Client Linkage Research Articles

Implementation of evidence-based multiple focus integrated intensified TB screening to end TB (EXIT-TB) package in East Africa: a qualitative study

IntroductionTuberculosis (TB) remains a major cause of morbidity and mortality, especially in sub-Saharan Africa. We qualitatively evaluated the implementation of an Evidence-Based Multiple Focus Integrated Intensified TB Screening package (EXIT-TB) in the East African region, aimed at increasing TB case detection and number of patients receiving care.ObjectiveWe present the accounts of participants from Tanzania, Kenya, Uganda, and Ethiopia regarding the implementation of EXIT-TB, and suggestions for scaling up.MethodsA qualitative descriptive design was used to gather insights from purposefully selected healthcare workers, community health workers, and other stakeholders. A total of 27, 13, 14, and 19 in-depth interviews were conducted in Tanzania, Kenya, Uganda, and Ethiopia respectively. Data were transcribed and translated simultaneously and then thematically analysed.ResultsThe EXIT-TB project was described to contribute to increased TB case detection, improved detection of Multidrug-resistant TB patients, reduced delays and waiting time for diagnosis, raised the index of TB suspicion, and improved decision-making among HCWs. The attributes of TB case detection were: (i) free X-ray screening services; (ii) integrating TB case-finding activities in other clinics such as Reproductive and Child Health clinics (RCH), and diabetic clinics; (iii), engagement of CHWs, policymakers, and ministry level program managers; (iv) enhanced community awareness and linkage of clients; (v) cooperation between HCWs and CHWs, (vi) improved screening infrastructure, (vii) the adoption of the new simplified screening criteria and (viii) training of implementers. The supply-side challenges encountered ranged from disorganized care, limited space, the COVID-19 pandemic, inadequate human resources, inadequate knowledge and expertise, stock out of supplies, delayed maintenance of equipment, to absence of X-ray and GeneXpert machines in some facilities. The demand side challenges ranged from delayed care seeking, inadequate awareness, negative beliefs, fears towards screening, to financial challenges. Suggestions for scaling up ranged from improving service delivery, access to diagnostic equipment and supplies, and infrastructure, to addressing client fears and stigma.ConclusionThe EXIT-TB package appears to have contributed towards increasing TB case detection and reducing delays in TB treatment in the study settings. Addressing the challenges identified is needed to maximize the impact of the EXIT-TB intervention.

English

Huge diagrams have unique properties for organizations and research, such as client linkages in informal organizations and customer evaluation lattices in social channels. They necessitate a lot of financial assets to maintain because they are large and frequently continue to expand. Owners of large diagrams may need to use cloud resources due to the extensive arrangement of open cloud resources to increase capacity and computation flexibility. However, the cloud's accountability and protection of schematics have become a significant issue. In this study, we consider calculations for security savings for essential graph examination practices: schematic extraterrestrial examination for outsourcing graphs in the cloud server. We create the security-protecting variants of the two proposed Eigen decay computations. They are using two cryptographic algorithms: additional substance homomorphic encryption (ASHE) strategies and some degree homomorphic encryption (SDHE) methods. Inadequate networks also feature a distinctively confidential info adaptation convention to allow the trade-off between secrecy and data sparseness. Both dense and sparse structures are investigated. According to test results, calculations with sparse encoding can drastically reduce information. SDHE-based strategies have reduced computing time, while ASHE-based methods have reduced stockpiling expenses.

Addressing constraints to informal providers\u2019 involvement in tuberculosis control: a qualitative study of patent medicine dealers and tuberculosis programme managers

BackgroundA major constraint to tuberculosis control is low case finding with under-reporting to national authorities. Evidence shows that Patent Medicine Dealers are first port of call for most people with symptoms of tuberculosis, yet there is poor referral of such clients to tuberculosis treatment facilities for further evaluation. This study investigated constraints to involvement of Patent Medicine Dealers in tuberculosis control.MethodsThis was a cross-sectional qualitative study among Patent Medicine Dealers and Tuberculosis Control Programme Managers in Ebonyi State Nigeria. Sixty-four Patent Medicine Dealers and five Tuberculosis Control Programme Managers were interviewed using Focus Group Discussion and In-Depth Interview respectively. Data was collected with electronic audio-recording device and analyzed using thematic approach.ResultsThere are some knowledge gaps about tuberculosis signs, symptoms, free-treatment policy and mode of operation of care service among Patent Medicine Dealers. Patent Medicine Dealers and Tuberculosis Control Programme Managers are willing to collaborate in tuberculosis control effort but constant demand for incentives by Patent Medicine Dealers and inability of National Tuberculosis Control Programme to keep up with such demands are obvious constraints.ConclusionsKnowledge gaps in tuberculosis, its control, constant demand for incentives by Patent Medicine Dealers and inability of National Tuberculosis Control Programme to satisfy such demands are constraints to involvement of Patent Medicine Dealers in tuberculosis control. More robust engagement of Patent Medicine Dealers in tuberculosis control with clear job description through tuberculosis education and provision of incentives to support them are recommended policy approaches to improve linkage of clients to tuberculosis treatment facilities.

How Smallness Fosters Clientelism: A Case Study of Malta

While it has long been assumed that smaller communities are more prone to particularistic politics, the relationship between state size and clientelism remains strongly undertheorized. Departing from the assumption that face-to-face contacts, overlapping role relations, stronger monitoring mechanisms, and the enhanced power of single votes contribute to the emergence of patron–client linkages, this article provides an in-depth case study of clientelism in Malta, the smallest member state of the European Union. The analysis reveals not only that patron–client linkages are a ubiquitous feature of political life in Malta, but also that the smallness of Malta strongly affects the functioning of clientelism by eliminating the need for brokers and enhancing the power of clients versus patrons. In addition, clientelism is found to be related to several other characteristics of Maltese politics, among which the sharp polarization between parties, extremely high turnout rates, profound executive dominance, and the incidence of corruption scandals.

Link workers' perspectives on factors enabling and preventing client engagement with social prescribing.

For a social prescribing intervention to achieve its aims, clients must first be effectively engaged. A 'link worker' facilitating linkage between clients and community resources has been identified as a vital component of social prescribing. However, the mechanisms underpinning successful linkage remain underspecified. This qualitative study is the first to explore link workers' own definitions of their role in social prescribing and the skills and qualities identified by link workers themselves as necessary for effective client linkage. This study also explores 'threats' to successful linked social prescribing and the challenges link workers face in carrying out their work. Link workers in a social prescribing scheme in a socioeconomically deprived area of North East England were interviewed in two phases between June 2015 and August 2016. The first phase comprised five focus groups (n=15) and individual semi-structured interviews (n=15) conducted with each focus group participant. The follow-up phase comprised four focus groups (n=15). Thematic data analysis highlighted the importance of providing a holistic service focusing on the wider social determinants of health. Enabling client engagement required 'well-networked' link workers with the time and the personal skills required to develop a trusting relationship with clients while maintaining professional boundaries by fostering empowerment rather than dependency. Challenges to client engagement included: variation in the volume and suitability of primary-care referrals; difficulties balancing quality of intervention provision and meeting referral targets; and link workers' training inadequately preparing them for their complex and demanding role. At a broader level, public sector cuts negatively impacted upon link workers' ability to refer patients into suitable services due to unacceptably long waiting lists or service cutbacks. This study demonstrates that enabling client engagement in social prescribing requires skilled link workers supported by healthcare referrer 'buy-in' and with access to training tailored to what is a complex and demanding role.

When Things Get Personal: How Informal and Personalized Politics Produce Regime Stability in Small States

AbstractThe personalization of politics, the decline of political parties and the weakening of political institutions in large democracies are considered to produce instability and to undermine democratic governance. Yet despite having extremely informal and personalized systems with non-ideological parties, small states around the world maintain significantly higher levels of democracy and regime stability than large ones. This article addresses this paradox by offering a systematic literature review of 167 case study publications on personalization and informal politics in 46 small states. The analysis reveals that personalized relations between political elites translate into either fragmentation or power concentration, while pervasive patron–client linkages structure the interaction between citizens and politicians. Despite the obvious downsides of these dynamics for democratic governance, the small state system is functional in the sense that it fulfils the needs of both citizens and politicians, which explains why small states have succeeded in maintaining their political stability.

One for all, all for one - Establishing a corporate linkage methodology for integrated health analytics in Canada

ABSTRACTObjectivesTo describe the successes, challenges and trade-offs encountered when establishing a standard patient linkage methodology for linking pan-Canadian health data across the continuum of care.
 ApproachHealth facilities, regional health authorities and ministries of health across Canada need access to timely, integrated health information across the continuum of care in order to make effective decisions to manage and improve their health systems. To better meet these needs, our organization has embarked on an initiative to integrate our web-based analytic tools. A requirement for this integration is the establishment of a corporate linkage standard.
 The scope is to enable linkage across a dozen patient-level data holdings including data from acute care, long term care, home care, rehabilitation, mental health, pharmaceuticals and registries for joint replacements and organ transplants. In Canada, provinces and territories issue jurisdiction-specific health care numbers (HCN) to their residents.
 A working group was established to review existing methodologies and to define a standard linkage. To gain support from the various groups in our organization to adopt the proposed standard, the right balance was sought between accuracy, timeliness, ease of implementation as well as availability and quality of data elements across our data holdings. In addition, an accurate patient linkage key was manually created as a benchmark to compare false positives and false negatives of the various candidate methods.
 ResultsIn general, adding data elements to the linkage methodology increased false negatives, decreased false positives and reduced the number of records that could be included in the linkage. Data quality issues affecting linkages varied across the data holdings and by jurisdiction.
 The final standard linkage methodology is simple and deterministic: link records by jurisdiction and HCN and exclude records where HCN is used by multiple people, for example, newborns who share their HCN with their mother.
 ConclusionArriving at a methodology that balanced the need for inclusiveness, simplicity and precision required collaboration, compromise, analysis and innovation. To date, the new client linkage standard has been implemented for ad-hoc analysis as well as in the data warehouse for our new web analytics tool. The implementation of the new client linkage standard represents an important foundational step towards creating an integrated analytics tool that spans across the continuum of care.

Analyzing the Foreign Policy of Microstates

The position of small states in international relations is traditionally described in terms of vulnerability and dependence. This dominant perspective is largely incomplete and inaccurate, because it disregards the element of exchange that characterizes the international linkages between many small and large states. In this article, I aim to outline and motivate an alternative model on the basis of which such relationships can be understood, which has been referred to as the international patron–client framework. After providing an overview of the contemporary academic literature on the role of small states in international politics, two sections follow in which I motivate the applicability of the patron–client framework to the field of international relations, and in which I explain the motives of both patron and client states. Subsequently, the accuracy and usefulness of the framework is examined on the basis of interview data gathered during field research in the three small client states of St. Kitts and Nevis, Seychelles, and Palau. The findings of this analysis indicate that the patron–client linkage offers a more fruitful model to study the relations between small and large states than the existing literature does, because it recognizes the element of exchange that such relationships entail.

A cluster randomized trial of an organizational linkage intervention for offenders with substance use disorders: study protocol.

BackgroundSubstance use disorders are highly prevalent in community correctional populations, yet these settings frequently are ill-equipped to identify and refer offenders to community-based treatment services. In particular, community corrections staff are often opposed to the use of medication in addiction treatment because of inadequate knowledge, resources, and organizational structures to facilitate client linkages to evidence-based services.Methods/designEach of the NIDA-funded Research Centers recruited 2 criminal justice agencies to participate in the study. Eligibility rules required study sites that were focused on community corrections (i.e., probation or parole), had few or no formal relationships with treatment providers for referring clients to medication-assisted treatment, and had no state or local policies prohibiting such relationships. Sites under the oversight of the same parent agency were eligible only if they were in geographically distinct catchment areas, and could be assigned to different study arms without cross-contamination at any level. The 18 clusters consisted of community corrections officers and their offender caseloads nested within agencies, each of which was partnered with at least one community-based substance abuse treatment program. Randomization was blocked by Research Center, within which one cluster was randomly assigned to a training-only condition (comparison) and the other to training followed by a strategic organizational linkage process (intervention). Line staff received a scientifically-grounded, systematically-delivered training session that addresses gaps in existing knowledge, perceptions, and information about medication-assisted treatment (MAT) and local availability of MAT services. Key decision-makers subsequently were asked to collaborate in a strategic planning process to enhance formal and informal linkages between criminal justice agencies and local MAT providers. It was hypothesized that the two implementation intervention components together would be more likely than staff training alone to improve the process of referring opioid- and alcohol-dependent adults under community supervision to appropriate addiction pharmacotherapy. Outcomes were measured at the client (referrals), line staff (attitudes), and organizational (linkage) levels.DiscussionThrough closer collaboration among criminal justice agencies and treatment providers, improved linkages to effective substance abuse treatment should yield significant clinical, public health and public safety benefits.Trial registrationClinical Trials gov registration number NCT01344122.

Tncs' Technology Linkages with Domestic Firms: An Investigation of the Ict Industry in Suzhou, China

On the basis of a comprehensive survey in the information and communication technology industry in China's Suzhou municipality, we examine the determinants of the technology linkages that transnational corporations (TNCs) make with domestic firms. We found that TNCs' domestic supply and client linkages and their decentralization of decision making had a significant and positive effect on technological interactions between domestic firms and TNCs. However, such linkages were constrained by the technology gap between TNCs and domestic firms and they are focused on new product developments for the domestic Chinese market. The results highlight the challenges that domestic Chinese firms face in establishing ‘global pipelines’ of knowledge exchange. The implications of the findings on technology and foreign direct investment policies in China are also assessed, and we argue that China has potential to pave a new way of technology development by taking advantage of its indigenous capacity and sizable domestic market.

Marketing capabilities under a collective brand – three longitudinal case studies of Australian SME experience

This paper considers the experiences of some Australian SMEs that support industry clients and promote themselves under a collective brand name of some sort. Three cases are considered. Two were created to access global markets, one in mining and one in aerospace in conjunction with industry associations, and the other sought to access a regional IT market with support from a local government authority. In all cases this market approach supplemented the local marketing efforts of the individual participants. Each case followed a different approach to sales and delivery arising from their marketing efforts and had varying degrees of success. Internal participant factors related to capability and mutual trust influenced what could be offered to the market and to enhance brand reputation. External factors related to market dynamics, and client linkage preferences influenced the way firms worked together.

Introduction: The Basic Law, Governance and Electoral Politics in China's Hong Kong and Macao since 1997

1 July 2007 marks the tenth anniversary of Hong Kong's retrocession to Chinese sovereignty to become a Special Administrative Region (SAR) of the PRC. The HKSAR has functioned under the ‘One Country, Two Systems’ framework as enshrined in the Basic Law, its mini-constitution. Upon the resumption of Chinese jurisdiction over Macao on 20 December 1999, a similar ‘One Country, Two Systems’ formula also came into effect for the new MSAR under its Basic Law. The ‘One Country, Two Systems’ formula that guarantees a high degree of autonomy in both Hong Kong and Macao is also a cornerstone of the PRC's strategy toward peaceful reunification with Taiwan. To provide a more balanced and informed understanding of these two Chinese SARs in actualizing the ‘One Country, Two Systems’ model, this special section of four articles adopts a bi-focal approach. On the one hand, it presents in a joint article the views of two leading mainland Chinese legal scholars (Professors Geping Rao and Zhenmin Wang, both National People's Congress Hong Kong Basic Law Committee members) on some vital dimensions of the Basic Law. On the other hand, it offers three articles with a more locally anchored perspective—a comparative analysis (by Professor Sonny Lo) of the contrasting HKSAR and MSAR experiences, and two case studies (by Professors Bruce Kwong and Eilo Yu) that highlight key features of patron–client linkages and informal politics dynamics in HKSAR and MSAR elections and politics.

Outcomes of HIV/AIDS case management in New York

The purpose of this study was to examine HIV case management (CM) outcomes in New York State. The results presented here are part of a larger study that explored: client needs identified during CM, success in arranging needs, other case managers used by the client, coordination between multiple case managers, client satisfaction with CM, and the correlation between health care costs and CM. This paper focuses on the linkage of clients with services. Twenty-eight agencies and 588 clients participated in the study. Each client's chart was reviewed; clients and case managers were interviewed. Almost 9,000 client needs were identified; 79.3% of these needs were for services. Over 72% of needed services were arranged for clients. However, of the services arranged, 12.9% were never utilized. Success in arranging services did not vary based on client demographics; client utilization of services, once arranged, varied based on only one demographic factor (clients who lived outside of New York City had higher utilization rates than those who lived in the city, p ≤ 0.05). Services provided directly by the CM agency were arranged and utilized more frequently than services provided by another agency ( p ≤ 0.05). Medical needs were arranged and utilized at a higher rate-and legal needs at a lower rate-than other services, regardless of where the service was provided ( p ≤ 0.05). On average it took 2.3 months to arrange a service; however it took less time to arrange medical services and more time to arrange legal services ( p ≤ 0.05). Females, individuals whose mode of HIV transmission was heterosexual contact, clients whose children were living with them, the inadequately housed, and those without a high school diploma had significantly more needs than other clients ( p ≤ 0.05). Our study supports CM models that provide intensive services to women with children; the provision of multiple services, in addition to CM, within a single agency; and the need for case manager training on how to work with clients to increase service utilization.

Linking Clients and Policy: Social Work's Distinctive Contribution

Social work's unique and distinctive contribution to American life, often expressed as a dual focus on the person and his or her environment, resulted from a specific frame of reference that linked clients and social policy. From the earliest origins of the profession, social workers understood the relationships between individuals and primary groups and between primary groups anti forces in the larger environment. This frame of reference provided an orientation to action that placed interventions in the environment on a par with interventions with the client system (Gordon & Schutz, 1977). This dual focus, unique to social workers, was evident during the profession's formative years - the period between the 1890s and the coming of the New Deal in the 1930s - and continues to be important today. This article discusses social workers' linkage of clients - initially conceptualized as neighbors and charity cases - and social policy concerns during the profession's formative years. The article concludes with a case study of a social policy effort, the ultimately successful campaign to enact social standards for industry. Early Social Work: Settlements and Charity Organization Both of the institutions traditionally associated with, the origins of the social work profession - charity organization societies and settlement houses - began as efforts to organize the local community and to introduce a personal relationship among workers - settlement residents, district agents, and friendly visitors - and clients-neighbors and charity cases. During the late 19th and early 20th centuries, industrialization, urbanization, immigration, and internal migration from rural areas to cities transformed American society. Previously a nation made up of small island communities, the United States increasingly became organized nationally (Weibe, 1967). Urbanization and industrialization characterized the emerging nation. The largest cities grew in size, and there were more of them. The proportion of urban dwellers increased from less than 20 percent in 1860 to nearly 40 percent in 1900 and more than 50 percent by 1920 (U.S. Bureau of the Census, 1975). As industrial production replaced agriculture as the major source of national wealth, business institutions became larger and more influential. Concomitantly, the disparity between rich and poor increased, and the likelihood of a personal relationship between poor people and wealthy people lessened. Reformers created settlement houses and charity organization societies to respond to the changing American city. Both settlement residents and charity workers were quick to perceive the interrelationships between local and state movements, state and regional developments, and local and national phenomena. These formative professional institutions, which oriented members of the first generation of social workers to their new profession, had in common an orientation to the community and to viewing the person as embedded in the community system. Each movement was based on English precedents - London's Toynbee Hall and other English social settlements and the English Charity Organisation Societies - but each movement developed a distinctive American pattern. Both movements owed much to the example of Thomas Chalmers, an early 19th century Scottish critic of the Poor Laws, who organized a parish-based system of charity to replace the poor law in Glasgow during the early 19th century (de Schweinitz, 1943). Settlement Houses Settlement houses responded to two complementary social imperatives of late 19th century America. Settlements had objective value because they addressed the increasing fragmentation of American life that resulted from the growing contrasts between rich and poor people, native born and immigrants, and Protestants and Catholics in late 19th century America (Addams, 1893a). In addition, the settlements responded to a subjective necessity that resulted from the lack of meaningful opportunities for middle-class young people, especially women (Addams, 1893b). …

Inner and Eastern Metropolitan (Melbourne) Health Care Network Client Linkage Index.

Inner and Eastern Metropolitan (Melbourne) Health Care Network Client Linkage Index.