Delivery Model Research Articles

The emergence and regression of political priority for refugee integration into the Jordanian health system: an analysis using the Kingdon’s multiple streams model

BackgroundThe prolonged presence of Syrian refugees in Jordan has highlighted the need for sustainable health service delivery models for refugees. In 2012, the Jordanian government adopted a policy that granted Syrian refugees access, free of charge, to the national health system. However since 2012, successive policy revisions have limited refugee access. This paper seeks to understand factors that initially put refugee integration into the health system on the policy agenda, as well as how these same factors later affected commitment to sustain the policy.MethodsThis paper draws on data from a document review of 197 peer-reviewed and grey literature publications, a media analysis of newspaper articles retrieved from four officially recognized newspapers in Jordan, and 33 semi-structured key informant interviews. We used Kingdon’s Multiple Streams Model – a well-established tool for analyzing policy adoption – to understand how political priority developed for integration of refugees into the health system.ResultsWe find that several factors helped bring attention to the issue, namely concerns over infectious disease transmission to host communities, high rates of chronic conditions among the refugee population and the increasingly urban and dispersed nature of refugees. At the outset of the conflict, the national mood was receptive to refugees. Politicians and government officials quickly recognized the crisis as an opportunity to secure material and technical support from the international humanitarian community. At the same time, global pressures for integrating refugees into national health systems helped move the integration agenda forward in Jordan and the region more broadly. Since 2012, there were several modifications to the policy that signal profound changes in national views around the continued presence of Syrian refugees in the country, as well as reduced external financial support which has undermined the sustainability of the policy.ConclusionThis case study underscores the dynamic nature of policymaking and the challenge of sustaining government commitment to the right to health among refugees. Our analysis has important implications for advocates seeking to advance and maintain momentum for the integration of refugees into national health systems.

Enhancing supply chain resilience in offsite construction through the procurement strategy: a systematic literature review

Purpose Offsite construction (OC) is an efficient method to reduce waste in the construction industry from a circular economy perspective. Yet, its uptake is subdued by the ambiguities around its supply chain. Hence, the purpose of this study is twofold: to identify the OC project delivery models, the limitations in their procurement approach to facilitate the resilience of the supply chain and interventions to promote supply chain resilience (SCR) and to identify the gaps in the existing procurement process and propose further research areas that implement strategies to improve SCR. Design/methodology/approach The study was conducted as a systematic literature review. In total, 41 peer-reviewed research papers published between 2013 and 2023 were shortlisted through the preferred reporting items for systematic reviews and meta-analysis guidelines. A descriptive analysis was conducted, followed by a thematic analysis. Findings The descriptive analysis reveals that the emphasis on digitising OC has shifted to transforming the business model, procurement and supply chain with a human-centric view. In thematic analysis, the predictability of the SC partners and the probabilities of evaluating the prospects are revealed as arbitrary characteristics in the current procurement strategies. Rewarding collaborative relationships among SC partners and incorporating provisions to postpone the module delivery are some interventions to promote flexibility. Drafting comprehensive and effective contracts that address transparency issues and facilitating the need for continuous development of capabilities through procurement are among the further research avenues proposed. Originality/value This study is a precursor demonstrating the potential of the procurement process to implement the decrees of SCR for better goal congruence of the OC supply chain.

Virtual Care: Perspectives From Family Physicians.

During the COVID-19 pandemic, virtual care expanded rapidly at Michigan Medicine and other health systems. From family physicians' perspectives, this shift to virtual care has the potential to affect workflow, job satisfaction, and patient communication. As clinics reopened and care delivery models shifted to a combination of in-person and virtual care, the need to understand physician experiences with virtual care arose in order to improve both patient and provider experiences. This study investigated Michigan Medicine family medicine physicians' perceptions of virtual care through qualitative interviews to better understand how to improve the quality and effectiveness of virtual care for both patients and physicians. We employed a qualitative descriptive design to examine physician perspectives through semistructured interviews. We coded and analyzed transcripts using thematic analysis, facilitated by MAXQDA (VERBI) software. The results of the analysis identified four major themes: (a) chief concerns that are appropriate for virtual evaluation, (b) physician perceptions of patient benefits, (c) focused but contextually enriched patient-physician communication, and (d) structural support needed for high-quality virtual care. These findings can help further direct the discussion of how to make use of resources to improve the quality and effectiveness of virtual care.

Teachers’ Perspectives on Best Occupational Therapy Service Provision in School-Based Practice: A Qualitative Study

ABSTRACT There is currently limited evidence regarding teachers’ perspectives of push-in and pull-out occupational therapy services in the school-based setting. Occupational therapy services can be delivered in different combinations and often vary based on the needs of the student, needs of the teacher and classroom, need for academic time, and need for social interactions. To examine teachers’ perspectives of push-in and pull-out services, a qualitative approach was used. Thirty-nine participants were recruited using a combination of convenience, snowball, purposive, and voluntary response sampling. Data was collected via a multiple choice and open response online survey. Thematic analysis was completed with the identification of six themes. Pros and cons of both push-in and pull-out service delivery, carryover, and modifications were discussed. Conclusively, most teachers preferred a combination of push-in and pull-out services, highlighting the importance of communication, collaboration, carryover, and finding the just-right fit for each student to best support their needs and learning styles. The findings of this study will better provide school-based occupational therapy practitioners with context for selecting the most appropriate service delivery model for each student.

Auditory Learner

Auditory Learner

Near vision impairment and effective refractive error coverage for near vision in Andhra Pradesh, India – The Akividu Visual Impairment Study (AVIS)

ABSTRACT Clinical relevance Near Vision Impairment (NVI) is common in developing countries. A substantial proportion of NVI can be addressed by providing spectacles. Innovative eye care programmes are needed to address NVI. Population-based epidemiological studies can provide vital data to plan such eye care service delivery models. Background To report the prevalence of NVI and effective Refractive Error Coverage (eREC) for near vision in West Godavari and Krishna districts in Andhra Pradesh, south India. Methods A population-based cross-sectional study was carried out using a Rapid Assessment of Visual Impairment methodology. Presenting and pinhole distance visual acuity were assessed followed by near vision assessment using a N notation chart at a fixed distance of 40 cm. If the presenting near vision was worse than N8, the best corrected near visual acuity was recorded with age appropriate near vision correction. NVI was defined as presenting near vision worse than N8 among those without distance vision impairment (6/18 or better in the better eye). Effective Refractive Error Coverage for near was calculated as the proportion of individuals with an adequate correction to the total participants, including those with inadequate, adequate, and no correction for near vision. Results Data of 2,228 participants aged ≥40 years were analysed. The mean age of these participants was 54.0 ± 10.4 years; 53.8% were women; 44.5% had no formal education. The prevalence of NVI was 27.1% (95% CI: 25.2–29.0%). NVI significantly associated with 70 and above age group (adjusted OR: 1.97; 95% CI: 1.45-3.70). Participants with formal education had lower odds for NVI (adjusted OR: 0.75; 95 % CI: 0.68-0.83). The eREC for near vision was 48.0%. Conclusion NVI affects over a quarter of people aged ≥40 years in the West Godavari and Krishna districts of Andhra Pradesh. However, eREC is under 50% and there is scope for improving this by establishing eye care services to achieve universal eye health for all.

A neuropsychological rehabilitation service delivery model for South African adults with acquired brain injury (RSDM-SA).

In low- and- middle- income countries (LMICs) such as South Africa, a high number of Acquired Brain Injuries (ABIs) and a lack of accessibility to healthcare lead to many survivors of brain injury not receiving the level of healthcare and rehabilitation required. Further, in LMICs life-saving or acute care is prioritized with an inadequate focus on the lifelong effects of ABI. This study used Program Theory to develop a Rehabilitation Service Delivery Model for South African Adults with Acquired Brain Injury (RSDM-SA) that caters for the unique nuances of a resource-constrained and culturally diverse context. The RSDM-SA has four interdependent levels, namely (i) Integration of Relevant Aspects of Explanatory Frameworks (ii) South African Contextual Influences on the Model (iii) Systemic Role players Necessary for the Model and (iv) Evidence-Based Guidelines in a Holistic Rehabilitation Process. The Model is a valuable resource in guiding future research endeavors and its contribution lies in the Model's focus on quality, accessibility, relevance, and efficiency, all of which are needed in healthcare internationally.

Radiopharmaceutical transport in solid tumors via a 3-dimensional image-based spatiotemporal model

Lutetium-177 prostate-specific membrane antigen (177Lu-PSMA)-targeted radiopharmaceutical therapy is a clinically approved treatment for patients with metastatic castration-resistant prostate cancer (mCRPC). Even though common practice reluctantly follows “one size fits all” approach, medical community believes there is significant room for deeper understanding and personalization of radiopharmaceutical therapies. To pursue this aim, we present a 3-dimensional spatiotemporal radiopharmaceutical delivery model based on clinical imaging data to simulate pharmacokinetic of 177Lu-PSMA within the prostate tumors. The model includes interstitial flow, radiopharmaceutical transport in tissues, receptor cycles, association/dissociation with ligands, synthesis of PSMA receptors, receptor recycling, internalization of radiopharmaceuticals, and degradation of receptors and drugs. The model was studied for a range of values for injection amount (100–1000 nmol), receptor density (10–500 nmol•l–1), and recycling rate of receptors (10–4 to 10–1 min–1). Furthermore, injection type, different convection-diffusion-reaction mechanisms, characteristic time scales, and length scales are discussed. The study found that increasing receptor density, ligand amount, and labeled ligands improved radiopharmaceutical uptake in the tumor. A high receptor recycling rate (0.1 min–1) increased radiopharmaceutical concentration by promoting repeated binding to tumor cell receptors. Continuous infusion results in higher radiopharmaceutical concentrations within tumors compared to bolus administration. These insights are crucial for advancing targeted therapy for prostate cancer by understanding the mechanism of radiopharmaceutical distribution in tumors. Furthermore, measures of characteristic length and advection time scale were computed. The presented spatiotemporal tumor transport model can analyze different physiological parameters affecting 177Lu-PSMA delivery.

Mathematical modeling of transdermal delivery of topical drug formulations in a dynamic microfluidic diffusion chamber in health and disease.

Mathematical models of epidermal and dermal transport are essential for optimization and development of products for percutaneous delivery both for local and systemic indication and for evaluation of dermal exposure to chemicals for assessing their toxicity. These models often help directly by providing information on the rate of drug penetration through the skin and thus on the dermal or systemic concentration of drugs which is the base of their pharmacological effect. The simulations are also helpful in analyzing experimental data, reducing the number of experiments and translating the in vitro investigations to an in-vivo setting. In this study skin penetration of topically administered caffeine cream was investigated in a skin-on-a-chip microfluidic diffusion chamber at room temperature and at 32°C. Also the transdermal penetration of caffeine in healthy and diseased conditions was compared in mouse skins from intact, psoriatic and allergic animals. In the last experimental setup dexamethasone, indomethacin, piroxicam and diclofenac were examined as a cream formulation for absorption across the dermal barrier. All the measured data were used for making mathematical simulation in a three-compartmental model. The calculated and measured results showed a good match, which findings indicate that our mathematical model might be applied for prediction of drug delivery through the skin under different circumstances and for various drugs in the novel, miniaturized diffusion chamber.

LEARNING STRATEGIES USED BY GRADE ONE ELEMENTARY TEACHERS IN TEACHING STUDENTS WITH SPECIAL NEEDS: REFLECTIONS AND DISPOSITIONS IN FOCUS

General Education teachers dont have exceedingly specialized capabilities in special education. We dont have much encounters in an inclusive classroom. Not continuously, but regularly, it appears that teachers feel unequal to the errand of educating students with special needs. It may be a characteristic of the calling that General Education teachers need certainty with such understudies, and feel incapable since we think we lack the skills. This can be something of a myth to be refuted. But teachers know more than they think they know. The challenge is getting these students to appreciate, engage, and keep them on task as much as possible without ruining the usual flow of the classes. Ten participants who are all Elementary teachers in selected public schools in Davao City are the focused in this study. The said participants are chosen through random sampling. All of them are licensed teachers and has experience teaching for almost two years to learners in grade one with disabilities. Many professionals in the literature express concerns about whether full inclusion is appropriate for all students with disabilities and emphasize the importance of maintaining a continuum of services. Supporters for a continuum of services for students with disabilities cite two main reasons. First, they believe there is an inadequate research base to advocate such a drastic change to the current educational system believes, the research evidence on the relative efficacy of one special education service delivery model over another is scarce, methodologically flawed, and inconclusive. Some studies support positive trends with inclusion programs; however, others have reported disappointing or unsatisfactory academic and social achievement through inclusion models.Learning in a remote setting may differ from mainstream, classroom-based environments. This includes expectations for students and course methodology. Curricula must often be adjusted. For example, homework can be simplified, allowing students to dictate rather than type, and audio materials can be provided for reading assignments during online class. KEY WORDS: learning strategies, grade one elementary teacher, teaching students with special needs, reflections

Whole Health Revolution: Value-Based Care + Lifestyle Medicine

An outdated and burdensome fee-for-service (FFS) reimbursement system has significantly compromised primary care delivery in the US for decades, leading to a dire shortage of primary care workers. Support for primary care must increase from all public and private payers with well-designed value-based primary care payment. Patient care enabled by value-based payment is typically described or “labeled” as value-based care and commonly viewed as distinctly different from other models of care delivery. Unfortunately, labels tend to put individuals in camps that can make the differences seem greater than they are in practice. Achieving the aims of value-based care, aligned with the quintuple aims of health care, is common across many delivery models. The shrinking primary care workforce is too fragile to be fragmented across competing camps. Seeing the alignment across otherwise separate disciplines, such as lifestyle medicine and value-based care, is essential. In this article, we point to the opportunities that arise when we widen the lens to look beyond these labels and make the case that a variety of models and perspectives can meld together in practice to produce the kind of high-quality primary care physicians, care teams, and patients are seeking.

A co-production model for the South African housing sector

Background: The public housing delivery practices in South Africa are fragmented, resulting in various outcomes concerning housing delivery. There is a pressing need to overhaul public housing delivery that puts citizens at the core of the delivery process.Aim: The current state-led model of delivering housing is not effective and by design, the model for housing delivery should include the participation of beneficiaries. The aim was to develop a co-production model for housing delivery.Setting: The article focused on the housing sector in South Africa.Methods: A qualitative research approach and grounded theory as research design was used. Instruments were document analysis and semi-structured interviews with participants who are stakeholders in housing co-production. Data collected was analysed through inductive thematic analysis.Results: The results suggested a self-reliant approach to housing delivery, which is demand driven with the state as a facilitator and not the provider of housing. The model for housing should have a component that does not perpetuate a culture of dependency and entitlement but promotes the concept of co-production.Conclusion: The article explored the possibility of introducing a co-production model for housing delivery model in South Africa. It was established that the role of government must shift to that of an enabler and facilitator instead of a provider of housing.Contribution: This proposed model contributes towards the body of knowledge in terms of promoting public service delivery and performance (in this instance in the housing sector) in South Africa as a country situated in Africa.

RIvER Clinic: Rethinking Incarceration and Empowering Recovery-An Innovative Postincarceration Care Delivery Model Implemented During the COVID-19 Pandemic.

The Rethinking Incarceration and Empowering Recovery (RIvER) Clinic was launched in June 2021 to address the health disparities experienced during and after incarceration. The RIvER Clinic's multidisciplinary, community-centered team engages patients during jail detention and after release via telehealth, collocated in community locations, on a mobile van, and in clinic. The clinic serves as a bridge between incarceration and the establishment of permanent health care and social services in the community. In 2022, a total of 479 visits were completed. The clinic provided multidisciplinary substance use support to all eligible patients, paying for 104 medication for opioid use disorder (MOUD) prescriptions for uninsured patients. Twenty-five percent of patients were transitioned to community-based care, and less than 5% of patients were reincarcerated. Despite some limitations, results demonstrate that the RIvER Clinic is successfully reintegrating a marginalized population into its community. The purpose of this article is to describe the implementation and preliminary outcomes of this postincarceration clinic.

Human capital development programme for mid-career agricultural extension workers: The case of Sokoine University of Agriculture BSc. agricultural extension and education training programme

Of recent, there is changing work environment for agricultural extension workers as they operate under the multi-stakeholders’ phenomenon. This increasingly poses a challenge to frontline extension workers trained on linear model (extension-researcher-farmer linkage) in extension services delivery. This is because, facilitating the multi-stakeholder processes requires competent agricultural extension workers well-versed in human relations. In recognizing the importance of human capital development for agricultural extension service delivery in Tanzania, Sokoine University of Agriculture established a mid-career agricultural extension training programme in 1998. Informed by the human capital theory, this study employed an evaluative study design to assess the impact of the Sokoine University of Agriculture (SUA) mid-career BSc. Agricultural Extension and Education training programme on human capital development. The study was conducted in five agro-ecological zones, that is, Eastern, Western, Central, Southern Highlands and Lake zones in Tanzania. The development of the sampling frame was done in collaboration with the Ministry of Agriculture (MoA), Ministry of Livestock and Fisheries (MLF) and President’s Office-Regional Administration and Local Government (PO-RALG). A total of 200 respondents-100 alumni and 100 farmers were sampled proportionately. A snowball sampling technique was used to replace the respondents who were selected randomly but could not be reached for interview. Data were collected from respondents through a questionnaire that covered a set of competences through analysis of the mid-career agricultural extension curriculum and consultations with public and private employers. In addition, literature review and observations were also used to supplement the collected information. The findings indicate that the agricultural training programme at Sokoine University of Agriculture (SUA) equipped graduates with appropriate knowledge, competencies and skills that improved their job performance and productive capacities that enabled them to interact with various stakeholders and facilitate multi-stakeholders’ processes. This is in line with the purpose of establishing the programme. Hence, this points to the need for continuous human capital building and motivations of agricultural extension workers for the improvement of their performance. Key words: Mid-career, Agricultural extension workers, Curriculum, Human capital, Multi-stakeholder processes

Preventing Violence in the Raced Margins: Alternate Rationalities, Possibilities, and Imaginaries

The organizational communication discipline has been criticized for not centering the voices of ethnic minority communities. This can be witnessed in the prevention of violence, where migrant communities are more vulnerable to the effects of violence but are underserved by Western models of violence prevention. Grounded in the culture-centered approach, the present study—drawing from interviews with 67 new migrants and 31 service providers—explores how organizations can assist in preventing violence among new migrant communities. The findings reveal how communication inequality reduces agency and can create an environment conducive to violence and how the current individualized model of service delivery does not attend to the cultural norms and needs of community members. Engaging with new migrant communities and addressing violence involves creating communicative avenues of dialogue and leveraging community agency in codeveloping infrastructures for transformation.

Abstract LB145: Implementing timely germline genetic testing for patients with pancreatic cancer via a point-of-care digital education and health assessment tool

Abstract Introduction: Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer-related deaths in the United States. National guidelines recommend germline genetic testing (GT) for all PDAC patients, but only 6.8-19% obtain GT. Current GT barriers include under-referral and genetic counselor shortage. Our goal was to improve uptake of GT among PDAC patients using a novel delivery model for genetic education and testing. Methods: The Genetic Information for Treatment Decisions (GIFTD) Initiative at Moffitt Cancer Center was created to streamline education and GT for PDAC patients. A Genetic Risk Education Coordinator (GREC), trained by licensed, board-certified genetic counselors, was hired to identify eligible patients and facilitate GT during clinician appointments. In partnership with Nest Genomics, a digital point-of-care tool was developed to collect personal and family history information, provide education about GT, and assess interest in GT. Patients receive a link from Nest ahead of their appointment via text and/or email to invite them to provide information and view education via mobile device. An auto-generated summary report with an indicator regarding GT interest is created in real-time for the GREC. Results: Seventy patients were invited to the Nest tool over the six-week launch period. Of those who opened the link, 83% (35/42) logged into their Nest account. Of these patients who logged into Nest, 71% (25/35) completed Nest’s GT education. The GREC met with 68% (17/25) of the patients that completed the education. 76% (13/17) of these patients were consented to GT. There were 2 patients who initially indicated that they were not interested in genetic testing in Nest but changed their mind after meeting with the GREC. Conclusion: Moffitt's collaboration with Nest through the GREC has successfully facilitated prompt germline genetic testing for PDAC patients, aiding in informed treatment decisions and family screening. Our preliminary findings suggest that the scalable Nest tool successfully captures PDAC patients who may be interested in GT, but follow-up with the GREC may further increase GT rates. Future directions for increasing uptake of GT and adhering to national guidelines include additional personalization and enhancement of the Nest tool. Citation Format: Jennifer B. Permuth, Sophie Moravec, Laura V. Barton, Revathy Suresh, Susan T. Vadaparampi, Jessica Rivera Rivera, J. Kevin Hicks, Teresa Ho, Dae Won Kim, Russel Palm, Pamela J. Hodul, Tara Schmidlen, Moran Snir, Laura Hayward. Implementing timely germline genetic testing for patients with pancreatic cancer via a point-of-care digital education and health assessment tool [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB145.

Rehabilitation delivery models to foster healthy ageing-a scoping review.

Rehabilitation is essential to foster healthy ageing. Older adults have unique rehabilitation needs due to a higher prevalence of non-communicable diseases, higher susceptibility to infectious diseases, injuries, and mental health conditions. However, there is limited understanding of how rehabilitation is delivered to older adults. To address this gap, we conducted a scoping review to describe rehabilitation delivery models used to optimise older adults' functioning/functional ability and foster healthy ageing. We searched Medline and Embase (January 2015 to May 2022) for primary studies published in English describing approaches to provide rehabilitation to older adults. Three authors screened records for eligibility and extracted data independently and in duplicate. Data synthesis included descriptive quantitative analysis of study and rehabilitation provision characteristics, and qualitative analysis to identify rehabilitation delivery models. Out of 6,933 identified records, 585 articles were assessed for eligibility, and 283 studies with 69,257 participants were included. We identified six rehabilitation delivery models: outpatient (24%), telerehabilitation (22%), home (18.5%), community (16.3%), inpatient (14.6%), and eldercare (4.7%). These models often involved multidisciplinary teams (31.5%) and follow integrated care principles (30.4%). Most studies used a disease-centred approach (59.0%), while studies addressing multimorbidity (6.0%) and prevalent health problems of older adults, such as pain, low hearing, and vision, or incontinence were scarce. The most frequently provided interventions were therapeutic exercises (54.1%), self-management education (40.1%), and assessment of person-centred goals (40%). Other interventions, such as assistive technology (8.1%) and environmental adaptations (7.4%) were infrequent. Focusing on primary studies, this scoping review provides an overview of rehabilitation delivery models that are used to foster healthy ageing and highlights research gaps that require further attention, including a lack of systematic assessment of functioning/functional ability, a predominance of disease-centred rehabilitation, and a scarcity of programmes addressing prevalent issues like pain, hearing/vision loss, fall prevention, incontinence, and sexual dysfunctions. Our research can facilitate evidence-based decision-making and inspire further research and innovation in rehabilitation and healthy ageing. Limitations of our study include reliance on published research to infer practice and not assessing model effectiveness. Future research in the field is needed to expand and validate our findings.

Fidelity of family centered care model to early disability diagnosis and rehabilitation in the United Arab Emirates.

The role of parents in supporting early intervention for young children with disabilities is critical. Indeed, models of family centered care (FCC), which emphasis strong partnerships between health professionals and families in disability health services delivery are now widely associated with best practice. While FCC is consistently argued to be an appropriate model for disability service delivery, its utilization is limited primarily to Western countries such as Australia and the United States. Countries such as the United Arab Emirates (UAE) have prioritized early childhood development and are thus in search of best practices for delivery of early intervention for children and their families. The aim of this study was to explore the appropriateness of the FCC model in disability service delivery in the UAE. This study was conducted from the perspectives of health professionals who are involved in disability diagnosis, referral and ongoing support for families and children with disabilities. A total of 150 health professionals were recruited from health facilities, rehabilitation centers and schools in the Emirates of Abu Dhabi. The 27-item Measure of Process of Care for Service Providers (MPOC-SP) was used for data collection. The data were subjected to confirmatory factor analysis to confirm applicability of the model to this context. Multivariate analysis of variance and moderation analysis were also conducted, to ascertain the relationship between participants' satisfaction levels with their ability to diagnose, refer and provide on-going support and their likelihood of practicing key components of FCC. Computation of confirmatory factor analysis provided support for applicability of the MPOC-SP in the UAE context. Further inspection showed moderate to large correlations between the four components of FCC measured by MPOC-SP, providing further support for utilization of FCC in disability health service delivery in the UAE. The study concludes with a call to policymakers in the UAE to consider developing disability health policy based on key components of FCC. This could be supplemented by development of training modules on FCC to upskill health professionals involved in disability diagnosis and rehabilitation.

Outpatient Parenteral Antimicrobial Therapy in a Safety Net Hospital: Opportunities for Improvement.

Outpatient parenteral antimicrobial therapy (OPAT) is a safe and cost-effective transitional care approach administered via different delivery models. No standards exist for appropriate OPAT program staffing. We examined outcomes of patients receiving OPAT via different care models to identify strategies to improve safety while reducing health care overuse. Retrospective demographic, clinical, and outcome data of patients discharged with OPAT were reviewed in 2 periods (April-June 2021 and January-March 2022; ie, when staffing changed) and stratified by care model: self-administered OPAT, health care OPAT, and skilled nursing facility OPAT. Of 342 patients, 186 (54%) received OPAT in 2021 and 156 (46%) in 2022. Hospital length of stay rose from 12.4 days to 14.3 in 2022. In a Cox proportional hazards regression model, visits to the emergency department (ED) within 30 days of OPAT initiation (hazard ratio, 1.76; 95% CI, 1.13-2.73; P = .01) and readmissions (hazard ratio, 2.34; 95% CI, 1.22-4.49; P = .01) increased in 2022 vs 2021, corresponding to decreases in OPAT team staffing. Higher readmissions in the 2022 cohort were for reasons unrelated to OPAT (P = .01) while readmissions related to OPAT did not increase (P = .08). In a well-established OPAT program, greater health care utilization-length of stay, ED visits, and readmissions-were seen during periods of higher staff turnover and attrition. Rather than blunt metrics such as ED visits and readmissions, which are influenced by multiple factors besides OPAT, our findings suggest the need to develop OPAT-specific outcome measures as a quality assessment tool and to establish optimal OPAT program staffing ratios.

An evaluation of the cost of human papilloma virus (HPV) vaccine delivery in Zambia

BackgroundHuman papillomavirus (HPV) is a common sexually transmitted infection and the leading cause of cervical cancer. The HPV vaccine is a safe and effective way to prevent HPV infection. In Zambia, the vaccine is given during Child Health Week to girls aged 14 years who are in and out of school in two doses over two years. The focus of this evaluation was to establish the cost to administer a single dose of the vaccine as well as for full immunisation of two doses.MethodsThis work was part of a broader study on assessing HPV programme implementation in Zambia. For HPV costing aspect of the study, with a healthcare provider perspective and reference year of 2020, both top-down and micro-costing approaches were used for financial costing, depending on the cost data source, and economic costs were gathered as secondary data from Expanded Programme for Immunisation Costing and Financing Project (EPIC), except human resource costs which were gathered as primary data using existing Ministry of Health salary scales and reported time spent by different health cadres on activities related to HPV vaccination. Data was collected from eight districts in four provinces, mainly using a structured questionnaire, document reviews and key informant interviews with staff at national, provincial, district and health facility levels. Administrative coverage rates were obtained for each district.ResultsFindings show that schools made up 53.3% of vaccination sites, community outreach sites 30.9% and finally health facilities 15.8%. In terms of coverage for 2020, for the eight districts sampled, schools had the highest coverage at 96.0%. Community outreach sites were at 6.0% of the coverage and health facilities accounted for only 1.0% of the coverage. School based delivery had the lowest economic cost at USD13.2 per dose and USD 28.1 per fully immunised child (FIC). Overall financial costs for school based delivery were US$6.0 per dose and US$12.4 per FIC. Overall economic costs taking all delivery models into account were US$23.0 per dose and US$47.6 per FIC. The main financial cost drivers were microplanning, supplies, service delivery/outreach and vaccine co-financing; while the main economic cost drivers were human resources, building overhead and vehicles. Nurses, environmental health technicians and community-based volunteers spent the most time on HPV related vaccination activities compared to other cadres and represented the greatest human resource costs.ConclusionsThe financial cost of HPV vaccination in Zambia aligns favourably with similar studies conducted in other countries. However, the economic costs appear significantly higher than those observed in most international studies. This discrepancy underscores the substantial strain placed on healthcare resources by the program, a burden that often remains obscured. While the vaccine costs are currently subsidized through the generous support of Gavi, the Vaccine Alliance, it’s crucial to recognize that these expenses pose a considerable threat to long-term sustainability. Consequently, countries such as Zambia must proactively devise strategies to address this challenge.