Care Delivery Models Research Articles

Machine Learning in Optimising Nursing Care Delivery Models: An Empirical Analysis of Hospital Wards.

This study aims to assess the performance of machine learning (ML) techniques in optimising nurse staffing and evaluating the appropriateness of nursing care delivery models in hospital wards. The primary outcome measures include the adequacy of nurse staffing and the appropriateness of the nursing care delivery system. Historical and current healthcare challenges, such as nurse shortages and increasing patient acuity, necessitate innovative approaches to nursing care delivery. For instance, the COVID-19 pandemic highlighted the need for flexible and scalable staffing models to manage surges in patient volume and acuity. A descriptive study was conducted in 39 inpatient wards across a university hospital and three state hospitals, involving 117 ward-level observations. Data were collected using the Rush Medicus Patient Classification Scale and analysed using k-Nearest Neighbour, Support Vector Machine, Random Forest, and Logistic Regression algorithms. Effectiveness was measured by the accuracy of machine learning predictions regarding nurse staffing adequacy, while suitability was determined by the congruence between observed nursing care models and patient needs. STROBE checklist. The Random Forest algorithm demonstrated the highest accuracy in predicting both nurse staffing adequacy and the appropriateness of nursing care delivery systems. The study found that 68.4% of wards had sufficient nurse staffing and 26.5% of wards used appropriate care delivery models, with functional nursing and total patient care models being the most commonly used. The study highlights functional nursing and total patient care models, emphasising the need to consider nurse qualifications and patient needs in selecting care systems. Machine learning, particularly the Random Forest algorithm, proved effective in aligning staffing with patient requirements. Machine learning, particularly the Random Forest algorithm, proves effective in optimising nursing care delivery models, suggesting significant potential for enhancing patient care and nurse satisfaction. The research underscores machine learning's role in improving nursing care delivery, aligning nurse staffing with patient needs, and advancing healthcare outcomes. The findings advocate for integrating machine learning in the planning of nursing care delivery models. This study sets a precedent for using data-driven approaches to improve nurse staffing and care delivery, potentially enhancing global clinical outcomes and operational efficiencies. The global clinical community can learn from this study the value of employing machine learning techniques to make informed, evidence-based decisions in healthcare management. While the study lacked direct patient involvement, its goal was to enhance patient care and healthcare efficiency. Future research will aim to incorporate patient and public insights more directly.

Novel Post-Neurointensive Care Recovery Clinic: Design, Utilization, and Clinician Perspectives.

Despite increasing interest in post-intensive care unit (ICU) clinical care and management, there have been limited descriptions focused on the post-neurologic (neuro)-ICU population. Here, we describe the design of a post-neuro-ICU Neurorecovery Clinic (NRC) and present data collected regarding the clinic's population, referrals, visits, and clinician satisfaction. This is a single-institution experience with a NRC designed to provide an infrastructure for post-ICU care to patients recovering from acute neurologic disorders or systemic conditions with neurologic sequelae. The clinic offers 2 visit types with different frequencies: a weekly visit and a monthly multidisciplinary visit. This study assessed clinical utilization and clinician perspectives regarding the clinic. Data on clinic referrals, no-show frequency, visit types, and diagnoses for both weekly and monthly visits were collected. A survey was conducted to assess clinician satisfaction and perspectives. Qualitative thematic analysis was performed to identify major themes among survey free responses. In a 2-year period, 225 patients were referred from the Massachusetts General Hospital neuro-ICU to the NRC. Of those, 105 (47%) were seen in clinic for at least one visit. The most common reasons for loss to follow-up were no shows (38%) and noncontracted insurance (21%). Twenty percent of visits were in-person (the rest were by telehealth). Forty-eight percent were new patients compared with return visits. The most common diagnoses were other (36%), ischemic stroke (26%), and traumatic brain injury (17%). An additional monthly multidisciplinary clinic has seen 14 patients with one no show. Clinicians found their experience in the NRC valuable. Identified benefits included interdisciplinary collaboration, being a more well-rounded and better clinician, improving effectiveness in managing post-ICU problems, and influencing ICU prognosis. Clinicians' greatest challenge was navigating resource limitations for patients. A postneuro-ICU NRC is a feasible model of care delivery for patients after severe acute neurologic disorders. Patients with a broad variety of diagnoses were seen in a 2-year period. Providers valued their clinic time and experiences. Future studies should evaluate whether this model of care improves patients' postneuro-ICU outcomes.

Breaking barriers: fostering equitable access to pediatric genomics through innovative care models and technologies.

The integration of genomic medicine into pediatric clinical practice is a critical need that remains largely unmet, especially in socioeconomically challenged and rural areas where healthcare disparities are most pronounced. This review seeks to summarize the barriers responsible for delayed diagnosis and treatment, and examines diverse care models, technological innovations, and strategies for dissemination and implementation aimed at addressing the evolving genomic needs of pediatric populations. Through a comprehensive review of the literature, we explore proposed methodologies to bridge this gap in pediatric healthcare, with a specific emphasis on understanding and speeding implementation approaches and technologies to mitigate disparities in underserved populations, including rural and marginalized communities. There are both external and internal factors to consider in demographic and social determinants when evaluating patient access. To address these barriers, potential solutions include telegenetic services, alternative care delivery models, pediatric subspecialist expansion, and non-genetic provider education. By improving access to pediatric genomic services, therapeutic interventions will also be more available to all pediatric patients. IMPACT STATEMENT: Genomic testing has clinical utility in pediatric populations but access for people from diverse demographic and social-economic groups is problematic. Understanding barriers responsible for delayed genetic diagnosis and treatment in pediatric populations will improve reach, adoption, implementation, and maintenance of genomic medicine in pediatric healthcare context. Innovative care models, adaptation of appropriate technologies, and strategies aimed at addressing pediatric genomic needs are needed.

Optimizing a care delivery model to influence clinical nurses' perception of the practice environment, job enjoyment, and intent to leave.

Optimizing a care delivery model to influence clinical nurses' perception of the practice environment, job enjoyment, and intent to leave.

Onsite Primary Care to Address Medical Needs Among Permanent Supportive Housing Tenants: A Feasibility Demonstration Project.

There is limited evidence on interventions to address the health needs of vulnerable patients in permanent supportive housing (PSH). Evaluate the feasibility of Project HOPE, a weekly onsite primary care pilot intervention for tenants of a single-site PSH program. Physicians, nursing, and pharmacy providers work with existing case managers to provide onsite routine and acute care, outreach, and care coordination. Operations began in November 2020. Chart review (n = 26) of electronic health records assessed primary care engagement during the 180 days pre- and post-implementation using paired t tests and McNemar's exact tests, alongside formative observations from site visits and monthly meetings. Compared to the pre period, there was a 50% increase in the proportion of tenants with any primary care engagement (95% CI, 0.24, 0.76), and 84.6% of tenants had at least one visit with Project HOPE. Tenants averaged 2.65 more PCP visits during the post period compared to the pre period (95% CI, 1.60, 3.71). Housing staff perceived improvements in care continuity, chronic disease management, and access to care for tenants. An onsite primary care delivery model led to increases in primary care engagement for high-acuity PSH tenants.

Prioritization and multilevel mapping of implementation strategies for a cancer rehabilitation navigation program.

Although determinants and strategies for implementing a cancer rehabilitation navigation (CRNav) program have been described, defining specific implementation interventions could improve uptake in oncology care delivery. This manuscript shares prioritized implementation interventions using a multilevel framework. We convened interdisciplinary stakeholders from two CRNav programs to participate in an implementation mapping focus group. Using a multilevel framework that considered provider-, clinic-, and system-level interventions, the focus group discussion guide sought participant input on specific interventions that needed to occur at each level to facilitate implementation. The focus group transcript was analyzed using deductive thematic coding to identify program implementation interventions at each level. The interventions were then shared with all stakeholders to seek agreement and prioritization using a modified Delphi process. A priori a 70% threshold was established to define agreement. Two rounds of Delphi were conducted. Fifteen stakeholders were recruited and nine participated in the focus group. The implementation mapping exercise identified 19 different interventions within the following Expert Recommendations for Implementing Change domains by level: provider level-use evaluative and iterative strategies, provide interactive assistance, train and educate stakeholders, support clinicians; clinic level-change infrastructure, support clinicians, adapt and tailor to context, use evaluative and iterative strategies; and system level-develop stakeholder interrelationship, use financial strategies, change infrastructure. Seven of 15 individuals completed both rounds of the Delphi. Fourteen interventions achieved agreement for high importance. Highest prioritized implementation interventions were develop a core champion team, develop a rationale for program justification, agree upon outcomes measures for the program, and examine and contextualize barriers that will influence the program. Clinical implementation of an innovative care delivery model requires attention to specific interventions that affect various levels within a health care system. These findings will inform future research and clinical efforts in the implementation of CRNav programs.

Rethinking chronic care: how blended patient-centered care delivery and innovative financing models can contribute to achieving universal health coverage – a case study of an integrated approach in Kenya

Abstract Universal Health Coverage (UHC) aims to ensure all individuals have access to essential health services without financial hardship. Chronic diseases, like hypertension and diabetes, play a critical role in achieving UHC due to their lifelong management needs. This paper examines the implementation of a digital and mobile-based, patient-centered care model aimed at improving care for hypertensive and diabetic patients in Kenya. Between 2018 and 2019, 1626 patients from 9 clinics in Nairobi, Kiambu, Nyeri and Vihiga counties were enrolled in an integrated non-communicable disease (NCD) care model including self-management devices for home monitoring, a digital health wallet (M-TIBA) for co-payment, and facility-based peer support groups. Follow-up data was collected November–December 2020. Results indicated significantly improved patient outcomes, with 50% of hypertensive and 74% of diabetic patients achieving disease control, compared to 42% and 52% at baseline. Additionally, peer group participation increased adherence to self-monitoring and lifestyle modifications, contributing to better health outcomes. Despite these successes, challenges such as accessing medications and technical issues with digital tools were identified. Financial sustainability and scalability remain critical concerns, particularly in under-resourced settings. The case study highlights the potential of digital health solutions to enhance chronic care and support UHC by improving accessibility and reducing costs. A multifaceted approach, combining digital tools with face-to-face support and addressing structural barriers in healthcare systems, is essential for long-term success. The findings contribute to the broader discourse on integrated care models for NCDs in low-resource settings, underscoring the importance of sustainable financing and innovative care delivery mechanisms.

Defining and Validating Criteria to Identify Populations Who May Benefit From Home-Based Primary Care.

Home-based primary care (HBPC) is an important care delivery model for high-need older adults. Currently, target patient populations vary across HBPC programs, hindering expansion and large-scale evaluation. Develop and validate criteria that identify appropriate HBPC target populations. A modified Delphi process was used to achieve expert consensus on criteria for identifying HBPC target populations. All criteria were defined and validated using linked data from Medicare claims and the National Health and Aging Trends Study (NHATS) (cohort n=21,727). Construct validation involved assessing demographics and health outcomes/expenditures for selected criteria. Delphi panelists (n=29) represented diverse professional perspectives. Criteria were validated on community-dwelling Medicare beneficiaries (age ≥70) enrolled in NHATS. Criteria were selected via Delphi questionnaires. For construct validation, sociodemographic characteristics of Medicare beneficiaries were self-reported in NHATS, and annual health care expenditures and mortality were obtained via linked Medicare claims. Panelists proposed an algorithm of criteria for HBPC target populations that included indicators for serious illness, functional impairment, and social isolation. The algorithm's Delphi-selected criteria applied to 16.8% of Medicare beneficiaries. These HBPC target populations had higher annual health care costs [Med (IQR): $10,851 (3316, 31,556) vs. $2830 (913, 9574)] and higher 12-month mortality [15% (95% CI: 14, 17) vs. 5% (95% CI: 4, 5)] compared with the total validation cohort. We developed and validated an algorithm to define target populations for HBPC, which suggests a need for increased HBPC availability. By enabling objective identification of unmet demands for HBPC access or resources, this algorithm can foster robust evaluation and equitable expansion of HBPC.

CURRICULUM FOR PRACTICE AND LEADERSHIP IN NURSING HOMES: THE US RESPONSE

Abstract The Teaching Nursing Home (TNH), which began in the 1980s under the leadership of Dr. Mathy Mezey, was a visionary approach to improving the lives of older adults in nursing homes through the efforts of the interdisciplinary healthcare team. The project had extraordinary outcomes, but for a host of political and economic reasons was never brought to full realization. Forty years and a pandemic later, the need for improving quality care in our nations’ nursing homes took center stage. Dr. Terry Fulmer (John A Hartford Foundation) and Nancy Zionts (Jewish Healthcare Foundation) provided extraordinary leadership to address what is now widely regarded as a devastating gap in the US healthcare system. With over $5 million in funding, academic/practice partnerships were revisited in a pilot project with renewed energy, creativity, and resolve by three major universities in Pennsylvania and four affiliated nursing homes. Early on, the lack of curriculum models for faculty educating pre-licensure students in the delivery of quality care in nursing home settings was identified as a barrier to progress in the TNH project. The authors of this paper present the groundbreaking work that was done by an interdisciplinary panel of over 40 expert healthcare practitioners and academicians who came to consensus in the identification and qualitative development of a curriculum that prepares healthcare professionals and their faculty through academic/practice partnerships. Competencies include: creating a culture of care; improving diversity, equity and inclusion; person/family-centered care; models of care delivery; geriatric syndromes; interdisciplinary practice; regulation and finance; and information technology.

Rethinking Access to Evidence-Based Treatments for Eating Disorders: A Commentary on Ali etal. 2024.

This commentary responds to the recent paper by Ali etal on the unmet treatment need for eating disorders. The commentary examines the ongoing barriers to accessing evidence-based treatments for eating disorders and considers the example of Australian initiatives like the Medicare Benefit Scheme's Eating Disorder Plan, which offers subsidized psychological and dietetic services. A recent review of the plan revealed uptake has been low, with significant disparities in access, particularly in underserved populations and those in rural and remote areas. The commentary highlights new areas to guide our thinking about closing the treatment gap, such as the role of virtual and/or hybrid models of care delivery, digital health tools, improving how we communicate about what we do, and the importance of shifting from a top-down approach to service design to human-centered, co-created models that better meet the needs of consumers. If we are to truly close the gap in the next 10 years, the landscape of eating disorder treatment requires bold, forward-thinking solutions-solutions that are not only reflective of the real, lived experiences of those affected but are also continuously evaluated and refined as they scale.

Nursing care delivery models and their impact on emotional exhaustion and practice environment: A cross-sectional study in Saudi Arabia

Background: Nursing staff outcomes, such as job satisfaction, work quality, emotional well-being, intent to leave, and the practice environment, have been linked to improvements in patient outcomes and staff job satisfaction. However, existing studies have not captured the impact of nursing models on emotional exhaustion and practice environments in the context of Saudi Arabia. Additionally, there is a gap in empirical evidence regarding the effectiveness of organizing nursing work within a total nursing or team nursing care model in ensuring staff well-being. Objective: This study aimed to examine the nursing care models used in a government hospital and their association with nurses’ emotional exhaustion and perceptions of the practice environment. Methods: A cross-sectional study was conducted with 314 nurses working at a hospital. Data were collected from January to May 2024 using the Maslach Burnout Inventory™ (MBI) to measure emotional exhaustion and the Practice Environment Scale of the Nursing Work Index (PES-NWI) to assess perceptions of the practice environment. Regression analyses were performed to examine the relationships between the nursing care model, emotional exhaustion, and the practice environment. Results: Among the 314 nurses surveyed, 201 (64%) reported using a total care model, 103 (32.8%) used a team nursing model, and 10 (3.2%) were unsure of the model used. Regression analysis revealed a significant association between the nursing care model and emotional exhaustion (p <0.001), with 42.5% of the variance in emotional exhaustion explained by the nursing care model (R² = 0.425). For the practice environment, a significant association was observed with the nursing care model (p <0.001), explaining 85.9% of the variance in the practice environment (R² = 0.859). Conclusion: The findings may guide nurse managers and policymakers in adopting nursing care models that best suit their organizations to enhance the quality of care. It is essential for hospitals to implement more flexible nursing care delivery models to enable nurses to utilize their full range of training and capabilities. These results have implications for healthcare administration and strategies that support the effective delivery of sustainable and holistic nursing care.

Medically assisted integrated rehabilitation program for people with opioid dependence: a quasi-experimental evaluation using multi-criteria decision analysis

Abstract Background Opioid use disorders constitute a vast disease burden, need for comprehensive treatment, and substantial costs to individuals, families, and society. The multifaceted needs of people with opioid dependence call for integrated care. The study aims to assess the added value of an integrated medically assisted rehabilitation (MAR) program providing opioid agonist therapy for patients with opioid dependence as compared to the standard of care (SoC) in Norway. Methods The intervention includes a comprehensive tertiary care integrated MAR program in Bergen. SoC is a much less intense primary care program in Oslo. 682 and 609 patients from Bergen, and 864 and 771 patients from Oslo were included in 2017 and 2019, respectively. A multi-criteria decision analysis (MCDA) framework was used where the relative preferences of the importance of the outcomes were obtained from a discrete choice experiment among five different stakeholder-groups. Seven outcomes related to health, well-being, experience of the care process, and cost were measured. The performance scores were measured in a study with a quasi-experimental design. Scores were analyzed using linear mixed methods. Performance scores for the outcomes were standardized and multiplied by their relative preferences to obtain the overall value scores in the MCDA. Results We found similar value scores for both care delivery models regarding physical functioning, psychological well-being, social relationships & participation, enjoyment of life, and total costs. The Bergen-model scored higher on continuity of care (0.733 versus 0.680), while the SoC-model scored higher on person-centeredness (0.772 versus 0.635). Overall value scores were marginally in favor of the MAR-Bergen (0.708 versus 0.705 for patients). Conclusion Acknowledging the significance of different life aspects emphasizes the need for integrated care at a specific level for people with opioid dependence. We conclude that the two highly effective treatment approaches produce promising outcomes in a challenging population and are quite similar. However, further research with more robust longitudinal data is needed.

Does Merit-based Incentive Payment System Performance Differ Based on Orthopaedic Surgeon Gender?

Value-based care payment and delivery models such as the recently implemented Merit-based Incentive Payment System (MIPS) aim to both provide better care for patients and reduce costs of care. Gender disparities across orthopaedic surgery, encompassing reimbursement, industry payments, referrals, and patient perception, have been thoroughly studied over the years, with numerous disparities identified. However, differences in MIPS performance based on orthopaedic surgeon gender have not been comprehensively evaluated. After controlling for potentially confounding variables such as experience, geography, group size, and Medicare beneficiary characteristics, does MIPS performance differ between men and women orthopaedic surgeons? The Medicare Physician and Other Practitioners and the Physician Compare databases were queried for years 2017, the first year MIPS was incorporated, and 2021, the most recent year with MIPS data published, to identify all physicians with a self-reported specialty of orthopaedic surgery. Together, these databases include all physicians who submitted at least 11 Medicare claims each year. Physician gender, US census region, years in practice, group practice size, billing practices, and patient demographic characteristics were collected for each surgeon. The MIPS Performance database was used to extract an overall MIPS performance score for each surgeon for each year. Payment adjustments, which are determined based on overall MIPS performance score, were derived for each surgeon based on the thresholds published by the Centers for Medicare & Medicaid Services. Payment adjustments include a negative adjustment, neutral adjustment, positive adjustment, or exceptional performance bonus and are associated with different thresholds each year. Statistical differences based on surgeon gender were assessed utilizing chi-square tests for categorical data, Student t-test for parametric continuous data, and Wilcoxon signed-rank test for nonparametric continuous data. Univariable and multivariable analyses were performed to analyze the relationship between surgeon gender and MIPS performance. After controlling for other patient and surgeon variables, woman gender was associated with a slightly increased MIPS performance score in 2021 (β 1.5 [95% confidence interval (CI) 0.02 to 3.00]; p = 0.047). However, this finding was statistically fragile, with the lower bound 95% CI being very close to the line of no difference. No association between surgeon gender and MIPS performance score was found in 2017 (β 2.2 [95% CI -0.5 to 4.9]; p = 0.11). Additionally, no relationship was found between gender and receiving either an exceptional performance MIPS bonus or a MIPS penalty in either year. Women orthopaedic surgeons scored slightly higher on the MIPS in 2021, after controlling for surgeon and patient variables, despite providing care for a higher percentage of dual Medicare-Medicaid eligible patients and more medically complex patients. However, this finding was statistically fragile, with a small effect size, a 95% CI close to 0, and no consistent association in MIPS performance in 2017. Additionally, with no differences in MIPS performance bonuses or penalties, the clinical monetary impact of this difference may be minimal. The observed association between surgeon gender and MIPS performance scores in 2021, with women orthopaedic surgeons achieving slightly higher scores, raises interesting questions about potential differences in practice behaviors, communication styles, care quality, or other unmeasured variables. These findings may reflect true differences in how care is delivered or documented as scored by the MIPS. However, given the small effect size, statistical fragility, and inconsistency across years, there is a chance that this finding may be spurious. That being so, future research should aim to validate or refute these findings by examining a broader range of variables including documentation practices, practice behaviors, institutional differences, potential systemic biases in scoring methodologies, and patient outcomes. Understanding whether these differences are true is important to ensure that performance metrics like MIPS accurately and equitably reflect care quality.

Performance Understanding and Learning System (PULSE-KEY): development of a framework for implementation and performance evaluation of healthcare delivery models of care

ObjectivesEfficient performance evaluation is essential for driving improvement, ensuring accountability and optimisation of outcomes in healthcare delivery. However, its complexity often leads to ineffective implementation. This article aims to advance...

Childcare as a social determinant of access to healthcare: a scoping review.

As health systems strive to screen for and address social determinants of health (SDOH), the role of access to childcare and barriers to healthcare posed by childcare needs remains underexplored. A gap exists in synthesizing existing evidence on the role of access to childcare as a SDOH. This scoping review aimed to examine and analyze existing literature on the role of childcare needs as a social determinant of access to healthcare. We conducted a structured literature search across PubMed, Scopus, health policy fora, and professional healthcare societies to inclusively aggregate studies across interdisciplinary sources published between January 2000 and June 2023. Two independent reviewers reviewed results to determine inclusions and exclusions. Studies were coded into salient themes utilizing an iterative inductive approach. Among 535 search results, 526 met criteria for eligibility screening. Among 526 eligible studies, 91 studies met inclusion criteria for analysis. Five key themes were identified through data analysis: (1) barriers posed by childcare needs to healthcare appointments, (2) the opportunity for alternative care delivery models to overcome childcare barriers, (3) the effect of childcare needs on participation in medical research, (4) the impact of the COVID-19 pandemic on childcare needs, and (5) the disproportionate burden of childcare experienced by vulnerable populations. Childcare needs remain underexplored in existing research. Current evidence demonstrates the relevance of childcare needs as a barrier to healthcare access, however dedicated studies are lacking. Future research is needed to understand mechanisms of childcare barriers in access to healthcare and explore potential interventions.

Remote APOE counseling and genotyping via telehealth: Early findings from a new care delivery model in the United States

Remote APOE counseling and genotyping via telehealth: Early findings from a new care delivery model in the United States

Patient Preferences for Location of Cancer Surgery in a Community Cancer Affiliate Network

Cancer centers are increasingly affiliating with regional hospitals, creating hub-spoke models for care delivery. Patient perspectives on accessing surgical cancer care within these systems are not well understood. The study purpose was to understand patient perceptions of hub-spoke models of care delivery and how they influence decisions regarding where to seek surgical care for cancer. We conducted semistructured interviews with patients from a rural catchment area who underwent surgery for breast cancer at a hub cancer center or its rural affiliate spoke hospital. We performed collaborative coding using both inductive and deductive coding strategies. Within- and cross-case analyses were performed, emphasizing factors in participants' choice of location for surgery and their impressions of the hub-spoke network affiliation. There were 18 participants who underwent breast cancer surgery at the hub (n= 8) or spoke (n= 10). Participants had universally favorable impressions of the hub hospital brand while they expressed mixed opinions about the spoke hospital. When choosing a hospital for surgery, participants considered their medical condition, access, and perceived quality. Although some were not influenced by the affiliate relationship (either because they would seek local care regardless or because they preferred to travel to the high-volume hub), for others the affiliate relationship provided excellent synergy, enabling them to access hub-quality care within their own community. Findings highlight unique patient perspectives that require distinct considerations when designing affiliate network models for surgical cancer care.

Short-Term Effectiveness of a Stepped-Care Model to Address Fear of Cancer Recurrence in Patients With Early-Stage Melanoma.

To investigate the effectiveness of the Melanoma Care Programme when implemented into routine clinical practice coupled with fear of cancer recurrence (FCR) screening and a stepped-care model of intervention delivery. Using a Type-I hybrid effectiveness-implementation design, individuals with stage 0-II melanoma and a Fear of Cancer Recurrence Inventory FCR severity score of ≥ 13 were offered the Melanoma Care Programme. The programme included a psychoeducational booklet and 3 to 5 psychotherapeutic telehealth sessions with a clinical psychologist, timed around routine dermatological appointments. Multivariable linear mixed modelling was used to analyse the effect of the intervention at 1-week post-intervention on patient-reported outcomes, including FCR severity (primary outcome), symptoms of depression, anxiety, and stress, melanoma-related knowledge, and health-related quality of life. One hundred and twelve participants completed the intervention from 146 participants screened for FCR. Adjusted multivariable linear mixed modelling demonstrated that participants who received the intervention reported a reduced FCR severity at 1-week post-intervention (mean change: -3.81 [95% CI: -4.67, -2.95], p<0.001) compared to baseline. Participants also reported improvements in melanoma-related knowledge (mean change: 0.64 [95% CI: 0.13, 1.15], p=0.014), depressive symptoms (mean change: -1.41 [95% CI: -1.92, -0.90], p<0.001), anxiety (mean change: -1.05 [95% CI: -1.48, -0.61], p<0.001), stress (mean change: -1.58 [95% CI: -2.22, -0.93], p<0.001), and health-related quality of life (mean change: 4.05 [95% CI: 2.84, 5.26], p<0.001). The Melanoma Care Programme maintained effectiveness when implemented into routine clinical practice with the addition of FCR screening and a stepped care model of delivery. This study is registered with the Australia and New Zealand Clinical Trials Register (ACTRN12621000145808).

Characterizing Oncologist Involvement in an Oncology Nurse-Led Primary Palliative Care Intervention (CONNECT).

Background and Objectives: Mixed success with primary palliative care delivery models may be related to inadequate communication between members of the care team. We sought to describe the previously unexamined role of oncologists in an oncology nurse-led primary palliative care intervention study. Design, Setting, and Subjects: We conducted a secondary analysis of data from Care Management by Oncology Nurses to Address Supportive Care Needs, a cluster-randomized controlled trial of a nurse-led primary palliative care intervention for adults with advanced cancer conducted at 17 community oncology clinics in Western Pennsylvania from 2016 to 2020. Nurses conducted three monthly study visits during which they developed care plans (CPs) with the patient and after which they updated the patient's oncologist. We characterized the level of oncologist involvement with the intervention. Results: Of the 336 patients randomized to receive primary palliative care, 266 completed at least one study visit and 233 (88%) had at least one visit where the oncologist was updated afterward. Across 674 total study visits, the oncologist was updated in 553 (82%) of the visits, signifying the oncologist awareness of the intervention. Of the times the nurse updated the oncologist, a CP was presented 29% of the time (163/553). Conclusion: In a large trial of oncology nurse-led primary palliative care, oncologists were often aware of but infrequently involved with the intervention. Future primary palliative care interventions should consider communication and engagement among team members.

Accessibility of Special Care Dentistry Across Countries: A Scoping Review.

People with special care needs often face significant barriers in accessing dental care due to physical and cognitive limitations, leading to high rates of dental issues like caries. Despite the growing recognition of these challenges, unmet dental care needs remain prevalent. This review aims to explore the global landscape of special care dentistry to identify gaps and opportunities for improving dental services for this population. A systematic search was conducted across three online databases-PubMed, Embase, and Scopus-to identify relevant articles from their inception through May 2024. Reference lists of the selected studies were also screened for additional sources. A thematic synthesis approach was applied to derive both descriptive and analytical themes. The scoping review was guided by the Arksey and O'Malley framework to examine the scope and nature of studies and documents related to dental care for individuals with special care needs. Furthermore, a Google search was performed to include accessible theses and official government documents from various countries. A total of 49 studies from 11 countries were reviewed, all centered on providing dental care for people with special needs. The analysis revealed three main themes: Human resources, care delivery model, and management. Within these, nine subthemes emerged: Mid-level oral care providers, dentists, special care dentistry as a specialty, tele-dentistry, mobile dentistry, hospital care, levels of healthcare provision, financial support, and education. These themes and subthemes highlight essential areas for enhancing services for those people. A holistic approach is essential to enhance dental care for people with special needs. Critical strategies, including the involvement of mid-level oral care providers, the adoption of tele-dentistry and mobile units, and the availability of hospital-based services for complex cases, are crucial. To truly transform care for those people, each country must adapt these strategies to its specific context, aligning resources and policies to create an inclusive, accessible, and effective system.