The research team, led by Hande İleri of the University of Health Sciences Turkey, Izmir Faculty of Medicine, together with Muhammed Mustafa Uzan and Yasemin Kılıç Öztürk, drew on the 2023 Türkiye Older Persons Profile Survey, a nationally representative dataset collected by the Turkish Statistical Institute. Because the analysis used anonymized secondary microdata obtained through official permission procedures, the study did not require separate ethics committee approval, and consent was handled as part of the original survey protocols. What makes the study methodologically notable is its scale and its weighting approach: rather than a convenience sample of clinic patients, it captures the older population of an entire country, with survey weights applied so the results reflect the true demographic composition of Türkiye’s aging citizens.

To measure digital engagement with health systems, the researchers constructed a composite score built from four components: mobile internet use, general internet browsing, use of mobile health applications, and use of e-government services. This composite approach matters because digital access is not a single on-or-off switch. An older adult might own a smartphone but never open a health app; another might browse the web fluently yet be stymied by the authentication steps of a government portal. By combining these indicators, the score captures a spectrum of practical, health-relevant digital capability rather than mere device ownership. On the other side of the analysis, healthcare access difficulty was measured with a composite score based on seven distinct reported problems in accessing or using healthcare services, ranging from the struggle to secure appointments to broader obstacles in navigating the system.

The statistical engine of the study was a set of survey-weighted general linear models, a technique appropriate for complex survey data because it incorporates the sampling weights of individual respondents, ensuring that underrepresented groups exert their correct influence on the estimates. After full adjustment for sociodemographic and health-related factors, the association held firm: each increment in the health-oriented digital access score was associated with a lower healthcare access difficulty score, with a coefficient of -0.045 and a 95 percent confidence interval spanning -0.066 to -0.024, and a p-value below 0.001. In plain terms, even after accounting for income, education, health status, and other confounders, older adults who were more digitally connected reported systematically fewer barriers to care.

Correlation, of course, is not causation, and the authors are careful to frame their findings as an association from cross-sectional data. It is possible that older adults who face fewer healthcare obstacles are also more likely to engage with digital tools, rather than the reverse. Yet the biological and social plausibility of the digital pathway is compelling. When appointment booking migrates to apps, when prescription renewals require portal logins, and when health information is distributed through websites, the person without those tools faces a compounding series of friction points. The finding that difficulty obtaining appointments affected fully half of the older population suggests that the scheduling bottleneck, increasingly digitized in many health systems, sits at the heart of the access problem.

The demographic backdrop amplifies the stakes. The proportion of older adults is rising worldwide, and Türkiye is squarely within this global transition. Healthy aging frameworks, including those promoted by international health bodies, emphasize timely access to healthcare as a pillar of wellbeing in later life. If the infrastructure of access is quietly shifting online while a large share of the elderly population remains offline, the digital divide ceases to be a technology story and becomes a health equity story. The Turkish data make this concrete: roughly one in seven older adults used mobile health applications, meaning that the vast majority, more than 85 percent, did not, even as digital channels became more common at many stages of healthcare access.

The study’s authors argue that digital inclusion should be treated as an integral component of broader efforts to promote equitable healthcare access for older adults, not as a separate technology policy. That framing has practical implications. Digital literacy programs targeted at seniors, simplified authentication for e-government health services, and hybrid systems that preserve telephone and in-person booking channels could all narrow the gap. The composite score developed in the study also offers a template for other countries: by measuring mobile internet use, browsing, health app adoption, and e-government engagement together, health ministries can track whether their digital transformation is actually reaching the populations that need care most.

Türkiye’s situation resonates far beyond its borders. Many health systems, from Europe to East Asia, have accelerated digitization in the wake of the COVID-19 pandemic, moving vaccination records, telemedicine, and appointment systems onto smartphones. Older adults everywhere show lower rates of adoption of these tools, and the Turkish study provides one of the clearest population-based quantifications of how that gap maps onto real difficulties in obtaining care. The finding that e-government use, often the gateway to subsidized or state-coordinated health services, stood at just 14.5 percent among older Turks illustrates how quickly administrative modernization can outpace the populations it is meant to serve.

There are also technical lessons in how the study was conducted. Using the individuals sampling weight in the general linear models guards against the distortion that arises when survey designs oversample certain groups, and the composite scoring strategy avoids the fragility of single-item measures, which can conflate, say, owning a tablet with being able to complete a telemedicine consultation. The seven-item healthcare access difficulty score similarly acknowledges that barriers to care are multidimensional, encompassing cost, transport, information, and scheduling. Together, these methodological choices lend weight to the central conclusion that the digital access association is not an artifact of a poorly specified model.

The study received no specific grant funding from public, commercial, or not-for-profit agencies, and the authors declare no competing interests. Published open access under a Creative Commons license, the research invites replication in other national contexts, and its message is likely to travel well: as health systems digitize, they must carry their oldest users with them, or the promise of technology-enabled care will harden into a new form of exclusion. With 8.6 million older adults represented in a single national dataset, and half of them struggling simply to book an appointment, the numbers from Türkiye read as a quantified call to action for every aging society watching its healthcare front door move onto a screen.

Subject of Research: The association between health-oriented digital access and healthcare access difficulties among older adults in Türkiye

Article Title: Health-oriented digital access and healthcare access difficulties among older adults in Türkiye: a population-based cross-sectional study

Article References: Health-oriented digital access and healthcare access difficulties among older adults in Türkiye: a population-based cross-sectional study. (n.d.). https://doi.org/10.1186/s12889-026-29258-0

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29258-0

Keywords: digital health, older adults, healthcare access, Türkiye, e-government, mobile health applications, health equity, aging, digital divide, BMC Public Health, cross-sectional study, health services accessibility

The research, led by Jamie L. Humphrey of RTI International together with Jason Williams, Sofia A. Oviedo, Bradley R. Ray, and Jessica D. Cance, addresses a question that has lingered as the synthetic opioid crisis deepened. Fentanyl and its analogs have driven unprecedented overdose mortality in the United States, but their effects extend beyond fatal poisoning. The drug’s extreme potency and rapid onset have altered injection frequency and syringe-sharing behavior in ways that heighten the risk of HIV transmission, and clusters of new infections in several states have underscored the urgency of embedding HIV testing, prevention, and treatment within settings where people who use drugs already seek care.

Integrated HIV services within substance use disorder treatment facilities have long been viewed as a critical intervention point for this syndemic of addiction, overdose, and infectious disease. Whether such services actually proliferated as fentanyl spread geographically, however, remained unknown. To find out, the research team assembled a longitudinal dataset of United States counties from 2015 through 2023, relying on geocoded facility listings from the National Survey of Substance Abuse Treatment Services and its successor, the National Substance Use and Mental Health Services Survey. The outcome of interest was the annual county-level proportion of substance use disorder treatment facilities reporting that they provided HIV services.

A central methodological challenge was defining when the fentanyl era began for any given county. Rather than relying on a single national date, the investigators derived state-specific onset points for rapid illicit fentanyl market penetration using data from the National Forensic Laboratory Information System, which tracks drug submissions to forensic laboratories across the country. This allowed the team to model each county’s trajectory of HIV service availability before and after the moment fentanyl effectively took over the local illicit drug supply, capturing the staggered diffusion of the synthetic opioid wave as it moved across the country.

The statistical approach was equally refined. The researchers employed longitudinal growth models with a beta distribution, a technique suited to modeling proportions bounded between zero and one, to estimate rates of change in HIV service availability across the study period. The models incorporated a set of time-varying covariates designed to isolate the effect of fentanyl’s arrival from other concurrent forces: county-level drug overdose mortality and HIV incidence rates, each lagged by two years to reflect plausible causal timing, as well as state-level policy factors including Medicaid expansion and prohibitions on prior authorization requirements for medications for opioid use disorder.

The headline result is striking in its simplicity. Between 2015 and 2023, the average proportion of substance use disorder treatment facilities providing HIV services doubled among counties that had treatment infrastructure in place. This was not a uniform trend, however. The geographic heterogeneity was considerable: following the introduction of fentanyl, HIV service availability increased in 38.8 percent of counties, remained stable in 14.0 percent, and decreased in 24.5 percent. Perhaps most sobering, 22.7 percent of counties had no measurable HIV service availability at all during the period because they lacked substance use disorder treatment facilities entirely, leaving residents of those areas without any local point of access to integrated care.

The adjusted models sharpened the temporal story. Before fentanyl’s arrival, the increase in HIV service provision within counties was modest and not statistically significant, with an estimated slope of 0.021 and a standard error of 0.013. After fentanyl was detected in a state’s drug market, integration accelerated markedly, with a post-fentanyl slope of 0.072 and a standard error of 0.009, a difference that was highly significant at P less than .001. A formal test of the interaction between the slope and fentanyl’s introduction confirmed that the acceleration was genuinely tied to the synthetic opioid’s arrival, with an interaction coefficient of 0.051 and a standard error of 0.014, also significant at P less than .001.

What these coefficients imply, in practical terms, is that the arrival of fentanyl appears to have functioned as a shock to the addiction treatment system, prompting facilities to adapt their service portfolios in response to a visibly escalating threat. The authors interpret this pattern as evidence of adaptive integration of HIV prevention and care within addiction treatment systems during the fentanyl era. Treatment organizations, confronting a drug supply that dramatically raised both overdose risk and injection-related HIV vulnerability, appear to have recognized that testing for HIV, linking patients to antiretroviral care, and offering preventive services were no longer optional adjuncts but core components of responsible care for a population facing compounded dangers.

Yet the study’s darker findings demand equal attention. Nearly one-quarter of United States counties had no in-person substance use disorder treatment infrastructure at all during the study window, a persistent service desert that no amount of integration within existing facilities can remedy. Moreover, even among counties with treatment capacity, the post-fentanyl period saw service availability decline in roughly one in four, indicating that the adaptive response was far from universal. Geographic disparities in access to integrated HIV and addiction services remain substantial, and the counties most vulnerable to overlapping overdose and HIV epidemics are often precisely those least equipped to respond.

The authors conclude that these patterns underscore the need for policies that expand substance use disorder treatment capacity and actively incentivize HIV service integration in underserved communities. As fentanyl, and increasingly its more potent analogs, continues to dominate the illicit drug supply, the window for preventive action narrows in the places least served. The research, which was supported by the National Institute on Drug Abuse under Award Number U24DA057611 and reviewed by the RTI International Institutional Review Board under protocol STUDY00022322, provides both a benchmark and a warning: the treatment system can respond to crisis, but only where treatment exists, and only when policy deliberately directs resources toward the communities where the syndemic burns hottest.

Subject of Research: Longitudinal county-level analysis of HIV service availability in US substance use disorder treatment facilities before and after the state-specific arrival of illicit fentanyl, 2015 to 2023.

Article Title: HIV service integration in substance use treatment facilities in the fentanyl era, 2015–2023

Article References: HIV service integration in substance use treatment facilities in the fentanyl era, 2015–2023. (n.d.). https://doi.org/10.1186/s12889-026-29460-0

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29460-0

Keywords: HIV services, fentanyl, substance use disorder treatment, integrated care, overdose crisis, health services accessibility, geospatial analysis, HIV prevention, Medicaid expansion, opioid epidemic, public health, service integration