[Show abstract][Hide abstract] ABSTRACT: Objective:
Attempts have been made to reduce childhood obesity through school-based programs. Systematic reviews of studies until 2006 reported a lack of consistency about effectiveness of such programs. Presented is an updated systematic review and meta-analysis.
Design and methods:
Replication of methodology used in previous comprehensive systematic review and meta-analysis of randomized controlled trials of school-based obesity prevention programs covering studies until 2006 to review studies thru January 2012.
Based on 32 studies (n = 52,109), programs were mildly effective in reducing BMI relative to controls not receiving intervention. Studies of children had significant intervention effects, those of teenagers did not, though the difference between the two groups was not statistically significant. Meta-regression showed a significant linear hierarchy of studies with the largest effects for comprehensive programs more than 1 year long that aimed to provide information on nutrition and physical activity, change attitudes, monitor behavior, modify environment, involve parents, increase physical activity and improve diet, particularly among children.
Unlike earlier studies, more recent studies showed convincing evidence that school-based prevention interventions are at least mildly effective in reducing BMI in children, possibly because these newer studies tended to be longer, more comprehensive and included parental support.
[Show abstract][Hide abstract] ABSTRACT: In this article, we present the results of a study that was conducted among 15 family physicians who had incorporated complementary and alternative medicine (CAM) into their clinical work in Israel. We aimed to explore the types of boundaries those physicians encountered, how these boundaries were contoured, and under what circumstances they were crossed. We conducted in-depth interviews with the physicians in 2008, and found that epistemological and cognitive boundaries did not pose a problem for them. However, with regard to the organizational boundary, the participants indicated that it was necessary to use a variety of strategies before they could utilize their CAM skills. Many of the participants indicated that the epistemological differences between the biomedical and CAM paradigms, such as the absence of evidence-based medicine in CAM practices, are not important. The ease with which boundaries were crossed in the complex social context described here is characteristic of postmodern societies. On the whole, the integrative physicians interviewed can be viewed as "postmodern" professionals who reject the impermeability of many long-established boundaries and hierarchies.
No preview · Article · Jul 2012 · Qualitative Health Research
[Show abstract][Hide abstract] ABSTRACT: To evaluate patient and physician characteristics associated with the type of psychotropic medications (anti-anxiety, antidepressant, or both) purchased.
The Clalit Health Care Services is the largest managed care health fund in Israel, a country that employs a universal healthcare system. We randomly sampled 30,000 primary care patients over the age of 22 as of January, 2006.
Overall, 2,217 purchased either antidepressant or antianxiety medications at least once during the year 2006 and had no prior purchases during the last quarter of 2005. The majority (1,518; 68.4%) purchased only anti-anxiety medications and as many as 264 (12%) purchased both anti-anxiety and antidepressant medications. The remaining 435 (19.6%) patients purchased only antidepressant medications. Physician level characteristics explained only a small portion of the variance and, thus, were not included in further analysis. Several patient level characteristics, including age, somatic, and psychiatric diagnosis were associated with the purchase of different types of medications.
Contrary to clinical guidelines, the purchase of anti-anxiety medications is more prevalent than the purchase of antidepressant medications. In a managed care setting, patient characteristics have a greater role in determining purchasing patterns than provider characteristics; potentially, because of the managed care characteristics that actively guide the care provided to patients.
No preview · Article · Jan 2012 · The International Journal of Psychiatry in Medicine
[Show abstract][Hide abstract] ABSTRACT: Caring for the elderly and for people with disabilities constitutes a major challenge for health and social services all over the world. In Israel, the state subsidizes care for poor people with disabilities and provides services for them. At the end of 2009, some 139,400 elders received long-term care (LTC) benefits from the National Insurance Institute and 24,000 were living in LTC institutions (for nursing, frail, and mentally frail patients).
The average cost of a 3-year stay in a nursing home was NIS 486,000 in 2011. LTC is very expensive for both the public purse and for the elderly and their families. In view of the limited sources of public funding, there is growing recognition of the need to combine private and public funding to cover the cost of long-term care. Expansion of private LTC insurance (LTCI), which insures against the need for LTC in the community or in an institution, is one of the alternatives currently being discussed by policymakers.
The current study examines the private LTCI market in Israel and analyzes the factors affecting ownership of LTCI policies. The study is based on financial data about the market, the LTCI policies marketed by the health plans, and the main policies marketed by insurance companies, as well as on data gathered through a population survey of 1,700 residents of Israel aged 22+ conducted by the Myers-JDC-Brookdale Institute in late 2006. A comprehensive review of the literature was conducted for an in-depth examination of various aspects of the market.
Among the key issues examined by the study:
The size of the private LTCI market in Israel and the factors affecting LTCI ownership
Individuals' perception of the probability of requiring long-term care and their assessment of the consequences, including perceptions about funding the care, if they even needed it
The effect of peoples' relationship with their children on ownership of LTCI
Tools to increase the knowledge, awareness and educated use of LTCI by consumers
The findings have been presented to the Minister of Health and the Minister of Senior Citizens' Affairs and to senior officials at both ministries, as well as the Commissioner of Insurance and senior members of the division and to the executive staff of the Geriatric Department at the Ministry of Health. The findings serve to support and improve the reforms in financing LTC and assist the decision-making processes in this area.
The study was funded with the assistance of the National Institute for Health Policy and Health Services Research.
[Show abstract][Hide abstract] ABSTRACT: Aims To identify parent-level and child-level risk factors for childhood obesity, to study health consequences and medical service utilization among the overweight children. Methods The study included families with children aged 4-11 years old, registered with Maccabi Healthcare Services at 2 community clinics in the Greater Jerusalem Area. During 2008, 409 mothers completed questionnaires and interviewers weighed and measured 714 children. There was a 50% response rate. Information on associated morbidity and utilization of Health Services was obtained from Maccabi's computerized database. Results Approximately 30% (122 of 409) of the families had at least one overweight or obese child (BMI>85th percentile / BMI>95th percentile, respectively). Twenty percent of the children sampled were overweight or obese(overweight:11.9%, 85 of 714. obese: 8.3%, 59 of 714). The variables with an independent effect on having at least one overweight child in the family were: father of Asian-African origin; immigration to Israel since 1995; non-academic education; a maternal age less than 40; a mother who had a history of being overweight and who reported lack of control over her eating habits. Variables with an independent effect on children's obesity/overweight were: age below 7 years old; eats a broad variety of foods (not fussy); has an 'inactive' lifestyle; eats the main daily meal at a daycare center or afternoon enrichment center at least once a week. Among the overweight children, mainly in the 7-11 age groups, a higher rate of associated morbidity (particularly asthma, orthopedic problems and dermatological conditions) was documented. The service utilization rates were also higher among overweight children compared to children within the normal weight range. Conclusions Pro-active medical monitoring of overweight or obese children must be encouraged even if they do not present other symptoms. Parents and caregivers should be provided with information regarding the risk factors for obesity, as some of those are modifiable. It is recommended that a follow-up study be conducted with a national representative sample of children to verify the findings.
Full-text · Article · Nov 2011 · Clinical Medicine & Research
[Show abstract][Hide abstract] ABSTRACT: This study evaluated patients' and physicians' characteristics associated with the purchase of benzodiazepines by older primary care patients in Israel. The analytic sample consists of those 6,421 patients age 65 and older. We used multi-level analysis with whether or not benzodiazepines were purchased at least once between June 2005 and 2007 as an outcome. We also evaluated patients' and physicians' characteristics associated with the purchase of benzodiazepines for 6 months or longer. Almost half the sample (41.5%) purchased benzodiazepines at least once during the study period and more than half (54.5%) of those purchasing benzodiazepines had a continued purchase for 6 months or longer. Physicians' characteristics explained only a small portion of the variance associated with purchasing, whereas patients' demographic and clinical characteristics were associated with purchasing. Any intervention to improve the use of benzodiazepines should be directed at both patients and physicians.
No preview · Article · Oct 2011 · Administration and Policy in Mental Health and Mental Health Services Research
[Show abstract][Hide abstract] ABSTRACT: A crucial element in controlling blood pressure is non-pharmaceutical treatment. However, only a few studies specifically address the question of hypertensive patients' compliance with physicians' recommendations for a healthy lifestyle.
To explore factors associated with hypertensive patients' compliance with lifestyle recommendations regarding physical activity, smoking cessation and proper diet.
We performed a secondary data analysis of a representative sample of 1125 hypertensive patients in Israel's two largest health funds. Data were collected in 2002-2003 by telephone interviews using structured questionnaires. The response rate was 77%. Bivariate and multivariate analysis was conducted.
About half of the hypertensive patients reported doing regular exercise and adhering to a special diet; 13% were smokers. About half reported receiving counseling on smoking cessation and diet and a third on physical exercise. A quarter reported receiving explanations regarding self-measurement of blood pressure and signs of deterioration. Multivariate analysis revealed that patients' beliefs about hypertension management, their knowledge on hypertension and its management, and physician counseling on a healthy lifestyle and self-care, have an independent effect on compliance with recommended lifestyle behaviors.
The low counseling rates suggest that there may be a need to improve physicians' counseling skills so that they will be more confident and effective in delivering this service to their patients. A model based on educating both physicians and patients may contribute to improving the care of hypertensive patients.
No preview · Article · Sep 2011 · The Israel Medical Association journal: IMAJ
[Show abstract][Hide abstract] ABSTRACT: Objectives: To evaluate patient and physician characteristics associated with the purchase of antidepressant medication for at least 6 months.
Clalit Health Services is the largest managed care health fund in Israel, a country that uses a universal healthcare system. We randomly sampled 30,000 primary care patients over the age of 22 years. Our analytic sample consisted of those 949 patients who did not purchase antidepressant medication during the last quarter of 2005 and purchased antidepressant medication at least once in 2006. We used multilevel analysis, with whether or not medication was purchased for at least 6 months as an indicator of adherence. Patient and physician characteristics were evaluated as potential predictors.
Only 23% of the sample was classified as adherent. Physician characteristics explained only a small portion of the variance in adherence and, as a result, were not included in multivariate analysis. Patients who did not have a somatic diagnosis, had a depression diagnosis, and were of higher socioeconomic status were more likely to be classified as adherent. Patients who purchased tricyclic antidepressants were less likely to be classified as adherent.
The findings suggest that in a managed care setting, there is high uniformity among physicians. Although physician characteristics explain little of the variability associated with adherence, certain patient characteristics as determined by their physicians (eg, antidepressant drug class, psychiatric diagnosis) do play a role in adherence.
No preview · Article · Sep 2011 · The American journal of managed care
[Show abstract][Hide abstract] ABSTRACT: This study analyzed the role of patient and physician characteristics associated with the purchase of antidepressant or antianxiety medications in Israel, a country that has a universal health care system.
A national sample of 30,000 primary care patients over the age of 22 was randomly drawn from the registry of the largest health care fund in Israel. Data concerning medication purchase between January and December 2006 were extracted. Physician and patient characteristics were merged with Israel's unique identification number. Multilevel analysis was conducted to identify patient- and physician-level predictors of medication purchase.
Overall, 19% (N = 4,762) of the sample purchased antidepressant or antianxiety medications. Individuals with greater general medical and psychiatric comorbidity were more likely to purchase antidepressant or antianxiety medications. Older adults, women, those of higher socioeconomic status, and immigrants (with the exception of Jews born in Asia or Africa) were also more likely to purchase medications. Arabs and Jews born in Asia and Africa were less likely to purchase medications even after all other variables were accounted for. Physician characteristics were minimally associated with the purchase of medications.
The findings demonstrate that despite universal health care access, there were variations by population groups. Educational efforts should target patients as well as physicians.
[Show abstract][Hide abstract] ABSTRACT: In 1998, Israel's national health insurance system introduced a modest co-payment for visits to specialist physicians. This study takes advantage of a natural experiment in which 15% of the population--the poor and disabled--was exempted from these co-payments. It used the micro-level panel data of three large health plans on the physician visits of 50,000 members per plan in 1997-2001. The data indicate that, following introduction of the co-payment, specialist visits increased among non-exempt members, relative to exempt members, of two health plans that together account for two-thirds of the population. This paper illustrates how, unlike the Health Insurance Experiment and other US studies of cost sharing, the structure of the co-payment in Israel may have inadvertently limited the incentive to decrease consumer demand and may have created an incentive for the health plans to increase visit rates, especially among the non-exempt members. Other countries that have implemented co-payment systems with exemptions may benefit from the Israeli experience in designing and evaluating their systems.
No preview · Article · Apr 2011 · International Journal of Health Planning and Management
[Show abstract][Hide abstract] ABSTRACT: To analyze the temporal trends of obesity over time among male adolescents of different ethnic origins.
Population-based national data of subjects presenting at recruitment centers for medical examinations as part of screening for military draft. Subjects were 17-year-old Jewish males (n=1 140 937) born in the years 1950-1986. Data on body mass index (BMI) were measured (without clothing and shoes) by physicians. We calculated the prevalence of obesity (BMI 29.4 or higher) for each year by ethnic origin group. A Multinomial logistic regression model was used to estimate the effects of ethnic origin and other risk factors on the likelihood of obesity.
Over time, obesity rates have risen among all ethnic groups of adolescents. Multinomial regression analysis showed a lower likelihood of obesity among those of Asia-Africa origin as compared with other groups. However, obesity rates have increased more significantly over time among this ethnic group compared with the other groups.
A significant finding of this study is the disparities in temporal trends in the likelihood of obesity over time. Among adolescents of Asia-Africa origin the likelihood of obesity increased more steeply over time compared with other groups of adolescents. Health services in Israel should thus consider Asia-African origin as a distinct risk factor and target interventions to prevent future obesity among these adolescents.
No preview · Article · Oct 2010 · International journal of pediatric obesity: IJPO: an official journal of the International Association for the Study of Obesity
[Show abstract][Hide abstract] ABSTRACT: Purpose – This article aims to analyze existing and preferred labor divisions between physicians and nurses treating patients with hypertension and diabetes in managed care organizations. Design/methodology/approach – A mail survey was conducted in 2002/2003 among a representative sample of 743 physicians employed by Israel's largest managed care health plans (78 percent response rate). A telephone survey among a representative sample of 1,369 hypertensive or diabetic patients (77 percent response rate) was also used. Findings – Findings reveal a conspicuous gap between actual labor division and what physicians perceive to be ideal. Possible reasons for this gap are discussed and strategies for facilitating collaboration, which would improve service quality as well as work life quality for both physicians and nurses. Originality/value – This study provides empirical data on the extent of nurse involvement in managed care organization chronic patient care, as well as comparing them to physicians' preferences regarding nurse involvement.
No preview · Article · Jun 2009 · International Journal of Health Care Quality Assurance
[Show abstract][Hide abstract] ABSTRACT: Obesity increased monotonically from 1.2% to 3.8% of males age 17 (1967-2003). Low socioeconomic status had an independent positive effect on obesity. The likelihood of obesity had risen more steeply over time among the low socioeconomic status group than among other adolescents. Rise in obesity, standard of living, and income inequality (as measured by the Gini index) increased concomitantly.
No preview · Article · Mar 2009 · Journal of Adolescent Health
[Show abstract][Hide abstract] ABSTRACT: The Myers-JDC-Brookdale Institute has since the implementation of the National Health Insurance Law 1995 conducted a biennial survey of the level and performance of health-care services from the perspective of service consumers. These follow-up surveys examine the achievement of the law's main objectives – improving health services and enhancing equity among population groups. The study is monitored by a joint steering committee representing the Ministry of Health, the Ministry of Finance, the health plans, the National Insurance Institute and consumer organizations.
The 2007 survey and findings presented in this report are the seventh in the series. A detailed summary of the national findings was widely distributed in early 2008, and this report presents an in-depth analysis of the findings, comparing health plans as well as different population groups. The main topics discussed are:
Trends over time in satisfaction with health plan services, availability, waiting time, preventive services, health condition and mental distress, and the burden of payments for health
Accessibility of services: forgoing medical care and prescription drugs due to cost, forgoing dental care due to cost, forgoing services due to distance and administrative restrictions by the health plans
Private insurance: supplementary, commercial and long-term care
Time devoted by doctors to patients, their coordination of treatment and their explanation to patients
Managing the medication regime
Evaluating the overall performance of the health system
The importance of the study lies in providing ongoing information to assist health plans managers and policymakers in following up on the performance measures for health services. The study sheds light on positive trends to be reinforced and on areas that require improvement, contributing to the public discussion and the planning of appropriate responses. The findings have been presented to policymakers at the health plans, the Ministry of Health, the Health Council, the National Council for Primary Medicine and the Knesset.
The survey was funded with the assistance of the Government of Israel, Clalit Health Services, Maccabi Healthcare Services, Leumit Health Fund and Meuhedet Health Plan
[Show abstract][Hide abstract] ABSTRACT: At present, Israel's mental health system functions separately from its physical health system in terms of financing, planning, organization and practice setting. The government is responsible for the provision of mental health care, while the country's four, competing, non-profit health plans are responsible for physical health care. A reform effort is underway to transfer legal responsibility for the provision of mental health care from the government to the health plans.
The main objectives of this paper are to summarize the key components of the reform, its objectives, and the concerns that it has raised. The paper also seeks to foster interactions between experts from Israel and other countries about the Israeli reform.
The analysis is based on official government documents, the scholarly literature about the Israeli reform and the relevant international literature about mental health care in other countries, participation in key public meetings related to the reform, discussions with leaders of the reform effort, and discussions with leading mental health experts in other countries.
Two elements of the reform--the application of managed care principles to mental health and the integration of mental and physical care--are shown to be central both to the reform's objectives and to the concerns that have been raised about the reform.
These same two elements are relevant to many countries implementing or considering reforms in their mental health systems.
The architects of the Israeli reform could learn a great deal from the experience with mental health care and related reforms in other countries. At the same time, the Israeli reform could offer important insights and lessons for other countries.
The Government of Israel should work with the international mental health care professional community to create frameworks that would facilitate cross-national learning.
It will be important to monitor the implementation of the reform and evaluate its impact, in order to assess the extent to which the objectives are met and the extent to which the concerns materialize. Cross-national research collaborations could be very helpful.
Full-text · Article · Jan 2009 · The Journal of Mental Health Policy and Economics
[Show abstract][Hide abstract] ABSTRACT: Using a cross-sectional design of 400 primary care patients with diabetes, the authors evaluated demographics, health status, subjective health and mental health, health behaviors, health beliefs, knowledge of diabetes treatment, satisfaction with medical care, and quality of medical care as potential predictors of QoL and QoL in the hypothetical absence of diabetes. Those who reported difficulties meeting basic needs, diabetes-related complications, worse subjective health, and dissatisfaction with medical care were more likely to report worse QoL. Those who reported difficulties meeting basic needs, higher cholesterol level, and worse subjective health also were more likely to report better QoL in the hypothetical absence of diabetes. In addition, diabetes management played a major role in one's QoL in the hypothetical absence of diabetes: Engaging in stricter diabetes self-care and taking pharmaceutical treatment for managing diabetes were associated with better QoL in the hypothetical absence of diabetes. Providing psychosocial support geared toward diabetes self-management may improve patients' QoL. When doing so, social workers need to be aware of the potential trade-off between following medical recommendations that advocate for a strict lifestyle and patients' QoL.
No preview · Article · Sep 2008 · Health & social work
[Show abstract][Hide abstract] ABSTRACT: The purpose of this paper is to identify the factors that contribute to the success or failure of quality assurance programs implemented by Israeli managed care health plans.
An in-depth study of seven quality assurance programs was conducted, comparing successful with unsuccessful ones using the comparative "case study" method. Employing a semi-structured questionnaire, 42 program directors and professionals in the field were interviewed.
A number of factors associated with the programs' success emerged. Those external to the program included: ongoing management support, resource allocation, information system support and perceived financial benefit for the organization. Internal factors included: leadership, perceived problem's importance, laying the groundwork in the field, involving field staff in planning and implementation and staff motivation.
The study provides insights into ways to encourage the implementation of successful quality assurance programs in the special organizational context of managed care health plans. As the implementation relies heavily on data, one important precondition is the development of computerized information systems to facilitate ongoing data collection. It is also necessary from the planning stage to take into account organizational factors that affect success.
No preview · Article · Feb 2008 · International Journal of Health Care Quality Assurance
[Show abstract][Hide abstract] ABSTRACT: In this article, we examined the effect of gender concordance on physicians' perception of their patients and of their medical condition, analyzing a data set of 8,258 visit questionnaires from the New Zealand National Primary Care Medical Care Survey conducted in 2001 2002. Multivariate analysis indicated that the concordant female patient/female physician dyad had a positive independent association with physicians' reporting high rapport and a negative independent association with reporting uncertainty about the diagnosis. The discordant female patient/male physician dyad had a positive independent association with physicians' perceptions of uncertainty of diagnosis and hidden agenda, and a negative independent association with rating the patient's condition of high severity. The findings suggest a need to raise male physicians' awareness to possible biases when treating female patients. The findings also suggest the need to empower female patients to take an active partnership role to improve their communication with male physicians.
[Show abstract][Hide abstract] ABSTRACT: This paper aims to analyze the development of "pay-for-performance" (P4P) programs implemented by Israel's two largest sick funds, insuring 78 percent of the population.
Analysis of the main features and their evolution over time, the observed outcomes and concerns related to implementing these programs.
Our analysis revealed that although implementation has been successful, both managers and physicians have voiced concerns regarding the effect of measuring clinical performance such as focusing attention on the measured areas while neglecting other areas, and motivating a statistical approach to patient care instead of providing patient-centered care.
The Israeli case provides an interesting example of nation-wide, long-term implementation of the pay-for-performance program. Therefore, it provides other countries with the opportunity to assess features that may facilitate successful implementation, as well as highlighting issues related to the outcomes of P4P programs.
No preview · Article · Feb 2008 · Journal of Health Organisation and Management
[Show abstract][Hide abstract] ABSTRACT: Despite continuous efforts, healthcare organizations still find it difficult to influence physicians to follow clinical guidelines. Previous studies have not taken into account the organizational context of the physicians' practice. We conducted a survey of a representative sample of 743 primary care physicians employed in Israel's 2 largest managed care health plans. The findings indicated that "commitment to the health plan" and "perceived monitoring by the health plan" had an independent positive effect on familiarity with guidelines for treating diabetes. We propose that managers of healthcare organizations consider enhancing physicians' commitment to the organization as a means for increasing their adherence with clinical guidelines, thereby improving the quality of care provided to diabetic patients.
No preview · Article · Jul 2007 · The Journal of ambulatory care management