Delivery Model Research Articles

Simulation Model of Precast Concrete Element Delivery on Time and Operational Costs of the Precast Yard in the Board Mill Construction Project

Simulation Model of Precast Concrete Element Delivery on Time and Operational Costs of the Precast Yard in the Board Mill Construction Project

Reanalysis of genomic data in rare disease: current practice and attitudes among Australian clinical and laboratory genetics services.

Reanalyzing stored genomic data over time is highly effective in increasing diagnostic yield in rare disease. Automation holds the promise of delivering the benefits of reanalysis at scale. Our study aimed to understand current reanalysis practices among Australian clinical and laboratory genetics services and explore attitudes towards large-scale automated re-analysis. We collected audit data regarding testing and reanalysis volumes, policies and procedures from all Australian diagnostic laboratories providing rare disease genomic testing. A genetic health professionals' survey explored current practices, barriers to reanalysis, preferences and attitudes towards automation. Between 2018 and 2021, Australian diagnostic laboratories performed over 25,000 new genomic tests and 950 reanalyses, predominantly in response to clinician requests. Laboratory and clinical genetic health professionals (N = 134) identified workforce capacity as the principal barrier to reanalysis. No specific laboratory or clinical guidelines for genomic data reanalysis or policies were identified nationally. Perceptions of acceptability and feasibility of automating reanalysis were positive, with professionals emphasizing clinical and workflow benefits. In conclusion, there is a large and rapidly growing unmet need for reanalysis of existing genomic data. Beyond developing scalable automated reanalysis pipelines, leadership and policy are needed to successfully transform service delivery models and maximize clinical benefit.

Is the Differentiated Service Delivery Model Suited to the Needs of People Living with HIV in Rwanda?

The primary goal of antiretroviral treatment is to improve the health of individuals with HIV, and a secondary goal is to prevent further transmission. In 2016, Rwanda adopted the World Health Organization's "treat-all" approach in combination with the differentiated service delivery (DSD) model. The model's goal was to shorten the time from HIV diagnosis to treatment initiation, regardless of the CD4 T-cell count. This study sought to identify perceptions, enablers, and challenges associated with DSD model adoption among PLHIV.This study included selected health centers in Kigali city, Rwanda, between August and September 2022. The patients included were those exposed to the new HIV care model (DSD) model and those exposed to the previous model who transitioned to the current model. Interviews and focus group discussions were also held to obtain views and opinions on the DSD model. The data were collected via questionnaires and audio-recorded focus group discussions and were subsequently analyzed.The study identified several themes, including participants' initial emotions about a new HIV diagnosis, disclosure, experiences with transitioning to the DSD model, the effect of peer education, and barriers to and facilitators of the DSD model. Participants appreciated reduced clinic visits under the DSD model but faced transition and peer educator mobility challenges.The DSD model reduces waiting times, educates patients, and aligns with national goals. Identified barriers call for training and improved peer educator retention. Recommendations include enhancing the DSD model and future research to evaluate its long-term impact and cost-effectiveness.

Primary contact physiotherapy for patients with suggested vestibulopathy for an Australian ENT clinic: a retrospective cohort study.

To examine the newly established role of a primary contact physiotherapist in an ENT clinic, in an Australian cohort and context, over two phases of development. A retrospective cohort study was conducted with data collected from a medical record audit. Over the study duration, the primary contact physiotherapist completed initial appointments with patients; follow-up appointments were subsequently conducted by medical staff. There was a 46 per cent reduction in patients with suggested vestibulopathy requiring an ENT medical review. This reduction could hypothetically increase to 71 per cent with follow-up primary contact physiotherapist appointments. Improvements in the service delivery model and a primary contact physiotherapist arranging diagnostic assessments could improve waitlist times and facilitate better utilisation of medical staff time. The primary contact physiotherapist can help in the management of patients with suspected vestibulopathy on an ENT waitlist. This is achieved through: a reduction of patients requiring ENT review, improvements to waitlist time and improved utilisation of medical specialists' time.

Personalization of E-Learning: Future Trends, Opportunities, and Challenges

Electronic learning (e-learning) has become one of the most influential trends in providing enhanced and easily accessible learning to users. However, in contrast to traditional e-learning systems that offer uniform content to all learners, personalized learning systems tailor educational materials and assessments to individual learners, ensuring a customized learning experience. Personalizing e-learning through artificial intelligence (AI) is beneficial in today’s diverse environment, where beginners can tailor the learning experience to suit their preferences and requirements. This paper focuses on the personalization of e-learning, exploring future trends, opportunities, and challenges through an in-depth survey of recent literature on the personalization of e-learning technologies such as extended reality (XR), virtual reality (VR), augmented reality (AR), and mixed reality (MR). Findings identify and propose that such tools should be included in curricula that support e-learning through personalized, adaptive, and delivery models.

Optimization of hybrid delivery by vehicle and drones

In this paper, we introduce the optimization of hybrid delivery by vehicle and drones. Hybrid delivery by vehicle and drones is advantageous for improving O2O last-mile delivery efficiency. However, vehicle stop selection and drone delivery sortie arrangement are challenging in the optimization of hybrid delivery by vehicle and drones because cyclic sorties and forward sorties jointly influence the total makespan of the delivery. To minimize the delivery makespan, an MILP model for hybrid delivery is formulated considering both the cyclic sorties and forward sorties of drones. In the proposed model, the intertwined influences of the flight times of cyclic and forward sorties and their further effects on total delivery makespan are depicted. Additionally, we introduce an ACO based on set covering for the selection of vehicle stops and a customized HGSADC for the arrangement of drone sorties. A study based on a simulated case and experiments based on 40 generated instances at different scales are explored to assess the optimization of hybrid delivery by vehicle and drones.

Data-Driven Exploration of National Health Service Talking Therapies Care Pathways Using Process Mining: Retrospective Cohort Study.

The National Health Service (NHS) Talking Therapies program treats people with common mental health problems in England according to "stepped care," in which lower-intensity interventions are offered in the first instance, where clinically appropriate. Limited resources and pressure to achieve service standards mean that program providers are exploring all opportunities to evaluate and improve the flow of patients through their service. Existing research has found variation in clinical performance and stepped care implementation across sites and has identified associations between service delivery and patient outcomes. Process mining offers a data-driven approach to analyzing and evaluating health care processes and systems, enabling comparison of presumed models of service delivery and their actual implementation in practice. The value and utility of applying process mining to NHS Talking Therapies data for the analysis of care pathways have not been studied. A better understanding of systems of service delivery will support improvements and planned program expansion. Therefore, this study aims to demonstrate the value and utility of applying process mining to NHS Talking Therapies care pathways using electronic health records. Routine collection of a wide variety of data regarding activity and patient outcomes underpins the Talking Therapies program. In our study, anonymized individual patient referral records from two sites over a 2-year period were analyzed using process mining to visualize the care pathway process by mapping the care pathway and identifying common pathway routes. Process mining enabled the identification and visualization of patient flows directly from routinely collected data. These visualizations illustrated waiting periods and identified potential bottlenecks, such as the wait for higher-intensity cognitive behavioral therapy (CBT) at site 1. Furthermore, we observed that patients discharged from treatment waiting lists appeared to experience longer wait durations than those who started treatment. Process mining allowed analysis of treatment pathways, showing that patients commonly experienced treatment routes that involved either low- or high-intensity interventions alone. Of the most common routes, >5 times as many patients experienced direct access to high-intensity treatment rather than stepped care. Overall, 3.32% (site 1: 1507/45,401) and 4.19% (site 2: 527/12,590) of all patients experienced stepped care. Our findings demonstrate how process mining can be applied to Talking Therapies care pathways to evaluate pathway performance, explore relationships among performance issues, and highlight systemic issues, such as stepped care being relatively uncommon within a stepped care system. Integration of process mining capability into routine monitoring will enable NHS Talking Therapies service stakeholders to explore such issues from a process perspective. These insights will provide value to services by identifying areas for service improvement, providing evidence for capacity planning decisions, and facilitating better quality analysis into how health systems can affect patient outcomes.

Neuropsychiatric Comorbidities and Psychotropic Medication Use in Medicare Beneficiaries With Dementia by Sex and Race.

Neuropsychiatric symptoms affect the majority of dementia patients. Past studies report high rates of potentially inappropriate prescribing of psychotropic medications in this population. We investigate differences in neuropsychiatric diagnoses and psychotropic medication prescribing in a local US cohort by sex and race. We utilize Medicare claims and prescription fill records in a cohort of 100% Medicare North and South Carolina beneficiaries ages 50 and above for the year 2017 with a dementia diagnosis. We identify dementia and quantify diagnosis of anxiety, depression and psychosis using validated coding algorithms. We search Medicare claims for antianxiety, antidepressant and antipsychotic medications to determine prescriptions filled. Anxiety and depression were diagnosed at higher rates in White patients; psychosis at higher rates in Black patients. (P < .001) Females were diagnosed with anxiety, depression and psychosis at higher rates than males (P < .001) and filled more antianxiety and antidepressant medications than males. (P < .001) Black and Other race patients filled more antipsychotic medications for anxiety, depression and psychosis than White patients. (P < .001) Antidepressants were prescribed at higher rates than antianxiety or antipsychotic medications across all patients and diagnoses. Of patients with no neuropsychiatric diagnosis, 11.4% were prescribed an antianxiety medication, 22.8% prescribed an antidepressant and 7.6% prescribed an antipsychotic. The high fill rate of antianxiety (benzodiazepine) medications in dementia patients, especially females is a concern. Patients are prescribed psychotropic medications at high rates. This practice may represent potentially inappropriate prescribing. Patient/caregiver education with innovative community outreach and care delivery models may help decrease medication use.

The impact of humanitarian aid on financial toxicity among cancer patients in Northwest Syria

IntroductionThe ongoing crisis in Syria has divided the country, leading to significant deterioration of the healthcare infrastructure and leaving millions of people struggling with poor socioeconomic conditions. Consequently, the affordability of healthcare services for the population has been compromised. Cancer patients in Northwest Syria have faced difficulties in accessing healthcare services, which increased their financial distress despite the existence of humanitarian health and aid programs. This study aimed to provide insights into how humanitarian assistance can alleviate the financial burdens associated with cancer treatment in conflict-affected regions.Materials and methodsThis research employed a quantitative, quasi-experimental design with a pre-test-post-test approach, focusing on evaluating the financial toxicity among cancer patients in Northwest Syria before and after receiving humanitarian aid. The study used purposeful sampling to select participants and included comprehensive demographic data collection. The primary tool for measuring financial toxicity was the Comprehensive Score for Financial Toxicity (FACIT-COST) tool, administered in Arabic. Data analysis was conducted using SPSS v25, employing various statistical tests to explore relationships and impacts.ResultsA total of 99 cancer patients were recruited in the first round of data collection, out of whom 28 patients affirmed consistent receipt of humanitarian aid throughout the follow-up period. The results of the study revealed that humanitarian aid has no significant relationship with reducing the financial toxicity experienced by cancer patients in Northwest Syria. Despite the aid efforts, many patients continued to face significant financial distress.ConclusionThe research findings indicate that current humanitarian assistance models might not sufficiently address the complex financial challenges faced by cancer patients in conflict zones. The research emphasizes the need for a more comprehensive and integrated approach in humanitarian aid programs. The study highlights the importance of addressing the economic burdens associated with cancer care in conflict settings and calls for a re-evaluation of aid delivery models to better serve the needs of chronic disease patients. The findings suggest a need for multi-sectoral collaboration and a systemic approach to improve the overall effectiveness of humanitarian assistance in such contexts.

Telehealth-Based Information Retrieval and Extraction for Analysis of Clinical Characteristics and Symptom Patterns in Mild COVID-19 Patients

Clinical characteristics of COVID-19 patients have been mostly described in hospitalised patients, yet most are managed in an outpatient setting. The COVID-19 pandemic transformed healthcare delivery models and accelerated the implementation and adoption of telemedicine solutions. We employed a modular remote monitoring system with multi-modal data collection, aggregation, and analytics features to monitor mild COVID-19 patients and report their characteristics and symptoms. At enrolment, the patients were equipped with wearables, which were associated with their accounts, provided the respective in-system consents, and, in parallel, reported the demographics and patient characteristics. The patients monitored their vitals and symptoms daily during a 14-day monitoring period. Vital signs were entered either manually or automatically through wearables. We enrolled 162 patients from February to May 2022. The median age was 51 (42–60) years; 44% were male, 22% had at least one comorbidity, and 73.5% were fully vaccinated. The vitals of the patients were within normal range throughout the monitoring period. Thirteen patients were asymptomatic, while the rest had at least one symptom for a median of 11 (7–16) days. Fatigue was the most common symptom, followed by fever and cough. Loss of taste and smell was the longest-lasting symptom. Age positively correlated with the duration of fatigue, anorexia, and low-grade fever. Comorbidities, the number of administered doses, the days since the last dose, and the days since the positive test did not seem to affect the number of sick days or symptomatology. The i-COVID platform allowed us to provide remote monitoring and reporting of COVID-19 outpatients. We were able to report their clinical characteristics while simultaneously helping reduce the spread of the virus through hospitals by minimising hospital visits. The monitoring platform also offered advanced knowledge extraction and analytic capabilities to detect health condition deterioration and automatically trigger personalised support workflows.

Collaborative and life cycle-based project delivery for environmentally sustainable building construction: views of Finnish project professionals and building operation and maintenance experts

PurposeThe energy performance gap (EPG) in building construction has been one of the major barriers to the realization of environmental and economic sustainability in the built environment. Although there have been a few studies addressing this issue, studying this topic with a special focus on the project delivery process has been almost overlooked. Hence, this study aims to address the EPG in building construction through the lens of collaborative and life cycle-based project delivery.Design/methodology/approachIn order to realize the objective of this study, the development of a theoretical framework based on the literature review was followed by a qualitative study in which 21 semi-structured interviews were conducted with Finnish project professionals representing clients, design/planning experts, constructors and building operation/maintenance experts to explore their views on the topic under study.FindingsThe findings reveal the project delivery-related causes of EPG in building construction. Moreover, the obtained results present a collaborative and life cycle-based delivery model that integrates project and product (i.e. building) life cycles, and it is compatible with all types of contractual frameworks in building construction projects.Research limitations/implicationsAlthough the findings of this study significantly contribute to theory and practice in the field of collaborative and sustainable construction project delivery, it is acknowledged that these findings are based on Finnish professionals’ input, and expanding this research to other regions is a potential area for further studies. Moreover, the developed model, although validated in Finland, needs to be tested in a broader context as well to gain wider generalizability.Originality/valueThe obtained results reveal the significance and impact of collaborative and life cycle-based project development and delivery on the realization of environmentally sustainable building construction.

A new service composition method in the cloud‐based Internet of things environment using a grey wolf optimization algorithm and MapReduce framework

SummaryCloud computing is quickly becoming a common commercial model for software delivery and services, enabling companies to save maintenance, infrastructure, and labor expenses. Also, Internet of Things (IoT) apps are designed to ease developers' and users' access to networks of smart services, devices, and data. Although cloud services give nearly infinite resources, their reach is constrained. Designing coherent and organized apps is made possible by integrating the cloud and IoT. Expanding facilities by combining services is a critical component of this technology. Various services may be presented in this environment based on the user's demands. Considering their Quality of Service (QoS) attributes, discovering the appropriate available atomic services to construct the needed composite service with their collaboration in an orchestration model is an NP‐hard issue. This article suggests a service composition method using Grey Wolf Optimization (GWO) and MapReduce framework to compose services with optimized QoS. The simulation outcomes illustrate cost, availability, response time, and energy‐saving improvements through the suggested approach. Comparing the suggested technique to three baseline algorithms, the average gain is a 40% improvement in energy savings, a 14% decrease in response time, an 11% increase in availability, and a 24% drop in cost.

Numerical modeling of ultrasound-triggered microneedle-mediated delivery of drug particles into bacterial biofilms

Ultrasonic microneedle patches, a class of ultrasound-driven transdermal drug delivery systems, are promising in addressing bacterial biofilms. This device has been proven to be more effective in treating Staphylococcus aureus biofilms than drug in free solution. However, there exists a notable gap in understanding how various excitation conditions and material parameters affect drug delivery efficiency. This study aims to fill this void by conducting an comprehensive multi-physics numerical analysis of ultrasonic microneedle patches, with the ultimate goal of enhancing drug delivery. First, we investigate the impact of various ultrasound frequencies on drug penetration depths. The findings reveal that local resonance can accelerate drug release within a shorter time window (first 1.5 h), whereas non-resonant frequencies enable more profound and prolonged diffusion. This information is crucial for medical professionals in selecting the most effective frequency for optimal drug administration. Furthermore, our investigation extends to the effects of applied voltage on temperature distribution, a critical aspect for ensuring medical safety during the application of these patches. Additionally, we examine how particles of different sizes respond to acoustic pressure and streaming fields, providing valuable insights for tailoring drug delivery strategies to specific therapeutic needs. Overall, our findings offer comprehensive guidelines for the effective use of ultrasonic microneedle patches, potentially shifting the paradigm in patient care and enhancing the overall quality of life.

Person-centered abortion care scale: Validation for medication abortion in the United States

ObjectiveMedication abortions now make up the majority of abortions in the US, with new service delivery models such as telehealth; however, it is unclear how this may impact patient experiences. The objective of the study is to adapt and validate a person-centered abortion care (PCAC) scale for medication abortions that was developed in a global South context (Kenya) for use in the United States. Study designThis study includes medication abortion patients from a hospital-based clinic who had one of two modes of service delivery: (1) telemedicine with no physical exam or ultrasound; or (2) in-person with clinic-based exams and ultrasounds. We conducted a sequential approach to scale development including: (1) defining constructs and item generation; (2) expert reviews; (3) cognitive interviews (n = 12); (4) survey development and online survey data collection (N = 182, including 45 telemedicine patients and 137 in-person patients); and (5) psychometric analyses. ResultsExploratory factor analyses identified 29-items for the US-PCAC scale with three subscales: (1) Respect and Dignity (10 items), (2) Responsive and Supportive Care (nine items for the full scale, one additional mode-specific item each for in-person and telemedicine), and (3) Communication and Autonomy (10 items for the full scale, one additional item for telemedicine). The US-PCAC had high content, construct, and criterion validity. It also had high reliability, with a standardized alpha for the full 29-item US-PCAC scale of 0.95. The US-PCAC score was associated with overall satisfaction. ConclusionThis study found high validity and reliability of a newly-developed person-centered abortion care scale for use in the US. As medication abortion provision expands, this scale can be used in quality improvement efforts. ImplicationsThis study found high validity and reliability of a newly-developed person-centered care scale for use in the United States for in-person and telemedicine medication abortion.

Evaluation of a digital Cognitive Behavioural Therapy programme for prison residents with histories of substance misuse (“Breaking Free”): Comparison of delivery models employed in the United Kingdom and the United States

Substance misuse is a criminogenic risk factor—however, substance-involved prison residents may have limited access to support and services that might be able to help them overcome their substance misuse. Research around the efficacy of the “Breaking Free” digital Cognitive Behavioural Therapy programme for substance-involved prison residents demonstrates that this digital technology may overcome barriers to support. Breaking Free is the first digital programme for substance misuse that has been implemented in prisons. In the United Kingdom (U.K.) the programme is delivered via secure desktop and laptop computers in staff-facilitated group sessions, and in the United States (U.S.) is delivered via individual secure tablets that prison residents can access independently, without staff support. This study compares U.K. and U.S. prison residents who have engaged with Breaking Free on a number of baseline measures (sociodemographic factors, types of problem substances reported, clinical complexity, and criminogenic risk factors). The delivery models employed in these two jurisdictions are compared in relation to their associations with prison residents’ engagement with the programme and the clinical outcomes experienced. Differences between U.K. and U.S. prison residents in baseline clinical and psychosocial factors were identified, including greater clinical complexity in the U.K. group. U.K. prison residents, who were supported by staff when using Breaking Free, demonstrated higher levels of engagement with the programme than U.S. prison residents who were not supported by staff. The different delivery models employed in the United Kingdom and United States appeared to be associated with group differences in clinical outcomes. Guidance for the optimal implementation of Breaking Free, based on findings from this study, is provided. Further analyses will explore how the different approaches to the delivery of Breaking Free might interact with the differences in prison resident characteristics identified in this study (sociodemographic, clinical and criminogenic), in order to influence prison resident engagement with the programme and clinical outcomes.

Micropolar Fluid Flows Past a Porous Shell: A Model for Drug Delivery Using Porous Microspheres

The creeping flow of an incompressible, bounded micropolar fluid past a porous shell is investigated. The porous shell is modeled using a Darcy equation, sandwiched between a pair of transition Brinkman regions. Analytical expressions for the stream function, pressure, and microrotations are given for each region. Streamline patterns are presented for variations in hydraulic resistivity, micropolar constants, porous layer thickness, and Ochoa-Tapia stress jump coefficient. An expression for the dimensionless drag for the unbounded case of the system is presented, and its variation with hydraulic resistivity and porous shell thickness is presented. The unbounded case represents a theoretical model for oral drug delivery using porous microspheres. It was found that optimal circulation between the porous region and the outer fluid occurred for low values of hydraulic resistivity and for a complete porous sphere.

Ranking the benefits of early contractor involvement: a client’s perspective

With the increasing popularity of collaborative project delivery models to deliver infrastructure projects, there has been a growing interest in the possibility of integrating contractors in the preconstruction phase of the project using Early Contractor Involvement (ECI). However, previous studies on the impact of ECI did not consider whether the observed benefits were the ones that motivated the client to use ECI. This study aims to investigate the ranking of the ECI benefits from the client’s perspective, as well as how this ranking is moderated by the client’s motivation. 32 participants from the same client organization were asked to rank the potential benefits of ECI using pairwise comparison which was analyzed using the Analytic Hierarchy Process (AHP) method. The findings show that the possibility to collaborate with the contractor, enhance constructability, and better quality of solution are the most desired benefits for the client. In addition, the benefits expected by the client organization are found to be moderated by what motivated the client to use ECI. These findings help to contextualize the ECI effects as identified in previous studies from the client’s perspective and give contractors a better awareness of which ECI benefits are most useful for the client side.

Using Bibliometrics and Grounded Theory in Investigating Factors Influencing Profit Distribution in Integrated Project Delivery Projects

Integrated project delivery (IPD) has gained significant attention as an effective alternative to traditional project delivery models. Profit distribution is a crucial aspect of IPD projects, influencing their overall success. This study aims to investigate the key factors impacting profit distribution to offer strategic guidance for project management practices. The study employs a comprehensive bibliometric analysis to establish an updated research framework in this domain. Through this analysis, 24 articles with highly relevant and extensively cited sources are identified for further examination. Grounded theory is subsequently applied to distill the findings. This process yields a foundational theoretical framework that delineates the factors influencing profit distribution in IPD projects, namely, contribution, resource-based input, effort level, and risk sharing. Additionally, a textual analysis of ten burst words is conducted to discern research trends and identify future areas of study. This research contributes to the existing literature by addressing gaps and providing a roadmap for future IPD investigations. A theoretical framework of influencing factors in profit distribution in IPD projects is developed based on the literature. The findings not only enhance understanding of profit distribution dynamics in IPD projects but also guide the implementation and optimization of IPD practices.

Aboriginal and Torres Strait Islander community members' experiences of care in an urban Aboriginal Community Controlled Health Service transforming to a Patient Centred Medical Home.

Background Few studies have examined patient experiences of the Patient Centred Medical Home (PCMH). This qualitative study explores the experiences of patients of an urban Aboriginal Community Controlled Health Service during its transition to a model of a PCMH. Methods Twenty-eight community members who were registered as patients of an urban Aboriginal Community Controlled Health Service were purposively recruited to participate in yarning interviews. Yarns were conducted using a guide containing open-ended questions in the same domains as those used in patient satisfaction surveys at the participating clinic. Data from yarns were analysed by Aboriginal and non-Indigenous researchers using thematic analysis. The interpretations of Aboriginal and Torres Strait Islander researchers were privileged in the analysis. Results Key themes highlighted the importance of relationships, connectedness, and personal growth and empowerment to community members' health and wellbeing, which they described as a journey of healing and recovery. Delays in implementing a process to empanel patients in a care team meant that most community members were unaware a PCMH had been implemented. However, community members commonly reported a more welcoming environment, more contact with the same doctor and more involvement of Aboriginal Health Workers in their care. Conclusions Aboriginal and Torres Strait Islander community members' narratives of their experiences bear evidence of the acceptability of a PCMH model for delivery in Aboriginal Community Controlled Health Services to improve relational care between patients and health staff. A patient-directed empanelment process has been implemented to better connect patients to their care team in the clinic, and the role of the Aboriginal Health Worker reshaped to strengthen connections between patients and their care team in and outside the clinic.

Digitally mediated relationships: How social representation in technology influences the therapeutic relationship in primary care

Relationships, built on trust, knowledge, regard, and loyalty, have been demonstrated to be fundamental to health care delivery. Strong relationships between patients and providers have been linked to more compassionate care delivery, and better patient experience and outcomes, and may be particularly important in primary care. The rapid adoption of digital technologies since the onset of COVID-19 has led health care systems to seriously consider a “digital-first” primary care delivery model. Questions remain regarding what impact this transformation will have on the therapeutic relationship. Using a rapid ethnographic approach this study explores how patient and provider understandings of therapeutic relationships and digital health technologies may influence relationship-building or maintenance between patients with complex care needs and their care providers. Three team-based primary care sites in Toronto, Ontario, Canada were included in the study. Across the three sites 9 patients with chronic health conditions, 1 caregiver, and 10 healthcare providers (including family physicians, family medicine residents, social workers, and nurse practitioners) participated. Interviews were conducted with all participants and 8 observations of virtual clinical encounters (phone and video visits) were conducted. Using social representation theory as a lens, analysis revealed that participants' constructions of therapeutic relationships and digital technologies were informed by their identities, experiences, and expectations. For participants to see technologies as enabling to the therapeutic relationship, there needed to be alignment between how participants viewed the role of technology in care and in their lives, and how they recognized (or constructed) a good therapeutic relationship. This exploratory work suggests the need to think about how both patients' and providers’ views of technology may determine whether digital technologies can be leveraged to meet patient needs while maintaining, or building, strong therapeutic relationships.