Francesco Paolucci’s research while affiliated with Newcastle University and other places

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Publications (75)


Are we Ready for the Next Pandemic? Public Preferences and Trade-offs Between Vaccine Characteristics and Societal Restrictions Across 21 countries
  • Article
  • Full-text available

February 2025

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43 Reads

Social Science & Medicine

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Katie Attwell

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[...]

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Francesco Paolucci
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Measuring factors associated with telehealth use by people who use mental health services: A psychometric analysis of a theoretical domains framework questionnaire

December 2024

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9 Reads

Journal of Telemedicine and Telecare

Introduction Telehealth has the potential to improve access to mental health care, especially for people living in rural and remote regions. Yet, telehealth accessibility remains a challenge in Australia, and there is a scarcity of appropriate, psychometrically sound tools for evaluating telehealth use by mental health service users. The aim of this study was to adapt and validate a scale for measuring factors associated with mental healthcare telehealth use. Methods A 39-item scale was adapted from the Theoretical Domains Framework questionnaire (TDFQ); a 14-domain framework for measuring implementation of evidence-based practice in health research and service delivery. Since use of the TDFQ in the service user and telehealth space is novel, we adapted and piloted the TDFQ using a rigorous and iterative consultation process and analysis. The study sample included 208 people who use mental health services (52% male). Preliminary analysis identified 32-items for inclusion in the exploratory factor analysis. Internal reliability and construct validity were also analysed. Results The resulting 21-item telehealth adaption of the TDFQ includes four factors, each with good internal reliability: satisfaction and habit (6 items), knowledge and training (5 items), benefit and value (6 items), and emotionality (4 items). Both the total scale and individual factors were positively associated with telehealth use. Discussion The telehealth adaption of the TDFQ is a psychometrically sound tool for assessing factors associated with the use of telehealth by people who use mental health services.


Willingness to participate in placebo-controlled surgical trials of the knee: a discrete choice experiment of patients and surgeons

December 2024

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20 Reads

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1 Citation

Bone and Joint Journal

Aims Surgeon and patient reluctance to participate are potential significant barriers to conducting placebo-controlled trials of orthopaedic surgery. Understanding the preferences of orthopaedic surgeons and patients regarding the design of randomized placebo-controlled trials (RCT-Ps) of knee procedures can help to identify what RCT-P features will lead to the greatest participation. This information could inform future trial designs and feasibility assessments. Methods This study used two discrete choice experiments (DCEs) to determine which features of RCT-Ps of knee procedures influence surgeon and patient participation. A mixed-methods approach informed the DCE development. The DCEs were analyzed with a baseline category multinomial logit model. Results The proportion of respondents (surgeons n = 103; patients n = 140) who would not participate in any of the DCE choice sets (surgeons = 31%; patients = 40%), and the proportion who would participate in all (surgeons = 18%; patients = 30%), indicated strong views regarding the conduct of RCT-Ps. There were three main findings: for both surgeons and patients, studies which involved an arthroscopic procedure were more likely to result in participation than those with a total knee arthroplasty; as the age (for patients) and years of experience (for surgeons) increased, the overall likelihood of participation decreased; and, for surgeons, offering authorship and input into the RCT-P design was preferred for less experienced surgeons, while only completing the procedure was preferred by more experienced surgeons. Conclusion Patients and surgeons have strong views regarding participation in RCT-Ps. However, understanding their preferences can inform future trial designs and feasibility assessments with regard to recruitment rates. Cite this article: Bone Joint J 2024;106-B(12):1408–1415.


PRISMA flowchart of the review process
A stacked column chart showing the number of studies that included each of the 41 unique attributes
Virtual Service Delivery in Mental Health and Substance Use Care: A Systematic Review of Preference Elicitation Studies

September 2024

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28 Reads

Community Mental Health Journal

Mental health and substance use disorders affect the lives of many people worldwide. Prevention and treatment of these conditions is important for optimal health and wellbeing, yet service access barriers are common. Virtual models of care may help to reduce barriers to receiving care. However, to facilitate uptake and use of virtual services, they need to appeal to patients and clinicians. This systematic review aimed to synthesise preference elicitation studies to determine what features of virtual mental health and substance use care are preferred by service users and service providers. Following the PRISMA guidelines for systematic reviews, we searched PubMed, PsycINFO, EconLit, MEDLINE, CINAHL, Academic Search Ultimate, and ProQuest Central for all available studies from database inception until May 2023. The Mixed Methods Appraisal Tool was used to assess the methodological quality of included studies. Nineteen studies met the eligibility criteria. However, none examined preferences for elements of different models of virtual care. Across the included studies, we identified 41 unique features that mapped to four themes of mental health and substance use care (‘service’, ‘treatment’, ‘clinician’ and ‘additional supports’). Participant preferences were for individual, in-person, effective, flexible, and low-cost treatment. These preferences varied based on demographic factors, such as culture, gender, and participant type (e.g., patients, clinicians, general population). A user-centred approach should be adopted when designing and implementing mental health and substance use services. While preferences for features of mental health and substance use services more broadly are known, preferences for different models of virtual care remain unexplored. Future research should examine what features of virtual services would lead to optimal uptake and use across different users and stakeholders.


Implementing clinical guidelines for gestational weight gain care: a novel application of Best-Worst Scaling to prioritise barriers

August 2024

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23 Reads

Background: Antenatal clinical guidelines recommending the provision of care for gestational weight gain (GWG) are not routinely delivered by antenatal care providers (ACPs). Determining barriers to such care delivery can inform the development of targeted strategies to improve implementation. However, no previous studies have identified which barriers are most important. Methods: A best-worst scaling (BWS) survey was developed to estimate the magnitude and rank the importance of barriers to the delivery of recommended GWG care. The survey was conducted between December 2020 and November 2021 with ACPs (medical, midwifery, and Aboriginal health workers) who provided care in public maternity services within three sites in New South Wales, Australia. ACPs were asked to select which of four barriers were most and least likely to inhibit five recommended GWG care practices (assessment of GWG; advice on GWG, diet and physical activity; and referral to specialist GWG services). Rankings of barriers were determined through choice frequency analysis for ACPs at each site. Results: A total of 143 ACPs completed the survey (64.4% response rate). For each of the five recommended GWG care practices, the most important barrier across all health sites and for both midwives and medical ACPs was ‘compared to other aspects of my job, the guideline care is not a high priority.’ There was some variation in the importance of barriers between sites. Across all sites, medical staff were more likely than midwives to report ‘I forget’ as a barrier to weighing and providing weight tracking and dietary advice and ‘I don’t feel confident (providing this GWG practice)’ as a barrier to providing referrals to a specialist GWG service. Conclusions: Best-worst scaling was a valuable method to rank the influence of barriers and to prioritise site-specific and profession-based barriers to ACP provision of guideline-recommended care for GWG. Not all barriers were equally important, and this ‘hierarchy’ differed across ACPs and sites. Implementation strategies should be developed to address the highest priority barriers, tailored to site and professional needs. Trial Registration: Australian and New Zealand Clinical Trials Registry, ACTRN12621000054819 (22/01/2021). http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380680&isReview=true


Intervention flowchart.
Intervention algorithm for depression stepwise care, based on the Patient Health Questionnaire (9-item).
Intervention algorithm for physical wellbeing stepwise care, based on the Kansas city Cardiomyopathy Questionnaire.
Investigating the effect of an online enhanced care program on the emotional and physical wellbeing of patients discharged from hospital with acute decompensated heart failure: Study protocol for a randomised controlled trial: Enhanced care program for heart failure

May 2024

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37 Reads

Objective Depression is highly prevalent and associated with increased hospitalisations and mortality among patients with heart failure (HF). This study will evaluate the effectiveness and cost-effectiveness of an online wellbeing program for patients discharged from hospital with acute decompensated heart failure (ADHF) in (i) improving emotional and physical wellbeing, and (ii) decreasing healthcare utilisation. Methods Two-arm randomised controlled trial. Eligible patients with ADHF will be recruited pre-discharge from two hospitals. Five hundred and seventy participants will be randomised to receive the intervention (online enhanced care program for HF: ‘Enhanced HF Care’) or usual care. Enhanced HF Care includes health education (11 micro-learning modules) and monitoring of depression and clinical outcomes via fortnightly/monthly surveys for 6 months, with participants offered tailored advice via video email and SMS. Cardiac nurses track real-time patient data from a dashboard and receive automated email alerts when patients report medium- or high-risk levels of depression or clinical symptoms, to action where needed. General practitioners also receive automated alerts if patients report medium- or high-risk survey responses and are encouraged to schedule a patient consultation. Results Sixty-five participants enrolled to-date. Co-primary outcomes (‘Minnesota Living with Heart Failure Questionnaire’ Emotional and Physical subscales) and healthcare utilisation (secondary outcome) at 1- and 6-month post-recruitment will be compared between treatment arms using linear mixed effects regression models. Conclusions This study has the potential to reduce the burden of depression for patients with HF by prioritising urgent mental health needs and clinical symptoms while simultaneously empowering patients with self-care knowledge. Trial registration The trial was prospectively registered via the Australian New Zealand Clinical Trials Registry: ACTRN12622001289707. Issue date: 4 October 2022.


Implementing clinical guidelines for gestational weight gain care: a novel application of Best-Worst Scaling to determine priority barriers

May 2024

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27 Reads

Background: Antenatal clinical guidelines recommending the provision of care for gestational weight gain (GWG) are not routinely delivered by antenatal care providers (ACPs). Determining barriers to such care delivery can inform the development of targeted strategies to improve implementation. However, no previous studies have identified which barriers are most important. Methods: A best-worst scaling (BWS) survey was developed to estimate the magnitude and rank the importance of identified barriers regarding the delivery of recommended GWG care. The survey was conducted between December 2020 and November 2021 with ACPs (medical, midwifery, and Aboriginal health workers) who provided care in public maternity services within three sites in New South Wales, Australia. ACPs were asked to select which of four barriers were most and least likely to inhibit five recommended GWG care practices (assessment of GWG; advice on GWG, diet and physical activity; and referral to specialist GWG services). Rankings of barriers were determined through choice frequency analysis for ACPs at each site. Results: A total of 134 ACPs completed the survey (62.4% response rate). For each of the five recommended GWG care practices, the most important barrier across all health sites and for both midwives and medical ACPs was ‘compared to other aspects of my job, the guideline care is not a high priority.’ There was some variation in the importance of barriers between sites. Across all sites, medical staff were more likely than midwives to report ‘I forget’ as a barrier to weighing and providing weight tracking and dietary advice and ‘I don’t feel confident (providing this GWG practice)’ as a barrier to providing referrals to a specialist GWG service. Conclusions: Best-worst scaling was a valuable method to rank the influence of barriers and to identify site-specific and profession-based priority barriers to ACP provision of guideline-recommended care for GWG. Not all barriers were equally important, and this ‘hierarchy’ differed across ACPs and sites. Implementation strategies should be developed to address the highest priority barriers, tailored to site and professional needs. Trial Registration: Australian and New Zealand Clinical Trials Registry, ACTRN12621000054819 (22/01/2021). http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380680&isReview=true



The roads to managed competition for mixed public-private health systems: a conceptual framework

April 2024

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31 Reads

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3 Citations

Health Economics Policy and Law

Health systems’ insurance/funding can be organised in several ways. Some countries have adopted systems with a mixture of public–private involvement (e.g. Australia, Chile, Ireland, South Africa, New Zealand) which creates two-tier health systems, allowing consumers (groups) to have preferential access to the basic standard of care (e.g. skipping waiting times). The degree to which efficiency and equity are achieved in these types of systems is questioned. In this paper, we consider integration of the two tiers by means of a managed competition model, which underpins Social Health Insurance (SHI) systems. We elaborate a two-part conceptual framework, where, first, we review and update the existing pre-requisites for the model of managed competition to fit a broader definition of health systems, and second, we typologise possible roadmaps to achieve that model in terms of the insurance function, and focus on the consequences on providers and governance/stewardship.


Citations (53)


... The aim of this case study is to assess the extent to which the Australian health system satisfies the preconditions for affordability and efficiency derived from the theoretical framework of managed competition for mixed public-private health systems (Henriquez et al., 2024). The study primarily focuses on the technical aspects, while considering the country's specific contextual factors. ...

Reference:

Preconditions for efficiency and affordability in mixed health systems: are they fulfilled in the Australian public-private mix?
The roads to managed competition for mixed public-private health systems: a conceptual framework

Health Economics Policy and Law

... Overall, our findings suggest the existence of a vulnerable part of the population, mainly composed of women, who appear to have paid the highest psychological and social debt following COVID-19 and who, therefore, should be monitored over time and offered specialistic interventions, even after many months after the COVID-19 infection [92]. From a preventive perspective of planning health services and carefully allocating resources, with a view to possible future new health emergencies, part of the health budget should be therefore intended to manage the long-term consequences of the pandemic in this part of the population, with ad hoc trained personnel and focused interventions [93,94] (https:// nexts train. org/ sars-cov-2/). ...

The dynamics of international health system reforms: Evidence of a new wave in response to the 2008 economic crisis and the COVID-19 pandemic?

Health Policy

... Next to country-specific aspects, all six reported common barriers including lack of knowledge, awareness, or acceptance, concerns about data protection and privacy, and hindering reimbursement structure. Similarly, previous (systematic) reviews identified common aspects reported by practitioners concerning E-mental health interventions such as more training and information to reduce concerns [8,11,27], financial reimbursement [8,11,28], blended approaches with face-to-face contact/therapeutic relationship [11,27,28], additional resources (i.e. new methods, facilities, staff, time) [11,28], and data security/privacy issues [27,28]. ...

Barriers and facilitators to the implementation of digital technologies in mental health systems: a qualitative systematic review to inform a policy framework

BMC Health Services Research

... Reduction of prevention and the efficiency and selection instruments for insurers) and design features of risk equalization and risk sharing. For example, the negative effects of risk selection (and thus the positive effects of risk equalization and risk sharing) might be more extensive as the scope for risk selection (in terms of possible selection actions by consumers and/or insurers) is larger [24]. ...

Scope and Incentives for Risk Selection in Health Insurance Markets With Regulated Competition: A Conceptual Framework and International Comparison
  • Citing Article
  • January 2024

Medical Care Research and Review

... This is compared to the universal healthcare system in Australia (Medicare), and that approximately half of the population is enrolled in private health insurance, with generally lower out-of-pocket expenses for healthcare users. 94 However, the Australian context allows for all women aged 50-74 to access free screening, our findings show that issues of inequitable access remain, with working-class women less likely than women in other social classes to access screening. Indeed, the final difference to note in the two studies is our consideration of social class through a Bourdieusian lens compared with Friedman's 35 analysis focused on indicators of high or low socioeconomic status (income and education level). ...

Preconditions for efficiency and affordability in mixed health systems: are they fulfilled in the Australian public-private mix?

Health Economics Policy and Law

... Furthermore, when a country's vaccination coverage falls below its herd immunity threshold, non-pharmaceutical interventions (NPIs) like lockdowns, travel restrictions, maintaining social distancing, and mask use must be adopted as part of the COVID-19 mitigation plan. Gebremariam et al. (2024) used an OLS estimator to assess the relationship between vaccination rates and COVID-19 cases, deaths, and reproduction rates across 49 African nations. The researchers discovered that vaccination rates were negatively and significantly correlated with both COVID-19 cases and deaths, while no stable or consistent statistical relationship was established between vaccination and reproduction rates. ...

Vaccine uptake and effectiveness: Why some African countries performed better than the others?
  • Citing Article
  • October 2023

Health Policy and Technology

... The IGS 2021 gathered the data during the COVID-19 pandemic in Singapore. It was when the state directives limited face-to-face activities, including work and formal education, to prevent the further spread of the virus (Wong et al. 2023). Instead, noncontagious online media were recommended as alternative communication tools. ...

Are we past the COVID-19 Pandemic? Insights from Singapore
  • Citing Article
  • July 2023

Health Policy and Technology

... It is also important to note that other interventions have also been explored to enhance quality of life in individuals with achondroplasia, mostly related to surgical interventions, such as limb lengthening, along with recently available pharmacologic treatments for children with achondroplasia [35]. Future research should explore how physical activity interventions might complement these existing approaches. ...

Interventions for improving clinical outcomes and health-related quality-of-life for people living with skeletal dysplasias: an evidence gap map

Quality of Life Research

... Stated preferences (SP) is a methodology widely used in the transportation literature (e.g., [29]), which has recently been demonstrated to provide valid and effective results also in the healthcare context (e.g., [30][31][32][33][34]). Differently from revealed preferences, which are collected by observing individuals' behavior, and thereby choices, this approach presents individuals with hypothetical scenarios and asks them to express their preferences. ...

Priority setting in the German healthcare system: results from a discrete choice experiment

International Journal of Health Economics and Management

... related to data availability) may hinder potential risk equalisation models. The incorporation of risk sharing into the risk equalisation formula (McGuire and van Kleef, 2018b) can be an easy and effective way to improve the scheme (and therefore, diminishing incentives for risk selection), when information constraints exist (Henriquez et al., 2023a(Henriquez et al., , 2023b. ...

Combining Risk Adjustment with Risk Sharing in Health Plan Payment Systems: Private Health Insurance in Australia
  • Citing Article
  • January 2023

SSRN Electronic Journal