Implementation Of New Services Research Articles

Multi-level authentication for security in cloud using improved quantum key distribution

ABSTRACT Cloud computing is an on-demand virtual-based technology to develop, configure, and modify applications online through the internet. It enables the users to handle various operations such as storage, back-up, and recovery of data, data analysis, delivery of software applications, implementation of new services and applications, hosting websites and blogs, and streaming of audio and video files. Thereby, it provides us many benefits although it is backlashed due to problems related to cloud security like data leakage, data loss, cyber attacks, etc. To address the security concerns, researchers have developed a variety of authentication mechanisms. This means that the authentication procedure used in the suggested method is multi-levelled. As a result, a better QKD method is offered to strengthen cloud security against different types of security risks. Key generation for enhanced QKD is based on the ABE public key cryptography approach. Here, an approach named CPABE is used in improved QKD. The Improved QKD scored the reduced KCA attack ratings of 0.3193, this is superior to CMMLA (0.7915), CPABE (0.8916), AES (0.5277), Blowfish (0.6144), and ECC (0.4287), accordingly. Finally, this multi-level authentication using an improved QKD approach is analysed under various measures and validates the enhancement over the state-of-the-art models

Legal Basis for The Activities of Law Enforcement Agencies Under the Legal Regime of Martial Law

Problematic issues related to the legal basis of the activities of law enforcement agencies under the legal regime of martial law are caused by significant threats to Ukrainian statehood, sovereignty, and territorial integrity of Ukraine. These aspects have become particularly acute after February 24, 2022, as a result of the full-scale invasion of the Russian Federation, which determines the relevance of the topic. The purpose of the study is to determine the legal basis for the activities of law enforcement agencies under the legal regime of martial law in the light of the latest socio-economic, ideological and security issues. Such methods as analysis, synthesis, deduction, induction, logical and legal method and forecasting were used in the article. Within the scope of the study, separate organizational and legal principles were singled out, which most widely illustrate the depth of changes in the activities of law enforcement agencies under martial law. The principle of situational implementation of new services to help the population is reduced to the fact that law enforcement personnel provided services to accommodate the population in shelters, provide drinking water and food to vulnerable groups, etc. The rule here is that for there to be an effective content in countering a separation, there is that need in revealing the prism's that exist which will be able in preventing the measures used in preventing armed group which to a greater extent will continue to be a threat in State's building a stable foreign policies.

Creating a framework for change: transitioning to value-based healthcare in Queensland.

Value-based healthcare has been described as the sustainable, equitable and transparent use of healthcare resources to achieve improved experiences and outcomes for people and communities. It is supported by all levels of government in Australia, with recent initiatives championing a shift away from traditional, clinician-centric care delivery to a more contemporary, value-based approach. To date, however, efforts in Queensland have focused on smaller scale siloed models of care and have not extended to the transformational change required to create equitable and sustainable healthcare delivery. The Queensland Health Allied Health Framework for Value-Based Health Care (the Framework) builds on contemporary frameworks with reference to the local context in Queensland and provides a structure and starting point for clinicians and managers to work together with consumers to transform services to focus on preventative health and wellbeing, shifting the focus of care to the community and sustainably improving the quality of care delivered. The Framework outlines key considerations for the design and implementation of new services, including understanding the care pathway, supporting an outcome driven workplace culture, measuring what matters and designing for outcomes. Several key lessons were learnt during the development of the Framework, including the importance of early and sustained consumer partnerships, of establishing a shared definition of value-based healthcare that enables integration across the care pathway and the need for leadership at all levels to actively support the change management process. While developed for Queensland public allied health services, the Framework is intended to be a system-wide tool relevant to all health professionals and services.

The ADEM project: implementation of ‘Good medicines use conversation’ for COPD-patients, embedded in multidisciplinary context.

COPD is a chronic, progressive disease, for which a multidisciplinary approach is crucial. Appropriate follow-up is crucial to improve the quality of life of COPD-patients and reduce associated healthcare costs. 
 A ‘Good medicines use conversation’ COPD is a pharmaceutical care intervention, conducted by the community pharmacist, consisting of a tailored-made education of the COPD-patient on the disease and its treatment. Scientific research (PHARMACOP-trial) has shown that this intervention significantly improves therapy adherence and inhalation technique and reduces exacerbation rates and associated hospitalizations. 
 The aim of the ADEM implementation project was to investigate the needs for a sustainable implementation of this intervention.
 The ADEM project was conducted in Flemish-Brabant (Belgium), with the integrated care region ‘Leuven Cares’ as a separate entity. 
 All participating pharmacies (9 in region Flemish-Brabant and 8 in region ‘Leuven Cares’) received a support package consisting of: 1) a three-part online training about COPD and a visual COPD-atlas; 2) a population management-tool (a query to identify COPD-patients in the pharmacy, resulting in a list of COPD-patients with a ‘score’ per patient as an initial proxy for patient prioritization); and 3) local interdisciplinary meetings (LIM) to discuss and promote the intervention. Pharmacist of the region Caring Leuven additionally received individual care plans, providing an overview of the healthcare status of each COPD-patient, and an individual coaching session.
 Semi-structured interviews were conducted with 8 participating pharmacists (4 region Flemish-Brabant, 4 region ‘Leuven Cares’). Thematic analysis was performed.
 
 All elements of the support package were positively evaluated by the participating pharmacists. The population management tool seemed to support pharmacists in planning, interpreting and prioritizing care for COPD-patients. A follow-up study is needed to further investigate the tool and to what extent population management contributes to a more qualitative and effective pharmaceutical care. 
 COVID-19, lack of personnel, lack of reimbursement and lack of time were identified as limiting factors for the implementation of the protocol-based COPD-intervention. Cooperation with the GP was indicated by the majority as minimal and insufficient. Therefore, LIM’s were evaluated as very important to inform GP’s about the pharmaceutical intervention and make local agreements about the multidisciplinary approach of COPD.
 The findings of this study are in line with the available evidence on the implementation of new services in pharmacies. Many pharmacists have the intrinsic motivation to offer extended pharmaceutical care, but current practices often do not allow this. Population management appeared to be a major factor that can be used to facilitate the implementation. By considering the needs of the local population, pharmacists can work in a more targeted way and prioritize the pharmaceutical services they offer. Given the group of chronically ill people in Belgium is expected to grow in the coming years due to the increasing ageing of the population, there will be an increasing demand for specialized interventions and advice from the pharmacist. It is therefore necessary to provide a sufficient framework for these services, bearing in mind the needs of the local population and the requirement for a pragmatic approach in the pharmacy. 

Which needs assessment tool to use? Review of the needs assessment tools for service evaluation

Abstract Background Needs assessment enhance patient-centered care quality and is important within evaluation process, as well as for implementation of new services. Needs assessment tools can help clinicians to plan treatment and also to assess subsequent service impacts. Aim of the present research was to review quantitative tools for mental health needs assessment, that are either self-reported or can be used by professionals or researchers. Methods A comprehensive literature search in two bibliographic databases was carried out following the PRISMA protocol. Additional search was performed in specific review papers. Included papers are quantitatively assessing the needs of people with mental health problems and exclude people with dementia or disabilities. Also other inclusion and exclusion criteria were applied. Results The majority of all studies were published in English (n = 234). The majority of research papers (n = 163) were conducted in Europe between 2000-2010, while in other countries the trend followed the year 2011. Preliminary results are showing that there are 29 different tools for needs assessment and 17 of them can be used at the system level also as an outcome measure. The most frequently used tool for assessing the needs that can be also used as an outcome measure was Camberwell Assessment of Needs (CAN) also in combination with Health of the Nation Outcome Scales (HoNOS). As well Cardinal needs schedule (CNS) and Resident Assessment Instrument Mental Health (RAI-MH) were used more than once. Conclusions When choosing an appropriate assessment tool, it is vital to use the most widely used ones, focusing on validated tools (culturally adapted), tools modified for specific populations (elderly, children, etc.) and also to bear in mind the ultimate goal that the service is aiming. CAN, HoNOS and CNS are assessing psychiatric and social care needs comprehensively. While RAI-MH is also a tool that is supporting seamless approach to person-centered care. Key messages • When choosing an appropriate assessment tool, it is vital to use the most widely used ones, focusing on validated tools and tools modified for specific populations. • When choosing an appropriate assessment tool, it is important to focus on the ultimate goal the service is aiming.

STRATEGIES IMPLEMENTED IN HOTEL COMPANIES BEFORE AND DURING THE OIL SPILL AND COVID-19

This theoretical-empirical study aims to analyze the strategic actions implemented by international entrepreneurs of hotels and inns located in Porto de Galinhas-PE (Brazil), and in the surroundings, in the face of the oil spill and Covid-19 catastrophes. It is a study of multiple cases with a qualitative approach. Documents and transcripts of semi-structured interviews carried out with directors, managers and employees of hotels, inn, Porto de Galinhas Hotels Association (AHPG) and Porto de Galinhas Convention & Visitors Bureau (PGACVB) were analyzed using the ATLAS.ti software. As a result of this study, it was found that with regard to strategic actions before disasters, it appears that differentiation was present in Hotels A, B and D and as differentiating elements are: services offered, personalized and regionalized drinks, revenue management and modern infrastructure. As for the strategic actions in the context of catastrophes, it is attested that the differentiation is also present in Hotel-A and Hotel-B with the implementation of new services (all inclusive and Bureau Veritas certification) respectively. This investigation reveals that differentiation forms the essential basis for the consolidation of the tourist destination in the domestic and international market. Therefore, these results indicate that the business strategies adopted in hotels and inns influence the strengthening of the tourist destination. In addition to the lack of internationalization studies in companies in the northeast of the country, investigations on the topic in the area of ​​tourism are incipient. The sector's organizations are especially important to maintain the sustainable development of tourism-oriented economies, such as the coast of Pernambuco.

No service is an island: towards an ecosystem approach to mental health service evaluation.

No service is an island: towards an ecosystem approach to mental health service evaluation.

Prenatal myelomeningocele repair: report of an inaugural case and considerations about the implementation of a new fetal neurosurgery program

Myelomeningocele (MMC) or open spina bifida is a neural tube defect which consists of a cleft in the vertebral column and a correspondent defect in the skin, causing the meninges and the spinal cord to be exposed. Despite some recommendations for nutrient supplementation during pregnancy, MMC remains very prevalent, especially in poor regions. MMC causes paralysis, urinary and gastrointestinal dysfunction, motor and neurological deficits, hydrocephalus and hindbrain herniation. Until 1997, the only way to repair this defect was performing surgery right after birth. In 2011, MOMS trial revealed a positive impact of prenatal surgery compared to postnatal. This paper reports the first case of one of the first myelomeningocele prenatal surgery programs in the North and Northeast regions of Brazil and discusses some issues about the implementation of new programs. The patient was a 34 years old woman in her second pregnancy, who was diagnosed at 22 weeks. She was submitted to an open fetal surgery applying MOMS protocol at 26 weeks of pregnancy and underwent cesarean at 36 weeks and five days of pregnancy. After two-years follow up, the baby girl did not need shunt for hydrocephalus, but has motor deficit in the lower limbs. Although fetal surgery is a high-tech procedure that demands a well-trained team, many families come from low-income regions. This way, the implementation of new services has an important social impact.

Digital transformation of the operator’s activity telecommunications based on operational and business support systems

The main factors increasing the income of telecom operators — the development of new services, improving the quality of services. Revenues of telecommunications network operators also depend on timely response to changes in demand and network efficiency. Therefore, the system of support of operational and business activities of the operator is important, thanks to which it is possible to achieve greater efficiency in the implementation of new services. These systems optimize the operation of telecommunications networks, helping to minimize costs and increase profits. There are currently several trends in the telecommunications market that encourage operators to implement operating systems and business support systems. First, the market for traditional operators is already saturated, so corporate profits are not growing as fast. That is why the issue of improving efficiency is much more important. Second, operators are moving from TDM networks to next-generation networks based on NGN technology. And because NGN technologies are more complex in the operation and delivery of services, the question arises about the importance of implementing operating systems and business support systems at the planning stage of the network concept using NGN. Today, operators also often prefer to outsource network management services, as it is unprofitable for each individual operator to purchase the same solutions from the same providers. Implementation of operational and business support systems is aimed at streamlining the management processes of operators, namely the processes of operation and maintenance, optimization of processes according to criteria selected in accordance with the objectives of the customer. Therefore, failure to establish criteria for management and operation can lead to the failure of a component and significantly affect the speed, quality or reliability of the service.

A first-hand experience of co-design in mental health service design: Opportunities, challenges, and lessons.

In an era of mental health service reform, co-design is emerging as a leading framework to guide the design and implementation of new services. Co-design uses the expertise of clinicians, those with lived experiences of services (both consumers and carers) and provocateurs (curious questioners) to understand a 'problem' and develop innovative strategies to address it. It relies on the creation of a safe environment where power imbalances are acknowledged and mitigated, and decisions are made collaboratively. Understanding how to do this effectively within the mental health sphere, where experiences of uneven power distribution and trauma are common, can feel overwhelming. Building a shared understanding of the opportunities and limitations within co-design is also important to establish its place within broader mental health reform. This paper uses an experiential approach to reflect on a co-design process, offering an opportunity to learn from a specific example. Factors that enhanced co-design included formal, remunerated roles, the allocation of time to establish and maintain an intimate, trusting team culture, and the capacity for all team members to be vulnerable. Equally important, strategies needed to be employed to mitigate the challenges inherent within the process, including the impact of power differences, a push to make fast-paced decisions, and a sense of cynicism remaining from previous projects or experiences. When these factors are attended to, the process of co-design can be dynamic, innovative, and transformational for the people participating in it, the project and the mental health sector.

Strengthening Pathology Capacity to Deliver Quality Cancer Care in Cities in LMICs.

Diagnostic pathology services for oncology health systems are essential; yet, surveys, observations, and hard data from across low- and middle-income countries have revealed that these services are almost always lacking adequate quality and often missing completely. The City Cancer Challenge Foundation (C/Can), the American Society for Clinical Pathology, and C/Can partner cities undertook intense analysis of their existing pathology services as part of a year-long assessment process including the specific formation of a pathology-focused team. Internal and external expert assessments identified sustainable solutions adapted to the local context and level of resources and created specific local implementation projects. Through local leadership, capacity development, and collaboration, services were improved city-wide in three cities: Cali, Colombia; Asunción, Paraguay; and Yangon, Myanmar. Common problems identified across cities included deficiencies in personnel training, equipment, reagents, processes, quality, and coordination. Specific solutions included quality training, standard process development and regulation, implementation of new services, and public-private collaboration. As the first cities joining the C/Can initiative, Cali, Asunción, and Yangon demonstrate the success of the approach and the value of local expertise in identifying problems and solutions. The additional value of international partners' expertise created opportunities for growth through mentorship and technical support. Importantly, the power of healthcare programs with strong political support is emphasized.

Does additional weekend and holiday physiotherapy benefit geriatric patients with hip fracture?- A case-historical control study.

Objective:To evaluate the new service model of additional weekend and holiday physiotherapy (PT) by comparing functional outcomes and hospital length of stay between a group of geriatric patients with hip fracture receiving daily PT training and a group of geriatric patients with hip fracture receiving weekdays PT training.Methods:A retrospective case-historical control chart review was conducted and a total of 355 patients were identified. Between-group comparisons were done on functional outcomes including Modified Functional Ambulation Classification (MFAC), Elderly Mobility Scale (EMS), Modified Barthel Index (MBI) and process outcome in terms of length of stay (LOS) in hospitals.Results:With similar characteristics, patients who received weekend and holiday PT training had a significant higher percentage of MFAC Category III and a significant lower percentage of MFAC Category II () and significant higher MBI scores ( deviation, median; Study group: points, 51 points; Control group: points, 43 points; ) upon admission to rehabilitation hospital. A similar trend in EMS scores (Study group: points, 7 points; Control group: points, 6 points; ) and MBI scores (Study group: points, 68 points; Control group: points, 64 points; ) were observed upon discharge from the rehabilitation hospital. The average LOS in acute hospitals remained static (Study group: days, 7 days; Control group: days, 6 days; ). The average LOS in rehabilitation hospital (Study group: days, 20 days; Control group: days, 23 days; ) and total in-patient LOS (Study group: days, 26 days; Control group: days, 28 days; ) were significantly reduced. A higher percentage of days having PT training during hospitalization in rehabilitation hospital was shown with the implementation of new service (Study group: 89.1%; Control group: 65.9%, ).Conclusion:Additional weekend and holiday PT training in post-operative acute and rehabilitation hospitalization benefits geriatric patients with hip fracture in terms of improved training efficiency, where hospital LOS was shortened with more PT sessions, without any significant impacts on functional outcome.

« Forum Passerelle »: an opportunity for caregivers to meet the professionals of service and support in Alzheimer's disease and related diseases.

The aim of this study was to assess 1) the satisfaction of caregivers of patients with Alzheimer's disease or related diseases regarding a new collective support intervention called Forum Passerelle(Gateway forum), and 2) to assess the impact of Forum Passerelle on the implementation of services and support for patients or caregivers. This is an observational study carried out on the basis of 3 Forum Passerelle (between October 2018 and February 2020). Following each Forum Passerelle, the caregivers' satisfaction was assessed and the number of services and support was counted. In total, 78 caregivers took part in these first Forum passerelle. The satisfaction survey showed that 98% of caregivers were satisfied with the topics covered by Forum Passerelle. The forum fully met the expectations of 61% of caregivers and partially for 39%. Among the caregivers contacted 3 or 6 months after the forum, 68% had set up a new service/support (85 new services/support for the sick relatives and 32 for caregivers) and 59% declared that these changes had taken place thanks to the Forum Passerelle. To conclude, the first 3 Forums Passerelle were received very favorably by caregivers and contributed to the implementation of new services to optimize home support for the sick relative.

A Digital Innovation for the Personalized Management of Adherence: Analysis of Strengths, Weaknesses, Opportunities, and Threats.

Introduction: Personalized medicine and management of adherence are potential solutions for the suboptimal use of medicines. Digital medication management innovations currently under development combine both aspects. This research aims to investigate facilitators for and barriers to the translation of digital innovations for personalized medicine and adherence management into clinical practice from the policymaker and regulator perspective.Methods: A mixed-method study was used combining a scoping review to identify main interests, semi-structured interviews (n = 5) with representatives of European health policymaking and regulatory organizations, and a supplementary literature review to investigate key subthemes. The SWOT analysis was used for the qualitative analysis.Results: The literature reviews and the qualitative interviews suggested that digital solutions can facilitate the personalized management of medications and improve quality and safety, especially as the openness for digital health solutions is increasing. Digital solutions may, on the other hand, add complexity to the treatment, which can be perceived as a potential barrier for their uptake. As more multidisciplinary and participative structures are emerging, digital solutions can promote the implementation of new services. Nevertheless, change progresses slowly in the task-oriented structures of health systems. Integration of digital solutions depends on all stakeholders' willingness and abilities to co-create this change. Patients have different capabilities to self-manage their medical conditions and use digital solutions. Personalization of digital health solutions and integration in existing service structures are crucial to ensure equality among population segments. Developments in the digital infrastructure, although they are partly slow and not well-aligned, enable the implementation of innovations in clinical practice leading to further advances in data generation and usage for future innovations.Discussion: This study suggests that digital solutions have the potential to facilitate high-quality medication management and improve adherence to medications, enable new service structures, and are essential to drive further innovations in health care. Nevertheless, increasing the self-responsibility of patients can have undesirable effects on health outcomes, especially within vulnerable population segments. Digital health solutions can be an opportunity to optimize the use of medicines and thus their efficiency. Well-conceived development and implementation processes are needed to also realize improvements in equality and solidarity within health systems.

How the Integration of Telehealth and Coordinated Care Approaches Impact Health Care Service Organization Structure and Ethos: Mixed Methods Study.

BackgroundCoordinated care and telehealth services have the potential to deliver quality care to chronically ill patients. They can both reduce the economic burden of chronic care and maximize the delivery of clinical services. Such services require new behaviors, routines, and ways of working to improve health outcomes, administrative efficiency, cost-effectiveness, and user (patient and health professional) experience.ObjectiveThe aim of this study was to assess how health care organization setup influences the perceptions and experience of service managers and frontline staff during the development and deployment of integrated care with and without telehealth.MethodsAs part of a multinational project exploring the use of coordinated care and telehealth, questionnaires were sent to service managers and frontline practitioners. These questionnaires gathered quantitative and qualitative data related to organizational issues in the implementation of coordinated care and telehealth. Three analytical stages were followed: (1) preliminary analysis for a direct comparison of the responses of service managers and frontline staff to a range of organizational issues, (2) secondary analysis to establish statistically significant relationships between baseline and follow-up questionnaires, and (3) thematic analysis of free-text responses of service managers and frontline staff.ResultsBoth frontline practitioners and managers highlighted that training, tailored to the needs of different professional groups and staff grades, was a crucial element in the successful implementation of new services. Frontline staff were markedly less positive than managers in their views regarding the responsiveness of their organization and the pace of change.ConclusionsThe data provide evidence that the setup of health care services is positively associated with outcomes in several areas, particularly tailored staff training, rewards for good service, staff satisfaction, and patient involvement.

Comparative Performance Evaluation of Public Transport Services from City Perspective

Now a day’s public transport services encounter distinctive challenges in planning, maintaining and operating their services from user, operator and city perspective. Further, the alteration in transport technologies and infrastructure facilities requires a huge amount of funds. Hence prior to making investment in, public transport services the performance of existing service should be evaluated from different perspective i.e. user, city and operator. In this research particular attention has been given to the city perspective. It is concerned with the traffic flow pattern, social and economical development and reduction in environmental pollution in a city. A literature review indicated that most of the studies are not structured in a simple manner and cannot find significant comparative information which helps in diagnosing problems in relation to different aspects from city perspective. Therefore, in this study a simple methodology is developed for comparative performance evaluation of public transport service considering these aspects individually as well as combined. In order to demonstrate the application of the proposed methodology; BCLL bus system and Mini bus system in Bhopal city were selected. It is expected that this study will be useful to take appropriate decisions before implementation of new services, and performance improvement of existing public transport services.

SCIENTIFIC LIBRARY AS A SCIENCE SUPPORT CENTER IN HIGHER EDUCATION INSTITUTION

Relevance of this topic is due to modern requirements for libraries of higher education institutions (HEI).Objective: Consideration of issues related to development of modern course of action for libraries of HEI – responsibility for dissemination of scientific research findings of scientists in global scientific information space.Methodology. Stages of implementation of new services in libraries of HEI, which are based on new competencies of information specialists, are investigated by the author using methods of scientific analysis and generalization.Results. Practical implementation of new services in activities of high school libraries for support and promotion of scientific researches is considered using the example of the scientific library of UEPA.Findings. Libraries of higher education institutions nowadays have a powerful potential to support and promote Ukrainian science. Library becomes an information broker in research of scientific status of teachers and HEI. The vector of attention to priority of providing services for author-scientist is changing in libraries of HEI. To become a full partner in development of digital science and education, librarians need to acquire new knowledge,skills and competences constantly. Modern librarians should feel free in intellectual environment of scientist, to work with metadata, to know search technologies, principles of information resources distribution, data storage. Besides, librarians should have a broad vision and understanding of publishing models, both traditional (commercial, public) and open access, intellectual property issues, and economic aspects of scientific publishing process.Being active participants of new infrastructure of scientific communication libraries help to increase visibility of scientific publications and their scientific influence. Effective mechanisms for publication activity growth, which libraries use nowadays, contribute to increasing ratings of scientific potential of HEI.

Discretionary Principles of Management: Justification of Practical Application in the Customs Service

In the context of globalization and internationalization of economic relations, there is an active development of customs services, in which regulation of a certain part of the customs service moves to the international level. The quality of services provided by the customs authorities influences not only the time needed to complete customs formalities, but also the financial risks and costs of all participants involved in foreign economic activity. The increasing foreign trade turnover requires improvement of the movement and processing mechanisms of goods and services across the customs border of the Russian Federation, which necessitates the active implementation of new services and technologies of customs clearance. Customs service is understood not only as a public service performed by public authorities, but also as a specific type of activity aimed at facilitating the implementation of foreign economic operations carried out by commercial organizations of the customs sphere.

Spiritist Hospital Chaplaincy in Brazil: 5Years of Documented Experience.

SpiritistHospital Chaplaincy in Brazil has been growing significantly in recent years, with the implementation of new services through the work of Spiritist Medical Associations (SMAs) in different regions of the country. This article describes the importance of historical interconnections from the advent of spiritism in the world and its introduction in Brazil to the emergence of Spiritist Hospital Chaplaincy in our country and presents the documented experience over 5years of spiritist chaplain care, in the period from 2012 to 2016, guided by the SMA of Piracicaba at the Unimed Hospital of Piracicaba (São Paulo). We documented 41,914 visits to 13,983 inpatients and an analysis of these records allowed us to reflect on the importance of this service and confirm its expansion and acceptance by different contemporary religious beliefs.

Implementing an integrated care management program in community pharmacies: A focus on medication management services

ObjectivesTo describe the initiation of a community pharmacy medication management service within a statewide integrated care management program. SettingOne hundred twenty-three community and community health center pharmacies in 58 counties of North Carolina. Practice descriptionIndependent and community health center pharmacies offering medication management as part of an integrated care management program to Medicaid, Medicare, dually eligible Medicare-Medicaid, and NC Health Choice beneficiaries in North Carolina. Practice innovationCommunity pharmacies joined an enhanced service network created by Community Care of North Carolina to provide medication management services as part of an integrated care management program. EvaluationDuring the first 3 months of the program, 41% of pharmacies consistently documented the medication management services. Interviews were conducted with pharmacists from the inconsistent pharmacies to drive program improvements. ResultsPharmacists at 73 community and community health center pharmacies were interviewed. The majority of pharmacists reported that challenges in “initiating services” and “documenting” were due to increased intensity of service and documentation compared with Medicare Part D medication therapy management requirements. Program changes to improve participation included revision of documentation requirements, authorization of technicians to transcribe pharmacists’ interventions, additional documentation templates, workflow consultations, and feedback on documentation quality. ConclusionCommunity pharmacies are capable of providing medication management integrated with care management. Some pharmacies have more difficulty initiating new services in the current workflow landscape. To facilitate implementation, it is important to minimize administrative burden and provide mechanisms for direct feedback. Pharmacy owners, managers, and leaders in pharmacy policy can use these findings to aid implementation of new services in community pharmacies.