Service Model Research Articles

Barriers and enablers to accessing perinatal health services for rural Australian women: A qualitative exploration of rural health care providers perspectives.

To identify perceived barriers and enablers for rural women in accessing perinatal care within their own community from the perspective of perinatal health care providers. A qualitative descriptive study design utilising reflexive thematic analysis, using the socioecological framework to organise and articulate findings. Victoria, Australia. Semi-structured interviews were conducted with nine perinatal health care providers who provide care to pregnant women or new mothers in rural communities. Participants were recruited across Victoria in 2023. Providers reported multi-level barriers and enablers that exist for rural women in accessing perinatal care within their communities. Barriers included women's personal circumstances, challenging professional relationships, inequitable service provision, ineffective collaboration between services and clinicians and government funding models and policies. Enablers included strength and resilience of rural women, social capital within rural communities, flexible care delivery and innovative practice, rural culture and continuity of care models. Rural perinatal health care providers perceived that rural women face multiple barriers that are created or sustained by complex interpersonal, organisational, community and policy factors that are intrinsic to rural health care delivery. Several addressable factors were identified that create unnecessary barriers for rural women in engaging with perinatal care. These included education regarding health systems, rights and expectations, equitable distribution of perinatal services, improved interprofessional relationships and collaborative approaches to care and equity-based funding models for perinatal services regardless of geographical location.

Recommendations for eligibility criteria concerning bariatric and metabolic surgical and endoscopic procedures for obese Hong Kong adults 2024: Hong Kong Society for Metabolic and Bariatric Surgery Position Statement.

The surgical management of obesity in Hong Kong has rapidly evolved over the past 20 years. Despite increasing public awareness and demand concerning bariatric and metabolic surgery, service models generally are not standardised across bariatric practitioners. Therefore, a working group was commissioned by the Hong Kong Society for Metabolic and Bariatric Surgery to review relevant literature and provide recommendations concerning eligibility criteria for bariatric and metabolic interventions within the local population in Hong Kong. The current position statement aims to provide updated guidance regarding the indications and contraindications for bariatric surgery, metabolic surgery, and bariatric endoscopic procedures.

Assistance in Strengthening Village Governance Through the Development of Standard Operating Procedures (SOP) and Increasing the Capacity of Villages Apparatus: Community Service in Sungai Arang Hamlet, Jambi, Indonesia

Effective village governance is an important foundation for sustainable development at the local level. However, many villages in Indonesia, including Sungai Arang Hamlet in Jambi, still face challenges in terms of governance, which can be seen from weak administrative systems, lack of transparency, and low capacity of village officials. This research uses a participatory community service approach which involves a series of activities, including: (1) Identifying village problems and needs through focus group discussions (FGD) and in-depth interviews; (2) Development of standard operating procedures (SOP) for various aspects of village administration; (3) Training and capacity building for village officials regarding SOP implementation; (4) Assistance and monitoring of SOP implementation; and (5) Evaluation of program impact. The research results show a significant improvement in village governance after program implementation. The developed SOPs have helped improve the efficiency and effectiveness of public services, increase transparency and accountability, and strengthen public participation in decision-making. In addition, the capacity of village officials has also increased, reflected in a better understanding of their duties and responsibilities, as well as a better ability to carry out administrative tasks. In conclusion, this community service program has made a positive contribution in strengthening village governance in Sungai Arang Hamlet. Developing SOPs and increasing the capacity of village officials has proven effective in improving the quality of public services, transparency, and accountability. This research recommends that this community service model can be replicated in other villages that have similar problems.

Time to Shine: Development of a new clinical model for a school health service: A practice development case study

Time to Shine: Development of a new clinical model for a school health service: A practice development case study

Assessing Electric Vertical Take-Off and Landing for Urban Air Taxi Services: Key Parameters and Future Transportation Impact

Urban air mobility (UAM) enabled by electric vertical take-off and landing (eVTOL) aircraft presents an innovative transportation system for mega-cities. An analysis of the techno-economic feasibility of eVTOL air taxis can provide insights into the development and potential impacts of this emerging mobility solution. This study examines eVTOL configurations and proposes a conceptual model for eVTOL air taxi services. A generic cost–revenue model is developed to evaluate the economic feasibility using the rate of return-on-investment approach. Two critical parameters are identified—maximum voyage and price per kilometer. The modeling analysis shows that eVTOL air taxis can achieve a positive rate of return given realistic assumptions on the critical parameters. Reductions in operating costs and increases in maximum voyage range improve financial viability. With technological advancement, eVTOL air taxis are expected to transform urban transportation by increasing capacity and flexibility. The techno-economic analysis provides useful implications for urban planning and policy regarding this innovative mobility mode.

Stepped, evidence-based and integrated care service model vs. usual care for mental disorders: A randomized controlled trial (RECOVER)

Stepped, evidence-based and integrated care service models have the potential to be used as a reference for mental health services. RECOVER aimed to evaluate cost savings, effectiveness, and cost-effectiveness of such a model within a two arm, assessor- and data analysist-blinded RCT in Hamburg, Germany. Participants aged 16–79 years with mental disorders were randomly assigned either to RECOVER or treatment as usual (TAU). Primary outcomes comprised costs, effectiveness (combined symptoms, functioning, quality of life), and cost-effectiveness, hierarchically ordered. Outcomes were evaluated according to the ITT principle, group differences regarding costs with adjusted generalized linear models, effectiveness with ANCOVA models, and cost-effectiveness with the incremental cost-effectiveness ratio (ICER) and cost-effectiveness acceptability curves (CEACs). Between 1/1/2018 and 12/31/2020, n = 891 were finally included (n = 477 in RECOVER, n = 444 in TAU). RECOVER was associated with significantly lower annual total costs (-22 %), health and social care costs (-25 %) and hospital costs (-50 %). Effectiveness analyses showed a significantly better outcome for RECOVER with the fully imputed data . The CEACs descriptively demonstrated that RECOVER was cost-effective with a probability of >95 %. Treatment in RECOVER resulted in substantial cost reductions with better cost-effectiveness. RECOVER can be recommended as a reference model for comprehensive and integrated mental health services.

Implementation of a palliative care service in a tertiary hospital in a developing country: Methods, strategies and results.

e24056 Background: In Rio de Janeiro, only 11 palliative care facilities exist, creating challenges in meeting the complex needs of patients with metastatic cancer. Our study aims to implement a palliative care service within an existing oncology practice. This approach holds promise as a model that could guide similar practices in low- and middle-income countries, offering a blueprint for the implementation of palliative care services on a broader scale. Methods: This descriptive study spans from February to December 2023, involving the monitoring of 176 patients. Eligible patients met criteria such as a FAST scale for dementia syndrome ≥ 7A, stage IV disease, ranking 5 stroke, terminal organic failure, uncontrolled symptoms, or requiring end-of-life care. The PC team, denoted as “Continued Care”, comprises a medical leader, 3 routine doctors, and 1 nurse. Activities undertaken by the team encompass consults requested by internal medicine and intensive care unit (ICU) teams, outpatient care, continuous education, and daily monitoring of patients with advance care plan (ACP). Results: Among 176 patients initially enrolled, outcomes were completed for 171 patients. Remarkably, 80% of those receiving PC assistance had an ACP in place, with 78% opting for exclusive non-invasive support. The overall death rate was 38%. Notably, among patients enrolled in the PC program, the ICU death rate was 31%. Conclusions: Institutional PC policies associated with the integration of a dedicated team into the hospital's routine, and investments in disseminating knowledge about irreversible illness processes and comfort strategies, emerge as a pivotal component in establishing a comprehensive and integrated model of PC services. This approach appears to surpass the effectiveness of traditional consult or sectorized model, emphasizing the importance of an institutionalized and holistic framework for delivering quality PC.

Wearable Smart Cardiac Care: Take Vipasyana for Example

The most direct challenge to the healthcare system in Taiwan associated with population aging is the chronic and growing shortfall in medical and nursing practitioners. The integration of artificial intelligence, Internet of Things, and advanced 5G communication technologies is making healthcare more streamlined and intuitive to improve healthcare service efficiency, encourage cross-disciplinary cooperation to improve patient health management, and introduce and mainstream innovative service models such as telecare. To this end, the wearable smart cardiac care system 'Vipasyana', jointly developed by the interdisciplinary research team of the Departments of Electrical Engineering and Computer Science at National Yang Ming Chiao Tung University, not only has an innovative fully functional wireless wearable electrocardiograph but also uses machine learning-based detection/prediction methods to detect and monitor for emergencies such as myocardial infarction, ventricular tachycardia/ventricular fibrillation, and heart failure. To handle the real-time streaming sensing data generated during clinical trials, a big data real-time streaming framework based on Apache Storm and microservices has also been integrated. In addition, a mobile phone app and virtual reality 3D ward round system providing a user-friendly management and monitoring tool for medical staffs were developed and integrated into the system. The 'Vipasyana' system is capable of providing precision medical services to individual patients.

Core competencies and perceived training needs of nurses in the background of Internet plus nursing service: a qualitative descriptive study†

Abstract Background The Internet plus nursing service program is being piloted in China, which has become a new home nursing service model led by nurses. To enable safe and effective homecare service delivery, nurses working in the program need a high level of competency. However, the content of these core competencies and the training needs of nurses for Internet plus nursing services are still unknown. Aim To describe nurses’ perceptions of core competencies and training needs to work in the Internet plus nursing service program, thereby providing a reference for the development of training programs. Methods A qualitative descriptive study using semi-structured interviews was conducted on 15 nurses with experience of working in the Internet plus nursing service program. Interviews were audio-recorded and transcribed verbatim, and the data were analyzed using thematic analysis. Results Core competencies involved comprehensive assessment competence, direct care practice competence, health education and consulting competence, risk estimation and response competence, and communication competence. Training needs involved complex operational items, knowledge of chronic disease management, professional communication, risk identification and response, nursing standards, norms, and procedures, and utilization of information technology. Conclusions The training system may be developed based on nurses’ core competencies and their training needs to promote professional development of the Internet plus nursing service.

Contemporary management of mesothelioma.

Pleural mesothelioma (PM) is an aggressive asbestos-associated thoracic malignancy with a median survival of 12-18 months. Due to continued asbestos use in many nations, global incidence is rising. Causes due to non-occupational, environmental exposure are also rising in many countries despite utilisation bans. For many years, platinum--pemetrexed chemotherapy was the solitary licensed therapy, but first-line combination immune checkpoint blockade has recently demonstrated improved outcomes, with both regimes tested in predominantly late-stage cohorts. In the second-line setting, single-agent nivolumab has been shown to extend survival and is now available for routine use in some regions, while second-line chemotherapy has no proven role and opportunities for clinical trials should be maximised in relapsed disease. Surgery for "technically resectable" disease has been offered for decades in many expert centres, but the recent results from the phase III MARS2 trial have challenged this approach. There remains no robustly proven standard of care for early-stage PM. The clinical trial landscape for PM is complex and increasingly diverse, making further development of specialist PM multidisciplinary teams an important priority in all countries. The observation of improving outcomes in centres that have adopted this service model emphasises the importance of high-quality diagnostics and equitable access to therapies and trials. Novel therapies targeting a range of aberrations are being evaluated; however, a better understanding of the molecular drivers and their associated vulnerabilities is required to identify and prioritise treatment targets.

Generative artificial intelligence in healthcare from the perspective of digital media: Applications, opportunities and challenges

IntroductionThe emergence and application of generative artificial intelligence/large language models (hereafter GenAI LLMs) have the potential for significant impact on the healthcare industry. However, there is currently a lack of systematic research on GenAI LLMs in healthcare based on reliable data. This article aims to conduct an exploratory study of the application of GenAI LLMs (i.e., ChatGPT) in healthcare from the perspective of digital media (i.e., online news), including the application scenarios, potential opportunities, and challenges. MethodsThis research used thematic qualitative text analysis in five steps: firstly, developing main topical categories based on relevant articles; secondly, encoding the search keywords using these categories; thirdly, conducting searches for news articles via Google ; fourthly, encoding the sub-categories using the elaborate category system; and finally, conducting category-based analysis and presenting the results. Natural language processing techniques, including the TermRaider and AntConc tool, were applied in the aforementioned steps to assist in text qualitative analysis. Additionally, this study built a framework, using for analyzing the above three topics, from the perspective of five different stakeholders, including healthcare demanders and providers. ResultsThis study summarizes 26 applications (e.g., provide medical advice, provide diagnosis and triage recommendations, provide mental health support, etc.), 21 opportunities (e.g., make healthcare more accessible, reduce healthcare costs, improve patients care, etc.), and 17 challenges (e.g., generate inaccurate/misleading/wrong answers, raise privacy concerns, lack of transparency, etc.), and analyzes the reasons for the formation of these key items and the links between the three research topics. ConclusionsThe application of GenAI LLMs in healthcare is primarily focused on transforming the way healthcare demanders access medical services (i.e., making it more intelligent, refined, and humane) and optimizing the processes through which healthcare providers offer medical services (i.e., simplifying, ensuring timeliness, and reducing errors). As the application becomes more widespread and deepens, GenAI LLMs is expected to have a revolutionary impact on traditional healthcare service models, but it also inevitably raises ethical and security concerns. Furthermore, GenAI LLMs applied in healthcare is still in the initial stage, which can be accelerated from a specific healthcare field (e.g., mental health) or a specific mechanism (e.g., GenAI LLMs’ economic benefits allocation mechanism applied to healthcare) with empirical or clinical research.

Prospective assessment of AI-enabled cost savings, continuous support, and psychosocial enhancement (AI New Era Study).

e13615 Background: Cancer patients (pts) need extensive primary care across their treatment journey, yet the world's primary health systems struggle with patient volume and resource scarcity. This study aims to assess the effectiveness of Artificial Intelligence (AI) medical service model in primary care and clinical service pre-screening, as well as their potential impact on improving the quality of medical services and reducing medical costs. Methods: A total of 17,856 medical consultation inquiries from 7,522 pts with various types of cancer have been collected and categorized. The study employed a novel AI-driven medical service model (based on large language model), amalgamating clinical guidelines with a local oncology database, to prospectively field questions from 454 cancer-afflicted pts. Clinicians evaluated the accuracy and comprehensiveness of the responses to basic medical issues, while pts assessed the intelligibility and satisfaction. Results: Treatment-related inquiries constituted 34.44% (n = 6,149) of the total, with 81.53% of pts asking such questions. Basic medical issues were addressed in 65.56% (n = 11,707) of inquiries, raised by 59.78% of pts. Specific concerns within basic medical issues included test report explanations (20.45%), adverse reaction consultations (19.82%), and medication information requests (17.66%). In light of the prevalence of basic medical issues, the study prospectively explores the potential of AI technology to revolutionize medical models, driving the advent of a new era in healthcare research. As result, the AI model exhibited high performance across several metrics: accuracy (96.87 ± 10.29), comprehensiveness (97.40 ± 9.91), intelligibility (95.72 ± 12.62), and satisfaction (96.34 ± 11.03). Notably, the model demonstrated a proficiency in identifying queries necessitating physician expertise, with a 95.60% accuracy rate upon review. A survey of 50 outpatients indicated an enhancement in service speed (7.78%) and patient satisfaction (14.29%). This increase in satisfaction was primarily ascribed to pts' heightened sense of control and safety. When benchmarked against GPT-4, the AI model's overall performance was significantly superior (95.08 ± 10.05 vs 89.70 ± 12.85, p<0.01), particularly in domestic drug knowledge and gene report analysis. Conclusions: Largely fueled by the advanced capabilities of large language model, AI has the potential to profoundly reshape the entire patient care journey. Our AI medical service model efficiently meets key healthcare needs, addressing over half of clinical issues and cutting costs. It also guides pts to the right specialists for timely care. Early surveys indicate better primary care and improved doctor-patient relations. Further research is needed to understand AI's effects on fairness, access, and outcomes across varied demographic and socioeconomic strata.

Assessing payment for ecosystem services to improve lake water quality using the InVEST model

Payment for ecosystem services is a conservation strategy designed to offer farmers financial incentives for managing land to provide ecological benefits without disturbing livelihoods. However, the distribution of spatial financial feasibility is challenging when implementing this strategy on watershed scale. This study aimed to develop payment for ecosystem services model to improve quality in lake water catchment. The model estimated incentive values based on the costs of farmers’ losses, water yields, and pollution loads. The potential loss was calculated by determining the income of farmers in lake water catchment spent on land conversion from intensive agriculture to agroforestry. Integrated Valuation of Ecosystem Services and Tradeoffs (InVEST) modeling tool was used to calculate water yield and pollution load. The model was tested with case study approach at Lake Rawa Pening in Indonesia, consisting of nine sub-basins and 75 village administrations. The results showed that the reference compensation for farmers was 1,255.97 USD/ha/year. Considering the spatial distribution of water yields, the incentive for each village varied widely from 891.54 USD/ha/year to 1,557.06 USD/ha/year, even within the same sub-basin. Ten villages had an incentive above 1,450.00 USD/ha/year. However, considering the water pollution load, 26 villages had an incentive above 1,450.00 USD/ha/year with a maximum of 2,024.17 USD/ha/year. Therefore, village boundary should be an analysis unit for determining spatial incentive feasibility rather than a sub-basin boundary. Moreover, the level of water pollution load can become an additional variable to justify the amount of incentives received by farmers.

Promoting sustainable development by mitigation of natural habitat quality decline through multifunctional urban land use: Insights from a multi-scenario simulation

Urban expansion threatens natural habitat quality (NHQ) and hinders the achievement of Sustainable Development Goals. Whether and how multifunctional urban land use (MFULU) can mitigate NHQ decline under future urban expansion remains unclear. This study developed a theoretical framework for mitigating NHQ decline via MFULU, and examined the mitigation based on a multi-scenario simulation using the Patch-generating Land use Simulation model and the Integrated Valuation of Ecosystem Services and Trade-offs model. Three future scenarios, each including MFULU and non-MFULU modes, were considered in the simulation: Business as Usual, Economic Development, and Ecological Priority. Urban expansion led to less encroachment into natural habitats in MFULU modes than in non-MFULU modes. Additionally, natural habitats were less aggregated, and more irregular than in non-MFULU modes under all scenarios, especially those with moderate and higher NHQ levels. Natural habitats were more aggregated and regular in MFULU modes than in non-MFULU modes under all scenarios. These results verified MFULU’s positive contributions in preserving natural habitats under the conservation effect of MFULU and improving the landscape patterns of natural habitats under the agglomeration effect of MFULU. The findings have implications for formulating land-sharing policies that realize win−win situations between sustainable urban development and a resilient ecological environment.

Examination of cybersecurity in open and distance learning within the scope of technical support services

Open and distance learning (ODL) activities aim to meet the expectations and needs of different individuals, societies, and systems by ensuring the continuation of learning with a lifelong learning philosophy and an egalitarian policy for everyone, regardless of time and place. Support services, which address the differentiated expectations and needs in all learning-related activities, serve the learning processes and the various stakeholders involved. Therefore, technical support services are included in support activities that require the use of technology as a tool, mediator, or technique in learning processes. In this study, ODL systems that are situated in digital space are examined within the scope of technical support services in line with the threats and dangers of the developing and expanding digital space. The aim is to create a technical support service model based on Herbert Simon's Bounded Rationality Theory and Otto Peters' Industrialization Theory, to ensure cybersecurity in ODL systems. In this study, which adopted a case study as one of the qualitative research methods, documents in the literature were examined first. Considering the literature, the opinions of eight field experts were gathered by ten interview questions. After the semi-structured interviews were transcribed, the data obtained were divided into codes and themes through thematic analysis. The findings stressed the importance of institutional culture, distribution of tasks and responsibilities, administrative support, institutional awareness, cybersecurity training, and the use of different technologies to ensure cybersecurity in ODL systems. Additionally, the experts emphasized a common view that smart systems should be used in the provision and maintenance of cybersecurity.

Research on the Impact of Digital Inclusive Finance on Green Innovation of SMEs

Green innovation is an effective driving force for high-quality development in the new era. As a new financial service model, digital inclusive finance provides a new way to solve the financing dilemma of green innovation. In order to investigate the impact of digital financial inclusion on the green innovation of small and medium-sized enterprises (SMEs), based on the panel data of SMEs in China from 2011 to 2021, this paper empirically tested the influence and mechanism of the two by using the panel fixed effect model and threshold regression model. The findings demonstrate that digital inclusive finance is effective in promoting the green innovation of SMEs and alleviates their financing constraints. The digitization level of digital inclusive finance also has a significant positive and non-linear effect of increasing “marginal effect” on the green innovation of SMEs. Notably, it has a greater significant role in driving green innovation for non-state-owned enterprises, enterprises located in the central and western regions, and SMEs with dispersed equity. Consequently, several policy implications are derived from these findings, which can provide a sustained impetus to help SMEs carry out green innovation activities and also provide a scientific basis for governments to improve digital financial inclusion policies and achieve economic equity.

ANALISIS FAKTOR YANG MEMPENGARUHI PEMBERIAN ASUHAN KEBIDANAN KEHAMILAN HOLISTIK DI LAYANAN BIDAN KOMUNITAS

All Indonesian citizens have the right to receive health services. “Health” refers to physical, mental, social and spiritual health (Health Law No. 17, 2023). This state is called holistic health. Holistic midwifery care has become an important part of midwifery practice today. The emergence of holistic midwives in maternity care in the Netherlands is a relatively new development. The first Dutch holistic midwife started her current practice around 2000. It took several years for a second holistic midwife to join her, but by the beginning of the next decade there were already more than a dozen midwives, and current estimates (2019) range between 20 and 30 holistic midwives which is active in the Netherlands (Hollander, 2019). Holistic therapy methods that can be applied in Indonesia in midwifery care include body and mind intervention (prenatal yoga), alternative medical service systems (acupressure, aromatherapy), manual healing methods, pharmacological & biological treatment (herbal therapy in midwifery practice), diet and nutrition, and so on (Minister of Health Regulation, 2018). The holistic midwifery service model for pregnant women can be integrated into the 10 T midwifery service standards in the interview aspect (Decree of the Minister of Health, 2020). The aim of this research is to determine the factors that influence the provision of holistic pregnancy midwifery care in community midwife services in Curug District, Serang City. The method used was bivariate chi-square and multivariate analysis using logistic regression with a total sample of 27 midwives. The research results show that there is a statistically significant relationship between knowledge with a P-Value of 0.000 (<0.05), attitude with a P-Value of 0.002 (<0.05), motivation with a P-Value of 0.023 (<0.05), and training with a P-Value of 0.000 (<0.05) on the provision of holistic pregnancy midwifery care in community midwifery services. Statistically there is no significant relationship between midwife practice place and P-Value 0.168 (>0.05), length of service with P-Value 0.286 (>0.05), education with P-Value 0.154 (>0.05), and age with a P-Value of 0.244 (>0.05) on the provision of holistic pregnancy midwifery care in community midwifery services. The variable that has the greatest relationship to the provision of holistic pregnancy midwifery care in community midwifery services in Curug District, Serang City is knowledge with logistic regression 86,456.

Implementation of a Culturally Sensitive Caring-Based Nursing Service Model Increasing Patient Satisfaction in Hospitals

BACKGROUND: Culturally sensitive caring-based nursing services yield numerous benefits for patients, nurses, and hospitals. One of the advantages hospitals derive is enhanced patient satisfaction and loyalty, leading to financial benefits. AIM: The aim of this study was to assess the impact of culturally sensitive caring-based nursing services on patient satisfaction in hospitals. METHODS: Quasi-experimental pre-post-test control group design. The sample consisted of inpatients that were purposefully selected. The formula for the difference in proportions between the two groups was used to determine the sample size, yielding a total sample of 360 people, 180 in the intervention group and 180 in the control group. The intervention group received model socialization, module books, and 2 months of assistance with model implementation practices, while the control group only received module books without socialization and assistance. Data collection utilized a patient satisfaction questionnaire developed from the Swanson caring instrument, validated for reliability. Data analysis involved independent sample t-tests to ascertain differences in patient satisfaction between the intervention and control groups, and the general linear model repeated measure (GLM-RM) test to assess the development of patient satisfaction during the intervention and the model’s contribution to its increase. RESULTS: The independent t-test yielded a p = 0.0001 <0.05, signifying a significant difference in patient satisfaction between the intervention and control groups. The GLM-RM test demonstrated a Partial Eta Squared value of 0.715, indicating that the model contributed to a 71.50% increase in patient satisfaction, with the remainder influenced by other variables. CONCLUSION: Culturally sensitive caring-based nursing services enhance patient satisfaction in hospitals. Suggestion: This model can be implemented across hospitals.

Emergency Department Use Among Adults Receiving Dialysis

People with kidney failure receiving maintenance dialysis visit the emergency department (ED) 3 times per year on average, which is 3- to 8-fold more often than the general population. Little is known about the factors that contribute to potentially preventable ED use in this population. To identify the clinical and sociodemographic factors associated with potentially preventable ED use among patients receiving maintenance dialysis. This cohort study used linked administrative health data within the Alberta Kidney Disease Network to identify adults aged 18 years or older receiving maintenance dialysis (ie, hemodialysis or peritoneal dialysis) between April 1, 2010, and March 31, 2019. Patients who had been receiving dialysis for more than 90 days were followed up from cohort entry (defined as dialysis start date plus 90 days) until death, outmigration from the province, receipt of a kidney transplant, or end of study follow-up. The Andersen behavioral model of health services was used as a conceptual framework to identify variables related to health care need, predisposing factors, and enabling factors. Data were analyzed in March 2024. Rates of all-cause ED encounters and potentially preventable ED use associated with 4 kidney disease-specific ambulatory care-sensitive conditions (hyperkalemia, heart failure, volume overload, and malignant hypertension) were calculated. Multivariable negative binomial regression models were used to examine the association between clinical and sociodemographic factors and rates of potentially preventable ED use. The cohort included 4925 adults (mean [SD] age, 60.8 [15.5] years; 3071 males [62.4%]) with kidney failure receiving maintenance hemodialysis (3183 patients) or peritoneal dialysis (1742 patients) who were followed up for a mean (SD) of 2.5 (2.0) years. In all, 3877 patients had 34 029 all-cause ED encounters (3100 [95% CI, 2996-3206] encounters per 1000 person-years). Of these, 755 patients (19.5%) had 1351 potentially preventable ED encounters (114 [95% CI, 105-124] encounters per 1000 person-years). Compared with patients with a nonpreventable ED encounter, patients with a potentially preventable ED encounter were more likely to be in the lowest income quintile (38.8% vs 30.9%; P < .001); to experience heart failure (46.8% vs 39.9%; P = .001), depression (36.6% vs 32.5%; P = .03), and chronic pain (60.1% vs 54.9%; P = .01); and to have a longer duration of dialysis (3.6 vs 2.6 years; P < .001). In multivariable regression analyses, potentially preventable ED use was higher for younger adults (incidence rate ratio [IRR], 1.69 [95% CI, 1.33-2.15] for those aged 18 to 44 years) and patients with chronic pain (IRR, 1.35 [95% CI, 1.14-1.61]), greater material deprivation (IRR, 1.57 [95% CI, 1.16-2.12]), a history of hyperkalemia (IRR, 1.31 [95% CI, 1.09-1.58]), and historically high ED use (ie, ≥3 ED encounters in the prior year; IRR, 1.46 [95% CI, 1.23-1.73). In this study of adults receiving maintenance dialysis in Alberta, Canada, among those with ED use, 1 in 5 had a potentially preventable ED encounter; reasons for such encounters were associated with both psychosocial and medical factors. The findings underscore the need for strategies that address social determinants of health to avert potentially preventable ED use in this population.

Implementation of a client–centric model of customer service (based on the example of customer service in the field of telecommunications and communications)

Growing competitive pressure and problems of customer churn in the telecommunications industry determine the need for an intensive transition to customer–centric service. The article studies the features of the implementation of a client–centric model of customer service using the example of customer service in the field of telecommunications and communications. The key stages and principles of transition to a customer–centric model are formulated, and the maturity levels of the customer relationship management system are highlighted. Based on the analysis of scientific literature on the research topic, the features and key approaches to managing customer service, development and strategic planning in the activities of telecommunications companies are determined. Objective differences are established in building relationships with B2C and B2B client segments. Based on the results of the study, recommendations are formulated for the implementation of a client–centric model of client service in the field of telecommunications and communications, suggesting a transition to an integrated construction of a client–centric business model for the telecommunications business. It is emphasized that despite the historical tendency towards short–term planning in the telecommunications industry, a customer–centric business model is becoming increasingly in demand in inextricable connection with the ecosystem approach and maximum customer retention.