Local Care System Research Articles

Cleft Care in the Developing: World: Building the Full Continuum in El Salvador

Objective: To reflect upon the evolution of global surgical care in lower and middle income countries (LMICs) through the analysis of healthcare delivery models and our senior author’s personal experiences to implement an advanced model of effective cleft care in the developing world. Materials and Methods: A thorough literature review was conducted on the need for cleft care in the developing world and how international organizations have responded. We analyzed the types of healthcare delivery models, delineating between those addressing immediate operations versus models emphasizing long-term healthcare investments through local infrastructure and primary care system expansion. We also highlight our senior author’s experiences, a craniofacial-trained plastic surgeon who has worked with a local cleft organization in Austin, Texas and undergone individual mission trips to El Salvador for over a decade. Results: In the United States, outcomes in cleft care have improved due to subspecialization and multi-disciplinary care. We believe that the combination of high-level surgical care and a coordinated team approach are the two most important determinants of good cleft outcomes and pillars of what we are trying to uphold in our model in El Salvador and the developing world. Implementation of a model named the Oblique Model, which achieves synergy between immediate and lasting investments while ensuring trusting partnerships, can enrich LMICs to build sustainable local healthcare delivery services, benefiting local communities through addressing the cleft care continuum from lip/palate treatment to orthodontics and orthognathic surgery. Conclusion: Global surgical care has undergone significant changes in recent decades. To respond to the rising need for cleft care in LMICs and ensure optimal outcomes, implementation of a model that encompasses multidisciplinary care, subspecialization, culturally sensitive discussion, partnership, and fellowship style training in both the first world and host countries is crucial for optimizing craniofacial care.

Barriers to and Facilitators of Effective Behavioral Health Crisis Care Services.

Expanded funding to support care across the crisis continuum is intended to improve behavioral health outcomes. A greater understanding of how to effectively implement and integrate local crisis care systems has been identified as a research and policy priority. The aim of this study was to explore provider perceptions of the barriers and facilitators associated with implementing effective behavioral health crisis services. The authors conducted semistructured qualitative interviews with personnel from 15 behavioral health crisis care programs across California. Purposive sampling was used to ensure adequate representation of peer specialists, clinicians, mental health workers, and program leaders. Interview transcripts were analyzed via an inductive approach to thematic analysis. On the basis of patterns identified in the data, initial codes were developed, reviewed, and combined into overarching preliminary themes and subthemes. Twenty-nine crisis care personnel participated. Facilitators of effective crisis care included an optimal crisis service structure, a client-centered approach, engagement with clients' support systems, and collaboration with community partners to link clients to services and enable safe delivery of crisis care. Barriers at the client, program, and system levels were identified, with solutions proposed for each. The participants identified features of crisis care that could improve program implementation and effectiveness or could help mitigate identified barriers. As states and local municipalities work to implement an integrated system of care across the crisis care continuum, input from frontline providers can be used to support the development of new programs, refine existing services, and inform future directions for research.

Empowering youth in care: the case of emancipatory research with care leavers

New sociology of childhood has emphasized that children are capable of being reflective, of behaving purposively and are able to influence the environment where they live. This concept is also referred to as ‘children as capable agents’ meaning that they can shape the environment. Despite this, children are rarely given the space for participation. The lack of participation is particularly evident within the child protection system, where the tension between children's right to protection and their right to participation becomes even more pronounced. Preventing them from participation is not only a violation of rights but also impacts their capability to exercise social citizenship. This can be particularly detrimental for care leavers who rank among the most socially excluded and disadvantaged groups of young people. This article addresses these issues by presenting the findings of the action-research project CarINg (Empowering Childcare Systems and Supporting Leaving Care from Inside), implemented in Italy and co-funded by the European Union. This research delved into the participation opportunities for care leavers within the care system, with a dual focus on enhancing the local alternative care system and empowering care leavers to actively voice and influence the status quo. Results show how active involvement of care leavers in the protection system and in the production of knowledge can empower them as individuals and enable them to contribute to bringing about change within the alternative care system. Whether all these changes happen depends on the capacity of the institutions to recognize that children are authentic agents and participants of the society.

Recovery Support and Capacity Assessment Using the Calculating an Adequate System Tool: Two Case Studies.

There are multiple, reliable, and authoritative federally managed data sources for understanding the incidence and prevalence of substance use disorder (SUD) and its sequela. However, there remains a gap in metrics representing the need and capacity for treatment and related supports within local communities. To address this challenge, Calculating an Adequate System Tool (CAST) was developed in 2016 by an interdisciplinary group of researchers at the Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality to assess the capacity of the SUD care system within a defined geographic area. It allows for risk assessment of local social and community determinants of substance abuse, as well as an assessment of local service needs across the continuum of SUD care. This article describes the application of the CAST to 2 counties in Ohio and 1 county in Montana. The purpose of using CAST for each area, results of the application, and experiences in utilizing the tool are described. Application of the CAST demonstrated unique findings within each of the geographic areas. In Ohio, recovery support services were lacking in both counties assessed, while differences in crime rate and alcohol outlet density were attributed to varying rates of drug-related hospitalization. Notable findings in Montana included an oversaturation of coalitions focused on substance use prevention and gaps in the areas of detoxification services, partial day treatment, recovery residences, and peer support specialists. CAST is a useful tool for guiding decision-making relative to substance use care needs and capacities for local geographic areas. Findings should be interpreted thoughtfully and in the context of data availability. CAST continues to be enhanced and further expanded for assessing capacity of local and statewide substance use care systems.

The Covid-19 pandemic as a driver towards integrated health care-learning from the experiences of UK community hospitals

Introduction: Many changes occurred in the UK National Health Service (NHS) during the COVID-19 pandemic-some positive and some negative. We were interested in how the pandemic drove integration of health care in small community hospitals in the UK.
 Method: Appreciative inquiry was used to understand staff perspectives of how community hospitals responded. A total of 20 organisations participated, representing 168 (34%) of community hospitals in the UK. Qualitative interviews were conducted, with a total of 85 staff members, using an online video platform. Community representation was featured through the membership of our project board and advisory group which includes Hospital Leagues of Friends. 30 case studies were developed from these interviews.
 Results: From our case studies we examine 4 types of integrated care: Multi-Disciplinary Team Working, Community Hospital and Primary Care, Community Hospital and Acute Care, Community Hospital and Local Community. In the interviews staff gave accounts of improved collaborations and partnerships across the local health and care system, and the consequent impact on patients, families, staff and the community. Many staff said that in many cases teamworking and partnerships were already established, so the trust was there to build on even closer joint working.
 Case studies demonstrating enhanced integration of health care at the micro, meso and macro level are described. Examples of micro changes were small but significant local improvements which impacted positively on the patient experience. Examples of meso changes were those that were across a community hospital or hospitals, with partnerships and joint working supporting improved services. We focus particularly on the macro level, where system-wide changes were implemented to embed innovations and integrated working. 
 We pay particular reference to factors that are known to be associated with successful integration as shown in a recently published systematic review, namely: organisational culture, workforce management, inter-organisational collaboration, leadership ability of staff, economic factors and political factors.
 Discussion: We discuss the learning from the case studies that in order to make the most of our community hospitals we need to be: making decisions locally, benefiting from excellent leadership, recognising community hospitals as community assets and looking after our staff. In particular locally devolved decision-making appropriate to local context was viewed as a critical success factor in swiftly making changes and improvements for the benefit of patients and families, and also for staff. Where this was supported by strong leadership, staff reported successful quality improvements. We continue to work with staff in online discussion groups in our Community Hospital Q Community Special Interest Group to build on this learning and share widely across the community hospital network.
 Conclusion: This study shows how the pandemic accelerated integrated care between staff, services and systems, and the improved recognition of the vital role of community hospitals as community services in the local health and care system.
 
 

'You're out on a limb, on your own': Social care personal assistants' (PAs') reflections on working in the Covid-19 pandemic - implications for wider health and care services.

In England, Personal Assistants (PAs) are part of an international trend towards state funded but client-hired or directly employed care workers. The Covid-19 pandemic highlighted and exacerbated pre-existing risks and advantages of this arrangement for both PAs and people with care and support needs. We aim to report PAs' reflections on their experiences of working since the pandemic started in 2020 and highlight the longer-term implications for health and care services. We undertook a large-scale, qualitative study in 2016-17 involving interviews with 104 PAs about their working lives. We re-interviewed PAs from this group twice to ask how the pandemic had affected them, once at the start of the pandemic in Spring 2020 and again in December 2021 -April 2022. This article reports findings from the last set of interviews undertaken with 38 PAs. Thematic analysis was conducted of interviews in which PAs discussed changes in tasks and responsibilities, pay and conditions, training, relationships and plans. This article focuses on the following themes: PAs' perceptions of their outsider status; support and training needs; job security; and whether PAs have an appetite for regulation to provide greater professional standing and connections. Interviews in this study were carried out during the Covid-19 pandemic over the telephone or virtually rather than in person so may have missed certain body language or informal relationship building. The sample may be under-representative of non-British PAs. We were unable to triangulate participants' accounts with others'. This study highlights the importance of national and local government including the PA workforce in planning for national emergencies. Consideration should be given by policy makers and local health and care systems to how PAs can be better supported than currently.

Centering family voice during a public health crisis: Challenge and opportunity for health collaborations and community systems of care.

Evidence is lacking about how to integrate family and community voice into systems of care. This is particularly relevant in public health crises when reducing barriers to health care and resources is critical for everyone, but especially community members who typically experience more barriers to care. Addressing this gap, this study investigated the voice strategies used by systems of care to respond to the COVID-19 pandemic. We conducted semi-structured interviews in three U.S. counties with agency leaders representing healthcare, public health, and early childhood partners in local systems of care (n = 15) and resource navigators who worked with families (n = 4). We found that systems of care were better able to identify and respond to family priorities when they used diverse voice strategies, implemented among multiple agencies involved and at multiple time points. Family and community voice helped uncover blind spots in the crisis response, facilitating reaching more individuals in need. Flexibility in safety net service policies and protocols was critical to each organization in the system of care. Systems of care that develop a multi-dimensional approach to voice strategies that can be readily mobilized in a public health crisis will be more apt to meet emerging needs. Questions remain about whether power sharing that occurred in the context of crisis translates into reform that builds out from family priorities. Common issues to meeting family needs that could be addressed prior to a crisis included outdated resource lists, confusing application processes, poorly translated materials, and insufficient broadband access. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Investigating the association between characteristics of local crisis care systems and service use in an English national survey - CORRIGENDUM.

Investigating the association between characteristics of local crisis care systems and service use in an English national survey - CORRIGENDUM.

Investigating the association between characteristics of local crisis care systems and service use in an English national survey.

In England, a range of mental health crisis care models and approaches to organising crisis care systems have been implemented, but characteristics associated with their effectiveness are poorly understood. To (a) develop a typology of catchment area mental health crisis care systems and (b) investigate how crisis care service models and system characteristics relate to psychiatric hospital admissions and detentions. Crisis systems data were obtained from a 2019 English national survey. Latent class analyses were conducted to identify discernible typologies, and mixed-effects negative binomial regression models were fitted to explore associations between crisis care models and admissions and detention rates, obtained from nationally reported data. No clear typology of catchment area crisis care systems emerged. Regression models suggested that provision of a crisis telephone service within the local crisis system was associated with a 11.6% lower admissions rate and 15.3% lower detention rate. Provision of a crisis cafe was associated with a 7.8% lower admission rates. The provision of a crisis assessment team separate from the crisis resolution and home treatment service was associated with a 12.8% higher admission rate. The configuration of crisis care systems varies considerably in England, but we could not derive a typology that convincingly categorised crisis care systems. Our results suggest that a crisis phone line and a crisis cafe may be associated with lower admission rates. However, our findings suggest crisis assessment teams, separate from home treatment teams, may not be associated with reductions in admission and detentions.

Analysing changes to the flow of public funding within local health and care systems: An adaptation of the System of Health Accounts framework to a local health system in England

Financial flows relating to health care are routinely analysed at national and international level. They have rarely been systematically analysed at local level, despite sub-national variation due to population needs and decisions enacted by local organisations. We illustrate an adaptation of the System of Health Accounts framework to map the flow of public health and care funding within local systems, with an application for Greater Manchester (GM), an area in England which agreed a health and social care devolution deal with the central government in 2016. We analyse how financial flows changed in GM during the four years post-devolution, and whether spending was aligned with local ambitions to move towards prevention of ill-health and integration of health and social care. We find that GM decreased spending on public health by 15%, and increased spending on general practice by 0.1% in real terms. The share of total local expenditure paid to NHS Trusts for general and acute services increased from 70.3% to 71.6%, while that for community services decreased from 11.7% to 10.3%. Results suggest that GM may have experienced challenges in redirecting resources towards their goals. Mapping financial flows at a local level is a useful exercise to examine whether spending is aligned with system goals and highlight areas for further investigation.

Anti–SARS-CoV-2 Pharmacotherapies Among Nonhospitalized US Veterans, January 2022 to January 2023

Several pharmacotherapies have been authorized to treat nonhospitalized persons with symptomatic COVID-19. Longitudinal information on the use of these therapies is needed. To analyze trends and factors associated with prescription of outpatient COVID-19 pharmacotherapies within the Veterans Health Administration (VHA). This cohort study evaluated nonhospitalized veterans in VHA care who tested positive for SARS-CoV-2 from January 2022 through January 2023 using VHA and linked Community Care and Medicare databases. Demographic characteristics, underlying medical conditions, COVID-19 vaccination, and regional and local systems of care, including Veterans Integrated Services Networks (VISNs). Monthly receipt of any COVID-19 pharmacotherapy (nirmatrelvir-ritonavir, molnupiravir, sotrovimab, or bebtelovimab) was described. Multivariable logistic regression was used to identify factors independently associated with receipt of any vs no COVID-19 pharmacotherapy. Among 285 710 veterans (median [IQR] age, 63.1 [49.9-73.7] years; 247 358 males [86.6%]; 28 444 Hispanic [10.0%]; 61 269 Black [21.4%] and 198 863 White [69.6%]) who tested positive for SARS-CoV-2 between January 2022 and January 2023, the proportion receiving any pharmacotherapy increased from 3285 of 102 343 veterans (3.2%) in January 2022 to 5180 of 21 688 veterans (23.9%) in August 2022. The proportion declined to 2194 of 10 551 veterans (20.8%) by January 2023. Across VISNs, the range in proportion of patients who tested positive who received nirmatrelvir-ritonavir or molnupiravir during January 2023 was 41 of 692 veterans (5.9%) to 106 of 494 veterans (21.4%) and 2.1% to 120 of 1074 veterans (11.1%), respectively. Veterans receiving any treatment were more likely to be older (adjusted odds ratio [aOR] for ages 65-74 vs 50-64 years, 1.18; 95% CI, 1.14-1.22; aOR for ages ≥75 vs 50-64 years, 1.19; 95% CI, 1.15-1.23) and have a higher Charlson Comorbidity Index score (aOR for CCI ≥6 vs 0, 1.52; 95% CI, 1.44-1.59). Compared with White veterans, Black veterans (aOR, 1.06; 95% CI, 1.02-1.09) were more likely to receive treatment, and compared with non-Hispanic veterans, Hispanic veterans (aOR 1.06; 95% CI, 1.01-1.11) were more likely to receive treatment. This study found that prescription of outpatient COVID-19 pharmacotherapies in the VHA peaked in August 2022 and declined thereafter. There were large regional differences in patterns of nirmatrelvir-ritonavir and molnupiravir use.

From American to Cisse: Sufism and the remaking of diasporic ties across the Atlantic

AbstractSince the 1980s, hundreds of predominantly working-class African-American Muslims have travelled or relocated to the rural yet renowned city of Medina Baye, Senegal. They were invited there by Shaykh Hassan Cisse, a Senegalese Islamic scholar and leader in the Tijani tariqa (Sufi order). This article focuses on the experiences of African-American and fellow diaspora Black Muslims living and learning with African Muslims in the Tijani hub of Medina Baye. It interrogates the assumptions, expectations and misunderstandings that characterize relationships between the two groups. I argue that, as members of the Tijani tariqa, diaspora Black disciples become integrated within the local system of collective care modelled by African disciples. Complicating analyses of African–diasporic exchanges that tend to differentiate and hierarchize the interconnected economic hardships facing diaspora Black and continental African communities, I argue that the relationship between these groups illustrates the role of Shaykh Ibrahim Niasse’s branch of the Tijani tariqa as a counterhegemonic social movement offering new paradigms of social and economic reciprocity that enable Black Muslims on both sides of the Atlantic to mitigate the contemporary impacts of racial capitalism and global apartheid.

Very rapid insight generation to support UK health and care systems: An AHSN approach.

COVID-19 challenges are well documented. Academic Health Science Networks (AHSNs) are a key partner to NHS and care organizations. In response to managing COVID-19 challenges, Wessex AHSN offered rapid insight generation and rapid evaluation to local NHS and care systems to capture learning during this period. This novel "Rapid Insight" approach involved one-off online deliberative events with stakeholders to generate insights linked to specific, priority areas of interest, followed by rapid analysis and dissemination of the findings. Key objectives were to enable system leaders to build their adaptive leadership capability and learn from the experience of COVID-19 to inform recovery planning and system support. Rapid Insight (RI) gathered together health and care professionals into a tightly managed, virtual forum to share system intelligence. Focused questions asked about the systems' response to the pandemic, what changes to continue and sustain, or discontinue. Participants responded simultaneously to each question using the virtual chat function. Immediate thematic analysis of the chat conducted in 48-72 h by paired analysts for each question strengthened analytical integrity. Mind maps, the key output, provided easily assimilated information and showed linkages between themes. Telephone or virtual interviews of key informants (health and care professionals and patients) and routinely collected data were synthesized into short reports alongside several RI events. However, insufficient time limited the opportunities to engage diverse participants (e.g., mental health users). Data from RI can scope the problem and immediate system needs, to stimulate questions for future evaluative work. RI facilitated a shared endeavor to discover "clues in the system" by including diverse opinions and experience across NHS and care organizations. Although these rapid virtual events saved on travel time, digital exclusion might constrain participation for some stakeholders which needs other ways to ensure inclusion. Successful rapid engagement required Wessex AHSN's existing system relationships to champion RI and facilitate participant recruitment. RI events "opened the door" to conversations between up to 150 multi-professional clinicians to share their collective response to COVID-19. This paper focuses on the RI approach with a case example and its further development.

A Phenomenological Exploration of Families' Experiences of the Mental Health System of Care in the Monadnock Region.

Accessing mental health treatment in rural locations is a unique challenge for families with youth experiencing adverse mental health conditions. Families often experience a variety of difficulties accessing and negotiating changes within the system of care. This study aimed to understand the experiences of families and their youth in navigating the mental health system in a rural community. Interpretative phenomenological analysis was used to examine how participants interpret their experiences within the local system of care. Qualitative interviews were conducted with eight families. Results included five main themes: youth experience, family experience, access to a system of care, relationships between stakeholders, and larger societal beliefs. Families highlighted their experiences accessing the local care system and their hope for strengthening community access and partnerships. Findings indicate that prioritizing family voices should be encouraged by local systems.

American Indian and Alaska Native overexposure to foster care and family surveillance in the US: A quantitative overview of contemporary system contact

Following a long history of forced assimilation through family separation, American Indian and Alaska Native (AIAN) children continue to be separated from their families by state child welfare agencies at exceptionally high rates. This study identifies those states with high levels of contemporary AIAN family separation through non-tribal state and local foster care systems. We describe how these risks vary over childhood and vary in magnitude relative to white children. We then examine three states with exceptionally high rates of AIAN foster care placement, Minnesota, Alaska, and Montana, in detail. We evaluate how child maltreatment reporting contributes to upstream inequalities in family separation through an examination of sources of maltreatment reports and types of alleged maltreatment across childhood. We conclude by arguing that child welfare scholars should understand contemporary AIAN child welfare system contact in the context of historical and ongoing settler colonialism. In order to reduce AIAN inequalities, child protective services should observe tribal sovereignty by deferring to the authority of tribes in caring for Native children and families and increasing the capacity tribes have to help their communities.

Stroke profile and care during the COVID-19 pandemic: What changed and what did not? A prospective cohort from Joinville, Brazil.

The COVID-19 pandemic has wrought negative consequences concerning quality of care for stroke patients since its onset. Prospective population-based data about stroke care in the pandemic are limited. This study aims to investigate the impact of COVID-19 pandemic on stroke profile and care in Joinville, Brazil. A prospective population-based cohort enrolled the first-ever cerebrovascular events in Joinville, Brazil, and a comparative analyzes was conducted between the first 12 months following COVID-19 restrictions (starting March 2020) and the 12 months just before. Patients with transient ischemic attack (TIA) or stroke had their profiles, incidences, subtypes, severity, access to reperfusion therapy, in-hospital stay, complementary investigation, and mortality compared. The profiles of TIA/stroke patients in both periods were similar, with no differences in gender, age, severity, or comorbidities. There was a reduction in incidence of TIA (32.8%; p = 0.003). In both periods, intravenous thrombolysis (IV) and mechanical thrombectomy (MT) rates and intervals from door to IV/MT were similar. Patients with cardioembolic stroke and atrial fibrillation had their in-hospital stay abbreviated. The etiologic investigation was similar before and during the pandemic, but there were increases in cranial tomographies (p = 0.02), transthoracic echocardiograms (p = 0.001), chest X-rays (p < 0.001) and transcranial Doppler ultrasounds (p < 0.001). The number of cranial magnetic resonance imaging decreased in the pandemic. In-hospital mortality did not change. The COVID-19 pandemic is associated with a reduction in TIA, without any influence on stroke profile, the quality of stroke care, in-hospital investigation or mortality. Our findings show an effective response by the local stroke care system and offer convincing evidence that interdisciplinary efforts are the ideal approach to avoiding the COVID-19 pandemic's negative effects, even with scarce resources.

Is it 'just' trauma? Use of trauma-informed approaches and multi-agency consultation in mental healthcare of looked after children.

This article presents three case studies of patients that a child and adolescent mental health service (CAMHS) have supported and its purpose is to encourage discussion of two key learning points. The first of these is the utility of developmental trauma as an approach for children with mental health presentations. The second centres on the importance of multi-agency working when working with young people, principally those within the UK's local authority care system ('looked after children'), who have had traumatic experiences in order to enhance positive outcomes. We also want to encourage consideration of the implications of developmental trauma for current core CAMHS therapeutic models in an attempt to reach beyond the often held narrative that the trauma formulation implies there is 'just trauma, no mental illness'.

The Evolution of External Healthcare Regulation in England; From Performance Oversight to Supporting Improvement Comment on "The Special Measures for Quality and Challenged Provider Regimes in the English NHS: A Rapid Evaluation of a National Improvement Initiative for Failing Healthcare Organisations".

The Special Measures and Challenged Provider (SMCP) Regime introduced for struggling healthcare organisations in England represents a subtle shift to the scope of external regulation from performance oversight to include supporting internal service improvement. External regulation alone has a had a mixed impact on the quality of care and Vindrola-Padros and colleagues' study highlights that externally driven improvement initiatives may also struggle to succeed in turning around performance. Principally, this is due to a failure in acknowledgment that poor performance results from a myriad of external and internal factors which coalesce to impede organisational performance. A struggling organisation may be indicative of wider issues in the local health and care system. Whole systems approaches to improvement with collaboration across providers and the effective use of data may support struggling organisations but their role maybe tempered with the increased centralisation of the delivery of improvement regimes such as SMCP.

Implementing and Evaluating Community Health Worker-Led Cardiovascular Disease Risk Screening Intervention in Sub-Saharan Africa Communities: A Participatory Implementation Research Protocol.

The increasing burden of non-communicable diseases (NCDs), particularly cardiovascular diseases (CVD) in low- and middle-income countries (LMICs) poses a considerable threat to public health. Community-driven CVD risk screening, referral and follow-up of those at high CVDs risk is essential to supporting early identification, treatment and secondary prevention of cardiovascular events such as stroke and myocardial infarction. This protocol describes a multi-country study that aims to implement and evaluate a community health worker (CHW)-led CVD risk screening programme to enhance referral linkages within the local primary care systems in sub-Saharan Africa (SSA), using a participatory implementation science approach. The study builds upon a prior community-driven multicentre study conducted by the Collaboration for Evidence-based Health Care and Public Health in Africa (CEBHA+). This is a participatory implementation research. The study will leverage on the CVD risk citizen science pilot studies conducted in the four selected CEBHA+ project countries (viz. Ethiopia, Rwanda, Malawi, and South Africa). Through planned engagements with communities and health system stakeholders, CHWs and lay health worker volunteers will be recruited and trained to screen and identify persons that are at high risk of CVD, provide referral services, and follow-up at designated community health clinics. In each country, we will use a multi-stage random sampling to select and then screen 1000 study participants aged 35-70 years from two communities (one rural and one urban). Screening will be done using a simple validated non-laboratory-based CVD risk assessment mobile application. The RE-AIM model will be used in evaluating the project implementation outcomes, including reach, fidelity, adoption and perceived effectiveness. Developing the capacities of CHWs and lay health worker volunteers in SSA to support population-based, non-invasive population-based CVD risk prevention has the potential to impact on early identification, treatment and secondary prevention of CVDs in often under-resourced communities. Using a participatory research approach to implementing mobile phone-based CHW-led CVD risk screening, referral and follow-up in SSA will provide the evidence needed to determine the effectiveness of CVD risk screening and the potential for scaling up in the wider region.

Inpatient care provider perspectives on the development and implementation of an addiction medicine consultation service in a small urban setting

BackgroundTo evaluate provider perspectives on the development and implementation of an inpatient Addiction Medicine Consult Service, including their awareness of the service, its perceived role in the continuum of care, and changes over time in their perceptions of care quality for inpatients with substance use disorders.MethodsRepeated cross-sectional survey of hospital-based physicians, nurses and social workers performed at service launch (April–June, 2017) and 4 years later (March–June, 2021).ResultsProviders had generally positive perceptions of the service and its impact on care quality, but encountered significant barriers at both time points in meeting patient needs (related to high patient complexity and difficulty connecting patients with community services post-discharge). Relative to physicians and social workers, nurses were less likely to be familiar with the service or see it as beneficial.ConclusionsFindings indicate that the service fills a gap that existed previously in the local system of care; however, numerous opportunities exist to further strengthen the system beyond the hospital setting to promote longer-term health among people who use substances. For nurses in particular, outreach, education, and other resources (e.g., dedicated nursing role support, nurse liaison) are warranted to ensure that nurses feel supported and confident caring for this patient population.