Correction: Exploring the Role of Volunteer Organizations in Developing Italy’s Community-Based Care Model

Approximately half of the people with HIV (PWH) in the United States are retained in HIV care and only 57% have achieved viral suppression, due to barriers including transportation access, stigma, poor mental health, substance use, and medical mistrust. Community-based HIV care models have potential to address the diverse needs of patients and to improve retention in care, but their success is contingent on acceptance by patients and key community stakeholders. Recognizing that the preferences of PWH who are out-of-care (PWH-OOC) likely differ from those retained in care, we conducted a mixed-methods study from June 2019 to May 2021 composed of surveys with PWH-OOC (n = 50) and in-depth interviews with key clinic and community stakeholders (n = 41) to examine the relative preference and perceived advantages and disadvantages for six different community-based HIV care models versus the traditional fixed-clinic model. Survey data was analyzed to assess average rank preference for each care model and interview transcripts were thematically coded to examine factors influencing model acceptance. The highest preference for care delivery was via a mobile clinic, followed by community-based peer navigation, primary care clinics, telemedicine, traditional HIV subspeciality clinic, homeless shelter, and drug treatment center. Common factors influencing preference included convenience, accessibility, potential to preserve confidentiality, quality of care assurance, opportunity to develop rapport with their HIV care provider, access to a smart device, and potential to alleviate versus exacerbate HIV stigma. Participants discussed need for integration of care models and for individuals to choose different care models at different times. Providers and patients differed in preference for care model and weighting of relative advantages and disadvantages of each. Findings highlight the need to integrate alternative, community-based care models into the national plan to end the HIV epidemic and to allow for PWH-OOC to choose the model most fitting based on individual circumstances.

The implementation of activity-based funding (ABF) in mental health from 1 July 2013 has significant risks and benefits. It is critical that the process of implementation is consistent with Australia's cherished goal of establishing a genuine and effective model of community-based mental health care. The infrastructure to support the application of ABF to mental health is currently weak and requires considerable development. States and territories are struggling to meet existing demand for largely hospital-based acute mental health care. There is a risk that valuable ABF-driven Commonwealth growth funds may be used to prop up these systems rather than drive the emergence of new models of community-based care. Some of these new models exist now and this article provides a short description. The aim is to help the Independent Hospital Pricing Authority better understand the landscape of mental health into which it now seeks to deploy ABF.

Introduction:Community-based healthcare models are crucial for reforming primary care delivery and integrating prevention, health promotion, and care services within communities. Volunteer organizations are increasingly recognized for their potential contributions; however, their integration within Italy’s emerging Community Health Center (CHC) model still needs to be explored. This study investigated the role of volunteer organizations in developing Italy’s CHC model by focusing on how these groups can enhance care coordination and community health outcomes.Methods:A qualitative descriptive approach was employed, combining semi-structured interviews and focus groups with key stakeholders, including CHC managers, primary care directors, social service providers, and volunteer organization representatives in the Piacenza area of Emilia Romagna. Data collection spanned July 2021 to March 2022, and thematic analysis was used to identify core themes related to the integration of volunteer organizations in CHCs.Results:The study identified four key areas where volunteer organizations contribute: (i) prevention and health promotion, (ii) identifying unmet needs and caregiver support, (iii) collaborative initiatives between CHCs and volunteers, and (iv) creating spaces for teamwork. Despite these contributions, challenges related to organizational coordination, limited operational specialization, and geographic disparities have been noted. Volunteer organizations were found to play a critical role in addressing gaps in community services, yet their involvement in CHC planning and execution varied across territories.Discussion:Although volunteer organizations have the potential to significantly enhance community-based care, their integration into Italy’s CHC model is hindered by limited coordination, funding constraints, and uneven involvement across regions. Strengthening partnerships, improving operational support, and creating dedicated collaboration spaces are essential to fully leveraging their contributions. Future research should explore strategies for enhancing the sustainability and scalability of volunteer-led initiatives within the CHC framework.

BackgroundEarly postnatal discharge is perceived as a factor that contributes to the possibilities of the maternal, neonatal complications and deaths. The implementation of the community-based postnatal care model is crucial to mitigate the morbidity and mortality of postnatal women and neonates during the first weeks of delivery. A community-based postnatal care model was developed for the management of neonates during the postnatal care period in the community.ObjectivesThe study aims to share the developed community-based postnatal care model that could assist postnatal women in the management of neonates.MethodEmpirical findings from the main study formed the basis for model development. The model development in this study was informed by the work of Walker and Avant; Chinn and Kramer Dickoff, James and Wiedenbach; and Chinn and Jacobs.ResultsThe results indicated that there was no community-based postnatal care model developed to manage neonates. The model is described using the practice theory of Dickoff, James and Wiedenbach elements of agents, recipients, context, process, dynamics and outcomes within the community context of the postnatal care period. The model was further described by Chinn and Krammer following the assumptions of the model, concept definition, relation statement and nature of structure.ConclusionThe utilisation of the model is critical and facilitates the provision of an enabling and supportive community-based context by primary caregivers for the effective management of neonates.ContributionThis study provides a reference guide in the provision of community-based postnatal care by postnatal women after discharge from healthcare facilities.

Introduction Engagement of general practitioners (GPs) is essential to improving rates of diagnosis and treatment of viral hepatitis, as traditional tertiary hospital-based models of care often face challenges. Aim We investigated Australian general practitioners' perceptions of a community-based model of care for patients with viral hepatitis. Methods We conducted a mixed methods study using survey questionnaires (23 GPs) and an open-ended interview guide (10 GPs) at primary care clinics in Brisbane, Queensland, Australia. Quantitative data were analysed using descriptive statistics in Stata 15.1 and qualitative data were analysed using thematic analysis following an inductive approach. Results Patient loss to follow up and high cost of diagnostic tests were identified as the biggest challenges to providing care for patients with viral hepatitis. Most GPs interviewed believe a more community-based model of care with support to GPs may improve uptake of care and increase both GP and patient engagement. General practitioners felt a community-based model of care could also improve viral hepatitis testing and follow-up rates. Discussion For Australian GPs, improving patient retention and diagnostics access were key pressure points in the viral hepatitis care pathway. A broader and more profound capacity-building allows community-based viral hepatitis care to be sustainable.

BackgroundPeople who sustain spinal cord injuries in low- and middle-income countries are vulnerable to life-threatening complications after discharge. The aim of this trial is to determine the effect on all-cause mortality of a sustainable model of community-based care provided over the first 2 years after discharge.Methods and analysisThe CIVIC trial is a single centre, parallel group trial with concealed and stratified randomisation. The protocol has been previously published (BMJ Open 2016;6:e010350). This paper provides the accompanying detailed statistical plan. In total, 410 people with recent spinal cord injury who are wheelchair dependent and about to be discharged from the Centre for the Rehabilitation of the Paralysed in Bangladesh are randomised to intervention or control groups. Participants assigned to the intervention group receive a model of community-based care in which a case manager provides ongoing telephone-based support and visits participants in their homes over a 2-year period. Participants assigned to the control group receive usual care which may involve a follow-up phone call or a home visit. The primary outcome is all-cause mortality at 2 years as determined by a blinded assessor (Bangladesh does not have a death registry). The primary effectiveness analysis will compare Kaplan-Meier survival curves (time from allocation to death) in the intervention and control groups using the log-rank test (two-tailed α = 0.05). Participants will be censored at the time they were last known to be alive or at the time of the follow-up assessment. Recruitment finished in March 2018 and the last assessment will be conducted in March 2020.DiscussionThe CIVIC trial will provide unbiased and precise estimates of the effectiveness of a model of community-based care for people with spinal cord injuries in Bangladesh. The results will have implications for provision of health services for people with spinal cord injuries and other conditions that cause serious disability in low-income and middle-income countries.Trial registrationANZCTR, ACTRN12615000630516, U1111-1171-1876. Registered on 17 June 2015.

Social factors associated with poor childbirth outcomes and experiences of maternity care include minority ethnicity, poverty, young motherhood, homelessness, difficulty speaking or understanding English, migrant or refugee status, domestic violence, mental illness and substance abuse. It is not known what specific aspects of maternity care work to improve the maternal and neonatal outcomes for these under-served, complex populations. This study aimed to compare maternal and neonatal clinical birth outcomes for women with social risk factors accessing different models of maternity care. Quantitative data on pregnancy and birth outcome measures for 1000 women accessing standard care, group practice and specialist models of care at two large, inner-city maternity services were prospectively collected and analysed using multinominal regression. The level of continuity of care and place of antenatal care were used as independent variables to explore these potentially influential aspects of care. Outcomes adjusted for women's social and medical risk factors and the service attended. Women who received standard maternity care were significantly less likely to use water for pain relief in labour (RR 0.11, CI 0.02-0.62) and have skin to skin contact with their baby shortly after birth (RR 0.34, CI 0.14-0.80) compared to the specialist model of care. Antenatal care based in the hospital setting was associated with a significant increase in preterm birth (RR 2.38, CI 1.32-4.27) and low birth weight (RR 2.31, CI 1.24-4.32), and a decrease in induction of labour (RR 0.65, CI 0.45-0.95) compared to community-based antenatal care, this was despite women's medical risk factors. A subgroup analysis found that preterm birth was increased further for women with the highest level of social risk accessing hospital-based antenatal care (RR 3.11, CI1.49-6.50), demonstrating the protective nature of community-based antenatal care. This research highlights how community-based antenatal care, with a focus on continuity of carer reduced health inequalities and improved maternal and neonatal clinical outcomes for women with social risk factors. The findings support the current policy drive to increase continuity of midwife-led care, whilst adding that community-based care may further improve outcomes for women at increased risk of health inequalities. The relationship between community-based models of care and neonatal outcomes require further testing in future research. The identification of specific mechanisms such as help-seeking and reduced anxiety, to explain these findings are explored in a wider evaluation.

BackgroundSocial factors associated with poor childbirth outcomes and experiences of maternity care include minority ethnicity, poverty, young motherhood, homelessness, difficulty speaking or understanding English, migrant or refugee status, domestic violence, mental illness and substance abuse. It is not known what specific aspects of maternity care work to improve the maternal and neonatal outcomes for these under-served, complex populations.MethodsThis study aimed to compare maternal and neonatal clinical birth outcomes for women with social risk factors accessing different models of maternity care. Quantitative data on pregnancy and birth outcome measures for 1000 women accessing standard care, group practice and specialist models of care at two large, inner-city maternity services were prospectively collected and analysed using multinominal regression. The level of continuity of care and place of antenatal care were used as independent variables to explore these potentially influential aspects of care. Outcomes adjusted for women’s social and medical risk factors and the service attended.ResultsWomen who received standard maternity care were significantly less likely to use water for pain relief in labour (RR 0.11, CI 0.02–0.62) and have skin to skin contact with their baby shortly after birth (RR 0.34, CI 0.14–0.80) compared to the specialist model of care. Antenatal care based in the hospital setting was associated with a significant increase in preterm birth (RR 2.38, CI 1.32–4.27) and low birth weight (RR 2.31, CI 1.24–4.32), and a decrease in induction of labour (RR 0.65, CI 0.45–0.95) compared to community-based antenatal care, this was despite women’s medical risk factors. A subgroup analysis found that preterm birth was increased further for women with the highest level of social risk accessing hospital-based antenatal care (RR 3.11, CI1.49–6.50), demonstrating the protective nature of community-based antenatal care.ConclusionsThis research highlights how community-based antenatal care, with a focus on continuity of carer reduced health inequalities and improved maternal and neonatal clinical outcomes for women with social risk factors. The findings support the current policy drive to increase continuity of midwife-led care, whilst adding that community-based care may further improve outcomes for women at increased risk of health inequalities. The relationship between community-based models of care and neonatal outcomes require further testing in future research. The identification of specific mechanisms such as help-seeking and reduced anxiety, to explain these findings are explored in a wider evaluation.

Accepted policy focusses on keeping older people in their own homes, but there is increasing concern about what this can mean in practice for vulnerable people, stressed resources and family caregivers. This chapter looks at the possibility of creating relational care in community settings and what this implies for planning of provision, loneliness, building resilience and health outcomes. It then addresses the question of loneliness in more detail. It presents new models of community-based care – Neighbourhood Cares, Wellbeing Teams, Buurtzorg Teams and the tanteLouise village in the Netherlands – with description, evaluation and quotes from interviews. How are they working, what contributes to their success and what does success look like? Each model is followed by a list of learning points.

Objectives. To evaluate changes in health related quality of life (HRQL) for individuals with Type 2 diabetes following the introduction of a new community-based model of care. Methods. A survey method was used in which HRQL, Problems Areas In Diabetes (PAID) and demographics were assessed before and 18 months after introducing the new service. Results. Overall HRQL and PAID scores were lower than published levels in individuals with diabetes but remained stable during the transition to the new model of care except for the bodily pain domain and deteriorating PAID scores for older patients. Four domains of SF36 health showed deterioration in the highest socio-economic groups. Deterioration was also observed in males, most notably mental health, in patients aged 54 years or less, 75 years or more and patients from socio-economic groups 1 and 2. HRQL was lowest at baseline and follow-up in socio-economic groups 6 & 7. Low levels of distress in patients across all deprivation categories was observed but remained stable over the transition. Conclusions. HRQL and distress associated with diabetes remained stable following the introduction of the new community-based model of care except for deterioration in the bodily pain domain and deteriorating PAID scores for older patients. Relevance for Practice. (i) Health related quality of life assessment is practical and acceptable to patients. (ii) In clinical governance terms it is good practice to monitor the impact of change in service delivery on the health of the patients in your care. (iii) Screening with health related quality of life tools such as generic and disease specific tools could help identify health problems otherwise undetected within current clinical care. Systematic identification of the most vulnerable groups with Type 2 diabetes should allow care to be better targeted.

Type 2 diabetes mellitus (T2DM) presents a major challenge in low- and middle-income countries (LMICs) due to workforce shortages, limited primary-care capacity, and fragmented chronic-care delivery. Community-based diabetes care models have emerged as scalable approaches to strengthen self-management and extend service reach. With this background, we aimed to synthesize global evidence on community-based diabetes care models, classify major intervention typologies, examine their alignment with the diabetes care continuum, and assess their effectiveness and implementation characteristics. A narrative review was conducted using a structured search of PubMed, Scopus, Web of Science, and Embase for studies published between January 2010 and March 2025. Eligible studies focused on community-based T2DM interventions delivered by community health workers (CHWs), peer educators, or digital-community hybrids. Interventions were categorized and mapped across the diabetes care continuum, and evaluated using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, as well as complementary integration models. Eleven studies were included, in which peer-led models were common in high-income countries, while CHW-led and hybrid models were predominant in LMICs. Interventions demonstrated clinically significant improvements in glycated hemoglobin (HbA1c), BMI, and self-efficacy. Successful models embedded within existing public health systems or culturally rooted community platforms showed higher adoption and long-term maintenance. Digital interventions enhanced reach, but faced challenges with sustained engagement and infrastructure support. The RE-AIM analysis revealed strong effectiveness and reach; however, long-term maintenance and adoption varied based on the level of contextual integration and supervision structures. Community-based T2DM care models offer scalable, sustainable strategies to improve disease control. Integration into national health platforms, supportive supervision, and digital augmentation enhance implementation success. Challenges persist in follow-up, cost-effectiveness, and equity design; scale-up should prioritize integration, financing, and CHW capacity.

IntroductionDecentralisation of healthcare commissioning in the UK has led to the development of multiple models of community-based care for COPD. Despite the huge costs associated with these long term condition...

BackgroundPatients with cancer commonly experience pain and suffering at the end of life days. Community-based palliative care can improve the quality of life of terminally-ill cancer patients and provide them with a merciful death. The purpose of this study was to develop an integrated model of community-based palliative care into PHC for terminally ill cancer patients.MethodThis study is a health system research (HSR) that was conducted in three phases from October 2016 to July 2020. In the first phase, dimensions of community-based palliative care were explored in patients with cancer using qualitative methods and conventional content analysis. In the second phase, a scoping review was carried out to complete the collected data from the qualitative phase of the study. Based on the collected data in the first and second phases of the study, a preliminary draft of community-based palliative care was developed for patients with cancer based on the framework of the World Health Organization. Finally, the developed model was validated using the Delphi technique in the third phase of the study.ResultsData analysis indicated that providing community-based care to patients with cancer is influenced by the context of care. According to the developed model, patients are identified as terminally ill, and then are referred to the local comprehensive health center in a reverse manner. After patients’ referral, they can receive appropriate healthcare until death by the home care team in relation to the comprehensive health center based on the framework of primary healthcare.ConclusionsThis model was developed based on the current Iranian healthcare structure and the needs of terminally ill cancer patients. According to the model, healthcare is provided in a reverse manner from the subspecialty centers to patients’ homes in order to provide easy access to palliative care. It is suggested to use this model as a pilot at the regional level.

In 2009, a high-deprivation district health board in New Zealand set up a community-based abortion clinic in order to provide a local service and to avoid out-of-region referrals. The service offers medical abortions for women with pregnancies of up to 63 days' gestation, and surgical abortion with local anaesthetic for women with pregnancies of up to 14 weeks' gestation. To describe the services developed and assess safety and timeliness for the first year of community-based services. An audit of clinical records for patients seen in 2010 was performed in order to obtain data on location of services, timeliness, safety and complications. Eighty-two percent of locally provided abortions in 2010 were medical abortions, completed on average less than two days after referral to the service. One percent of patients experienced haemorrhaging post abortion, and 4% had retained products. These rates are within accepted standards for an abortion service. This report illustrates that a community-based model of care can be both clinically and culturally safe, while providing a much-needed service to a high-needs population.

In 2010 and 2011 two deadly earthquakes struck the Canterbury region of New Zealand – placing even greater pressure on all parts of their health system. A new model of integrated care has helped Canterbury hospitals reduce the Average Length of Stay and readmission from elderly patients during the busy winter following these earthquakes. The Canterbury District Health Board (CDHB) predicted the region would run out of hospital beds by 2014 and fast-tracked its CREST programme. Community Rehabilitation Enablement Support Team (CREST) is a community-based rehabilitative supported discharge for older people. It also supports patients to be functionally independent to avoid future re-admissions. CREST is based on a collaborative care model, where a number of health professionals work together to manage care for the patient. The interdisciplinary CREST team consists of staff from Older Persons Health Specialist Services, community based care providers, general practitioners and allied health professionals. The Collaborative Care Management Solution (CCMS) is the shared information management platform for the programme. CCMS is used to enter and manage the patient’s care plan and goal ladder and any patient assessments, notes or medication information. The various healthcare providers responsible for the patient’s care – primary, secondary and community health professionals – can all access the information in real-time, make changes or updates and communicate with each other in a quick and efficient way. With CREST, clients improve their ability to function independently and the need for residential care or long-term home care is reduced. From a funding perspective, CREST uses a different funding model that is based on an alliance arrangement between the care providers and the funder. Care is funded for a team delivering the service and health outcomes, not for individual outputs. Each patient has a team of providers surrounding them, coordinating their care, and keeping them out of hospital. Data from CCMS is used to support a quality improvement process across all care providers involved and is critical to improving patient outcomes. CREST was introduced in April 2011, and more than 1,700 patients were kept out of hospital in the first year of the programme. More than 4,000 people have had their hospital length of stay reduced by management in the programme without a subsequent increase in readmission rates. Other benefits include better communication and teamwork, seamless care for patients, a reduction in errors and time savings. World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116624– http://www.ijic.org/ The results speak for themselves. Demand for community aged-care dementia services increased by 6.6%, while demand for rest home care fell 6.7% and hospital care remained stable between 2011 and 2012. The region’s spending on aged care fell from $22.25 million in 2010 to $21.9m in 2011 as demand moved to more appropriate community care settings. CREST has since been extended to accept referrals directly from GPs, avoiding a hospital admission altogether. This presentation will outline learnings from this successful rehabilitation and admission avoidance service that could be adapted for managing older persons’ health in other countries, including the paradigm shift needed to implement a new model of community-based care.