Collaborative Agreements Research Articles

What challenges exist within the child welfare system in meeting the health needs of children in care?

Abstract From society’s perspective, the goal of societal care is to protect disadvantaged children and provide them with improved opportunities. In the realm of social care, the child welfare system takes the place of parental responsibilities to safeguard children’s well-being and developmental needs, including their health. However, while holding child welfare agencies responsible, national legislation often lacks specific methods for fulfilling this mandate. Over the years, evidence has shown that limited health care access and unmet health needs often endure in care. In Sweden, efforts to address the issue include mandatory health assessments upon entry into care and collaborative agreements between social services and health care sectors. However, recent studies reveal that only one-third of children undergo these assessment, and collaborative agreements remain lacking in many local authorities. This suggests that additional legal requirements do not offer a straightforward solution. Dr Forsman, with a background in social work, will discuss the child welfare system’s responsibilities and the traditional reliance on social workers and foster carers to address health needs and coordinate care. What are the underlying barriers to successful advocacy and comprehensive health care coordination within the child welfare system? How can the system better respond to the health needs of children in care?

When Successful Action Research is not Legitimized as Scientific Contribution by the Central Sponsors: How can Morten Levin’s Three Pillars of Action Research Support the Arch of Research Collaboration between Large Public Organizations and Universities?

AbstractMorten Levin’s work on Action Research (AR) clearly stated that the three pillars participation, action and research was equally important. During his long practice as an AR pioneer, he campaigned for the legitimacy of AR within academia. In this paper we investigate how AR is perceived as sound research within a large and distributed organization. We present a retrospective case study based on a research collaboration between UiT The Artic University of Norway (UiT) and the Norwegian Labour and Welfare Organization (NAV), that fostered an AR project together, ‘Work inclusion, learning and innovation’ (ALIN), but later led to the termination of the collaboration agreement. The ALIN project fulfils all the criteria for being a successful AR project in terms Levin’s action, research and participation criteria. However, external audit and central NAV actors had different expectations of successful institutional research collaboration. Through our case we illustrate several conflict dimensions within the three AR pillars that must be challenged to strengthen the legitimacy of AR. The debate on rigour and relevance should not be limited to academic fields and include various actors and decision makers within large and distributed organizations.

An integrated approach to enhance vaccine uptake in chronic patients – the VacciNetwork project

Abstract Issue/problem Individuals with chronic illnesses are at a higher risk of infections and their complications. Vaccinations are crucial in reducing this risk and their integration in chronic care pathways can enhance vaccine uptake, but it requires a collaborative approach and increased awareness in care personnel, caregivers and patients. Description of the problem The Local Health Authority of Rome 2 (ASL Roma 2, with approx. 1.3 million residents) initiated an active promotion plan for recommended vaccinations in chronic patients in January 2023, and a Clinical Vaccinology Workbook was produced to guide healthcare workers in promoting vaccinations across various care settings. The plan aims to establish collaborative agreements with hospitals and territorial structures that manage these patients, integrating vaccination plans with clinical and healthcare pathways for a more holistic approach to chronic disease management, a model that could benefit similar populations globally. Results Data was extracted from administrative databases regarding vaccinations performed in 2022 and 2023 on fragile subjects, i.e., those with a marked ‘risk condition’, aged ≥18 years. The results showed that vaccine uptake was more than doubled (6675 vs. 2041; +227%). Notably, vaccinations rose among those with oncological-hematological diseases (+212%), asplenia (+185%), chronic kidney failure or on dialysis (+190%) and those with an HIV infection (+160%). Increases were also significant in other immunocompromised conditions (+194%). Lessons The practice underlines the importance of targeted vaccination programs within chronic care management. Collaborative healthcare frameworks can significantly improve vaccination rates, reducing the burden of infectious diseases in high-risk populations. These results underscore the potential applicability of such a model in other regions and countries, highlighting the universal relevance of integrated healthcare solutions. Key messages • Collaborative, integrated frameworks between clinical and vaccination services can represent a model for increasing vaccine uptake in chronic disease patients. • Strategic partnerships and education in healthcare settings can improve vaccination rates and contribute to more holistic chronic disease management.

A National Survey of Pharmacist Involvement in Hepatitis C Virus Management in the United States.

Models estimate that the United States will not meet its 2030 hepatitis C virus (HCV) elimination goal. Engagement of healthcare providers including pharmacists is critical for HCV elimination efforts. We aimed to characterise the involvement of pharmacists in HCV management. The study design was a cross-sectional survey. Investigators sent the questionnaire to pharmacy and HCV organisations' listservs and limited responses to licensed pharmacists with direct patient care. Questions assessed setting, HCV screening, prescribing, and management; and opinions, and perceived barriers and facilitators to pharmacists' HCV management. Two hundred and nine survey respondents across 45 states reported managing 24 patients/month, with 5.3 (±4.4) years' experience in HCV, and identified pharmacist-managed HCV at their site since 2013 (±5.8 years). Most practice at academic medical centres (29%, 58/203) under collaborative practice agreements (67%, 127/189), as ambulatory care pharmacists (70%, 131/187), in primary care (50%, 65/131). Many pharmacists provide screening, linkage to care, and/or referral (81%, 157/194); 99.5% (190/191) perform treatment evaluation and selection; 98% (180/183) provide treatment education, 93% (171/183) initiate treatment, and 90% (162/180) provide on- and/or post-treatment monitoring. Respondents indicated collaboration with prescribers as most helpful in their role in HCV management, whereas lack of reimbursement was a main barrier. Satisfying components include HCV cure, care and education provision; frustrations include socioeconomic factors impeding patients' follow-up and prior authorisations/insurance barriers. Survey results show the variety of pharmacists' roles in direct HCV patient care and may be used to increase other providers' awareness of pharmacists' services and contributions to HCV elimination efforts.

Open spaces and emergent dwellings. Innovative solutions to sustainable renovation of student housing.

Abstract The paper aims to report the research results that deal with the theme of educational open spaces such as schoolyards or student housing, framing it in an environmental dimension capable of enhancing the existing identity and landscape quality elements, at the same time responding to climatic vulnerabilities, but also to new needs of users, with adequate performance responses. The proposed research is part of a scientific collaboration agreement developed aim of supporting it in the field of environmental issues and innovative technologies for student housing with Agenzia del Demanio at the end to write guidelines for spatial functional, technological and environmental aspects of its sustainable design of heritage to be converted into student housing. University student living is an evolving form of housing, subject to significant investment and design experimentation. In addition to the issue of housing, the open space related to student housing even in the face of emergent dwelling becomes a continuation of housing and therefore cannot be underestimated. The proposed methodology from best practice highlights a new demand framework useful for the development of the guidelines of which an excerpt concerning open space is proposed here.

Raising data availability and quality for improved disruption and carbon footprint management through a novel approach to primary data sharing: Virtual Watch Tower / VWT

Abstract The global supply chain and logistics industry is a self-organizing ecosystem consisting of numerous actors that work together to move goods from end to end. The different stakeholders involved are usually interdependent organizations, like freight forwarders, carriers, terminals, and homeland security agencies and information exchange between them is required to coordinate the activities along the individual transport chains. However, the exchange of information has often been analog, flawed, late, and incomplete. New circumstances, like unprecedented supply chain disruptions, new regulatory requirements around greenhouse gas (GHG) emissions, and generally growing shipper expectations create an urgent need for improved data sharing between actors. New technologies, like digital platforms, networks, and architectures as well as social media, mobile, analytics, cloud, and internet of things (SMACT) have brought some improvements, but not the required holistic digital perspective required or expected. Averages and approximations are usually insufficient to close data gaps, e.g., only primary data allows for accurate GHG emission calculations. Primary data sharing is widely seen as the missing piece of the puzzle. Primary data is data from the source providing an accurate state and picture of a situation. Primary data sharing at scale requires a new form of digital collaboration. We propose a rethink of digital collaboration as a means for broader primary private data sharing for complete end-to-end datasets and data quality, particularly focusing on the sharing of data associated with both transport plans and progress made in the respective movements of goods for more better disruption and carbon footprint management through more accurate calculations of estimated times of arrival (ETA) and GHG emissions. We introduce an example for digital collaboration in end-to-end supply chains that is focusing specifically on primary data sharing. The new thinking around digital collaboration manifests itself in the Virtual Watch Tower / VWT initiative (www.virtualwatchtower.org). In 2022, RISE and Singapore Maritime Institute signed a collaboration agreement focused on innovation in shipping. The VWT initiative is the first collaborative project under the umbrella of this partnership. The VWT is led by RISE, A*STAR, and VTT. VWT is a community-driven, digitally empowered initiative, a cargo owner-driven, and terminal-centric approach for improved supply chain management. It is the users themselves who co-create and co-evolve the solution that they need. The initiative aims to create a community that shapes the digital tool (VWTnet) they need to reach the required higher levels of visibility. This, through primary data sharing across the supply chain ecosystem and between actors (VWT Users) participating in individual end-to-end transports (VWT Shipments). The VWT serves as an object of research to hone the new thinking and understand the implications of its implementation.

A Review of Studies on HIV Pre-Exposure Prophylaxis in Community Pharmacies in States with Restrictive Pharmacist Prescription Authority in the United States.

A systemic literature review was conducted to identify the primary literature that involved community pharmacy service and PrEP conducted in states that do not have expanded pharmacist prescriptive authority between 2000 to 2024. Ten publications were identified, describing nine studies, including four interview and survey studies, three intervention reports, and two ongoing clinical trials. None of these studies have a control group. Most pharmacists provide PrEP services in the community through a collaborative practice agreement with a primary care provider. Future clinical studies with randomized controlled designs are required to test novel strategies in the education and implementation of pharmacy-led PrEP services in a community pharmacy setting to increase PrEP access.

The Diary of the Sky as a methodological strategy to teach Astronomy in Elementary School

The aim of this paper is to describe some activities undertaken at different phases of a broader research project named “The Northern and Southern Skies: Teaching astronomy in schools”. This project is a collaborative agreement between São Paulo State University (Bauru Campus, São Paulo, Brazil) and La Sapienza Università (Rome, Italy). The project aimed to bridge the gap between the academic production in the field of astronomy education and the classroom experiences of elementary school teachers and their students. The project finds justification in the fact that elementary school teachers, in general, face significant challenges when teaching astronomy elements to their students. In this article, we describe some steps of this project and the teaching resource named Diary of the Sky and its implementation, starting with the translation of the original Il Diario del Cielo, in its Italian version, to Brazilian Portuguese (O Diário do Céu). The aforementioned Brazilian university offered in-service specialization courses to several elementary school teachers in the last few years (2018–2023), enabling them to interact with the dairy and understand key aspects of its methodology. Before using them, the Brazilian version was adapted to suit geographic local coordinates in the southern hemisphere—an opportunity for teachers in training to incorporate astronomical concepts into their planning. Throughout the academic year, students filled out their diaries on a daily basis. The Science Education Graduation Program at UNESP, along with teachers and researchers, acknowledged the value of this strategy and shared the data collected to be used in teaching courses at the masters and doctoral levels. Current studies on this methodology have now showed that the Diary of the Sky is a powerful and efficient tool for working introductory astronomy concepts with elementary students and training their respective teachers.

Unique model for pharmacist cross‐coverage in the ambulatory care setting

AbstractClinical cross‐coverage in ambulatory care pharmacy practice is currently lacking and can lead to gaps in patient care, lost revenue generation, and pharmacist burnout due to a lack of time and support for indirect patient care and non‐clinical activities. To address this need, a cross‐coverage model for a team of ambulatory care pharmacists practicing in diverse clinical settings was developed and is primarily supported by a single broadly‐trained pharmacist known as an ambulatory care generalist. Cross‐coverage from the ambulatory care generalist includes in‐person and virtual patient care as well as in‐basket management and is available to all clinic‐based pharmacists on the specialty and primary care team with a few select clinics involving a designated collaborative practice agreement. The cross‐covering pharmacist has been shown to positively impact productivity measures and components of pharmacist burnout. Widespread implementation of this cross‐coverage model has the potential to greatly impact pharmacy practice and patient care in the ambulatory care setting and increase sources of revenue.

Scientific collaborative within-group conduct, data-sharing, and publication agreements

Abstract As science becomes ever more collaborative, the mechanisms for working in large and more diverse groups become more necessary. In the present article, I explore the utility of within-group collaboration agreements on participant conduct toward other project participants, within-group data sharing, and authorship of published manuscripts for research groups. Such agreements can solidify the expectations of the interactions among collaborators, potential rewards, and a feeling of security for those involved in the projects. They could also lead to more productive and satisfying research, as well as improving the training of future scientists.

Abstract MP11: Evaluation of a Remote Patient Monitoring Hypertension Program with Telehealth Pharmacist Management in Nephrology Clinic Patients

Introduction: Remote patient monitoring (RPM) and physician-pharmacist collaborative models have potential in improving hypertension control. Herein, we report the effectiveness of a community based, self-measured blood pressure (SMBP) RPM program on BP control and healthcare utilization in a largely rural health system. Methods: A multidisciplinary team developed a self-measured blood pressure (SMBP) RPM program in central and northeast PA using a virtual platform with bluetooth-connected BP devices targeting patients with BP ≥140/90 mmHg seen in nephrology clinics. From 3/2022 to 9/2022, high BP notifications were transmitted to nephrologists. After 9/2022, BP notifications were transmitted first to pharmacists, who co-managed BP through collaborative practice agreements via telehealth. We captured pharmacist interventions by reviewing electronic health record documentation. Changes in SMBP over time and the effect of pharmacist interventions were analyzed using mixed effects models. All-cause hospitalizations and emergency room (ER) visits were compared in 6-month pre/post-enrollment periods. Results: A total of 205 patients (mean age 62.3y, clinic BP 146/84, 3.1 BP classes, 48% female, 53% CKD) were enrolled into the program and had ≥ 6 months follow-up data. SMBP control <140/90 improved from 30% during week 1 to 67% at 6 months and 74% at 12 months. Overall, systolic SMBP improved over the first 6 months with stronger effect on patients with higher baseline BP (baseline BP ≥150/100 mmHg: -3.3 mmHg/month (95% CI: -3.5, -3.1); baseline 140-149/90-99: -2.4 (95% CI: -2.6, -2.1) mmHg/month; baseline <140/90: -0.6 (-0.9, -0.4) mmHg/month). Pharmacist telehealth encounters were documented in 65% of patients; 46% had a BP medication adjustment; 37% had new BP medication classes, including 9% mineralocorticoid receptor antagonist. Pharmacist medication intervention was associated with greater decline in systolic BP over time (-1.3 mmHg/month; 95% CI: -1.6, -1.1). Comparing the 6 months pre vs. post-enrollment, patients experienced a reduction in hospitalizations (6.0% vs. 0%; Exact Mcnemar p=0.0005) and no difference in ER visits (14.9% vs. 12.9%; p=0.6). Conclusion: Participation in a nephrologist-pharmacist SMBP RPM program was associated with improvement in BP control and reduced hospitalizations. Future efforts are underway to refine delivery of this program for the largest impact on improving BP control.

Abstract P330: Next-Gen Hypertension Control: Integrating Clinical Pharmacists And Cutting-Edge EPIC Electronic Medical Record For Quality And Result Driven Approaches at Federally Qualified Health Centers

Hypertension management in Federally Qualified Health Centers (FQHCs) requires innovative and comprehensive strategies beyond traditional methods. This study explores a collaborative approach by integrating clinical pharmacists into the healthcare team and utilizing the EPIC Electronic Medical Record (EMR) system. The model addresses medical and non-medical health determinants, offering comprehensive treatment for underserved communities regardless of their ability to pay. We hypothesized that integrating clinical pharmacists would improve and sustain blood pressure control, resulting in more patients achieving their target health outcomes. As part of multidisciplinary teams, clinical pharmacists identify, track, and analyze patient data, manage medication therapies under collaborative practice agreements, and coordinate with other healthcare providers to ensure continuous care. By leveraging EPIC EMR’s data management and patient monitoring capabilities, clinical pharmacists use real-time data to tailor medication regimens, ensure timely interventions, and conduct follow-ups every 2 to 4 weeks via telemedicine or in-clinic visits until patients reach their goals. This approach enhances patient engagement and medication adherence, which is crucial for adequate blood pressure control and cost management. It also supports personalized care addressing medical needs, lifestyle, and socioeconomic factors affecting patient health. The study, initiated in January 2024, involves adult patients with hypertension at one of the largest FQHC in Houston, TX. Key performance indicators include the percentage of patients achieving target blood pressure levels, medication adherence rates, and the frequency of follow-up visits. Preliminary data from quarter 1, 2024, shows that out of 327 patients, 58% have had at least 2 consultations with a clinical pharmacist. Out of those patients, 46% reached blood pressure control below 140/90 mmHg, while 27% showed improvement toward their goal. This quality and result-driven approach elevates hypertension management standards, reduces health disparities, and enhances healthcare delivery within FQHCs. Clinical pharmacists have proven to be indispensable members of the healthcare team. This session aims to provide practical insights and strategies for healthcare professionals to implement similar models, paving the way for the future of hypertension care.

Impact of a diabetic retinal exam screening program on quality measure gaps at a family medicine practice

BackgroundDiabetic retinopathy is a common complication in people with diabetes, and annual screening is recommended by the American Diabetes Association. This annual exam is also a Health Effectiveness Data and Information Set quality measure. Barriers such as lack of access to healthcare or cost of specialist visits may impact the number of patients who receive these exams. ObjectiveThe objective of this study is to describe the impact of a diabetic retinal exam screening program at a rural family medicine center on the number of quality measure gaps resolved. Practice descriptionThis study occurred at a rural family medicine center in southwestern Pennsylvania with a medically underserved patient population. A pharmacist at the site holds board certifications in Advanced Diabetes Management and as a Diabetes Care and Education Specialist and manages diabetes through a collaborative practice agreement. Practice innovationA regional Medicaid plan provided a list of patients with a quality measure gap for an annual diabetic retinal exam and loaned a RetinaVue 700 Imager to take retinal photos. After screening eligible patients via phone, retinal exams were administered by student pharmacists and medical assistants to consenting patients over the course of 9 days. Images were then sent to an ophthalmologist to be interpreted. Evaluation methodsThe rate of quality measure gaps closed and satisfaction survey results are reported using descriptive statistics. ResultsA total of 61 patients were included in the analysis. This program closed quality measure gaps for 11 (18.0%) patients who were able to receive an in-office eye exam. ConclusionThis pilot project shows that offering in-office diabetic retinal exams may be an effective strategy to close quality measure gaps and provide access to screening among a medically underserved population.

Innovation and Commercialization Characteristics of Techno-Business Firms in Uganda: An Overview of Firm Processes, Strategies, and Challenges

The role of techno-business firms in shaping the innovation and commercialization processes in Uganda has been the focus of extensive research and analysis. The objective of this study is to provide a comprehensive understanding of the contributions of techno-business firms to the innovation and commercialization landscape in Uganda. To accomplish this, qualitative and quantitative research methods were employed using interviews and observational approaches. These methods involve gathering evidence, including observations and interviews with techno-business entrepreneurs. By examining the various factors that influence the growth of these firms, such as their approaches to Research and Development (R&D), marketing, and partnerships, this study sheds light on the ways in which techno-business firms drive innovation and commercialization in Uganda. This study indicates that R&D and Intellectual Property (IP) protection are vital components of firms’ innovation and commercialization initiatives. The study underscores the importance of grants or subsidies as the primary financing mechanism for firm activities. The study highlights that product or innovation development depends on collaborative agreements, adjustments to current products, and internal idea generation. This study reveals innovation and commercialization disparities and proposes remedies to bridge these gaps. This ultimately fosters transformative growth by enhancing industrial production and strengthening the connections between techno-business firms and the industrial sector

Revisiting research on the governance of interorganizational relationships

This essay re-examines the literature on the governance of interorganizational relationships, focusing on the insights of alliance research using transaction cost economics. Despite substantial progress, challenges arise because research has not devoted attention to some mechanisms of governance (i.e., administrative controls and supporting legal institutions) compared with others (i.e., incentives). Parties can develop bespoke collaborative agreements that mix and match various mechanisms of governance along these dimensions, rather than accessing a typical bundle commonly associated with a discrete organizational form. This conclusion challenges the iconic governance continuum and surfaces new methodological opportunities for this research stream. The essay also challenges what we think we know by identifying a variety of omitted variable problems that often crop up in governance research (e.g., focusing on the cooperative context of collaboration while not attending to the competitive context, excluding critical administrative structures when studying the interplay between contracts and trust, assuming transactional attributes are exogenous rather than endogenous to a search process, failing to account for shifting institutional supports for collaboration, etc.). By clarifying what we know and do not know about alliance governance, the essay identifies some pathways for developing more reliable, cumulative knowledge on interorganizational relationships.

Borne of necessity: pharmacy-based harm reduction and express sexually transmitted infection services

BackgroundHIV, hepatitis C virus (HCV), Sexually Transmitted Infections (STIs), and substance use disorder are interrelated epidemics. Augmented services to respond to this “syndemic” are hampered by shortages of health care workers, especially in rural areas. In an Indian Health Service hospital in rural Minnesota, the pharmacy sought to integrate harm reduction and express STI services into its scope of practice. ObjectivesProvide pharmacy-based harm reduction and express STI services to increase access to care for community members, especially those without a primary care provider. MethodsThe program was designed with input from tribal counterparts and internal medical staff. The pharmacy window was made the intake point for services for patient education, harm reduction materials, and STI testing and treatment. Collaborative practice agreements and standing orders greatly expanded the pharmacy’s ability to deliver care. Later in the program, the pharmacy was able to introduce patient incentives. ResultsFrom October 2022 to November 2023, the program had 500 visits from 101 unique patients with a median age of 36. Among users of the service, 71% did not have a primary care provider. Once patient incentives were introduced, express STI testing increased over 10-fold. The laboratory panels had a 44% positivity rate for either an STI or HCV. ConclusionsPharmacy can be an accessible and effective means of delivering harm reduction, STI, and HCV services. Patient incentives may greatly increase testing and detection of infectious diseases among patients who may otherwise not seek care.

Epidemiology of Homebound Population Among Beneficiaries of a Large National Medicare Advantage Plan.

Interest in home-based care is increasing among Medicare Advantage (MA) plans. The epidemiology of homebound MA beneficiaries is unknown. To determine the prevalence, characteristics, predictors, health service use, and mortality outcomes of homebound beneficiaries of a large national MA plan. Cross-sectional. National MA plan. Humana MA beneficiaries in 2022 (n = 2 435 519). Homebound status was assessed via in-home assessment using previously defined categories: homebound (never or rarely left home in the past month), semihomebound (left home with assistance, had difficulty, or needed help leaving home), and not homebound. Demographic, clinical, health service use, and mortality outcomes were compared by homebound status. In 2022, the overall prevalence of homebound beneficiaries was 22.0% (8.4% of beneficiaries were homebound, and 13.6% were semihomebound). In adjusted models, female sex (odds ratio [OR], 1.36 [95% CI, 1.35 to 1.37), low-income status or dual eligibility for Medicare and Medicaid (OR, 1.56 [CI, 1.55 to 1.57]), dementia (OR, 2.36 [CI, 2.33 to 2.39]), and moderate to severe frailty (OR, 4.32 [CI, 4.19 to 4.45]) were predictive of homebound status. In multivariable logistic regression, homebound status was associated with increased odds of any emergency department visit (OR, 1.14 [ CI, 1.14 to 1.15]), any inpatient hospital admission (OR, 1.44 [CI, 1.42 to 1.46]), any skilled-nursing facility admission (OR, 2.18 [CI, 2.13 to 2.23]), and death (OR, 2.55 [CI, 2.52 to 2.58]). The study period overlapped the tail end of the COVID-19 pandemic, and data were derived from a single national MA plan, which limits generalizability. Overall homebound prevalence in a national MA plan was 22.0% and was independently associated with increased health service use and mortality. Study findings can inform strategic initiatives to identify and manage care for homebound beneficiaries. Humana, under a collaborative research agreement with Johns Hopkins University.

Principles for delivering transformative co‐design methodologies with multiple stakeholders for achieving nature recovery in England

AbstractAchieving successful multi‐stakeholder collaboration for sustainable outcomes is complex. This paper provides key principles for future co‐design projects aimed at fostering an inclusive approach to research. These have been developed based on a novel methodology that co‐designed the essential components of a long‐term, collaborative agreement for a nature recovery scheme in England. Using an assortment of iterative, deliberative participatory methods, this research engaged a wide variety of stakeholders to produce a template agreement for an agri‐environmental policy. We demonstrate that a flexible, highly reflective approach resulted in positive engagement with previously marginalised stakeholders. The approach also successfully navigated the unequal power dynamics seen both within and between groups. Finally, multiple feedback loops allowed participants to continually build on previous interactions as they developed and reviewed the agreement. By drawing out the complexities of the co‐design process, this paper explains how co‐design efforts can produce potentially transformative outputs. We hope that the principles introduced here offer a useful starting point for those planning to undertake multi‐stakeholder co‐design.

Comparing South Dakota Pharmacist Perspectives of Pharmacy Services in Rural versus Urban settings

BackgroundAccess to healthcare services is a major barrier to residents of the rural state of South Dakota. As a highly accessible member of the healthcare team, outpatient pharmacists can play a key role in a patient's healthcare journey. There is a need to identify the unique barriers and facilitators pharmacists in both rural and urban areas face to maximize the impact of their role. ObjectiveThe objective of this work was to compare perceptions of rural and urban pharmacists regarding the facilitators and barriers to providing patient care in South Dakota. MethodsThis qualitative project highlights results from interviews and focus group sessions with a convenience sample of South Dakota pharmacists. Participants were recruited using a referral word-of-mouth system, contracts with healthcare market research agencies, newspaper advertisements, and posters displayed in public locations in South Dakota. Practice location was characterized as rural or urban based on United States Department of Agriculture definitions. Findings from interviews and focus group sessions were coded and analyzed using content analysis by two student researchers. ResultsParticipants included 12 rural-practicing and 21 urban-practicing pharmacists in South Dakota. In both rural and urban areas, key barriers included communication with providers (50% rural; 50% urban), lack of electronic health record access (25% rural; 14% urban), not enough staff (22% rural; 20% urban), and patient misunderstanding the scope of pharmacy (22% rural; 40% urban). Barriers specific to rural areas included time to provide services (22%), having smaller facilities (27%) and provider hesitation regarding collaborative practice agreements (29%). There were no urban-specific barriers. Facilitators specific to urban areas included frequent communication with patients (6.1%) and good quality support staff (9.1%). There were no rural-specific facilitators. ConclusionsNext steps include increasing awareness of pharmacy-based patient care services, researching further to identify the extent to which facilitators and barriers influence the ability to initiate and sustain pharmacy services in rural and urban areas, and providing support to pharmacies to overcome barriers and leverage facilitators.

Initial study of the Palu-Parigi By-pass road policy in Central Sulawesi Province, Indonesia

This research aims to do the assessing the feasibility of the Public-Private Partnership project in investing in the construction of the Palu-Parigi By-pass road through a PPP financing scheme, thereby providing opportunities for the private sector to participate in the provision of special road infrastructure. In this context, experimental criteria for determining Value for Money (VFM) are applied using the PPP model, to evaluate projects. The main objective also emphasizes the provision of greater VFM Goods through private financing, through conventional methods that are economical, efficient and effective. Furthermore, financial performance measurement reports apply several methods, including Payback Period (PP), Net Present Value (NPV), and Internal Rate of Return (IRR) which determine the feasibility and time required for returns on invested capital. The previous Economic Feasibility Study of the Palu-Parigi By-pass Road Construction project also showed an EIRR value of 20.1% in 2014, illustrating the economic development of this work. In connection with the limitations currently faced by the Regional Budget Agency of Central Sulawesi Province, the next PPP scheme is recommended for road construction by prioritizing infrastructure completion after the 28 September 2018 earthquake and the COVID-19 pandemic. The DBFMT (Design–Build–Finance–Maintenance–Transfer) model was also applied to the project, with GCA responsible for design, construction, financing, periodic maintenance and transfer at the end of the collaboration agreement.