Duplication Of Services Research Articles

Increased access to pediatric specialist healthcare using eConsult: A retrospective observational cohort and case–control study

ABSTRACT Objectives Primary care practitioners (PCPs) report that using the Champlain BASE™ eConsult service (eConsult) averts one-third of face-to-face (FTF) specialist referrals, however, there are concerns about duplication of services and adverse patient outcomes. Following an eConsult, we evaluated patient healthcare utilization and associated treatment costs. Methods Retrospective cohort study (2014 to 2018) of patients (<18 years old) for whom an eConsult visit averted a FTF specialist referral. Patients were linked to provincial health administrative databases and hospital electronic medical records for healthcare use for the same diagnosis and specialty for the 18 months following the eConsult. Concurrently, a retrospective case–control study compared utilization and costs between an eConsult versus a matched FTF visit for the same diagnosis. We also assessed PCP satisfaction. Results In follow-up, <5% of the study cohort of eConsult patients (n = 242) later accessed the healthcare system for the identical diagnosis and specialty type. FTF visits generate more frequent outpatient visits (12.6 times more [95% CI: 2.28 to 69.66, P = 0.002]) and higher costs compared to eConsult visits. There were no hospital admissions or deaths in patients with eConsult. PCPs (98%) described eConsult as an excellent service. Conclusions Using eConsult is associated with <5% of patients subsequently having a FTF visit for the same reason. Matched FTF visits generated more healthcare utilization and higher costs compared with eConsult. eConsult in pediatrics is safe and can minimize FTF specialist visits in elective cases and increase capacity, towards a more efficient and cost-effective healthcare system.

What are the attitudes and perceptions of general practitioners about the role of nurse practitioners in the community care setting: A scoping review

BackgroundThe Nurse Practitioner role in Australia is slowly expanding, with a well-established body of evidence supporting their introduction. Yet, there is a lack of consistent support from the medical profession for this role. Nurse Practitioners wishing to work in the community setting may, therefore, experience resistance from General Practitioners. ObjectiveTo identify and explore the attitudes and perceptions of Australian General Practitioners about Nurse Practitioners' community settings. To explore what is the view of GPs outside of Australia on this topic. MethodA scoping review of the Cochrane, MEDLINE, Psych INFO, and CINHAL databases was undertaken from 1995 to April 2023 and reported using PRISMA. Quality evaluation tools devised by Dixon-Woods et al. (2005) and previously used by Paterson et al. (2015) were used to evaluate the included studies. A narrative synthesis was then undertaken using the method described by Whittemore and Knafl (2005). FindingsThe scoping review identified 1623 potential publications. After a comparison of the title and abstract to the inclusion and exclusion criteria, 20 publications underwent an in-depth review, eight publications met the inclusion criteria for a full review. The review did not identify a publication from Australia. Elsewhere the attitudes of General Practitioners were influenced by the lack of definition of the Nurse Practitioner role, a lack of knowledge of the Nurse Practitioner skill level, fear of service duplication, deterioration in patient relationships, who had responsibility for the role and funding for the role. ConclusionThere is a lack of evidence in an Australian context to determine if General Practitioners in Australia have similar views to their international counterparts. Careful planning needs to be undertaken to overcome potential issues and to enable the Nurse Practitioner role to be effectively implemented in an Australian community setting.

Applying Experienced-Based Co-Design principles to improve digital health demand management processes in a large metropolitan multi-hospital health system

ObjectiveThis study describes the application of Experienced-Based Co-Design (EBCD) principles with an embedded implementation technology framework for improving digital health and informatics demand management processes in a multi-hospital healthcare system. The study identified barriers and enablers within the existing demand management system, proposed interventions to address these challenges and engaged in collaborative co-design with stakeholders. MethodsA multi-method qualitative approach aligning with EBCD principles was used. Framework mapping (Non-adoption, Abandonment, Scale-up, Spread, Sustainability) was applied to barriers and enablers associated with baseline practices. Reflexive thematic mapping and process charts were used to inform stakeholder priorities and co-design. Prototyping was iterative using feedback for continuous improvement with ongoing monitoring. ResultsFragmentation of information was a technological barrier, decentralized processes and service duplication were organizational barriers, and opportunities to improve clarity of governance policies were identified. Solutions were co-generated and prioritised by stakeholders. The co-design and prototyping phase followed an iterative approach which generated two interventions. For centralizing intake and management, a new workflow process was devised. For improving project portfolio visibility and developing a weighted scoring criterion, a single tool to track projects across the lifecycle and a scoring model based on prioritization techniques were created. ConclusionA novel application of an EBCD approach was used to improve demand management processes in a digital health and informatics service context in a large health system. It highlights the value and agility of EBCD to generate flexible and modular solutions for this digital health context and compares favorably to analogous approaches. Public interest summaryIn today's fast-paced digital age, it is vital for hospitals to manage health information innovation efficiently. This study used an Experienced-Based Co-Design design (EBCD) approach to improve how a multi-hospital health system handles and prioritizes digital health projects. We listened to stakeholders, identified challenges, including fragmented information and unclear processes, then co-created solutions. The EBCD produced an implementable streamlined method for managing digital health project requests, including prioritizing and tracking projects from start to finish. This outcome of the exemplar EBCD process is likely to ensure that the most critical health projects are prioritized. For the public, this means better, faster, and more efficient digital health services in the future.

Potential harms resulting from patient–clinician real-time clinical encounters using video-based telehealth: A making healthcare safer rapid evidence review

Objectives To review the evidence on harms associated with patient–clinician real-time encounters using video-based telehealth and determine the effectiveness of any related patient safety practices (PSPs), which are interventions, strategies, or approaches intended to prevent or mitigate unintended consequences of healthcare delivery and improve patient safety. Methods We searched PubMed, EMBASE, and Cochrane to identify eligible studies published from 2012 to 2022, supplemented by grey literature search. Outcomes of interest included adverse events and other specified harms (i.e., preventable hospitalizations, inappropriate treatment, missed or delayed diagnoses, duplication of services, privacy breaches). Findings Our search retrieved 7155 citations, of which 23 studies (including six randomized controlled trials [RCTs]) were eligible for review. Fourteen studies reported on adverse events or unintended effects of telehealth conducted in diverse settings. Adverse events such as death, reoperation, infection, or major complications were infrequent in both telehealth and usual care groups. Thirteen studies examined preventable hospitalizations or emergency department (ED) visits and reported mixed findings. Of the six RCTs, three showed no difference in risk of hospitalization or ED visits for telehealth compared to usual care and three showed reduced risk for patients receiving telehealth. We found no studies on the effectiveness of PSPs in reducing harms associated with real-time telehealth. Conclusions Telehealth was not inferior to usual care in terms of hospitalizations or ED visits. No studies evaluated a specific PSP. More research is needed to improve understanding of harms associated with real-time use of telehealth and how to prevent or mitigate those harms.

What Works for the Youth: Analysis of Youth Employment Policies in Rwanda

In Rwanda, over 75 percent of youth are not in education, employment and training (NEET). These are mostly absorbed in the informal sector that provides little or no protection to workers against shocks, and are prone to several socio-economic, technical, and financial constraints. Through desk review of existing policies and studies, key informant interviews (KIIs), and focus group discussions (FGDs), this study reviews and analyzes the existing youth employment policies (YEPs) and interventions with intent to identify the hurdles and outcomes of the actual implementation of these YEPs in Rwanda. Youths aged 18 to 30, policy makers, policy implementers, and implementing partners were the key target respondents. The study finds a multitude of YEPs and interventions to promote youth education and skilling, entrepreneurship, and business development funding; though most of them are more focused on supply than demand-side of the labor market, with limited vulnerable youth inclusivity. Common hurdles encountered during implementation of YEPs include: poor coordination among the vast YEPs causing monitoring challenges both at national and district level, and duplication of services. Difficulty to integrate education and skilling into decent youth employment, matching labor laws with youth welfare, cultural bias limiting young women from participating in some labor market activities, funding gaps, and limited youth engagement during program design. Addressing these challenges requires a well-coordinated stakeholder engagement, and strong collaboration between the public and private sector, as well as civil society organizations.

Informational continuity by midwives during birth at primary care settings in the Western Cape.

Informational continuity ensures that all health and psychosocial information of the pregnant women is available at all encounters with healthcare providers. The World Health Organization recognised that ineffective informational continuity during birth contributed to fragmented care and duplication of services, which ultimately influenced the morbidity and mortality rates of the pregnant women. The aim of this study was to delve into the midwives' experiences on informational continuity approaches that enable effective care coordination during birth within the primary health care setting. The study setting was two maternity obstetric units (MOUs) in the Western Cape, South Africa. A qualitative descriptive phenomenological design was used. Participants were recruited by using purposive sampling. Interviews were audiorecorded, transcribed verbatim and analysed. Three themes emerged from the findings. Theme one: adequate sharing of information with women during the intrapartum period. Theme two: efficient transition of information among midwives and other healthcare providers during the intrapartum period. Theme three: challenges to informational continuity during the intrapartum period. Communication with the women as well as with other healthcare providers during birth was effective. However, with minimal challenges, informational continuity was effectuated through communication among the midwives, the pregnant women and other healthcare providers. Informational continuity approaches among the midwives, with the women and between healthcare facilities are a prerequisite to ensure continuity of care and care coordination during birth.

Bridging gaps: improving the access of primary health care in rural Ukraine through mobile health units

Rural healthcare is an integral part of the Ukrainian healthcare system. However, access to healthcare for the rural population is uneven due to poor development of medical infrastructure and staffing. The problem of access to medical care in rural areas has been exacerbated by the full-scale war.The objective: to study and analyze the current state of accessibility of primary health care in rural areas in Ukraine, followed by a discussion of promising areas for the introduction of mobile health units as a tool for implementing the “Medical Guarantees” program in hard-to-reach regions of Ukraine.Materials and methods. The study included data from official statistical reports, regulatory documents and scientific sources. The methodology includes bibliosemantic, medical and statistical methods and the method of structural logical analysis.Results. It has been established that the low level of access to primary health care for the rural population of Ukraine has been significantly exacerbated by the devastating impact of the war on medical and transport infrastructure, especially in the frontline and recently de-occupied rural areas, and by migration processes. The situation is complicated by the fact that most patients in rural areas are elderly people who are physically unable to use public transportation, even if it is available. The analysis of international practice has shown that mobile health units can be introduced into the public healthcare system as a temporary measure to meet the urgent needs of the Ukrainian population, especially in rural areas. Integration of mobile health units into the state program “Medical Guarantees” can effectively address the urgent health care needs to increase access to health care for the rural population of Ukraine. State regulation of the division of these units will eliminate problems such as duplication and uneven service delivery and will create a transparent system of remuneration for the staff included in these units.Conclusions. The results of the study suggest that the practice of mobile medical units should be introduced as a tool for implementing the “Medical Guarantees” program for regions/locations of Ukraine with low access to medical infrastructure, namely remote rural areas and areas that have been devastated by the war. Mobile medical units will ensure the stability of access to primary health care services and contribute to improving the health of the population.

Informational continuity by skilled birth attendants during antenatal care in Lesotho.

Informational continuity (IC) is one of the four approaches that enables integrated people-centered health services. IC enables the availability of all health and psychosocial information of the pregnant women at all health encounters. World Health Organization (WHO) recognised that ineffective IC results in fragmented health care and duplication of services. Hence, IC may assist in the reduction of maternal morbidity and mortality. The purpose of this study was to explore and describe the experiences of skilled birth attendants (SBAs) with IC during the antenatal period. Three primary healthcare centers in Maseru district, Lesotho. A qualitative descriptive phenomenological design was used with purposive sampling to choose nine participants. Four themes emerged; Theme one: SBAs and pregnant women information communication, theme two: Information communication between the SBAs, theme three: information collection during ANC and theme four: guidelines used during ANC to standardise care. Several challenges regarding information communication form the sources of information, transition of information, information between caregivers and women which demonstrated the frustration between the women and the SBAs during ANC leading to ineffective care coordination. Enabling IC during ANC enables effective data collection from the sources of information, transition of information during care giving within and between health facilities. Effective informational continuity enables effective care coordination in ANC in Lesotho.

Military-Civilian Integration as a Tool to Bolster Mass Casualty Incident Response Globally

Abstract Objectives In a model of military-civilian trauma system integration, coordination of mass casualty incident response by military and civilian entities could be more effective through reduced duplication of services and improved resource utilization. The following study seeks to examine and address the challenges faced in establishing integrated trauma systems. Methods Through a survey this study comprehensively gathered data on trauma system capabilities and the current degree of military-civilian integration of 73 individual countries. Through a scoring method based on participant responses, countries were classified into three distinct integration types, ranging from minimal (Type I) to robust (Type III). This method allowed analysis of the association of numerous trauma system factors with increased integration status. Results A higher integration status is associated with coordinated use of military and civilian resources for aero-medical evacuation (Chi Square p<0.05). With regards to resource utilization, countries with higher integration status exhibited more rapid availability of blood products (Chi Square p<0.05), a critical factor contributing to improved mortality among traumatically injured patients. Conclusion By identifying key areas where integration can be strengthened, and by understanding the underlying factors shaping these frameworks, this research seeks to build more collaborative and resource-efficient responses to mass casualty incidents globally.

Transdisciplinary is the new multidisciplinary: why and how can healthcare workers and managers make the shift?

Introduction: Demand for healthcare services is increasing due to the ageing population and events such as the COVID-19 pandemic. Healthcare workers and managers can respond by shifting from multidisciplinary to transdisciplinary teams, where multiple services are integrated and designed around the healthcare needs of individuals and patient groups. 
 Background: Transdisciplinary teams provide the formal structures for healthcare professionals to blur professional boundaries, share and acquire new skills and knowledge, support each other, and provide high quality patient care. Instead of organising healthcare services in silos of professional groupings, transdisciplinary teams place the patient at the centre of care. Reorganising teams around the patient can reduce duplication of healthcare services, the number of healthcare professionals delivering services, and occasions of service. Healthcare professionals gain skills, time, and the ability to support each other, which are qualities of a flexible and capable workforce.
 Aims: In this submission, we show healthcare workers and managers how co-designed transdisciplinary teams can be translated into clinical practice. We aim to explain why and how to shift from multidisciplinary to transdisciplinary teams by 1) providing clinical evidence demonstrating how transdisciplinary teams can improve person-centred care and the healthcare workforce; and 2) sharing practical learnings when planning a transdisciplinary team.
 Methods/engagement: At the Mater Hospital Brisbane, assessment processes were reorganised around patients experiencing stroke symptoms. A transdisciplinary assessment was co-designed by allied health professionals, nurses, and managers where tasks and questions were integrated from occupational therapy, physiotherapy, speech pathology, social work, and nursing. A clinical mixed methods study evaluated the transdisciplinary assessment compared to usual multidisciplinary assessment. Patients and staff were also consulted during the clinical study via surveys and fortnightly meetings.
 Results/impact: All occupational therapists and physiotherapists completed transdisciplinary competency training, which improved staff availability and flexibility to comprehensively assess patients. Use of a transdisciplinary assessment resulted in a time saving of approximately 53 minutes per assessment, which indicated improved workforce productivity and capacity. The time saved could be reallocated to increasing rehabilitation time, or to an extra occasion of service to the same or other patients. Additionally, staff reported that the transdisciplinary assessment “saves time and helps staff manage clinical workloads by reallocating resources across teams” and resulted in an “agile workforce”. 
 Learnings/next steps: To co-design and shift from a multidisciplinary to transdisciplinary team, stakeholder consultation was imperative to ensure comprehensive planning and barrier identification. Addressing barriers when shifting to a transdisciplinary team involved behaviour change from staff. For example, a lack of confidence in the skills of another professional, or a lack of willingness to share skills could impede transdisciplinary efforts. To negotiate these barriers, it was essential to establish clear competency training requirements and educate staff on the purpose of transdisciplinary teams for improving patient care and workforce capacity. To translate transdisciplinary teams into other healthcare settings internationally, we propose the practice guidelines: 1) key stakeholders should be consulted to co-design the transdisciplinary team, identify and address implementation barriers; 2) competency training is required; and 3) staff education on transdisciplinary teams is required.

Promoting Coordination and Collaboration in Tribal Home Visiting Programs in the United States.

A joint statement from two federal agencies in the United States calls for coordination and collaboration between programs serving families of infants and toddlers who are at risk or developmentally delayed or disabled U.S. Department of Education and U.S. Department of Health and Human Services. Policy guidance: Joint statement on collaboration and coordination of the MIECHV and IDEA Part C programs. (2017). Individuals with Disabilities Education Act. ED/HHS Joint Guidance Document: Collaboration and Coordination of the Maternal, Infant, and Early Childhood Home Visiting Program and the Individuals with Disabilities Education Act Part C Programs. Young Native American children living on tribal lands in this country are currently eligible for two federal programs associated with these agencies which overlap in mission and implementation. This paper outlines potential strategies for creating a more seamless system of services for tribal families involving more centralized intake processes and procedures, cross training of staff to work across programs, and adopting more unifying approaches to program implementation. A streamlined system of services will result in interventions that better support family and child outcomes while reducing duplication of services, consolidating the limited number of qualified professionals available to provide services, and increasing convenience and cultural attunement of services to Native American families currently participating in both programs.

Management of chronic conditions in resource limited settings: multi stakeholders’ perception and experiences with receiving and providing integrated HIV, diabetes and hypertension services in Tanzania

BackgroundThe rising prevalence of non-communicable diseases (NCDs) alongside the continuing high burden of HIV poses a serious challenge to middle- and low-income countries’ healthcare systems. Pilot studies of integrated models of service delivery for HIV, hypertension and diabetes have demonstrated that they are feasible and acceptable among patients and care providers. This study assessed multi-stakeholders’ perspectives of the delivery and receipt of integrated care in Tanzania.MethodsA qualitative process evaluation was conducted in Dar es Salaam region of Tanzania where the integrated service delivery model was implemented from July to November 2021. In-depth interviews were held with seven key informants at the national, regional and district levels, eight healthcare providers, two researchers working at the integrated clinic and forty patients benefiting from integrated services at a large hospital. Three focus group discussions were held with community leaders and residents of the hospital’s catchment area, and clinic level observations were conducted. Thematic analysis was conducted followed by the use of Bronfenbrenner’s ecological model to identify factors pertinent to sustaining and scaling up of the integrated model.ResultsParticipants of the study at all levels were aware of the increased prevalence of NCDs specifically for hypertension and diabetes and were concerned about the trend of increasing co-morbid conditions among people living with HIV (PLHIV). The integrated service delivery model was positively perceived by stakeholders because of its multiple benefits for both patients and the healthcare system. These include stigma and discrimination reduction, improved quality of care, efficient use of limited resources, cost and time saving, reduced duplication of services and fostering of early detection for undiagnosed conditions. The organisation of the clinic was critical in increased satisfaction. Several challenges were observed, which included costs for NCD services relative to free care for HIV and inconsistent availability of NCD medications.ConclusionStakeholders reported numerous benefits of the integrated service delivery model that are fundamental in improving the health of many Tanzanians living with NCDs and HIV. These benefits highlight the need for policy and decision-makers to sustain and expand the integrated service delivery model as a solution to many challenges facing the health system especially at the primary care level.

A-165 Test Harmonisation Is a Key Enabler of Pathology Transformation

Abstract Background In April 2021 a new joint venture was formed to deliver and transform services across South East London. Two large NHS Foundation Trusts (Guy’s and St Thomas’, and King’s College hospitals) partnered with SYNLAB who are specialist pathology providers, bringing extensive global experience and expertise in setting up, transforming and running diagnostic services. The Trusts had been working in partnership for many years but were operating in numerous areas as two separate entities. There was duplication of services and tests, with different analytical platforms and very different ways of working, which led to variations in resulting and reporting. Our aim was to establish a single consolidated service, with a harmonised test catalogue, facilitating the provision of consistent results regardless of the origin of sample, and to have a single governance framework to drive improved accountability and optimisation of resources. Our view was that test harmonisation was essential to enable the deployment of a common core Laboratory Information Management System (LIMS) from the 24 legacy systems, and that the harmonisation process should be clinically led. Method We established forums (through a series of workshops) for comprehensive engagement and dialogue to allow key clinical leads from all services to meet and agree the path forward. After extensive collaborative engagement, a new model was created with a single “Strategic Clinical Lead” with pan-site responsibility appointed for each service from the existing senior clinical staff. The Strategic Clinical Lead works with their colleagues to drive consensus, seeking wide stakeholder engagement from end service users as required. Results From an initial repertoire of circa 7100 tests, test harmonisation has resulted in a 25% reduction, and in some services such as Virology, we identified 31% duplication in tests. The establishment of the new clinical model has resulted in improved efficiency and better use of resources including staffing as well as a reduction of variation of services. Importantly, test harmonisation is essential to move samples seamlessly in a hub and spoke model. The implementation of a single common core LIMS this year will significantly improve business continuity by facilitating seamless transfer of work between sites. Conclusion Extensive clinical engagement is key to transforming pathology services. The benefits of consolidation include an overall reduction in process variation leading to improved standardisation and therefore enhanced patient safety as a result of consistency in result reporting. We established a framework and new clinical model which has resulted in improved links between staff across all sites who are working collaboratively on the new target operating model (hub and spokes) which will be live in April 2024.

Community-based volunteering in response to Covid-19: people, process and planning

PurposeThe Covid-19 pandemic saw a dramatic rise in the number of people volunteering to support older people shielding at home. This study aimed to determine the processes by which volunteers were rapidly engaged in their communities and their impact on the older people who were supported and health and social care services.Design/methodology/approachThe study took place in South East England between May–August 2020. Semi-structured interviews were conducted with 88 participants including health and social care practitioners (n = 12), leaders of voluntary, community and social enterprise (VCSE) organisations (n = 25), volunteers (n = 26) and older people receiving volunteer support (n = 25). Policy and procedure documents were sourced from the VCSE organisation leaders. Data were analysed thematically according to a framework method.FindingsThe authors identified key themes of People, Process and Planning. People: volunteers had a significant, positive impact on older people in their communities, with volunteers themselves, also benefiting. Process: VCSE organisations needed to work together and with health and care providers to avoid gaps and duplication of services. VCSE organisations were able to act quickly, by-passing many complex operational procedures. However, there was a need to ensure the safety of both volunteers and older people. Planning: Looking forward, there were concerns about the long-term funding of VCSE organisations and the availability of volunteers.Originality/valueThis study took place during the first wave of the pandemic, hence, it provides a snapshot of how voluntary organisations operated at this time and highlights the importance of integration with health and care statutory services.

Promise and peril: how health system reforms impacted public health in three Canadian provinces

ObjectivesSeveral Canadian provinces and territories have reformed their health systems by centralizing power, resources, and responsibilities. Our study explored motivating factors and perceived impacts of centralization reforms on public health systems and essential operations.MethodsA multiple case study design was used to examine three Canadian provinces that have undergone, or are in the process of undergoing, health system reform. Semi-structured interviews were conducted with 58 participants within public health at strategic and operational levels, from Alberta, Ontario, and Québec. Data were analyzed using a thematic analytical approach to iteratively conceptualize and refine themes.ResultsThree major themes were developed to describe the context and impacts of health system centralization reforms on public health: (1) promising “value for money” and consolidating authority; (2) impacting intersectoral and community-level collaboration; and (3) deprioritizing public health operations and contributing to workforce precarity. Centralization highlighted concerns about the prioritization of healthcare sectors. Some core public health functions were reported to operate more efficiently, with less duplication of services, and improvements in program consistency and quality, particularly in Alberta. Reforms were also reported to have diverted funding and human resources away from core essential functions, and diminished the public health workforce.ConclusionOur study highlighted that stakeholder priorities and a limited understanding about public health systems influenced how reforms were implemented. Our findings support calls for modernized and inclusive governance, stable public health funding, and investment in the public health workforce, which may help inform future reforms.

Implementing integrated care clinics for HIV-infection, diabetes and hypertension in Uganda (INTE-AFRICA): process evaluation of a cluster randomised controlled trial

BackgroundSub-Saharan Africa is experiencing a dual burden of chronic human immunodeficiency virus and non-communicable diseases. A pragmatic parallel arm cluster randomised trial (INTE-AFRICA) scaled up ‘one-stop’ integrated care clinics for HIV-infection, diabetes and hypertension at selected facilities in Uganda. These clinics operated integrated health education and concurrent management of HIV, hypertension and diabetes. A process evaluation (PE) aimed to explore the experiences, attitudes and practices of a wide variety of stakeholders during implementation and to develop an understanding of the impact of broader structural and contextual factors on the process of service integration.MethodsThe PE was conducted in one integrated care clinic, and consisted of 48 in-depth interviews with stakeholders (patients, healthcare providers, policy-makers, international organisation, and clinical researchers); three focus group discussions with community leaders and members (n = 15); and 8 h of clinic-based observation. An inductive analytical approach collected and analysed the data using the Empirical Phenomenological Psychological five-step method. Bronfenbrenner’s ecological framework was subsequently used to conceptualise integrated care across multiple contextual levels (macro, meso, micro).ResultsFour main themes emerged; Implementing the integrated care model within healthcare facilities enhances detection of NCDs and comprehensive co-morbid care; Challenges of NCD drug supply chains; HIV stigma reduction over time, and Health education talks as a mechanism for change. Positive aspects of integrated care centred on the avoidance of duplication of care processes; increased capacity for screening, diagnosis and treatment of previously undiagnosed comorbid conditions; and broadening of skills of health workers to manage multiple conditions. Patients were motivated to continue receiving integrated care, despite frequent NCD drug stock-outs; and development of peer initiatives to purchase NCD drugs. Initial concerns about potential disruption of HIV care were overcome, leading to staff motivation to continue delivering integrated care.ConclusionsImplementing integrated care has the potential to sustainably reduce duplication of services, improve retention in care and treatment adherence for co/multi-morbid patients, encourage knowledge-sharing between patients and providers, and reduce HIV stigma.Trial registration numberISRCTN43896688.

Counterfeit Merchandise Identification Using Blockchain

As a result of a lack of openness, supply chain management frequently confronted issues such as service duplication, poor collaboration between divisions, and a lack of uniformity. Item duplicating is something which is extremely normal now-a-days and its exceptionally difficult to distinguish a fake item by simply checking it out forgers cause critical difficulties for authentic firms yet unreasonably many individuals have no clue about the whole measure of fake things effect on brands there are a few strategies concocted in the past to pull off this issue of item falsifying the most well-known strategies are utilizing radio frequency identification (RFID) labels, computerized reasoning QR code based frameworks and so forth however every one of them had many weaknesses for example the QR code can be duplicated from a certified item and put on a fake item, computerized reasoning purposes CNN and AI which needs high computational power etc. This undertaking is to further develop identification of fake items by following its store network history this is accomplished with block chain innovation which guarantees the recognizable proof and detectability of genuine items all through the store network block chain based framework makes all that decentralized that might be gotten to by a few gatherings simultaneously one of its fundamental benefits is that the recorded information is challenging changing without the assent of every interested individual which makes the information incredibly secure and safeguard from all weaknesses. This paper present’s framework planned utilizing blockchain innovation for discovery of fake items. Keywords: Blockchain, Counterfeit (Fake) product, QR code, Supply Chain, Transaction history.

Application Market of Industrial Robot in China

Robotics is a programmable mechanical system with a certain autonomy that can exercise in its environment and complete some prescribed tasks. Although industrial robots are robots, they mainly provide duplicate, large quantities, and standard services. Therefore, they also have a certain standardized requirements for the materials and semi -finished products. In addition, because industrial robots are not intelligent enough, the processing of fuzzy range can only be operated according to procedures. For example, when the screen has a small bump, the robot may judge that it cannot be operated, but if it is artificially determined, it can continue to be processed and sold. Even if the development of machine vision can solve these problems to a certain extent, non -standardized operations will reduce efficiency accordingly. Industrial robots can not only achieve simple processes such as handling, but also technically some complex processes can be achieved. However, for the consideration of cost and benefits, most industrial robot manufacturers will not choose to produce such products. Because such demand is not large enough, and the profit margin is not considerable enough.

PANDEMIC-INSPIRED COLLABORATIVE ROADMAP TO PROMOTE RURAL FOOD EQUITY ACROSS THE LIFESPAN

Abstract Early during the pandemic, access to food by residents across the lifespan was problematic in many communities. We observed well-intentioned responses by community organizations but a lack of centralized coordination across sectors. Most organizations were not aware of the efforts and capabilities of others causing duplication or gaps in services. Our team created a user-friendly, evidence-based roadmap to guide communities through developing and sustaining effective collaborative partnerships for food and nutrition-related problems to address together. We will describe elements of an effective, efficient roadmap development process using currently available evidence-based resources and creating evidence-informed resources when we identify gaps. Expected outcomes are: 1) format of the final roadmap; 2) types of groups willing to use it; 3) how well the roadmap was implemented; 4) feasibility of continued use of the roadmap by groups over the long term; and 5) potential to expand roadmap use to other communities.

Access to Community Support Services among Older Adults in Social Housing in Ontario.

Community support services are an integral enabler of aging in place. In social housing, older adult tenants struggle to access these services because of the siloed nature of housing and health services. This study examined the provision of government-funded community support services to 83 seniors' social housing buildings in Toronto, Ontario. Although there were 56 different agencies operating within the buildings, only about one third of older tenants were actually receiving services. There was a subset of services that were available in more than 80 per cent of the buildings, and the most widely accessed services were food supports, crisis intervention, transportation, caregiver support, and hearing/vision care. There were also many cases in which multiple agencies offered duplicative services within the same building, suggesting that there are opportunities for improving service coordination. Practice recommendations for increasing access to community support services among low-income older adults in social housing are provided.