation research using a rapid umbrella review, that is, an overview of systematic reviews, in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). In total, we searched 3 databases (PubMed, Web of Science, and Scopus) for studies focusing on telemedicine implementation frameworks, models, and tools, collectively referred to as "knowledge tools." Reviews meeting the operational definition of a systematically undertaken, secondary evidence synthesis, such as systematic and scoping reviews, and those published from January 2018 to May 2024 were considered. A meta-aggregative qualitative analysis was undertaken, comprising inductive thematic synthesis. Results: In total, 18 reviews were selected, encompassing 973 primary studies. Global perspectives were reflected in 61% (n=11) of the reviews, while 33% (n=6) focused on low- and middle-income country contexts. The primary research included in the reviews represented 63 countries, spanning the Americas, Europe, Africa, the Middle East, and Asia and the Pacific. Findings indicated substantial heterogeneity across the identified telemedicine implementation theories, models, and frameworks. However, following evidence synthesis, considerable convergence was observed, highlighting a state-of-the-art understanding of the essential requirements for a national telemedicine implementation ecosystem. These were categorized into "process" and "thematic" dimensions. Process dimensions included readiness and needs assessment, road map and planning, managing change, implementing telemedicine services, and continuous improvement and measuring performance. Thematic dimensions covered human and sociocultural aspects; organization, operations, management, and leadership; communication and coordination; policy, legal, and financial considerations; clinical health condition and quality of care; and the wider context. Conclusions: The findings of this study inform a pressing translational research knowledge gap in telemedicine implementation, hindering the implementation of high-quality, sustainable, and scalable telemedicine systems. The study contributes to building global consensus on the state of the art of key constructs in telemedicine implementation and recommends that future research focus on field-testing the evidence-based implementation tools to evaluate their usability and adaptability across diverse telemedicine contexts.

Objective: This scoping review investigates the potential of 6G technology in healthcare, particularly in smart city settings, focusing on its enhanced data capabilities, AI's role in healthcare optimization, infrastructure support, interoperability, quality standards, and privacy and security concerns. Patients and methods: The scoping review followed the Arksey and O'Malley framework, with Levac et al.'s methodological advancements. The review team searched academic databases like PubMed/Medline, SCOPUS, Embase, Web of Sciences, and IEEE Xplore. They also explored grey literature sources like Google Scholar, OpenGrey, and Web of Science Conference Proceedings. A search strategy was developed, and 145 studies were selected from an initial pool of 9835 records from 2010 to 2025. The review categorized 145 studies into three phases, focusing on deploying 6G technology in healthcare, the infrastructure required, and ethical considerations related to the technology's ethical implications. Result: Phase one focused on advancements like real-time imaging, performing medical procedures remotely, using predictive tools to analyze data, and providing care tailored to individual patients. Phase two examined how the next generation of wireless technology (6G) could interact with communication systems, including techniques to handle large amounts of data (massive MIMO) and using extremely high-frequency signals (terahertz communications) to transfer information faster. Phase three explored ethical concerns about applying 6G technology, such as systems that make decisions based on user intentions (intent-driven management) and organizing information around data-based designs (data-driven architecture). The review highlights how 6G technology could revolutionize patient care and medical services by enabling faster data transfers, reducing delays, increasing system capacity, and incorporating artificial intelligence. Conclusion: The scoping review shows the capability of the transformative potential of 6G technology, particularly in healthcare and urban development, emphasizing its enhanced data transfer speeds, reduced latency, and increased capacity that can significantly improve patient care through better remote monitoring, security, and telemedicine services. It stresses the vital role of policymakers in guiding the development of 6G infrastructure, ensuring effective spectrum allocation, and implementing robust security measures while addressing health and electromagnetic exposure concerns. Policymakers are urged to adopt security-by-design principles, adhere to international standards, and foster collaboration among academia, industry, and government to drive innovation and ensure the responsible deployment of 6G technology. By stimulating research and establishing clear performance metrics, they can facilitate continuous improvement and adaptation, ultimately benefiting society as a whole. The review concludes that strategic policy formulation is essential for maximizing the advantages of 6G technology, leading to more intelligent, productive, and sustainable societal frameworks.

Abstract Over the past two decades, private equity investment in health care has increased substantially. Proponents argue that private equity can optimize and improve health services, while critics warn that the business model of these firms is not aligned with the social values of care delivery and has harmful consequences for health systems and patients. It remains unclear to what extent - and how - subnational, national and supranational governments have attempted to regulate this activity. The purpose of this study therefore was to identify examples of implemented and proposed policy options for regulating private equity activity within health care, with the goal of elucidating the policy options available to regulators. We conducted a narrative review to identify proposed or implemented policy instruments in selected high-income countries, grouping them by type using a conceptual framework based on the works of Milton Friedman and Avedis Donabedian. Our search identified several examples of proposed or implemented policy options for addressing private equity activity in the countries under review. Most of these intervention examples fall into the category of disclosure, while only one focused on regulation of outcomes. Our study suggests that while some countries have started to develop policy interventions to directly address the role of private equity in health care, other countries do not specifically regulate private equity activity.

Abstract Background: Contact time in general practice (GP) refers to the duration a physician spends with a patient during an appointment. There are significant differences in contact times across OECD countries, raising questions about the influencing factors and potential consequences of these variations. Objective: To study the determinants and consequences of the length of consultations in GP care. Method: We descriptively investigate differences in average appointment durations in GP care across OECD countries. We then conduct a scoping review of the literature encompassing 150 studies in seven topical clusters. Results: We identify considerable differences in contact times across countries and find evidence for substitution effects between the length of consultations and the number of consultations per year. There is also an association between reimbursement schemes and visit lengths. The review reveals consistent evidence for a few determinants, such as patient characteristics and physician experience, but mixed evidence on the effects of contact time on shared decision-making and health outcomes. The literature is dominated by correlational studies. Conclusion: Descriptive comparisons show shorter contact times are substituted with more frequent visits, and fee-for-service payment systems result in longer contact times compared to capitation systems. For future health policy discussions, it is crucial to clarify which service delivery form is socially desired and economically sustainable.

Background: Telehealth technologies can enhance patients' and their families' access to high-quality resources in home-based palliative care. Nurses are deeply involved in delivering telehealth in home-based palliative care. However, no previous integrative systematic reviews have synthesized evidence on nurses' roles, facilitators, and barriers to implementing nurse-delivered telehealth in home-based palliative care. Objective: This integrative systematic review aimed to provide a comprehensive understanding of the roles of nurses and the multilevel facilitators and barriers to implementing nurse-delivered telehealth in home-based palliative care, which could inform future policy development, research, and clinical practice. Methods: This integrative systematic review was conducted using Joanna Briggs Institute methodological guidance. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We systematically searched articles published from January 1, 2014, to May 2024 in PubMed, Embase, Web of Science, CINAHL, and Cochrane Library. We included English-language; peer-reviewed; original; and qualitative, quantitative, and mixed methods studies that centered on nurse-delivered telehealth in home-based palliative care. We used the Mixed Methods Appraisal Tool to assess the quality of the included articles. Furthermore, 3 authors independently assessed eligibility, extracted data, and assessed the quality of articles. The entities to extract were identified by research questions of interest regardless of the type of study. We applied a convergent synthesis approach to integrate quantitative and qualitative data. Guided by the updated Consolidated Framework for Implementation Research (CFIR) 2.0, we synthesized the facilitators and barriers to implementing nurse-delivered telehealth in home-based palliative care. Results: This integrative systematic review identified 4819 unique articles, including 34 papers encompassing 29 unique primary research studies. Innovations were mainly delivered by nurses (n=8) and nurse-involved multiprofessional teams (n=18). The roles of nurses in telehealth home-based palliative care involve palliative care nurses, community nurses, nurse coordinators, nurse coaches or nurse navigators, and nurse case managers. Guided by CFIR 2.0, facilitators and barriers to implementing nurse-delivered, telehealth, home-based palliative care were identified to 6 implementation levels and 20 constructs. The key facilitators included the COVID-19 pandemic, cost avoidance to the health care system, engagement of patients and their family caregivers, and so on. The barriers included a lack of reimbursement and payment mechanisms, technical problems, insufficiently trained health care providers, and so on. Conclusions: This integrative systematic review synthesizes evidence on nurses' evolving roles in telehealth home-based palliative care and identifies multilevel facilitators and barriers to nurse-delivered, home-based palliative care implementation. With the empowerment of telehealth technologies, nurses could establish a stronger professional identity and develop leadership in home-based palliative care. Nurses should leverage influence to promote nursing practice, clinical management, and policy support in the implementation of telehealth home-based palliative care. Trial registration: PROSPERO CRD42024541038; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024541038.

Abstract Over the past two decades, private equity (PE) firms-private investors that use large pools of money to buy into and restructure companies-have become increasingly involved in U.S. healthcare ownership and management. PE's goal of acquiring quick financial gains is typically accomplished by assigning debt to the facilities and practices it buys, cutting labor costs, changing services to the most lucrative, upcoding diagnostic codes to raise prices, and merging, shutting down, or selling practices. This study shows that private equity has expanded into nearly every corner of U.S. healthcare, and in some sectors, such as hospitals, nursing homes and physician specialties, quite significantly. The PE business model is theorized to be incompatible with high quality, efficient, accessible healthcare. Empirical research supports this framework to some extent. Few studies find evidence for better healthcare quality/patient outcomes or lower expenditures. A few studies find better access in profitable areas for PE, and three find lower operating costs and/or higher operating margins, which may have negative impacts in other healthcare system outcomes. A few studies show no difference in various healthcare system outcomes. Otherwise, the preponderance of studies indicates worse or mixed (mostly worse) outcomes with PE ownership. PE involvement in healthcare is greater in the U.S. than Europe, but there is potential for it to reach similar levels in Europe. Federal and state policy initiatives to regulate PE in U.S. healthcare are in the incipient stage and would benefit greatly by more research on PE's impacts.

Introduction: The concept of transition refers to the shift from hospital-based care to home-based palliative care, encompassing the physical, emotional, and logistical adjustments patients and families face. This study aimed to synthesize the experiences of people in palliative situations at home. Methods: A systematic review using thematic synthesis was guided using Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) to organize the extracted information. Preparation of the qualitative synthesis followed ENTREQ-Enhancing transparency in reporting the synthesis of qualitative research recommendations. The literature search was carried out in MEDLINE, CINAHL, Psychology and Behavioral Sciences Collection, ProQuest, and Worldcat, until October 31, 2023, for articles addressing the experiences of people over 18 years of age in a palliative situation at home. Data analysis employed thematic synthesis, involving inductive coding, development of themes, and interpretative synthesis to provide a comprehensive understanding of patient experiences. Results: Of the 441 articles identified, 17 studies were included. Data analysis was guided by Meleis 's Theory of Transitions, and six distinct categories were included in the conditions of the transition (facilitators or inhibitors): "Personal Facilitators," "Community Facilitators," "Social Facilitators," "Personal Inhibitors," "Community Inhibitors," and "Social Inhibitors." Conclusions: Findings indicate that the unique nature of the palliative condition and self-perception requires nursing care adapted to the person's experiences. The data collected and the analysis carried out in this thematic synthesis of the literature collectively contributed to identifying the facilitating and inhibiting factors regarding the complex transition process, considering the Theory of Transitions. The findings highlight the importance of personalized care approaches that address patients' emotional, social, and logistical needs during the transition to home-based palliative care. They underscore the need for enhanced communication, caregiver support, and accessible healthcare resources to improve patient and family experiences, guiding future interventions and policy development in palliative care.

Abstract Background: Adults with special needs have dental problems requiring treatment; however, patient management could be extremely difficult under local anesthesia. This review aimed to compare the needs of pharmacological approaches versus non-pharmacological approach for dental treatment to adults with special needs. Methods: This systematic review was registered in PROSPERO (CRD42024528488). The systematic search was conducted in databases: PUBMED; EBSCO; SCOPUS, April 10, 2024. Clinical studies published in English from 2000 to June 2024, demonstrating the needs for pharmacological as compared with non-pharmacological approach in older adults over 18 years old were included. The primary outcome was the completion of dental treatment. Results: Titles and abstracts were screened after the initial search, then forty studies were identified for potential inclusion. After retrieving full-text studies, Information relevant to objectives and outcome measures was recorded by using a data extraction form and analyzed again by three reviewers. Only 2 articles were eligible and included. Conclusions: The best patient management approach could not be conclusive. Pharmacological approach remains necessary in many situations. Preparation of health care setting and multidisciplinary team is important to ensure patient safety. Further studies focusing on older adults with special needs are needed.

Abstract Background: with Europe's demographic diversity growing due to immigration, understanding and addressing the barriers to healthcare experienced by immigrants is of paramount importance. However, an updated systematic review of the literature on this topic is missing. Methods: we systematically searched the PubMed and Scopus databases to synthesise quantitative evidence regarding self-perceived barriers to healthcare access faced by immigrants in Europe. Peer-reviewed articles, written in English, published from 2011 onwards, studying adult populations not in detention centres were eligible for the review. Articles were charted according to the population of study, sample size, geographical area and level of study (local vs national), and applied methodology (descriptive vs inferential). Results: linguistic and health literacy barriers emerge as the most prominent, and most studied, barriers to healthcare for immigrants. The extant literature covers disproportionally Northern European countries; often uses small sample sizes and convenience sampling; and is particularly limited as far as the undocumented population is concerned. Discussion: policies should aim at increasing the availability of interpreters and healthcare materials translated in different languages, as well as at better training health professionals to address specific immigrants' needs. We encourage future research to focus on healthcare barriers faced by immigrants in Southern and Central European contexts; to improve results' robustness and external validity by using high quality sampling techniques and larger sample sizes, and including native populations as comparison groups; and to put more attention to the experience of undocumented immigrants, as they are the immigrant population with the most critical and precarious healthcare status.

India's healthcare system faces substantial challenges, including a high burden of communicable and non-communicable diseases, limited access to healthcare in rural areas, and a shortage of skilled healthcare professionals. Artificial intelligence (AI) offers promising solutions to address these gaps by enhancing diagnostic accuracy, improving disease prediction, and optimizing treatment management. This scoping review examines AI's role in early detection, treatment, and disease prevention in community health settings. A comprehensive literature search was conducted in PubMed, Embase, Scopus, and Google Scholar from January 2013 to July 2024. Eligible studies focused on the application of AI in public health, emphasizing early detection, disease prevention, and treatment interventions. Data on AI models, health outcomes, and performance metrics were extracted and analyzed in line with PRISMA-ScR guidelines. Forty-eight studies were analyzed and categorized into diagnostic accuracy, disease prediction, treatment management, and clinical validation. AI-based tools, such as AIDMAN for malaria detection, demonstrated high diagnostic accuracy (95%) and AUC (0.96). Predictive models for chronic kidney disease (93% accuracy) and diabetes (91% accuracy) showed substantial promise. TB screening using AI-powered cough analysis achieved 86% accuracy. The studies also emphasized AI's role in managing chronic diseases, facilitating early interventions, and reducing healthcare burdens in resource-limited settings. AI has the potential to revolutionize healthcare delivery in India, particularly in underserved regions, by enhancing early detection and treatment. However, challenges related to data privacy, algorithmic bias, and infrastructure require attention. Continued research and policy development are essential to fully harness AI's capabilities in improving public health outcomes.

Introduction: Multimorbidity is associated with adverse clinical outcomes, including increased symptom burden and healthcare utilisation, particularly towards the end of life. Despite this, there is no accepted method to identify the point at which individuals with deteriorating health due to long-term conditions are nearing the end of life or might benefit from a palliative care approach - conceptualised as 'Advanced Multimorbidity'. This scoping review explored how Advanced Multimorbidity is described and operationalised within the literature. Methods: Multiple electronic databases and Grey Literature sources were searched following scoping review frameworks. Two reviewers independently performed screening and data extraction. Content analysis was used to examine the different descriptions of Advanced Multimorbidity. Stakeholder consultations were undertaken with clinicians, academics and public participants. Patient and public involvement was separately integrated throughout this review from conceptualisation, design and reporting. Results: Forty-four different descriptions of Advanced Multimorbidity were identified from 38 publications. These varied in terms of the clinical conditions and descriptors used. Eighteen descriptions relied on a single indicator to identify Advanced Multimorbidity; 24 used a multidimensional approach. Stakeholder consultations highlighted the need for descriptions that are user-friendly and actionable. Conclusion: The lack of a standardised definition of Advanced Multimorbidity risks variance in clinical and research practice, potentially affecting patient care. A consensus on defining Advanced Multimorbidity would enable better identification of patients who could benefit from a palliative care approach, ensuring more consistent and person-centred care, as well as supporting research and policy development.

Background: Sexual and reproductive health (SRH) programmes and services aim to prevent complications of pregnancy and childbirth, unintended pregnancies, unsafe abortions, complications caused by sexually transmitted infections, including HIV, sexual violence and impacts from avoidable cancer. Objective: To systematically identify published economic evaluations of SRH programmes and services, assess the methods used and analyse how costs and outcomes are estimated in these studies. Settings: Low- and middle-income countries. Design: Systematic review and narrative synthesis. Methods: Eight databases were searched, including EMBASE, MEDLINE, Scopus, Health Technology Assessment, Web of Science, PsycINFO, National Health Service Economic Evaluation Database (NHS EED) and African Journals Online (AJOL) from 1998 to December 2023. The inclusion and exclusion criteria were developed using the Population, Intervention, Comparator, Outcome and Study Design framework. The review included economic evaluations alongside randomised trials and economic studies with modelling components. Study characteristics, methods and results of economic evaluations were extracted and tabulated. The quality of the studies was assessed using the Consensus Health Economic Criteria list and Philips checklists for trial-based and model-based studies, respectively. The review followed the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the results were synthesised narratively in line with Centre for Reviews and Dissemination guidance. Results: 7575 studies were screened and categorised. 20 studies were included in the review. The studies assessed the cost-effectiveness and costs of SRH programmes and services from an individual, healthcare or societal perspective. The main SRH programme considered was contraceptive services. The main outcome measures reported were disability-adjusted life years, quality-adjusted life years, couple years of protection and pregnancies averted. Most of the studies did not indicate the costing approach used, and many of the studies evaluated direct medical costs only. Most of the study designs were model-based with significant heterogeneity between the models. The review showed that many studies did not fulfil all of the requirements for a high-quality economic evaluation. 1 out of the 20 studies reviewed considered equity. Conclusions: The review revealed heterogeneity in approaches to evaluating the costs and outcomes of SRH programmes. These methodological limitations may have implications for their use by public health decision-makers to inform optimal decision-making. Prospero registration number: CRD42023435241.

Abstract Our review examines the operational dynamics and effectiveness of integrated healthcare models in Australia, focusing on their relevance for older rural adults with preventable chronic diseases. Using Whittemore and Knafl's (2005) systematic integrative review methods, we conducted a search across five databases, including Medline-EBSCO, PubMed, CINAHL, EMBASE, and SCOPUS. The Sustainable Integrated Chronic Care Models for Multimorbidity (SELFIE) framework, established by Leijten et al. (2018), was used for reflexive thematic synthesis. A two-stage screening process identified 15 integrated healthcare models, with five RCTs evaluating their effects on chronic conditions. The analysis revealed two key themes: aspects of care integration (service delivery, leadership, workforce, technology, and finance) and changes in patient and healthcare outcomes. Care coordination and multidisciplinary team care were common features, bridging gaps between health and social services for older patients. Despite challenges such as irregular funding and underutilisation of technology, several models demonstrated positive patient and healthcare outcomes. Virtual care platforms and remote monitoring systems have shown promise in improving patient engagement and enabling real-time care adjustments, particularly in rural areas with limited healthcare access. Our review highlights the need for integrated healthcare for older rural Australians with preventable chronic conditions, revealing the complexity of service models. Policy shifts towards coordinated services and changes in leadership and healthcare practices are essential to ensure this demographic receives integrated care that meets their needs.

Abstract Objectives: To identify health system contexts and mechanisms influencing general dental practitioners' (GDPs) participation in state funded, contracted primary oral healthcare. Methods: Peer-reviewed articles and other sources were identified via EMBASE, Medline (OVID), Web of Science and Google Scholar databases, grey literature search, citation tracking and expert recommendations. Studies meeting the inclusion criteria were assessed for rigour, relevance and richness, and coded to identify data relating to contexts, mechanisms and outcomes. Inductive and deductive coding was used to generate context-mechanism-outcome configurations (CMOCs) and develop the final programme theory. Results: Database searching identified 1,844 articles of which 29 were included. A further 33 sources were identified through adjunctive searches. Analysis identified key systems contexts influencing GDP participation. These include system emphasis on treatment over prevention, low priority for oral healthcare, funding constraints, and change implementation with minimal clinician consensus. At operational level, contracts can restrict GDP decision-making and ability to deliver high quality and holistic patient care. Key underlying mechanisms were feelings of ceded clinical and entrepreneurial control, stress and demoralisation, mistrust of the system and feeling undervalued. Conclusions: The factors influencing GDP participation in state-funded, contracted dental care over private dental care are complex. The findings presented in this review have the potential to act as a good place to start leveraging health system change including better GDP engagement and increase participation in publicly funded systems.

Background: Women with a history of hypertensive disorders of pregnancy are at an increased risk of cardiovascular disease. Although clinical practice guidelines for management of hypertensive disorders of pregnancy recommend involvement of a general practitioner for ongoing cardiovascular disease preventative care, there are no intervention strategies embedded within primary care aimed at improving risk assessment or management for women after hypertensive disorders of pregnancy. The study aim was to co-design an intervention to improve implementation of cardiovascular disease risk assessment and management following hypertensive disorders of pregnancy for primary care settings in a local health district in New South Wales, Australia. Method: Using the Integrated Knowledge Translation framework, a series of five co-design meetings with the investigative team and end users were conducted online. Meetings were informed by the Behaviour Change Wheel framework for intervention development and incorporated research findings from a systematic review and meta-analysis, surveys and an online discussion. Data from activities and audio recordings following each meeting were analysed thematically using inductive-deductive thematic analysis. Results were summarized after each meeting, and findings used to inform ongoing intervention development. Results: The 18 end users included women with lived experience of hypertensive disorders of pregnancy (n = 8), obstetricians (n = 2), midwives (n = 5) and general practitioners (n = 3). Target priorities were to improve communication between hospital staff and general practitioners following the occurrence of hypertensive disorders of pregnancy and increase the knowledge of general practitioners and women regarding cardiovascular disease prevention after cardiometabolic pregnancy complications. Part 1 of the intervention is set within the hospital setting and delivered via physical resources to address the communication gap between hospital and primary care providers about the occurrence of hypertensive disorders of pregnancy. Part 2 is delivered via an update to an existing general practice education platform and through resources for use within consultations to provide education for women and general practitioners about cardiovascular disease prevention after hypertensive disorders of pregnancy. Conclusion: The Integrated Knowledge Translation and Behaviour Change Wheel frameworks aided in the development of a targeted intervention to improve implementation of cardiovascular risk assessment and management for women after hypertensive disorders of pregnancy, based on gaps identified in current primary care practice.

Background: Surgical procedures present intricate challenges within healthcare delivery, often associated with higher risks of adverse events compared with non-surgical contexts. Patient and family engagement (PFE) throughout the perioperative journey is a possibility to enhance care quality, safety and patient-centredness. However, literature addressing PFE across the entirety of the perioperative journey remains sparse. Objective: The current scoping review aims to comprehensively map the existing interventions with PFE approach focused on improving patient safety across various types of surgical procedures throughout the perioperative journey. In addition, the review aims to understand the level and type of PFE approach adopted in this context. Eligibility criteria: Articles published in indexed peer-reviewed journals from 2003 to 2023, written in English, Portuguese or Spanish, that report on interventions with PFE approach targeting adult surgical patients, their families, caregivers, patient advocates and patient champions. The review includes articles reporting on both inpatient and ambulatory surgical patients. Methods: Following Joanna Briggs Institute guidelines and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews framework, this review systematically searched PubMed, Web of Science, SCOPUS, CINAHL, and PsycINFO for relevant articles. Eligible interventions were categorised using PFE framework regarding the level of engagement and mapped according to the WHO Global Patient Safety Action Plan 2021-2030. Results: Out of 765 records initially identified, 32 met the eligibility criteria for data extraction and analysis, of which 40% originated from the USA, followed by the UK (18%) and Canada (12%). 47% of the interventions targeted 'multiple/all types' of procedures, 19% focused on cardiothoracic surgeries and 9% on gynaecological procedures or organ transplant. The majority of the interventions (88%) focused on PFE at the direct care level, predominantly adopting a consultation-based approach. Furthermore, 81% of eligible interventions emphasised patient information and education, 16% addressed codevelopment of policy and 3% of interventions focused on patient advocacy. Conclusion: The findings show a predominant focus on PFE interventions targeting patient safety at the direct care level, particularly in the provision of patient information and education. However, interventions at organisational and policy-making levels are notably scarce. Further investment is required to promote interventions engaging patients and families at broader organisational and policy-making levels.

Background: In response to the significant increase in the global aging population, countries have increasingly prioritized Age-Friendly Primary Health Care (AFPHC) to address the unique needs of older adults. This study aims to develop a comprehensive model for assessing the progress of PHC systems in achieving the goals of an elderly-centered services. Method: A qualitative study design was utilized to develop the progress assessment model for AFPHC initiatives. This process involved a literature review (academic databases and manual search), semi-structured interviews, an expert panel discussion, and the Delphi technique for achieving consensus on the final model. Participants in the semi-structured interviews were selected based on specific inclusion criteria, which required professionals and stakeholders to have a minimum of two years of experience in care for older adults and active involvement in PHC. Additionally, older adults with a university education who had accessed PHC services in Iran at least three times were included. The expert panel was composed of multidisciplinary professionals who met similar criteria, ensuring a diverse and informed perspective. Findings: According to literature review results, 16 main domains and 28 sub-domains were identified. In the next step, through interviews, 7 main domains and 71 indicators were extracted. After summarizing the results of literature reviews, and interviews, and analyzing the results of the Delphi technique, the initial model with 7 main domains, including policymaking and planning processes related to older adults, principles of respect and interaction with older adults, education for older adults, principles of care and provision of services to older adults, access to PHC facilities, physical environment, specialized facilities and equipment, and human resources, was finalized along with the 60 indicators. Conclusion: The developed model for assessing progress of AFPHC Initiatives offers a comprehensive framework by focusing on key domains and indicators tailored to the needs of older adults. This model serves as a practical tool for assessing the progress of AFPHC, facilitating improvements in the quality and accessibility of PHC services for older adults.