Innovative Models Of Care Research Articles

Cost and outcomes of routine HIV care and treatment: public and private service delivery models covering low-income earners in South Africa

BackgroundWhile South Africa’s national HIV program is the largest in the world, it has yet to reach the UNAIDS 95–95-95 targets. To reach these targets, the expansion of the HIV treatment program may be accelerated through the use private sector delivery models. This study identified three innovative non-governmental primary health care models (private sector) providing HIV treatment, as well as two government primary health clinics (public sector) that served similar populations. We estimated the resources used, and costs and outcomes of HIV treatment across these models to provide inputs to inform decisions around how these services might best be provided through National Health Insurance (NHI).MethodsA review of potential private sector models for HIV treatment in a primary health care setting was conducted. Models actively offering HIV treatment (i.e. in 2019) were considered for inclusion in the evaluation, subject to data availability and location. These models were augmented by government primary health clinics offering HIV services in similar locations. We conducted a cost-outcomes analysis by collecting patient-level resource usage and treatment outcomes through retrospective medical record reviews and a bottom-up micro-costing from the provider perspective (public or private payer). Patient outcomes were based on whether the patient was still in care at the end of the follow up period and viral load (VL) status, to create the following outcome categories: in care and responding (VL suppressed), in care and not responding (VL unsuppressed), in care (VL unknown) and not in care (LTFU or deceased). Data collection was conducted in 2019 and reflects services provided during the 4 years prior to that (2016–2019).ResultsThree hundred seventy-six patients were included across the five HIV treatment models. Across the three private sector models there were differences in the costs and outcomes of HIV treatment delivery, two of the models had results similar to the public sector primary health clinics. The nurse-led model appears to have a cost-outcome profile distinct from the others.ConclusionThe results show that across the private sector models studied the costs and outcomes of HIV treatment delivery vary, yet there were models that provided costs and outcomes similar to those found with public sector delivery. Offering HIV treatment under NHI through private delivery models could therefore be an option to increase access beyond the current public sector capacity.

Implementation and scalability of shared care models for chronic eye disease: a realist assessment informed by health system stakeholders in Finland, the United Kingdom, and Australia

Background/ObjectivesSeveral health systems have implemented innovative models of care which share the management of patients with chronic eye diseases between ophthalmologists and optometrists. These models have demonstrated positive outcomes for health systems including increased access for patients, service efficiency and cost-savings. This study aims to understand factors which support successful implementation and scalability of these models of care.Subjects/MethodsSemi-structured interviews were conducted with 21 key health system stakeholders (clinicians, managers, administrators, policy-makers) in Finland, United Kingdom and Australia between October 2018 and February 2020. Data were analyzed using a realist framework to identify the contexts, mechanisms of action, and outcomes of sustained and emerging shared care schemes.ResultsFive key themes relating to successful implementation of shared care were identified as (1) clinician-led solutions, (2) redistributing teams, (3) building inter-disciplinary trust, (4) using evidence for buy-in, and (5) standardized care protocols. Scalability was found to be supported by (6) financial incentives, (7) integrated information systems, (8) local governance, and (9) a need for evidence of longer-term health and economic benefits.ConclusionsThe themes and program theories presented in this paper should be considered when testing and scaling shared eye care schemes to optimize benefits and promote sustainability.

Evaluation of a nurse-led glaucoma assessment clinic for non-complex patients.

The purpose of this study was to assess the safety, feasibility and effectiveness of a nurse-led glaucoma assessment clinic service. Glaucoma is a group of serious, irreversible optic neuropathies that progressively damage the optic nerve resulting in blindness. Over 64.3 million people globally are affected by glaucoma with numbers projected to increase to 111.8 million by 2040. Glaucoma is a major public health concern that requires the development of innovative models of care to meet current and future health care demands. A mixed method design was used to evaluate the assessment of non-complex glaucoma patients attending a new nurse-led clinic. Under an ophthalmologist's supervision, the glaucoma nurse completed 100 hof clinical training and assessment to ensure they were competent in completing and interpreting the required glaucoma assessment protocols. Interrater reliability between the glaucoma nurse and ophthalmology doctor was undertaken. Glaucoma patient waitlist appointment data were also compared before and after the introduction of the nurse-led clinics. This study adhered to the SQUIRE checklist for the reporting of excellence with quality improvement projects. Patients contributed to the evaluation of this new nurse-led service by providing follow-up feedback on their experience. Agreement between clinicians for appropriate follow-up appointment times was high with 93% (n= 315) agreement achieved. Furthermore in 297 (87.5%) cases, both clinicians agreed on the patient being referred to the doctor for follow-up review. Glaucoma consultations were shown to increase from 3,115 appointments in 2019/20 to 3,504 appointments in 2020/21 after the introduction of the nurse-led clinic. The nurse-led clinics accounted for 14.5% (n= 512) of clinic appointments. The introduction of the nurse-led glaucoma assessment clinic service allowed patients to be reviewed safely, efficiently and satisfactorily. This new service subsequently allowed for more complex glaucoma patients to be seen bythe ophthalmologists. Findings revealed that suitably trained glaucoma nurses are able to clinically assess and safely monitor stable non-complex glaucoma patients. Highlights the need for appropriate investment in clinical training and supervision to ensure that glaucoma assessment nurses are adequately prepared to undertake this new practice role.

Abstract P3-03-29: SMARTphone-Based Cardiovascular Risk Reduction in Breast Cancer Patients [SMART-BREAST]: A Randomized Controlled Trial

Abstract Introduction Breast cancer survivors are at greater risk for cardiovascular-related mortality compared to women without breast cancer. Accordingly, attention to reducing the risk of cardiovascular disease must be a priority in the long-term management of these patients. Objective To assess the efficacy of a smartphone-based model of care for exercise promotion, cardiovascular risk reduction and psychological wellbeing in women undergoing treatment for breast cancer. Methods Female patients with breast cancer across four tertiary Australian hospitals were screened for inclusion in this randomized controlled trial. Patients were randomized to standard care (SC), with or without an adjunctive smartphone application ‘BreastMate’ (SP) at time of diagnosis. The primary endpoint was change in exercise capacity, measured by the change in six-minute walk test (6MWT) distance at 12-months when compared to baseline, between groups. Secondary endpoints included changes in cardiovascular risk factors, psychological wellbeing, and major adverse cardiovascular events (MACE). Results Of the 103 patients recruited, complete follow-up data was available in 80 (77.7%) patients (age 60±12 years, SP=41, SC=39). At 12-months follow-up, the SP group had a statistically and clinically significant improvement in 6MWT distance (Median Δ46 (IQR 28 to 63) metres vs. Δ8 (-10 to 35) metres; p< 0.001). Compared to SC, patients in the SP group had a greater reduction in systolic blood pressure (Δ-5.1 (-10 to 0) vs 0 (-10 to 7) mmHg; p=0.03) and waist circumference (Δ-1 (-4 to 0) vs 0 (-1.5 to 1) centimetres; p=0.003) as well as a greater improvement in vitality as measured by the sf-36 questionnaire (48.1 ± 18.4 to 63.3±19.2 vs 48.3 ± 24.2 to 59.6±18.8; p=0.04). There was no significant difference in cholesterol levels, diabetes control, smoking cessation or incidence of MACE between groups (p-value for all=NS). Conclusion In patients with breast cancer, a smartphone-based cardiovascular risk reduction program, as an adjunct to standard care, improved exercise capacity, systolic blood pressure, waist circumference and patient-reported vitality at 12-months. This innovative model of care could be implemented to improve the cardiovascular risk profile of breast cancer survivors. Australia and New Zealand Clinical Trials Registry (ANZCTR12620000007932). Citation Format: Alexandra C. Murphy, Omar Farouque, Anoop N. Koshy, Belinda Yeo, Ron Dick, Voltaire Nadurata, Laura Roccisano, Christopher Reid, Matias Yudi. SMARTphone-Based Cardiovascular Risk Reduction in Breast Cancer Patients [SMART-BREAST]: A Randomized Controlled Trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-03-29.

Improving Diabetes Care Through Population Health Innovations and Payments: Lessons from Western Maryland.

Global budgets might incentivize healthcare systems to develop population health programs to prevent costly hospitalizations. In response to Maryland's all-payer global budget financing system, University of Pittsburgh Medical Center (UPMC) Western Maryland developed an outpatient care management center called the Center for Clinical Resources (CCR) to support high-risk patients with chronic disease. Evaluate the impact of the CCR on patient-reported, clinical, and resource utilization outcomes for high-risk rural patients with diabetes. Observational cohort study. One hundred forty-one adult patients with uncontrolled diabetes (HbA1c > 7%) and one or more social needs who were enrolled between 2018 and 2021. Team-based interventions that provided interdisciplinary care coordination (e.g., diabetes care coordinators), social needs support (e.g., food delivery, benefits assistance), and patient education (e.g., nutritional counseling, peer support). Patient-reported (e.g., quality of life, self-efficacy), clinical (e.g., HbA1c), and utilization outcomes (e.g., emergency department visits, hospitalizations). Patient-reported outcomes improved significantly at 12 months, including confidence in self-management, quality of life, and patient experience (56% response rate). No significant demographic differences were detected between patients with or without the 12-month survey response. Baseline mean HbA1c was 10.0% and decreased on average by 1.2 percentage points at 6 months, 1.4 points at 12 months, 1.5 points at 18 months, and 0.9 points at 24 and 30 months (P<0.001 at all timepoints). No significant changes were observed in blood pressure, low-density lipoprotein cholesterol, or weight. The annual all-cause hospitalization rate decreased by 11 percentage points (34 to 23%, P=0.01) and diabetes-related emergency department visits also decreased by 11 percentage points (14 to 3%, P=0.002) at 12 months. CCR participation was associated with improved patient-reported outcomes, glycemic control, and hospital utilization for high-risk patients with diabetes. Payment arrangements like global budgets can support the development and sustainability of innovative diabetes care models.

ATA2023Annual Conference &amp; ExpoMarch 4–6, 2023San Antonio, Texas

ATA2023Annual Conference &amp; ExpoMarch 4–6, 2023San Antonio, Texas

An interdisciplinary telemedicine innovation to enhance pediatric diabetes care in rural communities: A proposed practice initiative.

The COVID-19 pandemic highlighted disparities in healthcare access and outcomes, particularly among individuals with chronic conditions. A positive outcome of the pandemic was an increased use of telehealth and the creation of innovative models of care. In many organizations, nurses became the leaders for these new models. Before this change, pediatric medicine had far fewer telehealth models than adult medicine due to limited Medicaid reimbursement and equipment that was not designed with children in mind. This article describes a new model of care for children with diabetes. We will review how a nurse-led initiative with the incorporation of telehealth modalities can improve access and outcomes while reducing cost. Successful models of care will be reviewed, as well as programmatic planning, financial implications, and regulatory considerations. It is no longer necessary for families living in rural communities to drive long distances, missing school and work, to attend the frequent appointments needed for optimal management of pediatric diabetes. Telemedicine can bridge gaps in access to specialty care, and is feasible, reimbursable, and well-accepted by families and providers. Nurses in both primary care and pediatric specialty offices can initiate and support innovative telehealth models of care, such as this proposal. To win the backing of practice leadership, the availability of cost-effective videoconferencing equipment and software, improvements in telehealth reimbursement prompted by the pandemic, and enhanced patient and parent satisfaction and outcomes should be emphasized.

Sustaining a New Model of Acute Stroke Care: A Mixed-Method Process Evaluation of the Melbourne Mobile Stroke Unit.

Internationally, Mobile Stroke Unit (MSU) ambulances have changed pre-hospital acute stroke care delivery. MSU clinical and cost-effectiveness studies are emerging, but little is known about important factors for achieving sustainability of this innovative model of care. Mixed-methods study from the Melbourne MSU (operational since November 2017) process evaluation. Participant purposive sampling included clinical, operational and executive/management representatives from Ambulance Victoria (AV) (emergency medical service provider), the MSU clinical team, and receiving hospitals. Sustainability was defined as ongoing MSU operations, including MSU workforce and future model considerations. Theoretically-based on-line survey with Unified Theory of Acceptance and Use of Technology (UTAUT), Self Determination Theory (SDT, Intrinsic Motivation), and open-text questions targeting barriers and benefits was administered (June-September 2019). Individual/group interviews were conducted, eliciting improvement suggestions and requirements for ongoing use. Descriptive and regression analyses (quantitative data) and directed content and thematic analysis (open text and interview data) were conducted. There were 135 surveys completed. Identifying that the MSU was beneficial to daily work (β=0.61), not experiencing pressure/tension about working on the MSU (β=0.17) and thinking they did well working within the team model (β=0.17) were significantly associated with wanting to continue working within the MSU model [R2=0.76; F(15, 60)=12.76, P<.001]. Experiences varied between those on the MSU team and those working with the MSU. Advantages were identified for patients (better, faster care) and clinicians (interdisciplinary learning). Disadvantages included challenges integrating into established systems, and establishing working relationships. Themes identified from 35 interviews were MSU team composition, MSU vehicle design and layout, personnel recruitment and rostering, communication improvements between organisations, telemedicine options, MSU operations and dispatch specificity. Important factors affecting the sustainability of the MSU model of stroke care emerged. A cohesive team approach, with identifiable benefits and good communication between participating organisations is important for clinical and operational sustainability.

Embedding nurse-led supportive care in an outpatient service for patients with Chronic Obstructive Pulmonary Disease.

To describe a small multidisciplinary team's experience of the process of embedding nurse-led supportive care into an existing Chronic Obstructive Pulmonary Disease outpatient service. Case study methodology METHODS: Data were collected from multiple sources including key documents and semi-structured interviews with healthcare professionals (n= 6) conducted between June and July 2021. A purposive sampling strategy was used. Content analysis was applied to key documents. Interviews were transcribed verbatim and analysed using an inductive approach. Subcategories under the four-stage process were identified from the data. evidence of needs of patients with Chronic Obstructive Pulmonary Disease; gaps in care and evidence of other models of supportive care. Planning: setting the supportive care service structure and intention; resources and funding; leadership, specialization and respiratory/palliative care roles. relationships and trust; embedding supportive care and communication. benefits and positive outcomes for staff and patients, and, improvements and future considerations for supportive care in the COPD service. A collaboration between respiratory and palliative care services resulted in successfully embedding nurse-led supportive care in a small outpatient service for patients with Chronic Obstructive Pulmonary Disease. Nurses are well placed to lead new models of care that aim to address unmet biopsychosocial-spiritual needs of patients. More research is needed to evaluate nurse-led supportive care in Chronic Obstructive Pulmonary Disease and other chronic illness settings; the effectiveness of nurse-led supportive care from the perspective of patients and caregivers and the impact of nurse-led supportive care on health service usage. The development of the model of care is informed by ongoing discussions with patients with COPD and their caregivers. Data availability statement: Research data are not shared (due to ethical restrictions). Embedding nurse-led supportive care in an existing Chronic Obstructive Pulmonary Disease outpatient service is achievable. Nurses with clinical expertise can lead innovative models of care that address the unmet biopsychosocial-spiritual needs of patients with conditions such as Chronic Obstructive Pulmonary Disease. Nurse-led supportive care may have utility and relevance in other chronic disease contexts.

The Anatomy of a Hybrid In-Person and Virtual Sexual Health Clinic in Oncology.

Sexual health is compromised by the diagnosis and treatment of virtually all cancer types. Despite the prevalence and negative impact of sexual dysfunction, sexual health clinics are the exception in cancer centers. Consequently, there is a need for effective, efficient, and inclusive sexual health programming in oncology. This paper describes the development of the innovative Sexual Health Clinic (SHC) utilizing a hybrid model of integrated in-person and virtual care. The SHC evolved from a fusion of the in-person and virtual prostate cancer clinics at Princess Margaret. This hybrid care model was adapted to include six additional cancer sites (cervical, ovarian, testicular, bladder, kidney, and head and neck). The SHC is theoretically founded in a biopsychosocial framework and emphasizes interdisciplinary intervention teams, participation by the partner, and a medical, psychological, and interpersonal approach. Virtual visits are tailored to patients based on biological sex, cancer type, and treatment type. Highly trained sexual health counselors facilitate the virtual clinic and provide an additional layer of personalization and a "human touch". The in-person visits complement virtual care by providing comprehensive sexual health assessment and sexual medicine prescription. The SHC is an innovative care model which has the potential to close the gap in sexual healthcare. The SHC is designed as a transferable, stand-alone clinic which can be shared with cancer centers.

Innovative and Collaborative care models in Dementia

Alzheimer's Disease (AD) is the most prevalent cause of neurodegenerative disease accounting for 60-80% of dementia cases. With an aging population, the prevalence of AD is projected to reach 12.7 million. AD is a progressive disease and pathological changes sometimes start decades before clinical symptoms manifest. As age is the greatest risk factor for AD, it tends to predominantly affect older adults. AD is a family disease and has a great impact on caregivers (CG) leading to high levels of CG stress and burden with many dying before the person with dementia. Women are disproportionately affected by the disease, as they represent higher number of patients and caregivers. Due to the changing demographics, it is not uncommon to identify an older adult as the CG for their parent and more commonly a spouse. Alzheimer's disease continues to rapidly increase in incidence across the United States and worldwide without an approved disease modifying treatment or cure available. This combined with the small number of clinicians expert in diagnoses and management of dementia could prove disastrous for the access to quality care for patients and their family members. We desperately need to identify alternative models of care for the evaluation and treatment of dementia.In this session, we will review collaborative care models implemented at Banner Alzheimer's Institute (BAI) and outline the need for dementia collaborative care. We will present an overview of 4 specific models implemented at BAI - Family and Community Services; Dementia Care Partners; Project ECHO; Geriatric Psychiatry Clinic.

Empowering Tennessee Pharmacists to Initiate PrEP Using Collaborative Pharmacy Practice Agreements.

The uptake of Pre-Exposure Prophylaxis (PrEP) has revolutionized the fight against the Human Immunodeficiency Virus (HIV) epidemic. Consistent obstacles remain that have influenced the slow uptake of PrEP in the United States of America (USA). In order to address these barriers, pharmacists must be included in the dispensing and management of PrEP through collaborative pharmacy practice agreements (CPPAs). Our aim for this study was to characterize pharmacists' perceptions of initiating PrEP through a CPPA in the state of Tennessee. This qualitative study was conducted in the USA in 2021 with pharmacists practicing in Tennessee. A framework and specific questions guided the thematic analysis. The words and phrases were coded inductively and later collapsed into categories and placed into emergent themes. Two themes illustrate the voices of practicing pharmacists' integration in the dispensing and management of PrEP: (1) Learning from other states and previous successful CPPAs to advance and expand innovative models of patient care and (2) advocacy through public policy change to empower pharmacists to initiate PrEP. This qualitative study focused on exploring pharmacists' perceptions on the opportunity of initiating PrEP through a CPPA in Tennessee. These findings highlight the preparedness of pharmacists to advocate for easier initiative of PrEP in pharmacies across Tennessee, whether through relaxing existing CPPA regulation or pursuing independent prescriptive authority for pharmacists.

The education of specialized nurses' aides: current scenario and future perspectives

The complementary training in health care of the nurse aides (NAs), launched in Italy in 2003, has little impact on health care organisations. To analyse, through the regional provisions issued in the last three years, the current state of complementary training in health care and propose some recommendations for the nursing profession with respect to the inclusion of this figure in care teams. A documentary content analysis was conducted with respect to six main topics: recipients and admission to the courses, organisation and characteristics of the courses, learning evaluation, responsibilities of the new NAs, expected competences and skills. There is a clear need to update and standardise the contents of the courses, with a focus on current social and health problems and future scenarios, and to render more homogeneous the structure of the courses, to guarantee high standards at national level. The need of increasing the skills of the NAs is associated with the implementation of innovative care and organisational models that require the ability to care for populations whose needs have changed profoundly over the last twenty years. Health care teams with professionals with different skill-mix guarantee safe, appropriate, effective and efficient care: the organization should enable nurses to free up time to act out their competences in care planning, health promotion, therapeutic education, transition management and specialist functions.

Innovative models of healthcare delivery: an umbrella review of reviews

ObjectiveTo undertake a synthesis of evidence-based research for seven innovative models of care to inform the development of new hospitals.DesignUmbrella review.SettingInterventions delivered inside and outside of acute care settings.ParticipantsChildren and...

Effectiveness of RADAR: An Innovative Model to Organize Diabetes Care in First Nations Communities.

Challenges exist for the management of diabetes care in First Nations populations. RADAR (Reorganizing the Approach to Diabetes through the Application of Registries) is a culturally appropriate, innovative care model that incorporates a disease registry and electronic health record for local care provision with remote coordination, tailored for First Nations people. This study assessed the effectiveness of RADAR on patient outcomes and diabetes care organization in participating communities in Alberta, Canada. It revealed significant improvements in outcomes after 2 years, with 91% of patients achieving a primary combined end point of a 10% improvement in or persistence at target for A1C, systolic blood pressure, and/or LDL cholesterol. Qualitative assessment showed that diabetes care organization also improved. These multimethod findings support tailored diabetes care practices in First Nations populations.

Technology-Enabled Collaborative Care for Concurrent Diabetes and Distress Management During the COVID-19 Pandemic: Protocol for a Mixed Methods Feasibility Study.

The COVID-19 pandemic disrupted the delivery of diabetes care and worsened mental health among many patients with type 2 diabetes (T2D). This disruption puts patients with T2D at risk for poor diabetes outcomes, especially those who experience social disadvantage due to socioeconomic class, rurality, or ethnicity. The appropriate use of communication technology could reduce these gaps in diabetes care created by the pandemic and also provide support for psychological distress. The purpose of this study is to test the feasibility of an innovative co-designed Technology-Enabled Collaborative Care (TECC) model for diabetes management and mental health support among adults with T2D. We will recruit 30 adults with T2D residing in Ontario, Canada, to participate in our sequential explanatory mixed methods study. They will participate in 8 weekly web-based health coaching sessions with a registered nurse, who is a certified diabetes educator, who will be supported by a digital care team (ie, a peer mentor, an addictions specialist, a dietitian, a psychiatrist, and a psychotherapist). Assessments will be completed at baseline, 4 weeks, and 8 weeks, with a 12-week follow-up. Our primary outcome is the feasibility and acceptability of the intervention, as evident by the participant recruitment and retention rates. Key secondary outcomes include assessment completion and delivery of the intervention. Exploratory outcomes consist of changes in mental health, substance use, and physical health behaviors. Stakeholder experience and satisfaction will be explored through a qualitative descriptive study using one-on-one interviews. This paper describes the protocol of the study. The recruitment commenced in June 2021. This study was registered on October 29, 2020, on ClinicalTrials.gov (Registry ID: NCT04607915). As of June 2022, all participants have been recruited. It is anticipated that data analysis will be complete by the end of 2022, with study findings available by the end of 2023. The development of an innovative, technology-enabled model will provide necessary support for individuals living with T2D and mental health challenges. This TECC program will determine the feasibility of TECC for patients with T2D and mental health issues. ClinicalTrials.gov NCT04607915; https://clinicaltrials.gov/ct2/show/NCT04607915. DERR1-10.2196/39724.

Chronic Obstructive Pulmonary Disease and Telehealth: Remote Monitoring and Patient Outcomes

The integration of telehealth interventions into the management of Chronic Obstructive Pulmonary Disease (COPD) represents a transformative approach to improving patient outcomes and reducing the burden on healthcare systems. With the global prevalence of COPD on the rise, innovative care models, including remote monitoring and teleconsultation, have emerged as essential tools in the early detection and management of COPD exacerbations. These interventions not only lead to a significant reduction in exacerbation frequency and severity but also enhance patients' quality of life by empowering them to take an active role in their healthcare. Improved pulmonary function, medication adherence, and cost-effectiveness further underscore the value of telehealth in COPD care. The high levels of patient satisfaction and the potential for reduced mortality rates emphasize the promising future of telehealth in COPD management. As we continue to advance in technology and healthcare delivery, the comprehensive and personalized care offered by telehealth is poised to make a lasting impact on the lives of COPD patients worldwide.

Ten years of nurse consultation at the pediatric emergency department

The Nurse consultation (CI) was implemented in 2013 at the emergency department of the Lausanne Children's Hospital. It offers medical delegated care for children aged three to 18. Ten years after its implementation, this article takes stock of its progress. Patients and families are satisfied with the care provided at a rate of 94.3 %. The CI seems to offer quality and safe healthcare. It allows the emergency team to have more time and resources for patients whose lives are at risk or need careful assessment due to their age or medical history. The CI is an innovative and relevant model of care in the context of uncomplicated childhood illnesses.

Reducing Behavioral and Psychological Symptoms of Dementia in Acutely Ill Patients via Patient Engagement Specialists: A Pilot Feasibility Study.

Behavioral and psychological symptoms of dementia (BPSD) are common in hospitalized persons living with dementia (PLWD). This pilot aimed to test the feasibility of an innovative model of care, PES-4-BPSD (a dementia unit staffed with Patient Engagement Specialists, PES). Non-randomized pilot feasibility trial was conducted, enrolling N = 158 patients to the intervention unit (n = 79, a 10-bed dementia unit, staffed with nursing assistants, NAs, with mental health backgrounds, PES) and an enhanced control unit (n = 79, 40-bed medicine unit, staffed with NAs). All NAs/PES (N = 63) received dementia training, with completion rate of 82.5%. Overall, patients had ~1 NPI-Q (Neuropsychiatric Inventory Questionnaire) assessment/48 hr. 97% (n = 153) of PLWD exhibited at least one behavior. Average NPI-Q scores did not differ across intervention (5.36) and control (3.87) units (p = .23). Patients on the intervention unit had 88% (p = .002) shorter duration of constant observation. A dementia care unit staffed by PES is an innovative model requiring further research.

The impact of COVID 19 on the financial provision of healthcare providers: A Case Study “Morocco”

Background: This study focuses on evaluating the impact of the COVID-19 pandemic on healthcare providers in Morocco. The objective is to understand the financial challenges faced by these providers and the strategies they employ to maintain their services amidst the crisis. By gaining insights into their experiences and responses, valuable information can be obtained to help navigate the pandemic effectively. Methods: The study investigated the impact of COVID-19 on healthcare providers in Morocco. A survey was conducted with 221 physicians working in private practices. The survey collected data on demographics, patient volume, revenues, expenses, financial support, telehealth usage, and staffing. Data analysis included descriptive statistics and statistical tests. Ethical guidelines were followed to maintain participant confidentiality and research integrity. Results: Examining the financial impact of the COVID-19 pandemic on healthcare providers in Morocco, this study reveals significant challenges faced by healthcare providers. Key findings include workforce disruptions, a shift in patient care delivery, the importance of telehealth, financial strains on independent practices, and potential closures. The study underscores the need for targeted support, policy interventions, and innovative care models to ensure the sustainability of healthcare providers in Morocco. Discussion: The comprehensive study on healthcare practices in Morocco during the Covid-19 pandemic reveals significant challenges faced by the healthcare sector. Findings highlight workforce disruptions, shifts in patient care delivery, the importance of telehealth, financial strains on independent practices, and considerations of closure. The study emphasizes the need for targeted support, policy interventions, and innovative care models to ensure the sustainability of healthcare practices. Workforce-related issues, telehealth infrastructure, financial assistance, and tailored payment models are crucial for maintaining a resilient healthcare system that delivers high-quality care to patients and supports the well-being of healthcare professionals.