Model Of Care For Individuals Research Articles

Evaluating video and hybrid group consultations in general practice: mixed-methods, participatory study protocol (TOGETHER 2)

Background General practice is facing an unprecedented challenge in managing the consequences of the pandemic. In the midst of a policy drive to balance remote and in-person service provision, substantial workload pressures remain, together with increasing prevalence of long-term conditions, and declining staff numbers and morale. To address these challenges, some practices in the UK have been delivering video and hybrid group consultations (VHGCs) providing clinical care to multiple patients at the same time. Despite positive initial findings and enthusiasm, there are still gaps in our understanding of the influence VHGCs have on patient experience, healthcare utilisation, quality, safety, equity and affordability. Objectives To generate an in-depth understanding of VHGCs for chronic conditions in general practice, surface assumptions and sociotechnical dynamics, inform practice and extend theorisation. Methods Mixed-methods, multi-site research study using co-design and participatory methods, from qualitative, quantitative and cost-related perspectives. WP1 includes a national, cross-sectional survey on VHGC provision across the UK. In WP2 we will engage patients and general practice staff in co-design workshops to develop VHGC models with emphasis on digital inclusion and equity. In WP3 we will carry out a mixed-methods process evaluation in up to 10 GP practices across England (5 sites already running VHGCs and 5 comparison sites). Qualitative methods will include interviews, focus groups and ethnographic observation to examine the experiences of patients, carers, clinical and non-clinical NHS staff, commissioners and policy-makers. Quantitative methods will examine the impact of VHGCs on healthcare utilisation in primary and secondary care, patient satisfaction, engagement and activation. We will also assess value for money of group and individual care models from a health economics perspective. Conclusions We aim to develop transferable learning on sociotechnical change in healthcare delivery, using VHGCs as an exemplar of technology-supported innovation. Findings will also inform the design of a future study.

Evaluating video and hybrid group consultations in general practice: mixed-methods, participatory study protocol (TOGETHER 2)

Background General practice is facing an unprecedented challenge in managing the consequences of the pandemic. In the midst of a policy drive to balance remote and in-person service provision, substantial workload pressures remain, together with increasing prevalence of long-term conditions, and declining staff numbers and morale. To address these challenges, some practices in the UK have been delivering video and hybrid group consultations (VHGCs). Despite positive initial findings and enthusiasm, there are still gaps in our understanding of the influence VHGCs have on patient experience, healthcare utilisation, quality, safety, equity and affordability. Objectives To generate an in-depth understanding of VHGCs for chronic conditions in general practice, surface assumptions and sociotechnical dynamics, inform practice and extend theorisation. Methods Mixed-methods, multi-site research study using co-design and participatory methods, from qualitative, quantitative and cost-related perspectives. WP1 includes a national, cross-sectional survey on VHGC provision across the UK. In WP2 we will engage patients and general practice staff in co-design workshops to develop VHGC models with emphasis on digital inclusion and equity. In WP3 we will carry out a mixed-methods process evaluation in up to 10 GP practices across England (5 sites already running VHGCs and 5 comparison sites). Qualitative methods will include interviews, focus groups and ethnographic observation to examine the experiences of patients, carers, clinical and non-clinical NHS staff, commissioners and policy-makers. Quantitative methods will examine the impact of VHGCs on healthcare utilisation in primary and secondary care, patient satisfaction, engagement and activation. We will also assess value for money of group and individual care models from a health economics perspective. Conclusions We aim to develop transferable learning on sociotechnical change in healthcare delivery, using VHGCs as an exemplar of technology-supported innovation. Findings will also inform the design of a future study.

Stepped Care for Patients to Optimize Whole Recovery (SC-POWR): An Effectiveness Trial Evaluating a Stepped Care Model for Individuals With Opioid Use Disorder and Chronic Pain.

Many patients who receive treatment for opioid use disorder (OUD) report experiencing chronic pain (CP), which is associated with high levels of ongoing nonmedical opioid use and low retention in OUD treatment. In pilot studies of patients with OUD receiving buprenorphine or methadone who had CP, cognitive behavioral therapy (CBT) attenuated nonmedical opioid use compared with treatment-as-usual (TAU), but patients in both treatment arms exhibited similar pain improvements. Adding exercise and stress reduction to this model may augment pain-related outcomes. With funding from National Institutes of Health, we plan to conduct a randomized clinical trial of 316 patients with OUD and CP to test the effectiveness of TAU compared with Stepped Care for Patients to Optimize Whole Recovery (SC-POWR) to reduce nonmedical opioid use and pain (primary outcomes) (Aim 1) and decrease pain intensity and interference, alcohol use, anxiety, depression and stress, and improve sleep (secondary outcomes) (Aim 2). Eligible participants will be randomized to receive TAU (buprenorphine or methadone and at least once a month individual or group counseling) or SC-POWR (ie, TAU and up to 12 CBT sessions) for 24 weeks. Based on prespecified nonresponse criteria, SC-POWR may be stepped up at week 6 to receive onsite weekly group sessions of exercise (Wii Fit, Tai Chi) and "stepped up" again at week 15 to receive weekly group sessions of stress reduction (relaxation training, auricular acupuncture). They will be followed for another 24 weeks to evaluate durability of treatment response for illicit opioid use, alcohol use, pain, anxiety, depression, stress, sleep, and retention in medications for OUD (Aim 3).

Co-design of an integrated home-based primary care model for older adults living with frailty in Ontario, Canada

Background: The demand for home care is predicted to increase with increasing senior population and the aging-at-home phenomenon. Countries world-wide are preparing for this growing demand by making changes to their health care and social care systems. This change is much needed given that, globally, evidence shows that seniors are experiencing fragmented care particularly when they are living with frailty. To address this problem, the Central West Ontario Health Team in Canada is creating an integrated home-based primary care model for individuals 65+ who are living with frailty. At the ICIC23 Conference, I plan to share our research findings, design of the program, learnings from every phase of our co-design and change management approach, and findings from the evaluation of the pilot program. 
 Methods: The program is being co-designed (using Experienced Based Co-Design) in collaboration with patients, caregivers, primary care, hospitals, the municipality, mental health organizations, social workers, home and community care, and other community groups. To date, the co-design team has worked together in partnership to share experiences, segment the population, conduct an environmental scan of documents, and conduct quantitative and qualitative research. First, the team performed descriptive data analysis of hospitalization and community data, and then, three separate focus groups were held with local organizations, service providers, and patients and caregivers (n=60). The data that emerged from the focus groups was then thematically analyzed. The co-design team is now finalizing the program as it is set to be piloted in January 2023, at which point, the program will be evaluated (on measures such as emergency department (ED) diversion and patient experience), updated, and scaled up appropriately.
 Results: Research showed that 80% of Alternate-Level-of-Care days in the Region are among those who are 65+. A cohort of the older adult population are also high users of the ED who are being discharged home each time. Reported reasons for high ED use include isolation, confusion about the health care system, caregiver burnout, and not receiving proper care in the community in a timely manner. Our research also identified frail older adults to be particularly vulnerable. The program I will describe in the presentation will aim to address these issues. It is novel to Ontario, Canada, and will consist of a screening process to identify “at risk” older adults presenting to the ED, a comprehensive assessment, and ongoing access to an intraprofessional team (consisting of physicians, nurses, physiotherapists, nutritionists, pharmacists, and mental health professionals) that will work together on a shared care plan for each patient. All the tools are being adapted to meet a multi-faceted definition of frailty as well as local needs given that the Central West Region is one of the most ethnically diverse regions in the province. By co-designing, the aim is to implement an integrated program that matches the preferences of patients and their family-members and caregivers.
 Discussion: The learnings will be helpful to the many groups world-wide who are also planning on creating integrated co-designed primary-care based programs for diverse older adults experiencing frailty.

Care Delivery Interventions for Individuals with Cancer: A Literature Review and Focus on Gastrointestinal Malignancies.

Gastrointestinal malignancies represent a particularly challenging condition, often requiring a multidisciplinary approach to management in order to meet the unique needs of these individuals and their caregivers. In this literature review, we sought to describe care delivery interventions that strive to improve the quality of life and care for patients with a focus on gastrointestinal malignancies. We highlight patient-centered care delivery interventions, including patient-reported outcomes, hospital-at-home interventions, and other models of care for individuals with cancer. By demonstrating the relevance and utility of these different care models for patients with gastrointestinal malignancies, we hope to highlight the importance of developing and testing new interventions to address the unique needs of this population.

BEHAVIORAL HEALTH INTERVENTIONS IN THE HOSPICE SETTING: A SCOPING REVIEW

Abstract Hospice is a model of care for individuals with a life expectancy of less than six months who choose to focus their treatment on quality-of-life rather than extending life. In 2019, half of all Medicare decedents elected to receive hospice care. Behavioral health comorbidities are prevalent in hospice patients; approximately 40% experience significant depression and/or anxiety. Such comorbidities are associated with poor outcomes including increased physical symptoms, worse function, and lower quality-of-life. Despite the impact of behavioral health comorbidities on hospice patient outcomes, little research has focused on the use of behavioral health interventions in the hospice setting. We conducted a scoping review to characterize the types of behavioral health interventions administered to patients receiving hospice care. We searched four databases, generating 6,842 unique citations over any time period. 70 texts were reviewed and 31 were retained for analysis. Studies examined both psychotherapeutic (n=10) and psychopharmacologic (n=10) interventions, as well as other non-pharmacologic interventions (n=11). Duration of study follow-up was available for 17 of the studies, ranging from six days to six months. 14 studies reported information on interventionists, who were most commonly music (n=3) or massage therapists/acupuncturists (n=3). Average interventions were 47 minutes for six sessions. 18 studies presented statistically significant results related to primary outcomes, most commonly depression (n=9), anxiety (n=6), and pain (n=4). Our findings demonstrate a dearth of behavioral health interventions targeting hospice patients, suggesting the need for increased research and clinical focus on developing, evaluating, and implementing behavioral health interventions in the hospice setting.

Integrated Memory Care: Primary Care for Persons Living with Dementia

AbstractThe Integrated Memory Care (IMC) program is a nurse practitioner led, physician‐supported primary care model which serves individuals living with Alzheimer’s disease and related dementias (ADRD) and their care partners living in the community. Individualized care plans align with patients’ goals, and patients benefit from care coordination provided by an expert team that includes nurses, social workers, occupational therapists, and dementia care assistants, all working directly with primary care providers. The IMC adds a palliative care perspective as well, emphasizing aggressive symptom management and advance care planning, thereby providing holistic care for individuals living with ADRD.Over 2000 patients and family care partners have received care at IMC since 2015. The average age of the patient population is 78.6 years; 65% of patients are female; 42% of patients are non‐white. The practice has developed and tested dementia‐specific workflows that can be implemented in a fee‐for‐service primary care environment. Successful completion of dementia quality measures, such as documentation of dementia type and stage, as well as assessment of cognitive, functional, and behavioral symptoms, is >90%. The ambulatory care sensitive admission rate of patients enrolled in the program is 0.5‐0.9%, well below published rates of 13% to 15%. In a case‐matched control group of patients, the IMC relative risk of hospitalization was one‐half those managed in usual primary care.The IMC represents a novel model of care for individuals living with ADRD and their care partners, achieving superior patient outcomes and representing a financially sustainable model for this growing population. Its primary care systems and processes provide an integrated pathway to quality care, thereby facilitating the identification of patients in the primary care setting who are living with ADRD.

Exploring the effectiveness of a regional nurse practitioner led, long-acting injectable buprenorphine-based model of care for opioid use disorder.

The introduction of long-acting injectable buprenorphine preparations for opioid use disorder has been widely heralded as a breakthrough treatment, with several studies indicating positive results when using these medications. In many locations, nurse practitioners prescribe, administer, and monitor long-acting injectable preparations. The objective of this paper is to explore whether a reduction in dispensed needles and syringes is attributable to increased nurse practitioner prescribing of LAIB. We used a retrospective audit of needles dispensed through the health service needle and syringe program vending machine, and individuals treated with long-acting injectable buprenorphine by the nurse practitioner led model. In addition, we examined potential factors that may influence changes in the number of needles dispensed. Linear regression found that each individual with opioid dependence treated with long-acting injectable buprenorphine was associated with 90 fewer needles dispensed each month (p < 0.001). The nurse practitioner led model of care for individuals with opioid dependence appears to have influenced the number of needles dispensed at the needle and syringe program. Although all confounding factors could not be discounted entirely, such as substance availability, affordability, and individuals obtaining injecting equipment elsewhere, our research indicates that a nurse practitioner led model of treating individuals with opioid use disorder influenced needle and syringe dispensing in the study setting.

Position paper: Models of post-transplant care for individuals with cystic fibrosis

There is no consensus on the best model of care for individuals with CF to manage the non-pulmonary complications that persist after lung transplant. The CF Foundation virtually convened a group of international experts in CF and lung-transplant care. The committee reviewed literature and shared the post-lung transplant model of care practiced by their programs. The committee then developed a survey that was distributed internationally to both the clinical and individual with CF/family audiences to determine the strengths, weaknesses, and preferences for various models of transplant care. Discussion generated two models to accomplish optimal CF care after transplant. The first model incorporates the CF team into care and proposes delineation of responsibilities for the CF and transplant teams. This model is reliant on outstanding communication between the teams, while leveraging the expertise of the CF team for management of the non-pulmonary manifestations of CF. The transplant team manages all aspects of the transplant, including pulmonary concerns and management of immunosuppression. The second model consolidates care in one center and may be more practical for transplant programs that have expertise managing CF and have access to CF multidisciplinary care team members (e.g., located in the same institution). The best model for each program is influenced by several factors and model selection needs to be decided between the transplant and the CF center and may vary from center to center. In either model, CF lung transplant recipients require a clear delineation of the roles and responsibilities of their providers and mechanisms for effective communication.

Stakeholder-driven development and implementation of CRICIT: an app to support high-quality data capture and protocol monitoring for outpatient clinical trials with vulnerable populations.

Choosing an appropriate electronic data capture system (EDC) is a critical decision for all randomized controlled trials (RCT). In this paper, we document our process for developing and implementing an EDC for a multisite RCT evaluating the efficacy and implementation of an enhanced primary care model for individuals with opioid use disorder who are returning to the community from incarceration. Informed by the Knowledge-to-Action conceptual framework and user-centered design principles, we used Claris Filemaker software to design and implement CRICIT, a novel EDC that could meet the varied needs of the many stakeholders involved in our study. CRICIT was deployed in May 2021 and has been continuously iterated and adapted since. CRICIT's features include extensive participant tracking capabilities, site-specific adaptability, integrated randomization protocols, and the ability to generate both site-specific and study-wide summary reports. CRICIT is highly customizable, adaptable, and secure. Its implementation has enhanced the quality of the study's data, increased fidelity to a complicated research protocol, and reduced research staff's administrative burden. CRICIT and similar systems have the potential to streamline research activities and contribute to the efficient collection and utilization of clinical research data.

(18) Improving Outcomes: An Integrated Care Model for Individuals with Intellectual and Developmental Disabilities

(18) Improving Outcomes: An Integrated Care Model for Individuals with Intellectual and Developmental Disabilities

Family’s sufferings from asymptomatic COVID: Clinicians’ perspective

Anticipating dire consequences, in 2020 the world braced itself for the unparalleled pandemic by resorting to unprecedented measures including stringent lockdowns, unforeseen social isolations, spotlight focus, resource diversions besides reorganized healthcare systems to name the quintessential few. Such unifocal convergence enhanced the vulnerabilities of patients dependent on non-COVID healthcare assistance. For a nation with a meagre allocation of 0.7 hospital beds per 1000 people and a lopsided doctor-population ratio of 1:1800, COVID-centric measures created unintended complications. Ironically, many succumbed in myriad ways, not due to the pandemic but due to the attributes of the survival measures. While such consequences cannot be reversed, we need to be able to draw learnings from all such experiences. Particularly, as healthcare advances into the 21st century and we evolve towards an individualized care model, the contrasting “blanket treatment approach,” while an understandable contingency measure for pandemic emergencies, warrants serious attention.

Necessity of an Exclusive Health Care Model for Individuals with Quintessential Epigenetic Efficiency

Definition of health cannot be oversimplified. Understanding about health status of individuals should not be solely based on physiologic parameters examined in the resting state and comparing individual-specific health data with any established/obsolete statistical average because this approach could mislead people to anticipate better health without essential lifestyle interventions and modifications. Are we health-educating unhealthy people to curb their disease by adapting the lifestyle of healthy people? A healthy person could be abstaining from toxic substances, exercising regularly, consuming nutritious foods, sleeping adequately, reproducing naturally, excelling in sports, practicing spirituality, resisting disease developments/progressions, falling sick rarely every year, recuperating much faster even falls sick, ageing at slower pace and living longer. There is no miraculous medicine or therapy that could afford complete cure from the diseases unless unhealthy individuals incline to learn and adapt a healthy lifestyle. Unhealthy individuals, in this context, are those who have knowingly sabotaged their health despite being aware of the hazards of sedentariness, unstructured lifestyle, malnourishment, stress and ingesting toxic substances. Unhealthy people should not assume that they would return to health and sustain better health without comparing themselves with the qualities of healthy individuals. For instance, low back aches of people who cannot even activate their Erector Spinae to bend forward correctly are not the same as people who can bend forward correctly activating strong Erector Spinae while exercising with barbell or dumbbell. Of course, it may not be entirely possible to revitalize the chronically-diseased individuals but at least some of the health guidelines formulated on the basis of lifestyle of healthy individuals should be incorporated in the treatments and rehabilitations. The difference between healthy and unhealthy people is extremely vast which we have not yet acknowledged scientifically. Superior health-fitness excellence of healthy individuals is an expression of high epigenetic efficiency to favor Morbidity-Attenuated Life Years (MALYs). In contrast, Disability-Adjusted Life Years (DALYs) could be associated with different degrees of epigenetic inefficiency or epigenetic dysfunctions. MALYs belong to healthy persons and DALYs belong to unhealthy persons. DALYs are characterized by almost predictable disease/disability events but MALYs have been mysterious. The mysteries of MALYs can be solved by developing an exclusive health care model for healthy individuals and it would remain unsolved without the inclusion of Physiotherapists, Exercise Professionals and Dieticians. KEY WORDS: Epigenetics, Exercise Tolerance, Health, DALYs, Spiritual intelligence, Fitness, Functional status, Aging, Physical Activity, Lifestyle, Sedentary, Co-morbidities, Kinanthropometry, Salutogenesis.

Characteristics and Service Utilization by Complex Chronic and Advanced Chronic Patients in Catalonia: A Retrospective Seven-Year Cohort-Based Study of an Implemented Chronic Care Program.

The Chronic Care Program introduced in Catalonia in 2011 focuses on improving the identification and management of complex chronic (CCPs) and advanced chronic patients (ACPs) by implementing an individualized care model. Its first stage is their identification based on chronicity, difficult clinical management (i.e., complexity), and, in ACPs, limited life prognosis. Subsequent stages are individual evaluation and implementation of a shared personalized care plan. This retrospective study, including all CCPs and ACPs identified in Catalonia between 2013 and 2019, was aimed at describing the characteristics and healthcare service utilization among these patients. Data were obtained from an administrative database and included sociodemographic, clinical, and service utilization variables and morbidity-associated risk according to the Adjusted Morbidity Groups (GMA) stratification. During the study period, CCPs’ and ACPs’ prevalence increased and was higher in lower-income populations; most cases were women. CCPs and ACPs had all comorbidities at higher frequencies, higher utilization of healthcare services, and were more frequently at high risk (63% and 71%, respectively) than age-, sex-, and income level-adjusted non-CCP (23%) and non-ACP populations (30%). These results show effective identification of the program’s target population and demonstrate that CCPs and ACPs have a higher burden of multimorbidity and healthcare needs.

Feasibility of an Interactive Health Coaching Mobile App to Prevent Malnutrition and Muscle Loss in Esophageal Cancer Patients Receiving Neoadjuvant Concurrent Chemoradiotherapy: Prospective Pilot Study.

BackgroundExcessive muscle loss is an important prognostic factor in esophageal cancer patients undergoing neoadjuvant chemoradiotherapy (NACRT), as reported in our previous research.ObjectiveIn this pilot study, we prospectively tested the feasibility of a health coaching mobile app for preventing malnutrition and muscle loss in this patient population.MethodsBetween July 2019 and May 2020, we enrolled 38 male patients with esophageal cancer scheduled for NACRT. For 8 weeks from the start of radiotherapy (RT), the patients used Noom, a health coaching mobile app that interactively provided online advice about food intake, exercise, and weight changes. The skeletal muscle index (SMI) measured based on computed tomography and nutrition-related laboratory markers were assessed before and after RT. We evaluated the changes in the SMI, nutrition, and inflammatory factors between the patient group that used the mobile app (mHealth group) and our previous study cohort (usual care group). Additionally, we analyzed the factors associated with walk steps recorded in the app.ResultsTwo patients dropped out of the study (no app usage; treatment changed to a definitive aim). The use (or activation) of the app was noted in approximately 70% (25/36) of the patients until the end of the trial. Compared to the 1:2 matched usual care group by propensity scores balanced with their age, primary tumor location, tumor stage, pre-RT BMI, and pre-RT SMI level, 30 operable patients showed less aggravation of the prognostic nutritional index (PNI) (–6.7 vs –9.8; P=.04). However, there was no significant difference in the SMI change or the number of patients with excessive muscle loss (∆SMI/50 days >10%). In patients with excessive muscle loss, the walk steps significantly decreased in the last 4 weeks compared to those in the first 4 weeks. Age affected the absolute number of walk steps (P=.01), whereas pre-RT sarcopenia was related to the recovery of the reduced walk steps (P=.03).ConclusionsFor esophageal cancer patients receiving NACRT, a health care mobile app helped nutritional self-care with less decrease in the PNI, although it did not prevent excessive muscle loss. An individualized care model with proper exercise as well as nutritional support may be required to reduce muscle loss and malnutrition.

Emerging models of care for individuals with multiple chronic conditions.

To characterize emerging and current practice models to more effectively treat and support patients with multiple chronic conditions (MCC). We conducted a rapid literature scoping augmented by key informant interviews with clinicians knowledgeable about MCC care from a broad spectrum of US delivery systems and feedback from multidisciplinary experts at two virtual meetings. Literature findings were triangulated with data from semi-structured interviews with clinical experts. Reflections on early results were obtained from policy, research, clinical, advocacy, and patient representatives at two virtual meetings sponsored by the Agency for Healthcare Research and Quality. Emergent themes addressed were as follows: (1) more timely strategies for MCC care; and (2) trends not previously represented in the peer-reviewed literature. The rapid literature scoping relied on Ovid MEDLINE(R) and Epub Ahead of Print databases for the most recent 5-year period. Qualitative interviews were conducted by telephone. Virtual meetings provided oral and written (chat) captured inputs. Although the literature scoping did not identify a specific set of evidence-based care models, key informant discussions identified eight themes reflecting emerging approaches to population-based MCC care. For example, addressing the needs of individuals with MCC through a complexity lens by assessing and addressing social risk factors; extending the care continuum with home-based care; understanding how to address ongoing patient and caregiver supports outside of clinical encounters; and engaging available community resources. Integrating care for MCC patient populations requires processes for determining different subpopulation needs in various settings and lived experiences. Innovation should be anchored at the nexus of payment systems, social risks, medical needs, and community-based resources. Our learnings suggest a need for an ongoing MCC care research agenda to inform new approaches to care delivery incorporating innovations in technology and home-based supports for patients and caregivers.

Promoting Physical Activity via Telehealth in People With Parkinson Disease: The Path Forward After the COVID-19 Pandemic?

ObjectiveThere is mounting evidence in support of exercise and physical activity as a first-line approach to managing symptoms and potentially altering disease progression in people with Parkinson disease (PD). For many patients, a critical gap is the need for expert guidance to overcome barriers, set realistic goals, and provide personalized advice to optimize exercise uptake and adherence. The purpose of this case report is to describe a physical activity coaching program for individuals newly diagnosed with PD (Engage-PD) and to highlight rapid modifications made to this program in response to the COVID-19 pandemic.Methods (Case Description)Engage-PD is a single cohort implementation study of a coaching intervention grounded in self-determination theory being conducted at Columbia University Parkinson’s Foundation Center of Excellence in New York City, the early epicenter of the COVID-19 pandemic in the United States. The project was uniquely positioned to be adapted to telehealth delivery and to address an immediate need for support and guidance in the home environment, including people with early-mid stage PD. Participants completed baseline and follow up (3 months) assessments, and participated in up to four coaching sessions all delivered via telehealth platform. The intervention incorporated 1: 1 coaching, goal-setting, physical activity monitoring, and use of a disease-specific workbook to promote and support safe exercise uptake.ResultsWhile the program is ongoing, 52 referrals were reicieved and 27 individuals enrolled with PD in the first 2 months of the pandemic for a recruitment rate of 52%. Although direct comparisons with pre-coronavirus recruitment are difficult due to the recency of the Engage-PD implementation study, this recruitment rate was larger than expected, which may have been due to several factors (eg, most patients had limited, if any, access to in-person programs and therapy services during this time, so the Engage program filled an immediate need to provide exercise and activity guidance). There was a wide range of scores for both baseline physical activity and self-efficacy measures.ConclusionRemotely-delivered interventions may serve as a sustainable platform for physical activity coaching programs for people with PD as well as other neurodegenerative diseases.ImpactWith the uncertainty brought about by the current pandemic, this case report highlights the opportunity to shift the current model of care for individuals with neurodegenerative diseases such as PD.

Integrated Care in Parkinson's Disease: A Systematic Review and Meta-Analysis.

Quality of life in Parkinson's disease (PD) is affected by motor and nonmotor symptoms, necessitating an integrated care approach. Existing care models vary considerably in numerous domains. The objectives of this study were to perform a systematic review and meta-analysis of PD integrated care models and develop recommendations for a representative model. We conducted a systematic review of published integrated care models and a meta-analysis of randomized, controlled trials examining integrated care versus standard care. The primary outcome was health-related quality of life using a validated PD scale. We evaluated levels of care integration using the Rainbow Model of Integrated Care. Forty-eight publications were identified, including 8 randomized, controlled trials with health-related quality of life data (n = 1,149 total PD patients). Qualitative evaluation of individual care model integration guided by the Rainbow Model of Integrated Care revealed frequent clinical and professional integration, but infrequent organizational and population-based integration elements. Meta-analysis of randomized, controlled trials revealed significant heterogeneity (I2 = 90%, P < 0.0001). Subgroup analysis including only outpatient care models (n = 5) indicated homogeneity of effects (I2 = 0%, P = 0.52) and improved health-related quality of life favoring integrated care, with a small effect size (standardized mean difference [SMD], -0.17; 95% CI, -0.31 to -0.03; P = 0.02). Outpatient integrated PD care models may improve patient-reported health-related quality of life compared with standard care; however, because of variable methodological approaches and a high risk of bias related to inherent difficulties in study design (eg, blinding of participants and interventionists), generalizability of these results are difficult to establish. The Rainbow Model of Integrated Care is a promising method of evaluating elements and levels of integration from individual patient care to population health in a PD context. © 2020 The Authors. Movement Disorders published by Wiley Periodicals, LLC. on behalf of International Parkinson and Movement Disorder Society.

1208-P: Perspectives of Barriers and Enablers from Stakeholders of the Current Model of Care for Diabetes Management in an Australian Regional Area

As the prevalence of type 2 diabetes (T2D) escalates, improved models of care (MoC) are necessary to provide the most appropriate care across different geographical locations. Current issues that influence diabetes health include physical, social and psychological factors. This study explores the perspectives of Stakeholders (staff members of community health services) relating to barriers and enablers towards the MoC for individuals with T2D. Semi-structured interviews were conducted with 21 stakeholders working in a semi-rural, low socio-demographic region of Victoria, Australia. Questions were designed to elicit participants’ views on factors that can facilitate or impede access to care, and how best to enhance adoption of an appropriate MoC. Interview transcripts were analysed thematically and categorised using the individual, relationship, community, and societal levels of the socio-ecological model. Stakeholders identified barriers such as living alone and socio-economic constraints, as important to individuals. In terms of relationship factors, many complex influences outside the control of the individual were identified as resulting in diabetes management becoming a non-priority. Transportation issues and lack of culturally sensitive/safe spaces were also identified as significant barriers for clinic attendance, as were lack of GP understanding of other health professionals’ roles, particularly in a multidisciplinary care setting. Improved diabetes management was identified as an enabler. Stakeholders also perceived implementing an holistic approach to diabetes management as an important enabler for attendance at community centres. This study concludes that stakeholders valued a focus on improving the accessibility of a MoC, by adopting a more integrated approach in a more culturally and physically approachable environment. This may enhance patients’ engagement and the sustainability of care. Disclosure E.L. Kennedy: None. A. Ng: Consultant; Self; Roche Diabetes Care, Ypsomed AG. B.A. Gordon: None. G. Smith: None. A. Forsyth: None.

Patient Preferences for Prenatal and Postpartum Care Delivery: A Survey of Postpartum Women.

To describe patients' preferences for prenatal and postpartum care delivery. We conducted a cross-sectional survey of postpartum patients admitted for childbirth and recovery at an academic institution. We assessed patient preferences for prenatal and postpartum care delivery, including visit number, between-visit contact (eg, phone and electronic medical record portal communication), acceptability of remote monitoring (eg, weight, blood pressure, fetal heart tones), and alternative care models (eg, telemedicine and home visits). We compared preferences for prenatal care visit number to current American College of Obstetricians and Gynecologists' recommendations (12-14 prenatal visits). Of the 332 women eligible for the study, 300 (90%) completed the survey. Women desired a median number of 10 prenatal visits (interquartile range 9-12), with most desiring fewer visits than currently recommended (fewer than 12: 63% [n=189]; 12-14: 22% [n=65]; more than 14: 15% [n=46]). Women who had private insurance or were white were more likely to prefer fewer prenatal visits. The majority of patients desired contact with their care team between visits (84%). Most patients reported comfort with home monitoring skills, including measuring weight (91%), blood pressure (82%), and fetal heart tones (68%). Patients reported that they would be most likely to use individual care models (94%), followed by pregnancy medical homes (72%) and home visits (69%). The majority of patients desired at least two postpartum visits (91%), with the first visit within 3 weeks after discharge (81%). Current prenatal and postpartum care delivery does not match patients' preferences for visit number or between-visit contact, and patients are open to alternative models of prenatal care, including remote monitoring. Future prenatal care redesign will need to consider diverse patients' preferences and flexible models of care that are tailored to work with patients in the context of their lives and communities.