Community Care Program Research Articles

Examining the impact of the veterans affairs community care program on mental healthcare in rural veterans: A qualitative study

AbstractObjectiveTo investigate provider and administrators' perspectives about the impact of the Department of Veterans Affairs' (VA) Community Care program on acute and residential mental health treatment of rural Veterans.Data Sources and Study SettingPrimary data were collected from participants via interviews. Participants were employees of VA Healthcare Systems located in Northern New England, or employees of non‐VA mental health treatment settings affiliated with VA in Northern New England.Study DesignThis study was informed by the Consolidated Framework for Implementation Research (CFIR), with Community Care as the implemented program. Individual, semi‐structured interviews were conducted.Data Collection/Extraction MethodsIndividual interviews were transcribed, coded deductively using the CFIR, and inductively coded by locating themes.Principal FindingsTwenty‐one people completed interviews. Commonly reported challenges included community programs not focused on Veterans' needs, poor coordination of care, communication challenges, and problems tracking Veteran care. Facilitators included increased access to care and strengthening coordination of care.ConclusionsThe VA's Community Care program can address the acute or residential mental health needs of Veterans in rural settings in some circumstances, however there are challenges to successful implementation.

Getting mammograms shouldn’t be so bumpy: Improving mammogram workflow in VA community care.

345 Background: The interplay between VA-based care and Community Care (CC) has long been important for continuity of patient care, though transitioning care between the two is often fraught with problems. Mammograms ordered at VA San Diego (VASD) are often deferred to Community Care; while this process should be smooth and seamless, it is instead challenging to navigate, with inconsistent rates of completion and results often not relayed to patients leading to delayed/missed diagnoses. We applied extensive QI methodology towards overhauling the VASD Community Care Mammogram workflow to improve rates of CC mammogram completion and results released to patients in a timely manner. Methods: We evaluated the CC mammogram workflow and implemented interventions at VASD from 01/2022-04/2023. An A3 was used for tracking process improvement. Using Lean Six Sigma process improvement strategies, we identified several problematic areas within the CC Mammogram workflow that are prone to errors and can lead to patient safety issues. Weekly meetings/interviews were set up to identify pain points with the primary users to allow for continuous process evaluation and improvement. Primary outcome was the frequency with which a CC mammogram order had mammogram completed and result released to patient within the expected timeframe by VISN 22 metrics (BIRADS 0,3,4,5,6 <7 days and BIRADS 1,2 <14 days to notification). Results: Process mapping of the VASD CC mammogram process revealed significant waste and failure modes. Notably among these was the splintered tracking systems used across multiple users and lack of automated follow-up reminders. Multiple PDSAs involved standardizing workflow by developing an SOP that focused on standardization of tracking orders/results, creating automated task reminders, while also adding backup systems and double-checks. To centralize and standardize the patient tracking process, we repurposed the Coordinated Care Tracking System (CCTS), a VA-based tool that is used for tracking patients in other departments and creating reminders for follow up, while storing patient data in a centralized location. We also redesigned and streamlined the mammogram ordering menu within CPRS. Implementation of the above interventions increased monthly rates of mammograms completed and reported to patients in a timely manner from a median of 67.5% to 100% in all BIRADS groups by 10/2022, and sustained at 100% through 04/2023. Conclusions: Standardization of workflow and incorporation of CCTS software into the CC Mammogram process led to an appreciable improvement in rates of CC mammogram scheduling and timely result notifications. Improved tracking of CC mammogram patients has the potential to prevent unnecessary patient harm. It is worth considering whether CCTS and a similar standardized process should be incorporated into other CC programs, as these issues are not unique to VASD mammograms.

Increasing Access to Naloxone in Veterans Receiving Opioids Through Community Care

The United States is battling an opioid overdose epidemic, and Veterans are at almost double the risk compared to the general population. Veterans Health Administration (VHA) recognizes the critical role naloxone plays as a risk mitigation strategy in opioid prescribing; however, there was not a standardized process within the Kansas City VA Medical Center’s (KCVAMC) community care program. This quality improvement project included Veterans that received opioids through community care from 2022 to 2023. The Stratification Tool for Opioid Risk Mitigation and chart review were used along with descriptive statistics. Results found 11% (22 of 206) of Veterans were dispensed naloxone within one year prior to receiving their opioid prescription. This data indicated the importance of expanding access to naloxone in Veterans receiving opioids from community care providers. As a result of this data, the KCVAMC implemented an outpatient pharmacy protocol to dispense naloxone to appropriate Veterans that receive an opioid through the community care program. The protocol was initiated on March 29, 2023. From the end of March through 2023, naloxone dispensing for these Veterans increased from 11% to 67%.

Impact of VA Hematology/Oncology Clinical Pharmacy Practitioners in the Review of Community Prescriptions for Specialty Medications.

Within the US Department of Veterans Affairs (VA), eligible veterans can receive covered health care through the community care network. Many prescriptions for specialty medications made by community care prescribers are filled by outpatient VA pharmacies. Trained hematology/oncology clinical pharmacy practitioners (CPPs) review specialty medication prescriptions from community-based prescribers. This study's primary objective was to evaluate clinical interventions initiated by hematology/oncology CPPs at the Veterans Affairs North Texas Health Care System (VANTHCS) during their review of hematology/oncology specialty prescriptions from community care prescribers. A retrospective chart review of VANTHCS patients enrolled in the community care program with a specialty hematology/oncology prescription received and reviewed by a VA clinical hematology/oncology CPP was conducted for records from January 1, 2015, to June 30, 2023. The primary outcome was the number and types of clinical interventions. Secondary outcomes include the number of interventions accepted and/or denied by the prescriber and the financial implications of these interventions. Two hundred twenty-one specialty hematology/oncology prescriptions met the study inclusion criteria. VANTHCS hematology/oncology CPPs completed clinical interventions for 82 prescriptions (37%). Among those prescriptions, CPPs documented 97 clinical interventions. The most commonly documented interventions included managing/preventing a drug interaction (26%) and dose adjustment requests (25%). Hematology/oncology CPPs at VANTHCS are essential in reviewing anticancer medication prescriptions from community-based practitioners ; CPPs completed clinical interventions for more than one-third of the prescriptions and prescribers approved most of these interventions.

Equity in Access for Veterans in the VA Community Care Program

Equity in Access for Veterans in the VA Community Care Program

Spindle cell rhabdomyosarcoma: A study of demographics and socioeconomic factors using NCDB.

e23539 Background: Spindle cell rhabdomyosarcoma (SC-RMS) is a rare malignancy characterized by elongated spindle cells displaying eosinophilic and fibrillar cytoplasm, resembling smooth muscle fibers. SC-RMS is primarily diagnosed in children with particular involvement of the nasopharynx, parotid gland, nasal cavity, and paratesticular regions. Though surgical resection and chemotherapy are the current recommendations, definitive treatment guidelines remain unestablished. Because SC-RMS is a novel cancer type, evaluating the diagnostic trend of the disease has the potential to provide valuable insights into its epidemiology. An analysis of the National Cancer Database (NCDB) was conducted to identify the demographic factors associated with patients who have been diagnosed with SC-RMS. Methods: A retrospective cohort analysis of the 2004–2020 NCDB, using ICD-O-3 code 8912/3, included patients with a histologically-confirmed diagnosis of SC-RMS (N = 132). Demographic factors (age, sex, race, Hispanic status, educational attainment, insurance status, facility type, distance from facility, and Charles/Deyo score) were analyzed by descriptive statistics and incidence trends were interpreted in regression analysis. Results: A total of 132 patients with a confirmed diagnosis of SC-RMS were identified, with a declining incidence of diagnoses per year (R² = 0.4507). The average age of diagnosis was 33.9 years (SD = 27.2, Range = 1-90). SC-RMS was more commonly observed among males (63%), with a majority of patients being non-Hispanic (87%) and White (74.2%). The top primary site was the testis (20%). Most patients (83%) had a Charlson/Deyo comorbidity score of 0. The majority (69%) of patients received surgery as their primary treatment. Most patients were privately insured (49%) and resided in metropolitan areas with a population greater than 1 million (48%). More (29%) patients were in the highest quartile of income earners of $74,063 or greater. Patients were treated most often at an academic/research program (19%) or comprehensive community care program (12%). Patients lived an average of 68.2 miles (SD = 267.9, Range = 0.6 - 2403.1) from the treatment facility. Conclusions: To the best of our knowledge, this is the first NCDB analysis on SC-RMS. Our analysis revealed that the majority of SC-RMS patients were young males with primary involvement of the testis, supporting previous studies. Analysis of the socioeconomic factors of SC-RMS patients revealed that more patients were privately insured, resided in densely populated metropolitan areas, and were part of the top quartile of income earners. Further research is supported to better understand the impact of socioeconomic factors on diagnosis, treatment options, and overall mortality rates associated with SC-RMS.

Racial and Ethnic Differences in Health Care Experiences for Veterans Receiving VA Community Care from 2016 to 2021

BackgroundPrior research documented racial and ethnic disparities in health care experiences within the Veterans Health Administration (VA). Little is known about such differences in VA-funded community care programs, through which a growing number of Veterans receive health care. Community care is available to Veterans when care is not available through the VA, nearby, or in a timely manner.ObjectiveTo examine differences in Veterans’ experiences with VA-funded community care by race and ethnicity and assess changes in these experiences from 2016 to 2021.DesignObservational analyses of Veterans’ ratings of community care experiences by self-reported race and ethnicity. We used linear and logistic regressions to estimate racial and ethnic differences in community care experiences, sequentially adjusting for demographic, health, insurance, and socioeconomic factors.ParticipantsRespondents to the 2016–2021 VA Survey of Healthcare Experiences of Patients-Community Care Survey.MeasuresCare ratings in nine domains.Key ResultsThe sample of 231,869 respondents included 24,306 Black Veterans (mean [SD] age 56.5 [12.9] years, 77.5% male) and 16,490 Hispanic Veterans (mean [SD] age 54.6 [15.9] years, 85.3% male). In adjusted analyses pooled across study years, Black and Hispanic Veterans reported significantly lower ratings than their White and non-Hispanic counterparts in five of nine domains (overall rating of community providers, scheduling a recent appointment, provider communication, non-appointment access, and billing), with adjusted differences ranging from − 0.04 to − 0.13 standard deviations (SDs) of domain scores. Black and Hispanic Veterans reported higher ratings with eligibility determination and scheduling initial appointments than their White and non-Hispanic counterparts, and Black Veterans reported higher ratings of care coordination, with adjusted differences of 0.05 to 0.21 SDs. Care ratings improved from 2016 to 2021, but differences between racial and ethnic groups persisted.ConclusionsThis study identified small but persistent racial and ethnic differences in Veterans’ experiences with VA-funded community care, with Black and Hispanic Veterans reporting lower ratings in five domains and, respectively, higher ratings in three and two domains. Interventions to improve Black and Hispanic Veterans’ patient experience could advance equity in VA community care.

Effectiveness of a pharmacist-led, community group-based education programme in enhancing diabetes management: A multicentre randomised control trial

AimsThis study presents a protocol for the Pharmacy Integrated Community Care (PICC) program, meticulously designed to enhance Hemoglobin A1c (HbA1c) levels and augment knowledge about diabetes mellitus (DM) among individuals diagnosed with Type 2 Diabetes Mellitus (T2DM) in the Sarawak State of Malaysia. MethodsFrom 1 May to December 31, 2023, a prospective, multicenter, parallel-design randomised controlled trial will be conducted with two groups, each consisting of 47 participants. The intervention group will receive a structured, four-session group-based program guided by experienced pharmacists, focusing on medication adherence and diabetes management. The control group will follow the standard Diabetes Mellitus Adherence Clinic program. The primary outcomes of this study encompass enhancements in knowledge regarding diabetes medication management and adherence, followed by subsequent changes in HbA1c levels. ConclusionsThe successful implementation of the PICC program holds promise for enhancing health outcomes in the T2DM population, potentially leading to more effective diabetes management initiatives and better health practices in the community. Trial registration clinicaltrials.gov identifierNCT05106231.

Critical Changes in the Maternal Health Landscape: Community Care, Doulas, and Coverage

In this commentary, we present an overview of the accelerating trend toward community-based models for pregnancy care. Doula services, as part of community care programs, are the major target for new coverage changes. Obstetric professionals who include community care providers in their treatment plans can benefit from these local resources in the prenatal, birthing, and postpartum stages of patient management. Including community care programs may help achieve goals of improving health outcomes and health equity.

Relevance of a community care program from the perspective of its stakeholders: educational practices based on social responsibility

Educational desertation is an educational problem that affects part of the school-age population. In order to contribute to the reduction of these problems, there are several mentoring programs in support of children and adolescents that are developed from the public university, whose main objectives are aimed at strengthening the comprehensive training and increase the educational expectations of its participants to achieve their welfare. This qualitative-phenomenological study aims to understand the perspective of mothers and fathers on the relevance of a mentoring program in the academic area; a structured interview was used to collect data. The results obtained indicate that, through a series of identified categories, mothers and fathers are able to recognize the incidence of the program in the academic area, concluding that the program is relevant to achieve favorable results in school activities.

Appointment wait times for surgical care in the Veterans Health Administration and Community Care Program

BackgroundThe Veterans Health Administration has been criticized for long wait times; however, studies indicate that Veterans Health Administration wait times are shorter than those for the Veterans Health Administration’s Community Care Program. Previous studies have analyzed primary care wait times, but few have compared surgical specialties. MethodsUsing a publicly available data set of veteran appointments compiled from the Veterans Health Administration’s Corporate Data Warehouse, a nationally representative database containing 623,868 surgical consults from January 1 to June 30, 2021, mean differences in wait times between the Veterans Health Administration and the Community Care Program were calculated across surgical specialties. ResultsIn total, 49.6% of the surgical consults placed during the study period were for the Community Care Program. Across all surgical specialties, wait times were shorter in the Veterans Health Administration. Cardiothoracic surgery had the shortest mean wait times (23.1 days Veterans Health Administration; 30.0 days Community Care Program). The greatest difference in wait times was observed in plastic surgery, with Community Care Program appointments occurring 15.8 days later than Veterans Health Administration appointments on average. ConclusionAcross all surgical specialties, the Veterans Health Administration had shorter wait times than the Community Care Program during the study period.

188 Characteristics and outcomes of long-term care facility residents acutely admitted to hospital

Abstract Background Long-term care facility (LTCF) residents represent the frailest members of society and are three times more likely to attend the Emergency Department (ED) than older persons residing in the community. They are also more likely to suffer adverse events when admitted to hospital. This study aims to describe the profile of LTCF residents admitted to hospital in order to inform the implementation of a new nursing home liaison service as part of the Enhanced Community Care program. Methods All LTCF residents with acute admission to a model four hospital in 2022 were identified through the Hospital In-patient Enquiry (HIPE) database, and address of residence was verified using the Integrated Patient Management System (IMPS). Demographic and outcome data including International Classification of Diseases (ICD-10) diagnosis, Length-of-Stay (LoS), in-hospital complications, and mortality were analysed retrospectively. Results There were 724 ED attendances, resulting in 447 acute admissions by 327 residents. The majority of residents (63%, n = 281) arrived to the ED outside of normal working hours. The average age was 84 (range 46–102), and 60% (n = 194) were female. Most were admitted with infection (50%, n = 225), followed by fall with a fracture (16%, n = 70). The median LOS was 8 days (range 0.5–112), and 11% (n = 37) of residents died in hospital. Complications were common with 27% (n = 120) suffering from delirium, 8% (n = 37) falling, and 7% (n = 33) contracting Covid-19 in hospital. Conclusion LTCF residents frequently present with acute unscheduled care episodes. Around 40% of LTCF residents attending ED are not admitted, but those who are have a significant LoS fraught with complications. This study will inform the implementation of the nursing home liaison service with strategies aimed at reduction in potentially avoidable admissions, and alternative provisions of care targeted at common reasons for hospitalisation in this group.

Does a Community Care programme reach a high health need population and high users of acute care hospital services in Melbourne, Australia? An observational cohort study

ObjectiveThe Community Care programme is an initiative aimed at reducing hospitalisations and emergency department (ED) presentations among patients with complex needs. We aimed to describe the characteristics of the programme...

커뮤니티 케어에서 방문약료 경험에 관한 사례 연구

As our society enters an aging society, community care is emerging to enable the elderly to spend the rest of their lives in their own neighborhoods. This is a case study of pharmacists who provided home-based pharmaceutical services as part of the leading community care programs in Jeonju and Cheonan city. By interviewing pharmacists who provided home-based pharmaceutical services, we identified the status of pharmaceutical services in community care based on their experiences. Cheonan city has provided pharmaceutical services for poly-pharmacy users, visiting them three to four times a year, and most of the initial recipients have been retained. Jeonju city has provided three types of pharmaceutical services: medication counseling, medication counseling during the transition period after discharge, and medication counseling for diabetics. Both medication counseling and the discharge transition period service were provided twice per patient. The services provided were medication reorganization and medication counseling. The pharmacist thought that they had a better understanding of the senior and could focus on patient care. They had difficulty in preparing for the service in advance due to inadequate records of medication history, and medication reconciliation, and needed various contents to increase patient interest and pharmacist expertise. In order for the visiting pharmacy program to operate more effectively in community care in the future, it is necessary to increase the effectiveness of visiting pharmacy program by establishing an information-sharing platform and developing and disseminating various visiting pharmacy program.

Lessons learned from the hospital to home community care program in Singapore and the supporting AI multiple readmissions prediction model

AbstractIn a prior practice and policy article published in Healthcare Science, we introduced the deployed application of an artificial intelligence (AI) model to predict longer‐term inpatient readmissions to guide community care interventions for patients with complex conditions in the context of Singapore's Hospital to Home (H2H) program that has been operating since 2017. In this follow on practice and policy article, we further elaborate on Singapore's H2H program and care model, and its supporting AI model for multiple readmission prediction, in the following ways: (1) by providing updates on the AI and supporting information systems, (2) by reporting on customer engagement and related service delivery outcomes including staff‐related time savings and patient benefits in terms of bed days saved, (3) by sharing lessons learned with respect to (i) analytics challenges encountered due to the high degree of heterogeneity and resulting variability of the data set associated with the population of program participants, (ii) balancing competing needs for simpler and stable predictive models versus continuing to further enhance models and add yet more predictive variables, and (iii) the complications of continuing to make model changes when the AI part of the system is highly interlinked with supporting clinical information systems, (4) by highlighting how this H2H effort supported broader Covid‐19 response efforts across Singapore's public healthcare system, and finally (5) by commenting on how the experiences and related capabilities acquired from running this H2H program and related community care model and supporting AI prediction model are expected to contribute to the next wave of Singapore's public healthcare efforts from 2023 onwards. For the convenience of the reader, some content that introduces the H2H program and the multiple readmissions AI prediction model that previously appeared in the prior Healthcare Science publication is repeated at the beginning of this article.

Michigan Market Referral Coordination Initiative: a Regional Market Approach to VA Specialty Care

BackgroundThe Maintaining Internal Systems and Integrated Outside Networks (MISSION) Act of 2018 was created in response to reports of prolonged wait times for veterans accessing health care within the Veterans Affairs (VA) system. In Michigan, the MISSION Act Community Care Program led to an increased number of veterans receiving specialty care outside the VA system, in part due to the complicated process of coordinating specialty care within the VA system. From 2018 to 2020, the percentage of veterans referred to the VA Ann Arbor Healthcare System (AA) for specialty care from its two referring facilities, Battle Creek VA Medical Center (BC) and Saginaw VA Healthcare System (SAG), decreased from 54.4 to 27%.ObjectiveImprove the number of Michigan veterans choosing VA specialty care.InterventionIn 2021, three VA facilities in Michigan (AA, BC, and SAG) created a market-level referral system named the Michigan Market Referral Initiative (MMRCI). This unique approach used a centralized nurse-driven team to manage specialty referrals, working directly with the veteran to explore both VA and community care (CC) options.Main MeasuresReferrals triaged and acceptance rates for VA care were tracked. The localized Standard Episode of Care model was used to estimate cost savings. Post-intervention AA patient wait times were compared to local CC wait times.Key ResultsIn the 14 months after implementation of the MMRCI, the rate of veteran retention increased by 32.4%. The estimated dollars retained within the VA by MMRCI efforts was $24,105,251 as of 7/1/2022. Post-intervention AA wait times were superior to community care except in 3 specialties.ConclusionsThis multifacility effort is an example of a highly coordinated, veteran-centered collaboration that has led to successful retention of veterans within the VA system with resultant large-scale cost avoidance and comparable clinic wait times. Focusing on central care coordination and veteran engagement in the referral process are keys to its success, along with leveraging existing referral patterns between nearby VA facilities. This model could be extrapolated to other VA markets throughout the country where similar relationships exist.

Changes in the Rate of Emergency Presentation in Patients with Functional Neurological Disorder Attending a Long-term Community Care Program for FND

IntroductionPatients with Functional Neurological Disorder have a high return rate to Emergency Rooms.ObjectivesTo assess possible changes in Emergency Room presentation rates in patients with Functional Neurological Disorder following their attendance of specialized long-term multidisciplinary treatment and rehabilitation program.MethodsSeventy-two adult patients with Functional Neurological Disorder were included. These patients were consecutive referrals accepted for ongoing specialist FND treatment.The total number of Emergency Room presentations in the year prior to program admission was obtained from central health records. Patients were provided ongoing treatment for one year, during which the number of ER presentations was monitored. Patients received one or more of the following treatment modalities: psychoeducation, psychological therapy, psychologically informed physical and occupational rehabilitation and psychopharmacological treatments.We subsequently compared high and low emergency service users. Low ER users are those with pre-treatment Emergency Room presentations of less than 3 per year. High emergency service users are those who presented to the emergency room 3 or more times per year before the start of their treatment.ResultsThe mean emergency room presentation per year in the year leading to patients referral was 2.6 per patient, SD 9.4; dropped to 1.2 emergency room presentations per year, with a standard deviation of 4.4 in the year following the start of treatment. The difference was statistically significant (p= 0.02).There was a strong positive correlation between the pre and post-treatment number of presentations with a Pearson Correlation Coefficient of 0.976 (95% Confidence Interval 0.962 to 0.985).The reduction in emergency room presentations in both high and low-emergency service user groups was significant, with a mean difference of 12 ER visits a year in high-frequency emergency service users (p= 0.04) and a mean difference of 0.5 visits a year in low-frequency emergency service users (p < 0.001).ConclusionsOngoing specialist treatment and rehabilitation of patients with Functional Neurological Disorder significantly reduce their need for emergency room presentation, regardless of the treatment modality.Disclosure of InterestNone Declared

Implementing the Community Healthcare Network Model in Mid West community health care.

Integrated care, underpinned by a health and wellbeing approach, is central to Ireland's health service reform. This new Community Healthcare Network (CHN) model is in the process of implementation across Ireland as part of the Enhanced Community Care (ECC) Programme, a key deliverable of the Sláintecare Reform Programme that aims to 'shift left', ie change the way health care is delivered and bring more support closer to home. ECC aims to deliver integrated person-centred care, enhance Multidisciplinary Team (MDT) working, strengthen links with GPs and strengthen community supports. There are nine learning sites and 87 further CHNs.DeliverablesA new Operating ModelStrengthening governance and enhancing local decision-making through the development of a Community health network operating model, including a Community Healthcare Network Manager (CHNM), a GP Lead and Multidisciplinary Network Management Team.Enhancing primary care resources.Enhanced MDT workingProactive management of people with complex care needs in the community facilitated by the Multidisciplinary Team and new Clinical Coordinator (CC) and Key Worker (KW) roles.Redesign of the Clinical Team Meeting to allow virtual attendance and focused case discussion will facilitate GP attendance.Developing integrated care pathways between CHNs, Specialist Hubs (Chronic Disease and Frail Older Persons) and Acute Hospitals.Strengthening Community Supports, eg ALONE.Population Health ApproachPopulation health needs assessment utilising census data and health intelligence, local knowledge from GPs, PCTs, community services and service user engagement.Risk Stratification - resources applied intensively in a targeted manner to a defined population.Enhanced Health Promotion - addition of a Health Promotion and improvement officer to each CHN and the Healthy Communities Initiative, which aims to implement targeted initiatives to tackle challenges within specific communities, eg smoking cessation, social prescribing.Key enablers for implementationAppointment of a GP lead in all CHNs is essential to strengthen relationships and bring GP voice to health service reform.The CHN model has the potential to support the delivery of integrated care, providing opportunities for enhanced MDT working by identifying key personnel (CC, KW and GP lead) to support effective MDT functioning.Redesign of the clinical team meetings will support GP involvement and enhance collective decision making and joint working.Population risk stratification is necessary to deliver targeted services. CHNs need to be supported to carry out risk stratification. Furthermore, this is not possible without strong links with our CHN GPs and data integration.An integrated community case management system that can 'talk' to GP systems is a critical enabler for integration. The Centre for Effective Services completed an early implementation evaluation of the 9 learning sites. From initial findings, it was concluded that there is an appetite for change, particularly in enhanced MDT working. Key features of the model, such as the introduction of the GP lead, clinical coordinators and population profiling, were viewed positively. However, respondents perceived communication and the change management process as challenging.

Mortality and Excess Life-years Lostin Patients with Schizophrenia under Community Care: A 5-year Follow-up Cohort Study.

The mortality rate is a general indicator with which to measure care and management of schizophrenia. This cohort study evaluated the standardized mortality ratios of all-cause mortality and life-years lost in patients with schizophrenia under a community care program. The database of our study was obtained from the National Community Care Program System for Severe Mental Disorders. A total of 99,214 patients diagnosed with schizophrenia were enrolled before December 2014 and followed between 2015 and 2019. A total of 9483 patients died. Crude mortality rates (CMRs) and standardized mortality ratios (SMRs) calculations were then stratified by natural/unnatural causes and major groups of death were standardized according to the 2010 National Population SMRs. The corresponding life-years lost at birth were also calculated by gender and age. The SMRs of patients with schizophrenia were significantly elevated during the study period with an overall SMR of 4.98 (95% CI, 2.67-7.32) in patients diagnosed with schizophrenia. Neoplasms, cardiovascular diseases, cerebrovascular diseases, external injuries, and poisonings were the most significant causes of death among patients with schizophrenia compared to the general population. The life-years lost of patients with schizophrenia were 15.28 (95% CI, 13.26-17.30). Males with schizophrenia lost 15.82 life-years (95% CI, 13.48-18.16) and females lost 14.59 life-years (95% CI, 13.12-16.06). Clearly, patients with schizophrenia under community care had a high mortality rate in our study, even though the mental health services system has been integrated into the general healthcare system in China to narrow treatment gaps in mental health for > 10 years. In terms of mortality outcome indicators, effective and quality mental health services still have a long way to go. The current study demonstrates the potential for increased prevention and treatment of individuals with schizophrenia under community care.

Comparative Evaluation Of Clinical Performance Of Giomer Based And Hydrophilic Resin Based Pit And Fissure Sealant In Primary Molars: A Split Mouth Clinical Trial

Aim: The current in vivo study is done to compare the retention, marginal staining, marginal integrity, and development of new carious lesions between a hydrophilic resin-based sealant and a giomer-based pit and fissure sealant on primary molars.Study Design:180 primary molars from 45 participants are taken into consideration in this randomised clinical investigation. 90 primary molars were sealed with Beautisealant (Group 1) and the other 90 primary molars were sealed with Embrace Wet Bond sealant (Group 2). To evaluate the clinical performance Modified USPHS criteria will be used and applied immediately following sealant application, at 3, 6, and 12 months. The entire set of data was gathered, enteredinto MS Excel, and examined with SPSS 16.0. The parameters of clinical evaluation were compared using the Fisher's exact test and the Pearson Chi-Square test.Result: At the end of 12 months, 75.9% of group 2 primary molars still had sealants in place, compared to 26.2 percent of group 1, which is statistically significant (p.001). Conclusion: Hydrophilic sealants may be employed as efficient fissure sealants, particularly in children who are at high risk for tooth decay, overly salivate, are physically and intellectually challenged, have partially erupted molars, and for children enrolled in community care programs.