Alternative Health Care Delivery Research Articles

Healthcare System Sustainability Challenges in Nepal and Opportunities Offered by Alternative Healthcare Delivery Arrangements

The burden of chronic diseases in Nepal is increasing due to demographic and epidemiological transitions; alongside the persistent impact of communicable, maternal, newborn, and child health diseases, this critical situation acts as the precursor to rising healthcare costs. Nepal struggles to sustain its healthcare system amidst political instability, pandemics, natural disasters, and slow economic growth, particularly when healthcare funding is mainly dependent on out-of-pocket payments. Nepal requires lower-cost alternative healthcare delivery arrangements to provide high-value care while relieving economic sustainability pressures. Alternative healthcare delivery arrangements have a broad potential scope; they can involve strategic changes in how care is delivered and by whom, or they can also involve the application of information and communication technologies, e.g., telemedicine. This paper highlights the specific challenges to healthcare system sustainability in Nepal and the potential for high-value, lower-cost alternative healthcare delivery models to improve system performance in the longer term.

The Rise of Telemedicine in the Philippines during COVID-19: A Systematic Review of Utilization Trends and Patient Outcomes

The study discussed the telemedicine trends in the Philippines during the COVID-19 pandemic from 2019 to 2023. Determining the frequency of use of telemedicine, the factors that influenced its use before and during the COVID-19 pandemic, and the effects of telemedicine in improving the healthcare system in the Philippines. A systematic review was conducted using thematic analysis and the PRISMA checklist. The results presented a pattern indicating that teleconsultation usage corresponded to increased COVID-19 cases. Furthermore, telemedicine utilization surged from March 2020 to March 2022, with video consultations increasing from 5 to 495 monthly visits between 2019 and 2022. The study concluded that it was driven by increased mobile phone usage, improved patient satisfaction, government support, and increased video consultations, offering alternative healthcare delivery. Future studies should include more regions and timeframes to comprehensively present telemedicine trends in the Philippines.

Patient Characteristics Associated With Phone and Video Visits at a Tele-Urgent Care Center During the Initial COVID-19 Response: Cross-Sectional Study.

Health systems rapidly adopted telemedicine as an alternative health care delivery modality in response to the COVID-19 pandemic. Demographic factors, such as age and gender, may play a role in patients' choice of a phone or video visit. However, it is unknown whether there are differences in utilization between phone and video visits. This study aimed to investigate patients' characteristics, patient utilization, and service characteristics of a tele-urgent care clinic during the initial response to the pandemic. We conducted a cross-sectional study of urgent care patients using a statewide, on-demand telemedicine clinic with board-certified physicians during the initial phases of the pandemic. The study data were collected from March 3, 2020, through May 3, 2020. Of 1803 telemedicine visits, 1278 (70.9%) patients were women, 730 (40.5%) were aged 18 to 34 years, and 1423 (78.9%) were uninsured. There were significant differences between telemedicine modalities and gender (P<.001), age (P<.001), insurance status (P<.001), prescriptions given (P<.001), and wait times (P<.001). Phone visits provided significantly more access to rural areas than video visits (P<.001). Our findings suggest that offering patients a combination of phone and video options provided additional flexibility for various patient subgroups, particularly patients living in rural regions with limited internet bandwidth. Differences in utilization were significant based on patient gender, age, and insurance status. We also found differences in prescription administration between phone and video visits that require additional investigation.

Telemedicine in the primary care of older adults: a systematic mixed studies review

BackgroundFamily physicians had to deliver care remotely during the COVID-19 pandemic. Their efforts highlighted the importance of developing a primary care telemedicine (TM) model. TM has the potential to provide a high-quality option for primary care delivery. However, it poses unique challenges for older adults. Our aim was therefore to explore the effects of TM and the determinants of its use in primary care for older adults.MethodsIn this systematic mixed studies review, MEDLINE, PsycINFO, EMBASE, CINHAL, AgeLine, DARE, Cochrane Library, and clinical trials research registers were searched for articles in English, French or Russian. Two reviewers performed study selection, data extraction and assessment of study quality. TM’s effects were reported through the tabulation of key variables. TM use determinants were interpreted using thematic analysis based on Chang’s framework. All data were integrated using a joint display matrix.ResultsFrom 3,328 references identified, 20 studies were included. They used either phone (n = 8), videoconference (n = 9) or both (n = 3). Among studies reporting positive outcomes in TM experience, ‘user habit or preferences’ was the most cited barrier and ‘location and travel time’ was the most cited facilitator. Only one study reported negative outcomes in TM experience and reported ‘comfort with patient communication’ and ‘user interface, intended use or usability’ as barriers, and ‘technology skills and knowledge’ and ‘location and travel time’ as facilitators.Among studies reporting positive outcomes in service use and usability, no barrier or facilitator was cited more than once. Only one study reported a positive outcome in health-related and behavioural outcomes.ConclusionsTM in older adults’ primary care generally led to positive experiences, high satisfaction and generated an interest towards alternative healthcare delivery model. Future research should explore its efficacy on clinical, health-related and healthcare services use.

Abstract 10: Availability and Access to Hospital-Based Breast Cancer Early Detection and Diagnostic Services in Ghana

Abstract Purpose: Breast Cancer in Ghana is the leading type of cancer and second most common cause of cancer related death. Five-year survival in Ghana has been cited at 40-48% with most cases being stage 3 or 4 at diagnosis. Robust access to early detection and diagnostic services can lead to earlier stages of diagnosis and improved survival. The purpose of this study was to evaluate the early detection and diagnostic services available at hospital facilities nationwide in Ghana and to characterize geographic access. Methods: Trained research assistants administered a cross-sectional survey to all hospitals in Ghana from November 2020 to October 2021. Early detection and diagnostic services were characterized as having Basic, Core, or Enhanced services as per in the National Comprehensive Cancer Network (NCCN) framework for resource stratification. Availability of services were defined as available greater than 80% of the time, available less than 80%, or not at all. Results were analyzed for descriptive statistics in STATA. Results: 328 of 346 hospitals completed the survey. Of the 328 hospitals, 2 (1%) met NCCN Basic criteria alone, 11 (3%) of the hospitals met NCCN Core criteria, and none met NCCN Enhanced criteria. When including hospitals who offer services less than 80% of the year for varying circumstances, 3 (1%) met NCCN Basic criteria, 20 (6%) met NCCN Core criteria, and none met NCCN Enhanced criteria. Mammography was offered at 21 (6%) of the hospitals, 17 (5%) of which were available more than 80% of the year. Mapping and population data to estimate the percentage of population within various distances to hospital-based breast cancer early detection and diagnostic services will be done using Ghana 2021 census data in ArcGIS. Conclusion: Hospital based services for breast cancer early detection and diagnosis in Ghana are available but sparse. Many hospitals offer fragmented aspects of care outlined by the NCCN framework, but there are only a limited number of hospitals who offer the full spectrum of services. Understanding of current availability, and geographical distribution of services, provides a framework for potential targeted expansion or identification of alternative healthcare delivery models. Citation Format: Matthew Price, Anne Rositch, Florence Dedey, Mamadou Tounkara, Kirstyn Brownson, Raymond Price, Edward Kofi Sutherland. Availability and Access to Hospital-Based Breast Cancer Early Detection and Diagnostic Services in Ghana [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 10.

Effectiveness of Telemedicine in Diabetes Management: A Retrospective Study in an Urban Medically Underserved Population Area (UMUPA)

This paper examines the efficacy of telemedicine (TM) technology compared to traditional face-to-face (F2F) visits as an alternative healthcare delivery service for managing diabetes in populations residing in urban medically underserved areas (UMUPAs). Retrospective electronic patient health records (ePHR) with type 2 diabetes mellitus (T2DM) were examined from 1 January 2019 to 30 June 2021. Multiple linear regression models indicated that T2DM patients with uncontrolled diabetes utilizing TM were similar to traditional visits in lowering hemoglobin (HbA1c) levels. The healthcare service type significantly predicted HbA1c % values, as the regression coefficient for TM (vs. F2F) showed a significant negative association (B = −0.339, p &lt; 0.001), suggesting that patients using TM were likely to have 0.34 lower HbA1c % values on average when compared with F2F visits. The regression coefficient for female (vs. male) gender showed a positive association (B = 0.190, p &lt; 0.034), with HbA1c % levels showing that female patients had 0.19 higher HbA1c levels than males. Age (B = −0.026, p &lt; 0.001) was a significant predictor of HbA1c % levels, with 0.026 lower HbA1c % levels for each year’s increase in age. Black adults (B = 0.888, p &lt; 0.001), on average, were more likely to have 0.888 higher HbA1c % levels when compared with White adults.

Impact of COVID-19 Pandemic on Disease Control Status and Quality of Life of Patients with Acromegaly.

Background and Objectives: Despite the best efforts of healthcare workers and the deployment of alternative healthcare delivery solutions through telemedicine, the pandemic has disrupted standard care for patients with chronic conditions. The long-lasting pandemic has also had a profound impact on the quality of life (QoL) of the majority of patients with chronic illnesses. The management of rare diseases has been particularly challenging. We aimed to evaluate the impacts that the long-lasting pandemic had on the disease control status and QoL in patients with acromegaly. Materials and Methods: Our prospective study included 34 patients from a national referral centre. The baseline SAGIT and AcroQoL results were obtained in October 2020 during the lockdown period of the SARS-CoV2 pandemic. The follow-up results were assessed during the summer of 2022 in a period without any public health restrictions. All the patients were additionally evaluated for their attitude towards preventative public health measures against SARS-CoV2 spread and required mask wearing during the pandemic. Results: By comparing assessments in 2020 during the lockdown period and 2022 post-lockdown, we observed some improvement in SAGIT subscores T and I, most likely reflecting treatment changes in a small number of patients. The global SAGIT score remained stable. QoL measurement by AcroQoL did not demonstrate any changes. There was a negative correlation between SAGIT subscore S and the AcroQoL results. We also noted that the group of patients with the most negative attitude toward public health measurements for preventing SARS-CoV2 spread had higher AcroQoL results than others. Conclusion: Our results showcase that the SARS-CoV2 pandemic, lasting over two years, did not impact the disease control status and QoL in patients with acromegaly. The cohort continued to be well controlled and without changes in QoL. We measured a relatively favourable attitude towards the public health measures to prevent the spread of SARS-CoV2; in particular, patients who had a lower QoL had more positive attitudes towards these measures.

Recruitment Challenges of a Colorectal Cancer Screening Dissemination Study.

Dissemination strategies to reach underserved and minority populations to promote screening for colorectal cancer (CRC) are key to reducing disparities. We conducted a study to examine a tailored messaging approach to navigate individuals from communities (i.e., lower income, less access to care, and underscreened) to clinics to receive CRC screening. We encountered several political, demographic, and secular trend issues that required reconsideration and redesign of implementation strategies. Through study implementation from 2012 to 2017, changes in medical reimbursement and immigration policies-at the state level and later at the national level-affected healthcare delivery systems that had initially committed to supporting the study and our recruitment methods. Although our selected zip codes and sites had previously yielded high rates of CRC screening nonadherence, within a few years, these sites showed substantially higher screening adherence rates-yielding limited numbers of eligible participants. In addition, state immigration policy trends created mistrust and fear, leading to lower participation rates than anticipated. This report documents and provides valuable insights on how we and the community network developed creative strategies to overcome these challenges. New relationships with community partners were extended to tap advisory board input to meet the challenges. Criteria for clinic participation widened from originally selected Federally Qualified Health Centers (FQHCs) to various nonprofit, hybrid, and privately insured reimbursement types. Recruitment site options were creatively redefined to reach community participants where they live, work, and receive services. Strategies that engage community members in identifying alternative healthcare delivery structures and that link recruitment efforts to community-based service organizations were found to be critical to recapturing community trust in the face of unfavorable political environments. Widening the type of clinic partners from FQHCs to stand-alone nonprofits and private clinics and identifying unusual types of recruitment sites provided alternative solutions for successful study implementation. In prevention-based studies that face unplanned system and political barriers to recruitment, embedding the study in the community may aid in reestablishing trust levels to improve engagement and recruitment of clinic partners and eligible participants.

Identifying Digital Rhetoric in the Telemedicine User Interface

Telemedicine is an alternative healthcare delivery system whereby patients access digital technology to consult with a physician virtually. Patients first interact with telemedicine via a consumer-facing website. Telemedicine promises numerous benefits to patients, such as increased access to healthcare, yet poor usability of the telemedicine user interface (UI) may hinder patient acceptance and adoption of the service. The telemedicine UI moderates patients’ ability to utilize telemedicine, and therefore it must be usable, but it must also be rhetorical to motivate patients to perform certain actions. Digital rhetoric refers to UI elements that influence user actions and knowledge and is tied to usability because of these same human–computer interaction (HCI) factors. This study examined the usability of three telemedicine provider UIs and by identifying usability problems, reveals digital rhetoric that is significant to telemedicine UIs. The article concludes by offering heuristics of digital rhetoric that lead to optimal usability.

Integrating traditional medicine into the Ghanaian health system: perceptions and experiences of traditional medicine practitioners in the Ashanti region.

Traditional medicine (TM) plays a vital role in the Ghanaian health system by serving as an alternative healthcare delivery system for the majority of people. However, the quality of practice and level of TM practitioners' involvement in the integration of TM into the health system have not been fully investigated. This study employed a phenomenological qualitative study design to explore the perceptions, experiences and recommendations of TM practitioners in the Ashanti region regarding TM integration. Data were collected through individual interviews with 17 participants. Participants had knowledge about TM integration. They cited effective alternative healthcare delivery and improved patient outcomes as the key benefits of TM integration. However, they reported a shortage of approved TM products, poor visibility of TM integration and poor relational coordination of care as factors hampering the integration. Participants recommended improved interprofessional relationships, provision of financial support and improved publicity of TM as possible strategies to enhance TM integration in Ghana. The findings of the study clearly demonstrate that the Ghanaian health system is currently operating a consumer-led, tolerant health system with a parallel (between orthodox and TM practitioners) healthcare delivery model. Successful implementation of an effective TM integration would require improved integrative collaborative coordination of care between orthodox and TM practitioners in Ghana.

Rehabilitation Professional and Patient Satisfaction with Telerehabilitation of Musculoskeletal Disorders: A Systematic Review.

Telerehabilitation offers an alternative healthcare delivery remotely in a patient's environment at a lower cost, better accessibility, and equivalent quality to the standard approach. Several studies had examined the effectiveness of telerehabilitation inpatients with musculoskeletal disorders, and although there is evidence that it is at least equally effective as the standard care, the patient and rehabilitation professional satisfaction with the delivery method is not conclusive. A systematic review was conducted to study the patients' and rehabilitation professionals' satisfaction with telerehabilitation for musculoskeletal disorders. A search for relevant studies on 29 April 2021 was carried out in Medline/PubMed, Scopus, and Web of Science (WOS). The search terms included “telerehabilitation,” AND “satisfaction” AND “musculoskeletal disorders,” “telehealth,” “telemedicine,” “patient experience,” and “pain”. Fifteen eligible studies with 12,341 patients were included in this systematic review. A report was included if it (a) assessed the satisfaction of patients or professionals or both as one of the outcomes of a telerehabilitation intervention, (b) included adults 18 years and above with musculoskeletal disorders, and (c) is an intervention study using a quantitative approach. The quality of studies was assessed using the critical appraisal checklist tool developed by Joanna Briggs Institute (JBI). Most of the studies reported that patients were satisfied with both telerehabilitation and face-to-face intervention. However, few studies reported that patients were more satisfied with telerehabilitation compared to face-to-face of intervention. Patients in one study had preferred the incorporation of telerehabilitation and face-to-face sessions. Two of three studies had reported overall satisfaction with telerehabilitation by the professionals. Overall, there is evidence that patients and rehabilitation professional are satisfied with telerehabilitation compared to face-to-face consultation.

POSB57 Budget Impact Analysis of XprESS to Treat Sinus and Eustachian Tube Dysfunction in Spain: Positive Impact on the Care Pathway with Reduced Costs and Increased Hospital Capacity

With increasing surgical waiting lists due to COVID-19, there is a need to consider alternative healthcare delivery models to enhance efficiency, improve outcomes and increase hospital capacity. This analysis aims to estimate the budget impact of using XprESS to treat sinus and eustachian tube dysfunction in Spain in different care settings. Additionally, the impact of using XprESS on hospital capacity (i.e., number of bed days and operating room (OR) hours required) was assessed.

Physiotherapists\u2019 perceptions of and willingness to use telerehabilitation in Kuwait during the COVID-19 pandemic

BackgroundTelerehabilitation has been considered a suitable alternative healthcare delivery system during the COVID-19 outbreak, and many studies have promoted its feasibility in delivering physical care to patients who live with pain and disability. Physiotherapists’ perceptions and willingness are two key factors that influence the provision of remote physiotherapy.AimTo investigate physiotherapists’ perceptions of and willingness to use telerehabilitation in Kuwait during the COVID-19 pandemic and to explore the barriers that may hinder the use of telerehabilitation in this sector.MethodsThe following methods were used: (1) a cross-sectional survey and (2) face-to-face semi-structured interviews. In the cross-sectional survey, an electronic questionnaire was sent to 747 physiotherapists who were working in the governmental health sector. The questionnaire included four sections: perceptions of telerehabilitation, comfort with technology, willingness to use telerehabilitation, and barriers to using telerehabilitation. Six interviews were conducted with physiotherapy managers to explore the barriers and facilitators of telerehabilitation practice.Data analysisIn this study, descriptive data analysis was conducted, and a cross-tabulation technique was used to find the associations between the variables, in which chi-square tests were used to identify the significance of the results, where p < 0.05. Thematic content analysis was used for the interviews.ResultsOnly 273 completed questionnaires were received, giving a response rate of 36.5%. Most of the respondents (237; 86.8%) considered telerehabilitation a viable option to deliver healthcare to patients during the COVID-19 pandemic. In spite of the lack of information and communication technology (ICT) (156; 57.1%), 89% (243) of the respondents were willing to integrate telerehabilitation into their conventional practice, as cultural and social norms were not against the use of telerehabilitation systems. The results indicate that the more the physiotherapists used the internet and email in their work and the more comfortable they were with technology, the more willing they were to use telerehabilitation systems (p = 0.01). The physiotherapy managers reported that patients’ privacy and the confidentiality of their data were considered barriers.ConclusionIn Kuwait, physiotherapists show overall positive perceptions towards and a willingness to use telerehabilitation to facilitate patients’ access to physiotherapy services. There are several barriers to employing telerehabilitation. Accordingly, recommendations are suggested.

Nursing With the People: Reimagining Futures for Nursing.

We wish to advance a theory of nursing that intentionally engages in questions of politics and economics, centering equity and justice as a foundation for the provision of nursing care. As health care costs rise and health disparities widen, nurses have a clear imperative to develop alternative health care delivery models unmoored from the conventional employment and profit-driven structures that now disappoint us. This mandate arises from our disciplinary focus that emphasizes social justice as a social and moral good linked to the human services nurses provide. This kind of sociopolitical engagement is not auxiliary to nursing but rather central to our ethos. A health care environment that prioritizes profit over the well-being of people is an anathema to our disciplinary focus which, we believe, should center communities and people. The health care system that has forged nursing in the United States, transforms nursing into a commodity. This reinscribes inequality for those who are unable to access care, contributes to environmental harm through profligate hospital pollution and waste, and exploits nursing staff as workers. Nurses have a history of both upholding oppressive systems that disenfranchise segments of the public, usually poor, often People of Color, and engaging in innovative alternatives to the status quo. We wish to foster revolutionary alternative care delivery models that free us from the neoliberal confines of for-profit health care. Ultimately, we argue, nursing as a discipline and a science cannot neglect our role as whistleblowers and change agents. Nor can we presuppose that our dysfunctional and harmful health care structure in the United States is a foregone conclusion. Health care is constructed, which means it can be reconstructed. If we wish to realize our emancipatory potential as nurses, critically examining our role in upholding oppressive structures is a critical step toward a more robust future of nursing.

Are Digital Clinics the Future of Persistent Pain Treatment?

The societal and economic burden of chronic pain has been increasing in recent years, with a 2018 British Pain Society study estimating 8 million adults in the UK to be suffering from moderate to severely disabling chronic pain. The ongoing COVID-19 pandemic has exacerbated this issue, with massive increases in treatment waiting times and an increase in prevalence of persistent pain observed. As a result, the problems associated with chronic pain treatment mentioned earlier have only been further exacerbated by the ongoing COVID-19 pandemic. Recent rapid advance in technology have led to the emergence of digital clinics, an alternative healthcare delivery method. Several studies have shown the effectiveness of digital clinics on reducing waiting times, patient costs and increasing satisfaction levels. A survey conducted by Leva Clinic, UK’s first CQC registered, fully research-led, centralised, digital and MDT led chronic pain clinic provided some insight into patient’s views of treatment provided by digital pain clinics. Whilst feedback from patients and other studies have shown digital clinics to be a viable alternative of traditional clinics, it brings its own set of advantages and disadvantages. It is therefore paramount that clinics consolidate various aspects of current pain management practice and bring together MDT members to a single point of access to provide patients with treatment that unites the advantages of traditional and digital clinics. It is our hope and goal that with proper regulation and management, digital clinics should support reducing the global burden and prevalence of chronic pain.

Prioritising models of healthcare service delivery for a more sustainable health system: a Delphi study of Australian health policy, clinical practice and management, academic and consumer stakeholders.

Objectives Healthcare expenditure is growing at an unsustainable rate in developed countries. A recent scoping review identified several alternative healthcare delivery models with the potential to improve health system sustainability. Our objective was to obtain input and consensus from an expert Delphi panel about which alternative models they considered most promising for increasing value in healthcare delivery in Australia and to contribute to shaping a research agenda in the field. Methods The panel first reviewed a list of 84 models obtained through the preceding scoping review and contributed additional ideas in an open round. In a subsequent scoring round, the panel rated the priority of each model in terms of its potential to improve health care sustainability in Australia. Consensus was assumed when ≥50% of the panel rated a model as (very) high priority (consensus on high priority) or as not a priority or low priority (consensus on low priority). Results Eighty-two of 149 invited participants (55%) representing all Australian states/territories and wide expertise completed round one; 71 completed round two. Consensus on high priority was achieved for 59 alternative models; 14 were rated as (very) high priority by ≥70% of the panel. Top priorities included improving medical service provision in aged care facilities, providing single-point-access multidisciplinary care for people with chronic conditions and providing tailored early discharge and hospital at home instead of in-patient care. No consensus was reached on 47 models, but no model was deemed low priority. Conclusions Input from an expert stakeholder panel identified healthcare delivery models not previously synthesised in systematic reviews that are a priority to investigate. Strong consensus exists among stakeholders regarding which models require the most urgent attention in terms of (cost-)effectiveness research. These findings contribute to shaping a research agenda on healthcare delivery models and where stakeholder engagement in Australia is likely to be high. What is known about the topic? Healthcare expenditure is growing at an unsustainable rate in high-income countries worldwide. A recent scoping review of systematic reviews identified a substantial body of evidence about the effects of a wide range of models of healthcare service delivery that can inform health system improvements. Given the large number of systematic reviews available on numerous models of care, a method for gaining consensus on the models of highest priority for implementation (where evidence demonstrates this will lead to beneficial effects and resource savings) or for further research (where evidence about effects is uncertain) in the Australian context is warranted. What does this paper add? This paper describes a method for reaching consensus on high-priority alternative models of service delivery in Australia. Stakeholders with leadership roles in health policy and government organisations, hospital and primary care networks, academic institutions and consumer advocacy organisations were asked to identify and rate alternative models based on their knowledge of the healthcare system. We reached consensus among ≥70% of stakeholders that improving medical care in residential aged care facilities, providing single-point-access multidisciplinary care for patients with a range of chronic conditions and providing early discharge and hospital at home instead of in-patient stay for people with a range of conditions are of highest priority for further investigation. What are the implications for practitioners? Decision makers seeking to optimise the efficiency and sustainability of healthcare service delivery in Australia could consider the alternative models rated as high priority by the expert stakeholder panel in this Delphi study. These models reflect the most promising alternatives for increasing value in the delivery of health care in Australia based on stakeholders' knowledge of the health system. Although they indicate areas where stakeholder engagement is likely to be high, further research is needed to demonstrate the effectiveness and cost-effectiveness of some of these models.

Identifying alternative models of healthcare service delivery to inform health system improvement: scoping review of systematic reviews

ObjectiveTo describe available evidence from systematic reviews of alternative healthcare delivery arrangements relevant to high-income countries to inform decisions about healthcare system improvement.DesignScoping review of systematic reviews.Data sourcesSystematic reviews of...

Evaluations of healthcare delivery models in Australia: a scoping review protocol.

The aim of this review is to identify and describe the evidence base of published primary, comparative healthcare delivery model evaluations that require the employment of additional healthcare practitioners undertaken in Australia. In Australia, formal processes are utilized in assessing the value of new pharmaceuticals and medical services, which inform decisions on whether to list new items on the Pharmaceutical Benefits Schedule and Medicare Benefits Schedule, respectively. There are no formal processes to aid in decision making on the funding of new, evaluated healthcare delivery models. This imbalance undervalues the available evidence on healthcare delivery models, leading to the sub-optimal allocation of resources between new health technologies and new healthcare delivery models within the Australian health system. Eligible studies will evaluate healthcare delivery models that require the employment of additional healthcare practitioners (either to replace existing practitioners of another type or to provide new services). Studies must include a comparator to evaluate a condition of interest being treated using alternative healthcare delivery models, or no treatment, and will involve observation of outcomes over a similar period of time. Studies in any Australian setting will be included. Interventions aimed at primary preventions will be excluded. PubMed, Embase and CINAHL will be searched for articles published from 2008. One reviewer will review titles, and then two reviewers will independently review abstracts to identify eligible studies. One reviewer will extract data on study characteristics and design. The results of the data extraction will be presented in a table with examples of case studies.

Scoping review of Australian evaluations of healthcare delivery models: are we making the most of the evidence?

Objective Healthcare delivery models describe the organisation of healthcare practitioners and other resources to provide health care for a defined patient population. The organisation of health care has a predominant effect on the receipt of timely and appropriate health care. Efforts to improve healthcare delivery should be evidence informed, and large numbers of evaluations of healthcare delivery models have been undertaken. This paper presents a scoping review of Australian evaluations of new healthcare delivery models to inform a discussion of the appropriate use of such evidence to improve the efficiency and sustainability of the Australian health system. Methods A systematic scoping review was undertaken, following an a priori published protocol. PubMed, Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for primary comparative studies of healthcare delivery models undertaken in Australia and published between 2009 and 2018. Primary prevention studies, such as health promotion activities, were excluded. Results Of 14923 citations, 636 studies were included in the scoping review. Of these, 383 (60%) were randomised control trials. There were 18 clinical specialties in which over 10 evaluations were identified. Most models involved allied health practitioners or nurses. Conclusion Evaluations of healthcare delivery models provide important evidence that can be used to improve the use of the most important and costly assets of health systems, namely the healthcare practitioners who deliver health care. A nationally coordinated system is required to support local health services to assess the local value of alternative healthcare delivery models. What is known about the topic? The organisation and delivery of health care is continuously evolving in response to changes in the demand and supply of health care. New healthcare delivery models are often evaluated in specific locations, but it is not clear how such evidence informs the delivery of care in other locations. What does this paper add? This paper reports the findings of a scoping review of Australian evaluations of healthcare delivery models, highlighting the large and increasing number of such evaluations that have been published in the past 10 years. What are the implications for practitioners? Opportunities to improve health system efficiency are likely being lost due to the underuse of the available Australian evidence on new healthcare delivery models. Local health services need support to interpret such evidence in their local context, which could be provided through the development of a national framework for local evaluation.

Employers as Consumers of Healthcare.

Amazon, Berkshire Hathaway, and JP Morgan Chase shocked the industry with its announcement to join forces to cut healthcare costs and improve healthcare services for its employees. This is just the latest of employer efforts to disrupt the industry by the creation of alternative healthcare delivery networks that demonstrate high-value, low-cost services as compared with what traditional provider systems have to offer. What factors are behind this industry disruption, and what are the key implications for nurse executives?