Location Of Service Delivery Research Articles

Export and import statistics on e-commerce in computer services: classification and evaluation challenges

The specific domain of e-commerce within computer services has been insufficiently explored as a distinct area of scholarly inquiry. It is typically subsumed under the broader umbrella of ICT services, a classification that complicates accurate statistical market assessments. Present static accounting methodologies provide only a roundabout means for estimating the scope of international trade activities within the computer service sector. This study engages in a comprehensive analysis of the nuances involved in accounting for the export and import of computer services. It examines the global practices of data gathering for statistical purposes, confronts classification dilemmas, and addresses the complexities of identifying the service delivery location and mode. The culmination of this analysis is a set of proposed enhancements to statistical accounting methods. For the sake of international comparisons, it is advisable to equate the cross-border e-commerce of computer services with the exportation of services through the first mode of cross-border supply, which constitutes approximately 75% of all exported computer services. The adoption of more granular tracking methodologies for cross-border transactions necessitates the creation of a standardized ontology at the international level. The urgency of establishing a definitive conceptual framework and performing a thorough market analysis for e-commerce is underscored by the need to fine-tune policy support measures, evaluate the export potential of emerging markets, propose exemptions for e-commerce from traditional trade regulations, implement fair taxation policies, avert discrimination in determining the tax base, promote statistical coherence, and sustain a consistent stance during international negotiations and disputes resolution.

Medicare Payment Policy: The Basics.

The mechanisms of payment for medical services are complicated and create predictable incentives. Physicians can benefit from understanding how hospitals, practices, employers, and payers understand payment, since this has a role in determining how certain patient care services are valued and prioritized. Type of hospital, location of service delivery, and a physician's relationship with the payer or provider entity can greatly impact the value of a physician's work. The landscape of payers is large, but Medicare payment has come to drive the behavior of many private payers. This article will outline the key components of Medicare and how they apply to physicians, hospitals, and ambulatory surgical centers to provide a basic structure for thinking about payment for medical services. This review of the fundamentals of Medicare payment will provide a framework for physicians to understand the financial incentives that underlie clinical and operational decisions in the healthcare system.

Occupational therapy in multiple sclerosis

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Main objective To assess the benefits and harms of occupational therapy interventions for improving daily functioning, participation, and quality of life in people with multiple sclerosis. Secondary objectives To assess whether the effects of occupational therapy interventions differ according to the format of intervention delivery (individually versus group) and to the location of service delivery (outpatient, inpatient, or home‐based therapy).

Mapping of Pro-Equity Interventions Proposed by Immunisation Programs in Gavi Health Systems Strengthening Grants.

Reaching zero-dose (ZD) children, operationally defined as children who have not received a first dose of the diphtheria, tetanus, and pertussis (DTP1) vaccine, is crucial to increase equitable immunisation coverage and access to primary health care. However, little is known about the approaches already taken by countries to improve immunisation equity. We reviewed all Health System Strengthening (HSS) proposals submitted by Gavi-supported countries from 2014 to 2021 inclusively and extracted information on interventions favouring equity. Pro-equity interventions were mapped to an analytical framework representing Gavi 5.0 programmatic guidance on reaching ZD children and missed communities. Data from keyword searches and manual screening were extracted into an Excel database. Open format responses were analysed using inductive and deductive thematic coding. Data analysis was conducted using Excel and R. Of the 56 proposals included, 51 (91%) included at least one pro-equity intervention. The most common interventions were conducting outreach sessions, tailoring the location of service delivery, and partnerships. Many proposals had "bundles" of interventions, most often involving outreach, microplanning and community-level education activities. Nearly half prioritised remote-rural areas and only 30% addressed gender-related barriers to immunisation. The findings can help identify specific interventions on which to focus future evidence syntheses, case studies and implementation research and inform discussions on what may or may not need to change to better reach ZD children and missed communities moving forward.

Development of a Minimum Reporting Set of Contextual Factors for Rehabilitation Studies: A Delphi Study.

ObjectiveTo identify the most important categories of the International Classification of Service Organization in Rehabilitation (ICSO-R 2.0) for a minimum reporting data set.MethodsA 2-step Delphi survey was used. Rehabilitation experts from all world regions including physicians, nurses, neuropsychologists, physiotherapists, and others, were invited to participate. In the first round, all participants were asked to rate the categories and subcategories of the ICSO-R 2.0 with the following criteria: Being relevant for study outcomes; Being distinctive among different rehabilitation settings; Being feasible to use and reported by objective figures or other clear characterization. All categories that were rated relevant, distinctive and feasible by more than 60% of respondents from the first round were included in the second round.ResultsThe most important and relevant factors for the minimum reporting set in rehabilitation services regarding the provider were: human resources, context, technical resources, quality assurance and management, location of provider, and ownership. Regarding the service delivery, the most important and relevant factors were: target group, rehabilitation team, aspect of time and intensity, setting, location of service delivery, modes of referral, facility and reporting and documentation.ConclusionSeveral categories were identified, and reduction in these through discussions and iterative voting at workshops and consensus conferences is needed before finalizing the reporting set.LAY ABSTRACTA goal of this Delphi study was to identify the most important parameters of the International Classification of Service Organization in Rehabilitation (ICSO-R 2.0), to characterize rehabilitation services and identify important missing categories needed in a minimum reporting set. The most important and relevant factors for developing a minimum reporting set regarding the provider were: human resources, context, technical resources, quality assurance and management, location of provider, and ownership. Regarding service delivery the most important and relevant factors were: target group, rehabilitation team, aspect of time and intensity, setting, location of service delivery, modes of referral, facility and reporting and documentation. These factors should be discussed further, and a final set should be developed in workshops through discussion and iterative voting.

The Refugee and Immigrant Core Stressors Toolkit (RICST): Understanding the Multifaceted Needs of Refugee and Immigrant Youth and Families Through a Four Core Stressors Framework.

Research indicates that refugee and immigrant youth commonly face four core stressors during resettlement in a new country and culture: trauma, acculturative stress, resettlement stress, and isolation. This Four Core Stressors framework can be used to educate providers about these populations’ unique needs and support assessment of relevant socioecological factors influencing health. To facilitate education, training, and dissemination of this framework and complement existing provider resources, we developed the Refugee & Immigrant Core Stressors Toolkit (RICST), a free, web-based toolkit that provides an overview of the Four Core Stressors framework, assessment questions across the four domains, scaffolding to identify needs and points of triage, and recommended interventions. Public hosting of the RICST via REDCap began in March 2018. In addition to the toolkit, users are prompted to provide location of service delivery, intended purpose of use, and interface feedback. Between March 2018 and October 2020, the RICST was used over 2300 times across 6 continents. Most providers used the toolkit to learn more about the needs of refugee and immigrant youth in general, and several noted that it is a valuable educational tool for staff unfamiliar with these populations. Open-ended qualitative feedback indicated high usability. Amidst historically high levels of forced displacement, tools to support provider effectiveness in working with these populations are increasingly needed. The RICST shows promise as an educational, assessment, and treatment-planning tool for providers working with refugee and immigrant families globally. Future directions include location-specific resource mapping and culture-specific intervention strategies.

Differentiated Service Delivery Models for HIV Treatment in Malawi, South Africa, and Zambia: A Landscape Analysis.

Many countries in Africa are scaling up differentiated service delivery (DSD) models for HIV treatment, but most existing data systems do not describe the models in use. We surveyed organizations that were supporting DSD models in 2019 in Malawi, South Africa, and Zambia to describe the diversity of DSD models being implemented at that time. We interviewed DSD model implementing organizations for descriptive information about each of the organization's models of care. We described the key characteristics of each model, including population of patients served, location of service delivery, frequency of interactions with patients, duration of dispensing, and cadre(s) of provider involved. To facilitate analysis, we refer to 1 organization supporting 1 model of care as an "organization-model." The 34 respondents (8 in Malawi, 16 in South Africa, 10 in Zambia) interviewed described a total of 110 organization-models, which included 19 facility-based individual models, 21 out-of-facility-based individual models, 14 health care worker-led groups, and 3 client-led groups; jointly, these encompassed 12 specific service delivery strategies, such as multimonth dispensing, adherence clubs, home delivery, and changes to facility hours. Over two-thirds (n=78) of the organization-models were limited to clinically stable patients. Almost all organization-models (n=96) continued to provide clinical care at established health care facilities; medication pickup took place at facilities, external pickup points, and adherence clubs. Required numbers of provider interactions per year varied widely, from 2 to 12. Dispensing intervals were typically 3 or 6 months in Malawi and Zambia and 2 months in South Africa. Individual models relied more on clinical staff, while group models made greater use of lay personnel. As of 2019, there was a large variety of differentiated service models being offered for HIV treatment in Malawi, South Africa, and Zambia, serving diverse patient populations.

P085 The development of a UK-wide rheumatology specialist physiotherapy capabilities framework

Abstract Background/Aims Rheumatology physiotherapy is a specialist area requiring specific skills and knowledge. At all levels of practice, physiotherapists play an essential role in patient management. There is not yet any profession-specific competency guidance in this area. The aim of this paper is to describe the processes undertaken in creating and reviewing a national rheumatology physiotherapy competency framework suitable for all levels of practice. Methods A national survey of rheumatology physiotherapy practice was completed in October 2019. At the end of the survey participants were invited to be involved in the development of a rheumatology physiotherapy competency and capabilities framework. Forty-seven physiotherapists expressed an interest and were invited to comment, critique and feedback on a draft rheumatology specialist competency framework document that had been developed in parallel to the survey. Results Twenty-five physiotherapists provided feedback on Version 1 of the draft framework. Responses were received from bands 6 - 8 post holders and from NHS and private provider work settings. Involvement was sought and received from the four nations of the UK: England, Northern Ireland, Scotland and Wales. For the 465 competencies within the draft framework, over 1,000 comments were received. These comments were reviewed and amalgamated into a Version 2 framework. Agreement level of the expert reviewers’ opinions on these competencies was generally high. In addition to competency statement specific feedback, general comments on content, aims, impacts and utility of the document were also received which informed the revisions undertaken. Version 2 reflects the expert input and constructive, excellent advice received. Themes within general comments included: defining expert speciality practice; focus on what is unique about Rheumatology for a physiotherapist; impacts and considerations from location of service delivery, e.g. primary versus secondary care, urban versus rural, large teaching hospital versus district general hospital; rotational versus non-rotational posts; enough authority of the final framework to support the need for funding in training and development, as well as leading to new roles; breadth and variability required within single post-holders; addressing blurred lines, unrecognised capabilities and supporting career progression; justification for working at a higher level than given credit. Conclusion There is a strong desire amongst the rheumatology physiotherapy profession to progress this project and to engage with and support the development of a national rheumatology physiotherapy competency framework. Many specialist physiotherapists have contributed their expertise in their own time to agree competency statements. The process has ratified the further development and future publication of this framework. Disclosure W.J. Gregory: Honoraria; W.G. has received honoraria from Abbvie, Pfizer and UCB. H. Chambers: None. C. McCrum: Honoraria; C.McC. has received honoraria from Novartis.

Optimizing Differentiated HIV Treatment Models in Urban Zimbabwe: Assessing Patient Preferences Using a Discrete Choice Experiment

Differentiated service delivery holds great promise for streamlining the delivery of health services for HIV. This study used a discrete choice experiment to assess preferences for differentiated HIV treatment delivery model characteristics among 500 virally suppressed adults on antiretroviral therapy in Harare, Zimbabwe. Treatment model characteristics included location, consultation type, healthcare worker cadre, operation times, visit frequency and duration, and cost. A mixed effects logit model was used for parameter estimates to identify potential preference heterogeneity among participants, and interaction effects were estimated for sex and age as potential sources of divergence in preferences. Results indicated that participants preferred health facility-based services, less frequent visits, individual consultations, shorter waiting times, lower cost and, delivered by respectful and understanding healthcare workers. Some preference heterogeneity was found, particularly for location of service delivery and group vs. individual models; however, this was not fully explained by sex and age characteristics of participants. In urban areas, facility-based models, such as the Fast Track model requiring less frequent clinic visits, are likely to better align with patient preferences than some of the other community-based or group models that have been implemented. As Zimbabwe scales up differentiated treatment models for stable patients, a clear understanding of patient preferences can help in designing services that will ensure optimal utilization and improve the efficiency of service delivery.

International Classification of Service Organization in Rehabilitation: An updated set of categories (ICSO-R 2.0).

To develop a revised version of the International Classification of Service Organization in Rehabilitation (ICSO-R). Qualitative study. Not applicable Methods: The revision was based on testing the first version of the ICSO-R; 2 discussion rounds invited by the ICSO-R working group of the Standardized Rehabilitation Reporting Subcommittee of the World Health Organization Liaison committee of the International Society of Physical and Rehabilitation Medicine, and a call for corrections from a group of international experts. The resulting ICSO-R 2.0 version is composed of 2 dimensions (formerly 3); the Provider dimension and the Service delivery dimension. The categories of the Funding dimension from the first version of ICSO-R were incorporated into each of the other dimensions. The Provider dimension now consists of 9 categories and the Service delivery dimension consists of 14 categories. Subcategories have been added to 7 categories: governance/leadership, funding of provider, target groups, location of service delivery, setting, rehabilitation team, and funding of service delivery. This updated version of ICSO-R provides a prerequisite for rehabilitation service organization assessment and implementation projects, reporting of contextual influences in clinical trials and many other aspects. In addition, ICSO-R 2.0 can be used for several purposes, e.g. to analyse and compare the provision of rehabilitation services in health systems and to support the quality management of rehabilitation services. However, the development of value sets for each (sub)category and further validation studies are still needed.

Peningkatan Profesionalisme Guru Matematika MtS/SMP Pesisir Selatan Melalui Pelatihan Merancang Penilaian Pada Kurikulum 2013

Situation analysis in the field illustrates that the assessment used by MTS / SMP Mathematics teachers in the 2013 curriculum has not been implemented optimally. One of the causes is the lack of understanding of MTS / SMP Mathematics teachers about the assessment in the 2013 curriculum. In addition, because there are too many SMP teachers in the South Coast, so not all teachers have received training. In other words, the prevalence of assessment training in the 2013 Curriculum. Therefore, the importance of conducting assessment design training in the 2013 Curriculum. This activity was carried out in three stages, namely preparation, implementation, and completion. The preparatory phase is carried out by coordinating with the State Junior High School in the South Coast, surveying the location of service delivery, determining the location of service, and technical preparation of training and instruments. The implementation phase is carried out with three methods, namely lecture and training, and exercises to design the assessment in the 2013 Curriculum, the last stage is analyzing the questionnaire and the work of the teacher to make a report. The results of the training activities showed that after conducting the training it was produced that 84% of teachers understood the design of the assessment in the 2013 Curriculum was obtained through questionnaires given to participants. Teachers have been able to design the 2013 curriculum assessment correctly.

A Conceptual Model to Estimate Staffing Requirements of Medical Faculties of Medical Sciences Universities in Iran

Background: No specific model has been developed so far to determine the number of clinical faculty members required for medical schools as the most important and most costly workforce. Objectives: Since any action in this regard needs to understand the current status, this study aimed to identify the factors and variables involved in staffing of medical schools in Iran. Methods: This was an analytical descriptive study conducted with qualitative approach in early 2016. Participants included 15 educational deputies of Medical Sciences Universities in Iran who were selected through purposeful intensity sampling. Data were collected using in-depth interviews and analyzed using inductive qualitative content analysis via seven-stage framework analysis. Results: Five categories of factors were identified to affect the number of clinical faculties in Medical Sciences Universities of Iran, namely “faculties’ functions and range of work”, “characteristics of faculty members”, “features of the faculties’ service delivery location”, “department/major properties”, and “dominating objectives and policies”. Conclusions: A variety of subjective and inaccurate factors are considered for estimating the required number of clinical faculties in Iran among which only a few are the same as criteria for other faculties. The prerequisites that organize the factors and components in the form of a system are: clearly determining the responsibility of clinical education space and then, defining relatively identical financial incentives for various functions of faculty members.

Differentiated models of care for postpartum women on antiretroviral therapy in Cape Town, South Africa: a cohort study

Background: The numbers of women initiating lifelong antiretroviral therapy (ART) during pregnancy and postpartum is increasing rapidly, presenting a burden on health systems and an urgent need for scalable models of care for this population. In a pilot project, we referred postpartum women who initiated ART during pregnancy to a community-based model of differentiated ART services.Methods: Eligible women (on ART for at least 3 months with viral load (VL)<1000 copies/mL) were offered a choice of two ART models of care: (i) referral to an existing system of community-based ‘adherence clubs’, operated by lay counsellors with medication collection every 2–4 months; or (ii) referral to local primary healthcare clinics (PHC) with services provided by clinicians and medication collection every 1–2 months (local standard of care for postpartum ART). For evaluation, women were followed through 6-months postpartum with VL testing separate from either ART service.Results: Through September 2015, n = 129 women were enrolled (median age, 28 years; median time postpartum, 10 days). Overall, 65% (n = 84) chose adherence clubs and 35% (n = 45) chose PHCs; there were no demographic or clinical predictors of this choice. Location of service delivery was commonly cited as a reason for choice by women selecting either model of care; shorter waiting times, ability to receive ART from lay counsellors and less frequent appointments were motivations for choosing adherence clubs. Among women choosing adherence clubs, 15% never attended the service and another 11% attended the service but were not retained through six months postpartum. Overall, 86% of women (n = 111) remained in the evaluation through 6 months postpartum; in this group, there were no differences in VL<1000 copies/mL at six months postpartum between women choosing PHCs (88%) vs. adherence clubs (92%; p = 0.483), but women who were not retained in adherence clubs were more likely to have VL≥1000 copies/mL compared to those who remained (p = 0.002).Discussion: Adherence clubs may be a valuable model for postpartum women initiating ART in pregnancy, with good short-term outcomes observed during this critical period. To support optimal implementation, further research is needed into patient preferences for models of care, with consideration of integration of maternal and child health services, while ART adherence and retention require ongoing consideration in this population.

Reframing HIV care: putting people at the centre of antiretroviral delivery.

The delivery of HIV care in the initial rapid scale-up of HIV care and treatment was based on existing clinic-based models, which are common in highly resourced settings and largely undifferentiated for individual needs. A new framework for treatment based on variable intensities of care tailored to the specific needs of different groups of individuals across the cascade of care is proposed here. Service intensity is characterised by four delivery components: (i) types of services delivered, (ii) location of service delivery, (iii) provider of health services and (iv) frequency of health services. How these components are developed into a service delivery framework will vary across countries and populations, with the intention being to improve acceptability and care outcomes. The goal of getting more people on treatment before they become ill will necessitate innovative models of delivering both testing and care. As HIV programmes expand treatment eligibility, many people entering care will not be ‘patients’ but healthy, active and productive members of society 1. To take the framework to scale, it will be important to: (i) define which individuals can be served by an alternative delivery framework; (ii) strengthen health systems that support decentralisation, integration and task shifting; (iii) make the supply chain more robust; and (iv) invest in data systems for patient tracking and for programme monitoring and evaluation.La délivrance des soins du VIH dans le déploiement initial rapide des soins et du traitement du VIH a été basée sur des modèles existants dans les cliniques, qui sont courants dans les régions bénéficiant d’importantes ressources et largement indifférenciées pour les besoins individuels. Un nouveau cadre est proposé ici pour le traitement basé selon les intensités variables de soins, adaptés aux besoins spécifiques des différents groupes de personnes à travers la cascade de soins. L’intensité des services est caractérisée par quatre éléments de délivrance: (1) les types de services délivrés, (2) l’emplacement de la délivrance des services, (3) Les prestataires des services de santé et (4) la fréquence des services de santé. La façon dont ces éléments sont développés dans un cadre de prestation de services peut varier selon les pays et les populations, l’intention étant d’améliorer les résultats d’acceptabilité et des soins. Le but d’obtenir plus de personnes sous traitement avant qu’ils ne tombent malades nécessitera des modèles innovateurs de prestation à la fois pour dépistage et pour les soins. Comme les programmes VIH étendent l’éligibilité au traitement, beaucoup de gens qui entrent dans les soins ne seront pas des “malades- mais des éléments sains de la société, actifs et productifs. Afin de tenir le cadre à l’échelle, il sera important de: (1) définir les individus qui peuvent être traités par un cadre alternatif de prestation, (2) renforcer les systèmes de santé qui soutiennent la décentralisation, l’intégration et le transfert des tâches; (3) rendre la chaîne d’approvisionnement plus robuste et (4) investir dans des systèmes de données pour le suivi des patients et pour le suivi et l’évaluation du programme.Los servicios de atención del VIH durante el inicio de la primera etapa de rápida expansión del tratamiento y cuidados del VIH estaban basados en modelos clínicos existentes, comunes en lugares con abundancia de recursos y poco diferenciados en cuanto a necesidades individuales. Aquí se propone un nuevo marco para el tratamiento basado en intensidades variables de cuidados, hecho a medida según las necesidades específicas de los diferentes grupos de individuos a lo largo del tratamiento. La intensidad del servicio se caracteriza por cuatro componentes de entrega: (1) tipología de los servicios ofrecidos, (2) lugar de entrega de los servicios, (3) proveedor de los servicios sanitarios, y (4) frecuencia de los servicios sanitarios. El cómo estos componentes conforman un marco de entrega de servicios variará según el país y la población, con la intención de mejorar la aceptabilidad y los resultados de los cuidados. El objetivo de conseguir que más personas reciban tratamiento antes de que enfermen requerirá de modelos innovadores en la oferta tanto de pruebas para detección como de los cuidados. A medida que los programas para el VIH expandan los criterios de elegibilidad para el tratamiento, muchas de las personas que comiencen a recibir cuidados no serán “pacientes- sino miembros sanos, activos y productivos de la sociedad. Con el fin de expandir la escala de esta estructura, sería importante: (1) definir cuales individuos pueden ser atendidos dentro de un marco de entrega de servicios alternativo; (2) fortalecer los sistemas sanitarios que apoyan la descentralización, integración y delegación de funciones; (3) robustecer la cadena de proveedores; e (4) invertir en sistemas de datos para el seguimiento de pacientes y para la monitorización y evaluación de programas.

How much does it cost to get a dose of vaccine to the service delivery location? Empirical evidence from Vietnam's Expanded Program on Immunization

Few studies document the costs of operating vaccine supply chains, but decision-makers need this information to inform cost projections for investments to accommodate new vaccine introduction. This paper presents empirical estimates of vaccine supply chain costs for Vietnam's Expanded Program on Immunization (EPI) for routine vaccines at each level of the supply chain, before and after the introduction of the pentavalent vaccine.We used micro-costing methods to collect resource-use data associated with storage and transportation of vaccines and immunization supplies at the national store, the four regional stores, and a sample of provinces, districts, and commune health centers. We collected stock ledger data on the total number of doses of vaccines handled by each facility during the assessment year.Total supply chain costs were estimated at approximately US$65,000 at the national store and an average of US$39,000 per region, US$5800 per province, US$2200 per district, and US$300 per commune health center. Across all levels, cold chain equipment capital costs and labor were the largest drivers of costs. The cost per dose delivered was estimated at US$0.19 before the introduction of pentavalent and US$0.24 cents after introduction. At commune health centers, supply chain costs were 104% of the value of vaccines before introduction of pentavalent vaccine and 24% after introduction, mainly due to the higher price per dose of the pentavalent vaccine.The aggregated costs at the last tier of the health system can be substantial because of the large number of facilities. Even in countries with high-functioning systems, empirical evidence on current costs from all levels of the system can help estimate resource requirements for expanding and strengthening resources to meet future immunization program needs. Other low- and middle-income countries can benefit from similar studies, in view of new vaccine introductions that will put strains on existing systems.

The drivers of customer satisfaction in strategic consulting engagements

PurposeThis exploratory study aims to identify the key drivers of customer satisfaction for strategic consulting engagements in a global context. Specifically, the authors compare the attitudes of US and non‐US senior executives to learn how they evaluate consulting engagements.Design/methodology/approachThe literature surrounding selection of management consultants and client satisfaction with consulting work is reviewed. A thematic content analysis was used to evaluate the responses of 35 US and 22 non‐US senior executives.FindingsThe results reveal both similarities and differences when compared to the outcomes of previous research generally, but they also highlight apparent distinctions based on the country location of the executive. Consistent with previous research, consultant characteristics, customer focus, and value emerged as broad themes driving client satisfaction. In addition, project management and enterprise considerations also emerged as significant drivers of satisfaction. Detailed analysis of responses reveals interesting locational differences underlying satisfaction.Practical implicationsThe key implication of this study is the identification of new drivers for customer satisfaction in strategic consulting engagements. These new elements are primarily related to enterprise and project management issues. In addition, this research suggests that the relative importance of customer satisfaction drivers may differ between executives based in the USA and those based elsewhere.Originality/valueThe paper provides a broad overview of satisfaction issues in consulting services, particularly with multinational enterprises as the client. It also offers a more in‐depth discussion of the relative importance of key drivers depending on the location of service delivery. By consolidating these elements into a single discussion, the paper provides a unique viewpoint not available in the current literature. Although exploratory, the holistic approach applied here should allow academic researchers to compare and contrast the results of this research to previous findings. Partners and key account managers at consulting firms might also consider the relative emphasis placed on elements of their service offerings.

Presumed competence reflected in the educational programs of students with IDD before and after the Beyond Access professional development intervention

Background Judgements about students' competence influence the goals of their individualised education programs (IEPs), the location of service delivery, and their placement in general education (GE) as opposed to special education (SE) classes. The purpose of this study was to describe how presumed competence to learn the GE curriculum was reflected in the IEPs of students with intellectual and developmental disabilities (IDD), and in the reported percentage of time that these students spent in GE classes prior to and following the Beyond Access professional development intervention.Method Five educational teams of students with IDD participated in a professional development intervention that emphasised students' presumed competence to learn grade‐level GE curriculum. Students' pre‐ and post‐intervention IEPs were qualitatively analysed and team member reports of percentage time spent in GE classes were averaged.Results Five categories of presumed competence were identified. Following intervention, emphasis on learning the GE curriculum, a shift in location of service delivery from outside to within the GE classroom, and increased time spent in GE classes were reported.Conclusions The Beyond Access intervention shows promise for enhancing views of the competence of students with IDD to learn the GE curriculum and for increasing their inclusion in GE classrooms.

Experiences of Medical Advisors in the Workers' Compensation System in British Columbia

AbstractAttending physicians and medical advisors, physicians contracting their services to the Workers' Compensation Board, have key roles in assisting injured workers to return to work. A literature review of the role of the physician in the compensable return to work process reveals a lack of information regarding the experiences of medical advisors. This descriptive phenomenological study was undertaken to explore the lived experiences of four medical advisors in a northern rural service delivery location. The purpose of the research was to gain an understanding of the medical advisors' experiences in the compensable return to work process and in the compensation system. Analysis of the interview data revealed a central theme of commitment to quality medical care for injured workers, along with three major themes and several minor themes subsumed within the major concepts: providing medical opinions — requiring factual information, clarifying the diagnosis, no previous relationship with worker, categories of injuries; working with attending physicians and specialists — building relationships, evidence based treatment plans, role of the attending physician, role of the medical advisor; and, working within the workers' compensation environment — structure and policies, expedited services, and case management/team environment. This research report presents the central theme as the foundation through which the major themes are interconnected. This study does not generalise to all medical advisors, but relays stories that contain the essence of a lived experience.

Community rehabilitation, or rehabilitation in the community?

Purpose : Political and other considerations are increasing the profile of 'community rehabilitation' but there is little agreement on the nature of community rehabilitation or its benefits and disadvantages. This paper clarifies some of the underlying conceptual and evidential matters in the context of the WHO International Classification of Functioning model of disablement. Classifications : Rehabilitation services can be classified by their specialist skills (e.g. spinal injury services, wheelchair services), by the geographic location of the service (e.g. inpatient stroke service), by the organization managing the service (e.g. social services rehabilitation service), or by location of service delivery. There is no useful consistent comprehensive classificatory system, and all classificatory labels may carry hidden implications. Evidence : The evidence suggests that rehabilitation is more effective when given in the patient's own environment. It also suggests that most so-called community rehabilitation teams are relatively short-lived and are not multi-disciplinary and not expert. Solution : We should work towards a network of rehabilitation teams, some specialized in specific diseases or interventions, and some in longer-term involvement with patients in the community with special emphasis on increasing social participation and ensuring good support. At all times we should balance the advantages of delivering the service in the patient's home against the obvious problems concerning practicality and the equitable use of scarce specialist staff time.