Component Of Service Provision Research Articles

Impact of early telephone contact on 3-month follow-up rates following residential drug and alcohol treatment: A randomized controlled trial

Background: Routine outcome monitoring (ROM) is an important component of service provision and qualitity assurance procedures. However, a major logistical and financial challenge for organizations is successfully following up participants once they have left residential alcohol and other drug treatment. The aim of the current study was to assess the impact and effectiveness of an “early” follow-up contact and brief interview on subsequent 3-month ROM follow-up success. Methods: Participants were 800 clients attending specialist residential alcohol and other drug treatment provided by The Salvation Army. As part of routine outcome assessment procedures, all people attending these programs are asked to complete a 3-month follow-up assessment. Participants were randomly allocated either to the early contact condition (i.e., “early” 2-week follow-up contact prior to the 3-month follow-up assessment) or to the control condition (i.e., no “early” 2-week follow-up prior to the 3-month follow-up assessment). The primary outcomes were the proportion of participants who were followed up and surveyed at 3 months. Results: There were significantly higher follow-up rates at 3 months post discharge for participants in the early contact group (55.6%) compared with the control condition (46.1%). Although there were higher rates of 3-month follow-up for participants in the early contact group, rates of successful survey completion were not significantly different between the 2 groups. Conclusions: Including an early 2-week telephone call prior to the 3-month assessment increased the number of participants we were able to follow up at 3 months post discharge but did not improve the rate of survey participation at 3 months. The additional costs associated with this activity and the modest increase in follow-up rates need to be considered prior to organizations investing in these follow-up enhancement activities.

Experiences of parents of children with special needs at school entry: a mixed method approach

The transition from pre-school to kindergarten can be complex for children who need special assistance due to mental or physical disabilities (children with 'special needs'). We used a convergent mixed method approach to explore parents' experiences with service provision as their children transitioned to school. Parents (including one grandparent) of 37 children aged 4 to 6 years completed measures assessing their perceptions of and satisfaction with services. Semi-structured interviews were also conducted with 10 parents to understand their experience with services. Post transition, parents reported lower perceptions of services and decreased satisfaction than pre-transition. The following themes emerged from the qualitative data: qualities of services and service providers, communication and information transfer, parent advocacy, uncertainty about services, and contrasts and contradictions in satisfaction. The qualitative findings indicate that parents were both satisfied and concerned with aspects of the post-transition service provision. While the quantitative results suggested that parents' experience with services became less positive after their children entered school, the qualitative findings illustrated the variability in parents' experiences and components of service provision that require improvements to facilitate a successful school entry.

Can reproductive health voucher programs improve quality of postnatal care? A quasi-experimental evaluation of Kenya's safe motherhood voucher scheme.

This study tests the group-level causal relationship between the expansion of Kenya’s Safe Motherhood voucher program and changes in quality of postnatal care (PNC) provided at voucher-contracted facilities. We compare facilities accredited since program inception in 2006 (phase I) and facilities accredited since 2010-2011 (phase II) relative to comparable non-voucher facilities. PNC quality is assessed using observed clinical content processes, as well as client-reported outcome measures. Two-tailed unpaired t-tests are used to identify differences in mean process quality scores and client-reported outcome measures, comparing changes between intervention and comparison groups at the 2010 and 2012 data collection periods. Difference-in-differences analysis is used to estimate the reproductive health (RH) voucher program’s causal effect on quality of care by exploiting group-level differences between voucher-accredited and non-accredited facilities in 2010 and 2012. Participation in the voucher scheme since 2006 significantly improves overall quality of postnatal care by 39% (p=0.02), where quality is defined as the observable processes or components of service provision that occur during a PNC consultation. Program participation since phase I is estimated to improve the quality of observed maternal postnatal care by 86% (p=0.02), with the largest quality improvements in counseling on family planning methods (IRR 5.0; p=0.01) and return to fertility (IRR 2.6; p=0.01). Despite improvements in maternal aspects of PNC, we find a high proportion of mothers who seek PNC are not being checked by any provider after delivery. Additional strategies will be necessary to standardize provision of packaged postnatal interventions to both mother and newborn. This study addresses an important gap in the existing RH literature by using a strong evaluation design to assess RH voucher program effectiveness on quality improvement.

Cultural Barriers to the Transition from Product to Product Service in the Medical Device Industry

Manufacturing companies are increasingly moving up the value chain by expanding their value offering to include service components, namely Product Service Systems (PSS). Due to the fundamental differences between the provision of products and services, many struggle to effectively integrate the two into a single cohesive offering. This is particularly true of companies operating in the medical device field as, due to the high level of regulatory requirements and controls, implementation of the ‘soft' components of service provision is difficult. The aim of the research is to facilitate companies to move up the value chain from product to product-service provision. Once identified, barriers can then be directly addressed and overcome, thereby allowing the development of a cohesive PSS offering. This will be achieved by identifying existing cultural barriers in relation to the application of PSS strategy within a product-orientated business. This information can be used to facilitate the application of PSS models with produc-orientated companies. This paper details qualitative research, undertaken with eight product-orientated medical device companies and two service practitioners, which establishes, details and analyses the primary cultural barriers in relation to product to product-service transition. These cultural barriers are further extrapolated through a supporting literature research.

Addressing the Spiritual Needs of Hospitalized Asian Americans: Predictors of Satisfaction among a National Sample of Inpatients

Tailoring services to address patients' spiritual needs is widely recognized to be an important component of service provision in health care settings. Yet, despite the growth of the Asian American population, little research has examined predictors of Asian American patients' satisfaction with this process. To address this gap, the present study employed a national sample of Asian Americans (N = 2,102) to identify predictors of satisfaction with the manner in which their spiritual needs were addressed during hospitalization. The results indicate that nursing, visitors, the discharge process, room quality, and food service played significant roles in satisfactorily addressing Asian American patients' spiritual needs. The implications are discussed for social workers as key players in the health care team and administrators of the discharge process.

Assessing Cognitive Functioning in Older Patients: The Why, Who, What, and How

In the coming years, speech-language pathologists (SLPs) can expect the numbers of older patients on their caseloads to increase. Epidemiological data indicate that the elderly represent one of the fastest growing segments of the U.S. population as national life expectancy continues to increase (U.S. Census Bureau, 2011). Unfortunately, as people age, they become more vulnerable to medical conditions and diseases (e.g., hypertension, Alzheimer's disease, Parkinson's disease) that compromise the integrity of their brain structures and functioning (Alzheimer's Association, 2011; Roger et al., 2010). These conditions and diseases negatively affect our cognitive and communication abilities. In this article, I will focus on cognitive assessment, an important component of service provision to older patients. More specifically, I will review the rationale, issues, and procedures pertaining to evaluating attention, memory, and executive functioning abilities in older patients.

Mobile Rehabilitation: Eine Innovation in der ambulanten medizinischen Rehabilitation

Domiciliary rehabilitation is an innovative form of outpatient medical rehabilitation. All components of service provision are delivered in the rehabilitant's home by a multidisciplinary team headed by a physician. The key context factors in the rehab process can be taken into account firsthand. The target group of domiciliary rehabilitation consists of multimorbid patients with severe functional limitations and complex assistance needs, whose rehabilitation options would be poor without this outreach service. Here, as suggested by the WHO concept of functional health, the interaction between health condition and environmental factors is kept in view much better than in other forms of rehabilitation. The positive effects and the efficiency of the rehabilitation measures provided can be assessed very well at a high descriptive level. This fact had been a precondition for legal establishment of domiciliary rehabilitation as a regular service. Domiciliary rehabilitation not only complies with key demands in the health and social policy fields, such as priority of outpatient over inpatient treatment or rehabilitation to precede and accompany long term care, it also constitutes an alternative concept challenging the traditional inpatient rehabilitation approach. The patient, hence, no longer is to fit into the institutional framework of outpatient or inpatient rehabilitation, but the team will fit into the specifics of the patient's unique social and material situation.

Managing perinatal mental health disorders effectively: identifying the necessary components of service provision and delivery

Aims and MethodTo identify problems with the management of perinatal mental health disorders and areas where improvements are thought-required. The study used qualitative methods comprising focus groups with recovered patients and interviews with health professionals.ResultsIssues we identified included a lack of knowledge, skills, integrated working, poor access to resources and ill-defined professional roles and responsibilities. Improving care and service provision requires the development of training and education programmes, care pathways and protocols, and referral guidelines and liaison services.Clinical ImplicationsDifficulties over managing perinatal mental illnesses occur at all levels of healthcare provision. Our findings confirm best practice recommendations which emphasise improved joint working and the provision of specialist services in all localities.

Women's Health Resources: Facilitating a Community of Care for Midlife Women

Since 1981 research has explored the role of women's health centres in providing health information and education to women in a non-traditional setting. These settings have been designed to provide more appropriate, and often more comprehensive, care by responding to the specific health issues and needs of women across the age continuum. The type of care and resources provided by these centres make a significant contribution to women's capacity for participation in decisions and action around their own, health. This article examines the service delivery and perceived roles of one such centre, the Women's Health Resources (WHR) centre in Calgary, Canada. Data for this paper were extracted from WHR evaluation forms for 199 midlife women seeking individual consultation, as well as personal interviews that were conducted with four female staff members. Clients of the WHR cited numerous reasons for seeking service at the centre, the most common being for emotional health care, nutritional consultation or more comprehensive information on a specific illness. Three major components of service provision at the centre were identified: information, psychological care and complementarity of services. Women used the information they gained from WHR services to aid in health decision-making and as a resource for empowerment in being partners in their own health. Clients noted that the WHR was a valuable source of additional information beyond what their own family physician and/or specialist were able to provide. The feminist and woman-centred care at WHR, in conjunction with the emphasis on education, offers an invaluable source of information and services for women. Through the shared experiences of both the clients and staff of this centre, this article provides an outline of how such services are perceived and utilized.

The need for effective assessment and management of pain among older people in care homes

The increasing number of older people requiring interventions for improved health and social care has been identified as a crucial challenge for the twenty-first century. The reported high prevalence of pain in older people in long-term care facilities has been described as a public health issue not only in the USA but also globally. Rather than merely extending life, the reduction of morbidity, ways of coping with disability, preventing incapacity, extending the quality of life and enhancing the functional independence of older people are identified as important components of service provision. In Britain, the number of people aged over 65 years has doubled in the last 70 years and the number of people over 90 years is expected to double in the next 25 years, which will increase the need for health care in the future. Estimates for the UK indicate that approximately 445 800 older people are currently resident in care homes. The UK government has recently pledged to provide high-quality care and treatment for this population, to treat older people with respect and dignity and to allocate fair resources for conditions that affect them, while simultaneously easing the financial burden of long-term care.

Patient Satisfaction: A Customer Service Approach

In health care, as in any service business, monitoring quality is an important component. Patient satisfaction, despite its measurement difficulties, is an excellent gauge of the institution's ability to delivery quality service. As part of quality improvement activities, the Division of Neurosciences at the Toronto Hospital measured patient satisfaction on various validated dimensions, then attempted to identify which components of service provision were key in determining patients' overall levels of perceived satisfaction with care. Results indicated that much of perceived quality and satisfaction was explained by the dimension of care which included prompt response to needs, organization, efficiency of care and communication. The authors recommend focusing improvement efforts on activities with the greatest potential to influence patient satisfaction.