Implementation Of Action Plan Research Articles

A roadmap towards implementing health technology assessment in Oman

PurposeHealth technologies are advancing rapidly and becoming more expensive, posing a challenge for financing healthcare systems. Health technology assessment (HTA) improves the efficiency of resource allocation by facilitating evidence-informed decisions on the value of health technologies. Our study aims to create a customized HTA roadmap for Oman based on a gap analysis between the current and future status of HTA implementation.Design/methodology/approachWe surveyed participants of an advanced HTA training program to assess the current state of HTA implementation in Oman and explore long-term goals. A list of draft recommendations was developed in areas with room for improvement. The list was then validated for its feasibility in a round table discussion with senior health policy experts to conclude on specific actions for HTA implementation.FindingsSurvey results aligned well with expert discussions. The round table discussion concluded with a phasic action plan for HTA implementation. In the short term (1–2 years), efforts will focus on building capacity through training programs. For medium-term actions (3–5 years), plans include expanding the HTA unit and introducing multiple cost-effectiveness thresholds while from 6–10 years, publishing of HTA recommendations, critical appraisal reports, and timelines is recommended.Originality/valueAlthough the HTA system in Oman is still in its early stages, strong initiatives are being taken for its advancement. This structured approach ensures a comprehensive integration of HTA into the healthcare system, enhancing decision-making and promoting a sustainable, evidence-based system addressing the population’s needs.

Spatio-temporal migratory patterns, habitat crossing and within-individual movement repeatability of Central Mediterranean European Rollers Coracias garrulus

Populations of long-distance migratory species may exhibit dissimilarities in the leeway of scheduled annual migration programs, the routes they follow and their convergence at ecological barriers. The aim of this study was to fill the current geographical gap, spanning over 1,100 km longitudinally between southern France and eastern Austria, in the pan-European assessment of the migration ecology of the European Roller Coracias garrulus, and contribute to completing the puzzle of spatio-temporal patterns of migration, stopover and wintering at the Western-Palearctic scale for this species. We utilized high-resolution GPS tracking data from adult Rollers breeding in Italy and Croatia, tracked on their intercontinental seasonal journeys between 2018 and 2022 and modelled the variation of migratory components both at individual and population levels. Rollers from the Central Mediterranean exhibited a clockwise spring migration loop, following a Central African migration route and wintering across a wide longitudinal belt spanning from Namibia to Mozambique. Northern savannah zones were used as long stopovers, both in autumn (Chad/Sudan) and spring (Central African Republic/Cameroon). The probability of movement was significantly higher during the night and in spring. Migration speed varied according to season (> in spring) and the habitat crossed (sea > desert > rainforest > savannah). Individuals tracked in successive years showed high consistency of key migratory parameters and partial winter home ranges overlap, in contrast with the large variability of migratory parameters at the population level. This work bridges the current geographical gap of Roller migration ecology at the European level and helps meet conservation needs at the scale of the species’ flyway, with new ecological information valuable for the implementation of International Single Species Action Plans (ISSAP) dedicated to the Roller.Significance statementTracking studies help to disentangle intraspecific variation in migratory strategies and wintering destinations among populations, as well as investigate individual-level decisions taken en route across seasonal journeys. By GPS tracking the intercontinental migration of adult Rollers we found that spatio-temporal components of migratory and flight strategy largely depend on extrinsic factors such as daytime, season and the habitat they traversed, and vary at population level. In contrast, within-individual consistency in migratory and wintering patterns emerged across years. Our findings emphasize the need for effective conservation strategies at the flyway scale.

Long-term effect of intravenous antimicrobial use in a pharmacist-led ASP at a small Japanese acute care hospital

Background: Antimicrobial resistance (AMR) remains a crucial, healthcare issue for which many countries have devised a national action plan. In Japan as well, antimicrobial stewardship programs (ASP) are being implemented in acute care hospitals under this policy framework. Clinical pharmacists play a central role in ASP, often jointly with infectious disease (ID) physicians. However, in Japan, a shortage of ID physicians has resulted in some ASP being led solely by pharmacists. While reports of the short-term effects of this situation are emerging, the long-term impact of pharmacist-led ASP is still largely unknown in Japan. The present study retrospectively examined the long-term effects of pharmacist-led ASP in a small, Japanese, acute care hospital. Method: The present study examined a pharmacist-led ASP in an acute care hospital (287 beds) in Japan which was launched in August 2015 and assessed the duration of therapy per 1000 patient-days (DOT) as the primary outcome by comparing the pre-intervention period (April 2013-July 2015) with the intervention period (August 2015-March 2023) using linear regression analysis. Additionally, segmented time-series analysis was conducted for each, additional intervention, and the impact of reduced activity due to the coronavirus disease 2019 (COVID-19) pandemic during the intervention. The DOT at the study center were compared with the national average of facilities implementing ASP. Result: While the DOT for all intravenous antimicrobials showed a slight increase on linear regression (r=0.01; P=0.1), the DOT of antipseudomonal intravenous antimicrobials significantly decreased (r=-0.027; P < 0 .01). Moreover, a significant reduction in DOT was observed immediately after the initiation of prospective review and feedback for carbapenems and daily prospective review and feedback for all intravenous antimicrobials (-3.2 and -2.4; P < 0 .001 for the intercept). An increase in DOT was observed during the COVID-19 pandemic-related reduction in activity time, and a rapid decline was observed upon the resumption of activities. Conversely, the average, nationwide DOT significantly increased for all intravenous antimicrobials as well as for antipseudomonal intravenous antimicrobials (r=0.02 and r=0.004; P < 0 .01) Conclusion: Sustaining an effective, pharmacist-led antimicrobial stewardship program led to a continual decrease in the DOT of antipseudomonal intravenous antimicrobials in a small, Japanese, acute care hospital despite a nationwide increase in their use following implementation of the national AMR action plan. Detailed analysis of pharmacists’ activities across multiple facilities is necessary to verify these effects.

Moving inclusion forward for students with special educational needs in the Asia-Pacific region

This paper draws on a comparative study of seven jurisdictions in the Asia-Pacific region to examine current challenges to progressing inclusive education for students with special educational needs (SEN) in mainstream schools. The study used a qualitative approach to collect data from each jurisdiction through a purposive sampling of knowledgeable, university-associated informants. Content analysis was used to identify and quantify specific challenges reported in the data. Subsequently, these items were coded as themes to form a matrix of challenges within and across jurisdictions. Findings revealed that challenges were broadly consistent with recent global trends and shared many commonalities, despite occurring in diverse societal, political and education systems. These challenges are: lack of adequate initial teacher education and ongoing professional development for practicing teachers; lack of resources and support to meet the needs of students with SEN; inconsistent policy guidelines and implementation action plans; restricted stakeholder engagement and collaboration across all levels of education; and limited local inclusion research to inform practice in schools. The findings underscore the need for government and institutional commitment and oversight to bridge the policy-to-practice gap, and an urgent need for local research to identify and disseminate successful approaches for including students with SEN throughout the region.

Multi-criteria techniques based proposals for the End of Childhood Index: Reference levels and compensation issues

Child well-being is a subject of paramount importance, since a careful analysis of all the aspects related to childhood may have a major impact on the society as a whole. In this paper, based on the End of Childhood Index, which is a fully compensatory composite indicator published annually by the international organisation Save the children, we analyse the added information that can be provided through the use of multi-criteria analysis techniques. On the one hand, rather than analysing the overall performance of the countries by the use of the fully compensatory scenario, we make use of the international reference levels and performance bands provided by Save the Children itself, allowing to measure the distance of each country with respect to these levels. Besides, the use of a non-compensatory scenario offers interesting insights about the possible imbalances of each country, which is helpful in decision making processes. First, based on the data of the last available year, 2021, an overview of the worldwide analysis and a further detailed single region analysis is carried out. Second, a dynamic analysis over a period of five years (2017–2021) is undertaken. In this line, in order to guide childhood decision makers towards the identification of possible opportunities for improvement and the implementation of the corresponding action plans, the multiple reference point technique makes it possible to analyse the compliance in each one of the indicators, based on the use of distance reference levels and the joint consideration of a fully and non-compensatory composite indicators.

Assessing the Effectiveness of UNDP’s Climate Action Initiatives at the Local Level: A Thematic Analysis of Implementation Strategies and Outcomes

Sustainable development has been considered as the global phenomena in every field of life. The United Nations developed a program to attain sustainability. This programme is a United Nations agency tasked help countries to eliminate poverty and achieve sustainable economic growth and human development. The UNDP emphasizes in promoting local capacity towards long-term self-sufficiency and prosperity. Therefore, this research aimed to analyse the effectiveness of UNDP climate action initiatives and outcome on local level. The study employs a research design involving the selection of previously published case studies from different regions worldwide, which highlights various climate-related challenges and the effectiveness of UNDP initiatives in addressing them. The data was collected from different sources, such as the World Bank’s official website and UNDP’s official website, and previously published studies were also utilized. Thematic analysis approach was applied to assess the implementation strategies and outcomes across different regions. The findings reveal similarities and differences in the implementation of UNDP climate action plans and the challenges countries face in executing these initiatives. Through thematic analysis and interpretation of results, the study provides valuable information for developing effective policies to address climate-related challenges. Additionally, the research also suggests directions for future studies. The thematic analysis showcases specific case studies, including renewable energy deployment in Pacific Island Nations, ecosystem restoration in the Sahel Region, climate-smart agriculture in Southeast Asia, and climate-resilient urban planning in Latin America. These cases illustrate UNDP’s commitment to promoting climate action and sustainable development through innovative projects and partnerships. This research contributes to understanding the effectiveness of UNDP’s climate action initiatives at the local level and informs future policy and programmatic efforts in this area.

Improving Accessibility to Outpatient Department Through Reduction of Third Next Available Appointment in Tertiary Hospital in Taif, Saudi Arabia

Background The Outpatient Department (OPD) of Al Hada Armed Forces Hospital - Taif Region (AHAFH) plays a critical role in providing specialized medical services to a diverse population in Taif region, Saudi Arabia. The hospital faces the challenge of ensuring timely access to a comprehensive array of 40 specialized services and subspecialties, supported by 120 rooms in the OPD. This article outlines a significant understanding of the patient flow process and queuing mechanism in the context of the OPD and the dynamics of supply and demand. Local Problem Our project was initiated during the last few weeks of fourth quarter 2020, which revealed a concerning trend of increasing the third next available appointment (TNAA), surpassing the optimal target of <14 days. Methods The study used pre-test and post-test monitoring of the TNAA. Patients’ categories of referral were identified as urgent and routine. We also established a referral and discharge criteria for each clinic specialty and reminder messages on patient appointments 24 hours and 48 hours prior to their actual appointment. Interventions The Plan-Do-Study-Act (PDSA) model for improvement was utilized to implement action plans and interventions to address the increase of TNAA (in days) in the OPD. Weekly huddles were conducted to monitor project progress, action plans, data, and challenges. Results During the intervention phase, notable changes were observed in the control chart, including shifts in TNAA mean decreasing from 9.4 days to 5.6 days after the implementation of four PDSA cycles. Moreover, the average TNAA in each quarter showed consistent reduction in TNAA, with an average of six days in Q1 2022. Conclusions The study sheds light on the complexity of managing the patient flow and access in an outpatient setting. By implementing effective strategies and continuous and vigilant monitoring of the outcomes, outpatient departments can strive to ensure that patients receive specialized care in a timely manner.

Impacts of covid-19 pandemic on NDC implementation action plan for the agricultural sector in Nigeria

Climate Change is one of the biggest challenges of the 21st Century. In 2015, the world reached a milestone in addressing this menace with the adoption of the Paris Agreement on Climate Change. Article 3 of the Agreement requires Parties to the agreement to pledge and implement their Nationally Determined Contributions (NDCs) towards climate change adaptation and mitigation. Nigeria as a signatory to the Paris Agreement deposited its NDC with the Agreement’s secretariat in 2017 and have also designed its internal NDC Implementation Action Plan for five Key sectors before the outbreak of the coronavirus (Covid-19) pandemic in 2019. In order to contain the spread of the coronavirus, certain restrictive measures (such as lockdown and closure of business) have been adopted both locally and internationally. This paper uses doctrinal research approach to appraise the impacts of the Covid-19 pandemic and its containment measures on Nigeria’s NDC Implementation Action Plan for the Agriculture Sector. The paper finds that the Nigeria’s NDC Implementation Action Plan for the Agriculture Sector is highly ambitious if properly implemented. There is also no legal framework for the NDC Implementation Action Plan in Nigeria. This paper concludes by suggesting a procedural right-based approach for the Implementation of the Action Plan in Covid-19 and Post Covid-19 era in Nigeria.

Characterization of Metal Elements in Atmospheric Fine Particulate Matter and Their Sources in Winter in the Southern Sichuan Urban Agglomeration

To investigate the concentration characteristics and sources of metal elements in PM2.5 during winter heavy pollution in the southern Sichuan urban agglomeration (Zigong, Luzhou, Neijiang, and Yibin), the metal elements in PM2.5 were measured using membrane sampling methods from December 30, 2018 to January 14, 2019, and the enrichment factor method (EF) and positive matrix factorization(PMF) were applied to investigate the sources of metal elements. The metal element observation data of Zigong in the same period of 2015 were also used to investigate the changes in metal element pollution and enrichment in Zigong in the middle and end of the implementation of China's Air Pollution Prevention and Control Action Plan. The main findings were as follows:① The concentrations and percentages of metal elements in particulate matter in different cities did not differ significantly. The elements with higher concentrations in the four cities showed similarities, with Al, Sb, and Fe at the top. From the comparison of different observation periods in Zigong, the concentrations of all elements except Tl changed. ② The results of the enrichment factor calculation showed that the enrichment of the elements Cr (Zigong and Yibin), Ni, Cu, As, Se, Ag, Cd, Sb, Tl, and Pb in the urban agglomeration was high. The comparison of the enrichment levels of elements in Zigong for different observation periods showed that the enrichment levels of all elements, except Cu, tended to decrease in the winter observation period of 2018. ③ The results of PMF source analysis showed that the metal elements in each city mainly originated from dust sources, coal-fired sources, industrial sources, and traffic sources, whereas there was a mixed contribution among the sources. The contribution of the main sources differed among cities, in which Zigong was dominated by traffic dust sources and mixed sources, Luzhou was dominated by industrial sources, Neijiang had a similar contribution from different sources, and Yibin was dominated by traffic sources.

Enhancing team dynamics through digital coaching: the role of managerial and peer support

PurposeAlthough the literature on the effectiveness of team interventions is constantly expanding, there has been a strong focus on the process mechanisms that could explain their success, often overlooking the contextual aspects in which these interventions are carried out. Based on the Context-Mechanism-Outcome framework, this study aims to investigate the influence of contextual factors on the effectiveness of digital team coaching interventions that use social network visualisation to enhance team coordination and reduce interpersonal conflicts.Design/methodology/approachUsing a multi-wave, longitudinal design, this research analysed 38 work teams from three organisations over three-time points. Data collection focused on manager and peer support, the mechanisms of training transfer and action plan implementation and the outcomes of these interventions. Surveys were administered in three organisations, involving 317 respondents across different phases. The intervention spanned six to eight months, incorporating three to four structured online group sessions. Each session involved a multi-stage process, concluding with a result-oriented action plan about work-related goals. The intervention included social network visualisation, discussions, coaching and continuous refinement of action plans.FindingsThe analysis highlights how manager support significantly correlates with team coordination and performance, mainly when teams are less engaged in implementing action plans. Peer support did not show a mediating effect on training transfer or outcomes but had direct positive impacts on team coordination and performance.Practical implicationsTeams actively implementing action plans may require less immediate managerial support for effective coordination and high performance. The manager’s role becomes crucial, particularly in the early stages of the intervention or in those teams where online coordination alone may not be adequate for action plan implementation. Peer support for training transfer could enhance the effectiveness of the intervention in achieving desired team outcomes; therefore, cultivating a supportive peer environment is crucial for the success of such interventions. Monitoring and assessing team dynamics are vital to maximise the benefits of digital team coaching interventions.Originality/valueThis study stands out for its innovative exploration of the interplay between managerial and peer support in the context of digital team coaching, using social network visualisation as a novel approach to enhancing team dynamics.

Multidisciplinary care for patients with gastroesophageal cancers (GEC): A quality improvement initiative in community cancer clinics.

e16096 Background: Evidence-based guidelines for GEC management recommend multimodal care, which involves close coordination between medical, surgical, and radiation oncologists, together with specialists to manage symptoms and treatment-related adverse events (AEs). Optimizing the high level of multidisciplinary care required for effective GEC management poses substantial challenges for community oncology care teams. Methods: In August-October 2023, 57 healthcare providers (HCPs) from 4 US community oncology clinics completed surveys on challenges, barriers, and improvements needed in the multimodal care of patients with GEC. Based on findings from the baseline data, 70 HCPs participated in audit/feedback (AF) sessions to review site-specific gaps and challenges and develop action plans to address identified gaps. Follow-up surveys will evaluate the impact of changes in practice following action plan implementation. Results: Providers identified their 3 top challenges to providing care for patients with GEC: interdisciplinary care coordination, providing patient-centered supportive care, and managing AEs. They reported that care coordination was hampered by low frequency and poor-quality communication between medical oncology and surgical teams, by misalignment on methods of communication, and by a lack of relationship between the specialties. About one-third of HCPs reported recognizing and managing AEs as the most challenging aspect of caring for patients with GEC, including AEs that were immune-related (26%), dermatologic (19%), gastrointestinal (19%), neurologic (14%), immunosuppression-related (10%), and respiratory (5%). After the AF sessions, HCPs reported improving communication and coordination among care team members as an important means of improving and individualizing patient care plans and integrating new therapies into clinical workflows. Action plans included streamlining communication with surgical teams, increased use of patient navigation, and ensuring that every patient is reviewed through the multidisciplinary tumor board. With regard to AE management, action plans included improving patient education on AE identification, and better communication within the team on nutritional support. HCPs who participated showed improved confidence, knowledge, and competence in appropriately sequencing systemic therapy and surgical interventions. Conclusions: GEC care teams from community cancer clinics reported dissatisfaction with multidisciplinary care coordination, including poor communication between specialists involved in multimodal care of patients with GEC. Integration of sustainable changes in clinical workflows driven by this initiative improved oversight of multimodal care, improved workflows, and improved AE management.

Opportunities and challenges in antimicrobial resistance policy including animal production systems and humans across stakeholders in Argentina: a context and qualitative analysis

IntroductionGaps in antimicrobial resistance (AMR) surveillance and control, including implementation of national action plans (NAPs), are evident internationally. Countries’ capacity to translate political commitment into action is crucial to cope...

Energy Consumption Analysis and Management Strategies for the Dairy Farm in India Towards Sustainable Development

ABSTRACT Environmental pollution and the rapid decline in the availability of fossil fuels are the major concerns of the electric power industry in recent years. Effective utilization of electrical energy is the need of the hour in building the nation towards sustainable development. This study presents the energy consumption analysis and management performed in a diary firm located in Tamil Nadu, India. Initially, the energy usage of the firm is estimated based on its electricity bills, meter readings, and survey followed by detailed energy consumption analysis and evaluation. The study employs guidelines provided by the Indian Bureau of Energy Efficiency for energy management. The detailed analysis performed finds scopes for improvement in efficient energy usage. Numerical analysis shows that implementation of proposed action plans that include installation of automatic power factor correction, replacement of overheating equipment, and replacement of lighting systems with energy-efficient lighting would save annual energy of 123.96 kWh which in turn results in the reduction of annual CO2 emission by 117.76 tonnes. Furthermore, this paper also proposes a novel optimal process scheduling which optimally schedules different processes in the firm without affecting productivity. This makes an additional savings of INR 4,23,360 per annum in the energy cost by minimizing the maximum demand of the firm with zero investment. A comparison of the proposed approach with existing methodologies available in the literature shows the effectiveness of the proposed technique.

Barriers and opportunities (B&O) for developing low carbon transportation (LCT) policies in Turkey

From a global perspective, climate change mitigation requires countries to consider Low-Carbon Development (LCD) policies, including “Low-Carbon Transport (LCT)” and decarbonization options, which should be ideally developed within a place-based scope. Due to the complex structure of the transportation sector, mitigation actions require not only technological but also behavioral shifts, which can be challenged by the existing legislative and socio-economic structure of a region. Therefore, it is essential to identify and assess barriers and opportunities (B&Os) as a necessary initial phase in the development of national mitigation strategies. Turkey voluntarily started climate change mitigation by preparing the legislative and political infrastructure as a part of the European Union Harmonization Process. Detection of B&Os in other dimensions required an in-depth evaluation of existing LCT barriers and instruments (B&Is) in the IPCC literature in terms of their applicability and priority for Turkey. A focus group study with transport sector representatives was conducted to evaluate 15 barriers and 19 instruments (proposing 285 B&I matrix combinations), followed by a brain-writing exercise that revealed 12 main barriers (i.e., a lack of measurable targets, an imbalanced modal split, a lack of institutional coordination and data archiving, etc.). Various opportunities have been identified, such as the increased utilization of Intelligent Transportation Systems and the timely adoption of vehicle and fuel technologies in the EU region. These opportunities would not only contribute to the development of a national climate change mitigation strategy but also facilitate the implementation of place-based action plans, including climate change action plans and sustainable urban mobility plans at the city level.

National Athletic Trainers' Association Position Statement: Emergency Action Plan Development and Implementation in Sport.

An emergency action plan (EAP) is a written document detailing the preparations and on-site emergency response of health care professionals and other stakeholders to medical emergencies in the prehospital setting. The EAP is developed to address any type of catastrophic injury response and should not be condition specific. The objective of this National Athletic Trainers' Association position statement is to provide evidence-based and consensus-based recommendations for developing and implementing an EAP for sports settings. These recommendations were developed by a multidisciplinary expert panel that performed (1) a comprehensive review of existing EAP evidence, (2) a modified Delphi process to define consensus recommendations, and (3) a strength of recommendation taxonomy determination for each recommendation. An EAP is an essential tool designed to facilitate emergency preparedness and an efficient, coordinated emergency response during an athletic event. A comprehensive EAP should consider modes to optimize patient outcomes, the various stakeholders needed to develop the plan, the factors influencing effective implementation of the EAP, and the roles and responsibilities to ensure a structured response to a catastrophic injury. These evidence-informed recommendations outline the necessary steps for emergency planning and provide considerations for the immediate management of patients with catastrophic injuries. Increasing knowledge and implementation of the EAP to manage patients with catastrophic injuries improves the overall response and decreases errors during an emergency.

Targeted interventions to address local challenges in HR+/HER2- and HER2+ breast cancer treatment in community-based settings.

e23213 Background: Advancements in novel targeted agents and antibody-drug conjugates (ADCs) have dramatically improved patient outcomes and survival for breast cancer patients, yet the successful utilization of these agents remains a key challenge for clinicians, particularly in the community. To improve the care of HR+/HER2- and HER2+ patients, a quality improvement (QI) initiative was conducted across 6 community-based oncology practices. Methods: Between 7/2023 and 10/2023, multidisciplinary oncology team members (N = 98) across 6 US-based community oncology practices were surveyed to identify gaps in the treatment and management of patients with HR+/HER2- and HER2+ breast cancer. Providers then participated in audit/feedback (AF) sessions where they (a) assessed site-specific practice gaps identified via the provider surveys; (b) received targeted education based on their specific gaps; and (c) developed action plans for improvement. Follow-up surveys administered 90 days after AF sessions will evaluate the impact of practice changes driven by the QI initiative. Results: Top challenges reported by providers in caring for patients with HR+/HER2- and HER2+ breast cancer were providing patient-centered supportive care measures (37%), individualizing treatment plans (18%), and managing treatment-related adverse events (14%). Reported challenges in treatment sequencing included rapidly evolving guideline recommendations (44%) and knowing which treatment to select when patients are eligible for multiple lines of therapy (34%). Additionally, oncology team members reported having the most difficulty managing treatment-related neurological effects (32%), neutropenia (16%), and GI toxicities (14%). Providers believed improved collaboration across interprofessional teams (28%) and increased patient education/referrals for supportive care (26%) would most improve care for breast cancer patients. To address the identified gaps at each location, teams participated in targeted AF sessions focused on addressing their specific gaps and developed action plans, such as developing new workflows for improving care coordination, implementing institutional protocols for identifying and managing adverse events, and improving patient supportive care, quality-of-life assessments, and distress screenings. Full findings from baseline surveys will be presented, along with follow-up surveys measuring real-world impact of the system-level practice changes. Conclusions: Through this QI initiative, teams identified gaps/barriers in their own practices, and developed and implemented action plans for improvement. These data and actionable insights support safe, effective, and evidence-based integration of novel therapies into HR+/HER2- and HER2+ breast cancer care to optimize patient outcomes.

Beyond the binary: A transformative implementation science initiative to improve LGBTQ+ cancer care.

11010 Background: Patient, provider, and system-level barriers contribute to significant disparities in care of LGBTQ+ persons, including delays in screening and diagnosis, and poorer outcomes. This implementation science initiative was designed to identify and address root causes of disparities in care for LGBTQ+ patients (pts) and drive sustainable change to improve health equity in LGBTQ+ cancer care. Methods: In 2023, a steering committee of 3 expert oncologists and 5 LGBTQ+ cancer pts convened to develop survey instruments and a point-of-care LGBTQ+ Cancer Care Toolkit. Next, LGBTQ+ pts with cancer (N = 817) and oncology providers (OPs) from 2 academic and 5 community-based practices (N = 115) completed surveys to reveal alignments and discordances in beliefs, perceptions, and practices regarding cancer care. OPs participated in audit-feedback (AF) sessions to critically assess system-specific practice gaps, prioritize areas for improvement, and develop action plans for improving LGBTQ+ cancer care. Results: Provider-reported top challenges in care included: unsure how sexual orientation/gender identity (SOGI) affect treatment considerations (35%), unsure how to discuss SOGI (30%),and systemic barriers that limit inclusion (29%). While most providers (84%) were at least moderately comfortable treating LGBTQ+ pts, these data suggest they overestimated the level of comfort of their pts. For example, only 24% of pts reported feeling safe disclosing their LGBTQ+ identity, while 65% of providers thought pts felt safe. Additionally, while most providers (73%) thought it was important to know a pt’s gender identity, only 46% thought it was important to know sexual orientation, and only 3% of providers reported routinely discussing SOGI with new pts. Patients and providers were not concordant in several other key areas, including the experience of pts’ partners, measures of inclusivity, and supportive care services offered, such as fertility preservation. Survey data also revealed systemic barriers to equitable care, such as EMR documentation of SOGI. In AF sessions, teams reviewed survey outcomes, and developed action plans for improvement, including integrating the toolkit, updating EMR documentation, developing LGBTQ+ education, and adopting measures of inclusivity. Notably, following the intervention, there were considerable gains in provider confidence and knowledge, and ~70% of providers committed to discussing SOGI with their pts at first introduction. Conclusions: Through this QI initiative, teams identified patient-, provider-, and systemic-level barriers that affect LGBTQ+ cancer care in their own practices and implemented action plans to address key challenges. The sustainable changes implemented in this QI initiative represent key opportunities for improvement that can be implemented in clinics across the country to improve equitable LGBTQ+ cancer care.

Implementation of Area-Specific Action Plans (ASAP) for community-based MPAs in Cagayancillo, Palawan, Philippines: funded versus not funded

The Area Specific Action Plan (ASAP) for community-based MPAs serves as an outline of the framework for the purpose, design, and implementation of MPAs. The funding from the US Department of the Interior (USDOI) through Tanggol Kalikasan (TK) was used for the planning, training, and implementation of the Area-Specific Action Plan (ASAP) through Tanggol Kalikasan (TK). Two barangays from the Municipality of Cagayancillo were chosen as beneficiaries of the funding. This study aimed to assess the level of implementation of the ASAP on coastal resource management (CRM) and law enforcement in the community-managed MPAs in Cagayancillo Island, Palawan, through a comparison of the results of the perception survey interviews of the respondents from the control sites and funded sites. Four marine protected areas (MPAs) in the Cagayancillo region were selected as study areas: the MPAs in Barangays (Bgy.) Sta. Cruz (C1) and Nusa (C2) which did not receive additional funding from TK served as control sites; while Bgy. Mampio (F1) and Bgy. Talaga (F2) which received funding from TK, served as the funded site. The results showed that all CRM indicators were fully implemented (4.0) in C1, C2, and F2. The F1, on the other hand, had moderate implementation (2.0) of conducting seminar-workshops on MPA and poor implementation (1.0) of posting tarpaulin, signage, and other infographics. In terms of law enforcement, I1 had significantly moderate implementation (2.0) compared to other barangays. The implementation of ASAP in F1 was badly affected by Typhoon Odette in December 2021. Taking all factors into consideration, personal interview results revealed that the key to the effective implementation of MPAs’ CRM and law enforcement activities significantly depends on the leaders of a barangay. Well-established leadership can efficiently and responsibly implement projects within their areas.

Drawing up the public national Rational Pharmacotherapy Action Plan as part of social and health services reform in Finland: a bottom-up approach involving stakeholders

BackgroundEnsuring equal access to medicines and their appropriate and safe use at reasonable costs are core functions of health systems. Despite that, few descriptions of national medicines policies' development processes and implementation strategies have been published. This study aimed to describe the government program-based development of the Rational Pharmacotherapy Action Plan in Finland as a part of the undergoing major health and social service system reform, also covering the implementation of rational pharmacotherapy in the reformed system and processes.MethodsThe data of this qualitative study consisted of public reports and Steering Group meeting memos related to the development of the national Rational Pharmacotherapy Action Plan that the Ministry of Social Affairs and Health coordinated. Qualitative content analysis applying systems theory and the conceptual framework of integrated services as theoretical frameworks was used as an analysis method.ResultsThe national Rational Pharmacotherapy Action Plan covering 2018–2022 was created in a bottom-up development process involving a wide range of stakeholders. Rational pharmacotherapy was redefined by adding equality as the fifth pillar to complement the previously defined pillars of being effective, safe, high-quality, and cost-effective. The Action Plan formed a normative framework for long-term development, with a vision and principles focusing on people-centeredness, better coordination and management of the medication use processes, the continuity of treatment paths and the flow of patient and medicines information through partnerships, and evidence-informed policies and practices.ConclusionThrough intensive stakeholder participation, the bottom-up approach created a national vision and principles of rational pharmacotherapy along with strong commitment to implementing the goals and measures. The concern lies in ensuring the continuity of the Action Plan implementation and achieving a balanced long-term development aligned with the integrated and reformed national social and health services system. The development of the pharmaceutical system has several national and EU-level dependencies requiring political long-term commitment. While the Action Plan differs from the national medicines policy, it forms a good basis for long-term development covering important parts of medicine policy at the micro, meso, and macro levels of the service system.

Abstract PO5-05-04: Advancing Treatment and Management of Patients with HR+/HER2- Breast Cancer: Findings from a Quality Improvement Initiative

Abstract Background: With the advent of novel oral oncolytics, the cancer care delivery model for HR+/HER2- breast cancer (BC) is evolving, shifting the responsibility for medication adherence and monitoring and managing of side effects to patients and their caregivers. In this quality improvement (QI) initiative, we aimed to uncover and address gaps in patient and provider education, risk reduction, adverse event management, and shared decision-making in order to improve outcomes for HR+/HER2+ patients on oral oncolytics. Methods: From 9/2022 to 12/2022, 54 HCPs who treat breast cancer and 111 HR+/HER2- BC patients from 4 US community oncology clinics completed surveys assessing attitudes, values, and challenges related to practice patterns, education, and therapy adherence in HR+/HER2- BC. HCPs participated in audit-feedback sessions to reflect on survey results and their own practice, and developed action plans to improve care, which were implemented in subsequent collaborative patient-provider learning sessions. Results: Top reported HCP challenges in HR+/HER2- BC care include providing patient-centered supportive care measures (32%), patient adherence/lack of follow up (22%), and individualizing treatment plans (17%). Additionally, 43% of providers reported that improved collaboration across interprofessional teams would most improve care. Top reported patient challenges include worry about and/or difficulty managing side effects from treatment (26%), difficulty scheduling visits with many different HCPs/following up (24%), and difficulty communicating with healthcare teams (16%). In surveys, 28% of patients reported frequently or very frequently missing/skipping doses of oral breast cancer medication. Top reasons for missing/skipping doses included forgetting or not having it nearby (36%), cost (21%), and side effects (20%). To address the top challenges identified in baseline surveys, HCPs developed and implemented action plans, such as improving the identification of patients at high risk of recurrence, establishing patient-provider educational sessions, increasing the use of patient navigators, incorporating oral adherence toolkits, and educating patients and staff about available supportive care resources. After implementation of patient-provider collaborative education sessions at community clinics, patients reporting high levels of knowledge about BC treatment options and communicating side effects/symptoms increased from 27% to 57%, and 37% to 77%, respectively. At 60-day follow-up, 58% of patients reported taking a more active role in treatment decision-making, and 52% reported setting reminders/alarms/using apps to remember to take medication on time. Conclusions: Patient adherence to oral oncolytic medications remains a challenge in BC treatment. This quality improvement initiative uncovered underlying barriers to effective treatment management of HR+/HER2- breast cancer patients on oral oncolytics. Action plans and educational resources were developed and implemented to address identified barriers and optimize treatment management for HR+/HER2- BC. These methods and findings represent key opportunities for improvement that can be implemented in community oncology practices to improve adherence to oral oncolytics and overall HR+/HER2- breast cancer care. Citation Format: Jane Meisel, Chelsie Anderson, Ilona Dewald, Jeffrey Carter, Cherilyn Heggen, Kelly McKinnon. Advancing Treatment and Management of Patients with HR+/HER2- Breast Cancer: Findings from a Quality Improvement Initiative [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-05-04.