Outreach Services Research Articles

Prevalence and factors associated with immunization coverage among children under five years in Mohamed Mooge health center, Hargeisa, Somaliland: a cross-sectional study

BackgroundRoutine immunization contributes greatly to reduction in mortality from vaccine preventable diseases among children. The Somaliland Demographic and Health survey, 2020 revealed that only 13.7% of children in Marodijeh (Hargeisa) region had received all recommended vaccines, which is far below the World Health Organization (WHO) target of 80%. We therefore, assessed factors associated with immunization coverage among children under five years at Mohamed Mooge Health Center in Hargeisa, Somaliland.MethodsInstitutional based cross-sectional study was conducted on 174 systematically sampled, consented mothers that visited Mohamed Mooge Health Center for antenatal care during December 2022 to May 2023. Data was collected using a structured questionnaire. Data was analysed using SPSS and the relationship between dependent and independent variables was checked chi-square test at p ≤ 0.05. Finally, candidate variables were tested by using multivariate logistic regression in order to control potential confounders and the result was presented using AOR and 95% confidence interval. Model fitness was checked using Hosmer-Lemeshaw goodness of fit test with P > 0.05 for fitness. Multicollinearity between variables was checked using correlation coefficients at 0.80 or higher. ResultAmong 174 study participants, the prevalence of overall vaccine completion in this study was 55.3%. Women who had being aware about childhood immunization on BCG vaccination (AOR = 3.887; 95% CI: 1.275, 6.844), pentavalent (AOR = 11.385; 95% CI: 5.424–14.464), and measles (AOR = 3.074; 95% CI: 1.822–6.130) had higher odds of having immunized their children. Mothers who had employment had higher odds of having their children immunized against measles (AOR = 4.069; 95% CI: 1.822–6.130) compared to those who had not.ConclusionsFull immunization coverage was lower than the target set by the World Health Organization in this study area. The current study revealed that, the mother’s awareness of childhood vaccinations on BCG, pentavalent, measles and employment status of mothers were positively associated with immunization coverage. To promote vaccination coverage, the government should implement a national awareness campaign on childhood immunization and increase the number of outreach services.

An exploration of healthcare use in older people waiting for and receiving Australian community-based aged care services.

Home care packages (HCPs) facilitate older individuals to remain at home, with longer HCP wait times associated with increased mortality risk. We analyze healthcare cost data pre- and post-HCP access to inform hypotheses around the effects of healthcare use and mortality risk. Regression models were used to assess the impact of delayed HCP access on healthcare costs and to compare costs whilst waiting and in the 6- and 12 month periods post-HCP access for 16 629 older adults. Average wait time for a HCP was 89.7 days (SD = 125.6) during the study period. Wait-time length had no impact on any healthcare cost category or time period. However, total per day healthcare costs were higher in the 6 and 12 months post-receipt of a HCP (AU$61.5, AU$63, respectively) compared with those in the time waiting for a HCP (AU$48.1). Inpatient care accounted for a higher proportion of total healthcare costs post-HCP (AU$45.1, AU$46.3, respectively) compared with in the wait time (AU$30.6), whilst spending on medical services and pharmaceuticals reduced slightly in the 6 month (AU$7.1, AU$6.3) and 12 month (AU$7.2, AU$6.3) post-HCP periods compared with in the wait time (AU$7.9, AU$7.1). Increased spending post-HCP on inpatient care or non-health support afforded by HCPs may offer protective effects for mortality and risk of admission to aged care. Further research should explore the association between delayed access to inpatient care for geriatric syndromes and mortality to inform recommendations on extensions to residential care outreach services into the community to improve the timely identification of the need for inpatient care. Geriatr Gerontol Int 2023; 23: 899-905.

Insights from the scale-up and implementation of the Deadly Liver Mob program across nine sites in New South Wales, Australia, according to the RE-AIM framework

BackgroundThe Deadly Liver Mob (DLM) program is a peer-led health promotion program that aims to improve access to screening and treatment for blood borne viruses and sexually transmissible infections for Aboriginal and Torres Strait Islander Australians. In this paper, we used client and staff insights to explore the successes and challenges of implementing the DLM program according to the RE-AIM framework, which explores real-world implementation of interventions according to reach, effectiveness, adoption, implementation, and maintenance.MethodsClients and staff were recruited through the DLM program. Semi-structured interviews were conducted with four Aboriginal and Torres Strait Islander and 11 non-Aboriginal or Torres Strait Islander health workers, as well as 33 Aboriginal and Torres Strait Islander clients of the program.ResultsFindings show the positive effects of the DLM program, in creating a culturally safe and sensitive environment for Aboriginal and Torres Strait Islander clients to access care. In particular, the employment of frontline Aboriginal and Torres Strait Islander workers to deliver the education was touted as one of the primary successes of the program, in enabling workers to build trust between clients and mainstream health systems, which has the flow on effect of encouraging clients to go through to screening. The use of the RE-AIM framework illustrates the challenges of implementing real-world interventions across various locations, such as the difficulties in delivering DLM in regional and remote areas due to covering large geographic areas with minimal public transport available.ConclusionsThe data emphasise the need for interventions to be adaptable and flexible, altering elements of the program to suit local and community needs, such as by offering mobile and outreach services to enable access across regional and rural areas. The findings of this evaluation have been used to develop tools so that the learnings from DLM can be shared with others who may be hoping to implement DLM or other similar programs.

Addressing mpox at a Frontline Community Health Center: Lessons for the Next Outbreak.

The 2022 mpox (formerly monkeypox) outbreak affected predominantly men who have sex with men (MSM), likely through sexual transmission, which resulted in institutions specializing in sexual health being at the frontlines of the mpox outbreak. Fenway Health in Boston serves close to 10 000 MSM annually, which includes more than 2400 MSM who are living with HIV and 3320 MSM with active HIV preexposure prophylaxis (PrEP) prescriptions. We report on the programs implemented and changes to clinical practice at Fenway Health during the mpox outbreak. Fenway Health diagnosed its first case of mpox in June 2022 and treated this patient with tecovirimat. In early July 2022, Fenway Health administered its first dose of the Jynneos vaccine under the Emergency Use Authorization for protection against mpox. As of October 6, 2022, 69 people had tested positive for the mpox virus at Fenway Health. Among the 69 people who tested positive, 43 (62.3%) self-identified as male, with the remaining not reporting a sex or gender identity, and 40 (58.0%) reported their sexual orientation as gay or bisexual. Twenty-five people (36.2%) were treated with tecovirimat. As of October 30, 2022, Fenway Health had administered 6376 doses of the Jynneos vaccine. The programmatic changes involved in rollout and scale-up of vaccination, treatment, and community outreach services at Fenway Health during the 2022 mpox outbreak that we describe here could inform strategies to address subsequent outbreaks.

Exploring the Systemic Structures That Affect Access to Physical Therapist Services for Non-Indigenous Black People in Australia.

Physical therapy is generally considered to be a white profession in Western nations. Australia's increasingly diverse population, driven largely by growth in immigration, invites Australian health systems to be responsive to factors that may impact on non-white Australian population's access to health care. Here, the authors sought to explore non-Indigenous Black people's perspectives of physical therapy in Australia. Eligible participants (n = 12) took part in semistructured, in-depth interviews and were prompted to discuss their experiences and perceptions of physical therapy. Interview data were analyzed using critical discourse analysis, underpinned by critical race theory. Participants were on average 29.4years (SD = 12.9) from diverse cultural and linguistic backgrounds. Participants described mostly positive experiences with physical therapists, but they noted that it was not widely accessed by their communities, with 2 key discourses underpinning these discussions. Discourse 1, "physiotherapy is a solution for white people," established physical therapy as primarily accessed by and welcoming of white people. "Whiteness" and the perpetuation of Western norms in physical therapy resulted in little consideration of other cultural practices. Participants' discussions also pointed to the intersections of systemic racism and social inequities such as low income and language barriers, impacting Black people's engagement with physical therapy. Discourse 2, "physiotherapists are white," was mostly concerned with how the perceived "whiteness" of professionals and lack of Black physical therapists impacts cultural safety and comfort when accessing physical therapy. Our results suggest that Westernization and whiteness persist among discourses surrounding physical therapy. Such discourses are likely to inform Black people's perceptions and experiences of physical therapy. Our analyses suggest avenues to enhance the cultural diversity of the profession and improve physical therapy accessibility for Black people in Australia by providing culturally appropriate material, including critical reflexivity, epistemic and cultural humility in the curricula, recruiting staff from diverse backgrounds, and providing outreach services to underserved populations. These findings highlight the need for increased cultural safety and diversity within the physical therapy profession to improve equity.

Value-based care of older people-The impact of an acute outreach service unit on emergency medical service missions: A quasi-experimental study.

Transfers to the emergency department can be burdensome for the residents of long-term residential care facilities (LTRCFs) and often lead to adverse effects. Since March 2019, a nurse-led acute outreach service unit "Mobile hospital" (in Finnish, Liikkuva sairaala, LiiSa) has been providing on-site care to LTRCF residents to reduce transfers to the emergency department. This study compares the numbers and acuities of emergency medical service (EMS) missions carried out in the LTRCFs of Espoo and Kauniainen during two six-month periods: before the implementation of LiiSa and with LiiSa in use. In Finland, EMS missions are divided into four categories (A-D), with category A missions being the most urgent. These categories were used to investigate the impact on mission acuities. Due to the implementation of LiiSa, the number of EMS missions decreased by 16.8% (95% confidence interval 10.6%-22.6%, p < 0.001), the number of category D missions by 19.8% (7.1%-30.8%, p = 0.003) and the number of category C missions by 30.3% (17.3%-41.3%, p < 0.001). Changes in the numbers of category A and B missions were not statistically significant. LiiSa helped to avoid many transfers of frail LTRCF patients to the emergency department, and it did not hinder the care of patients with true emergencies by EMSs.

The police paradox: A qualitative study of post-overdose outreach program implementation through public health-public safety partnerships in Massachusetts.

Post-overdose outreach has emerged in the United States as an increasingly common response to non-fatal overdose. This qualitative study investigates the implementation of such programs through public health-public safety partnerships in Massachusetts. We conducted semi-structured interviews with post-overdose outreach team members, overdose survivors, and family members who received outreach. Interview transcripts were inductively analyzed to identify emergent themes and subsequently organized within the framework of Ecological Systems Theory. Forty-nine interviews were conducted, including 15 police officers (80% male, 100% non-Hispanic White); 23 public health partners (48% male, 87% non-Hispanic White); 8 overdose survivors who received outreach services and 3 parents of survivors who received services (collectively 27% male, 64% non-Hispanic White). Implementation factors identified across all levels (macrosystem, exosystem, mesosystem, and microsystem) of Ecological Systems Theory included key program facilitators, such as access to police data and funding (macro), interagency collaboration (exo), shared recognition of community needs (exo), supportive relationships among team members (meso), and program champions (micro). Common barriers included inherent contradictions between policing and public health mandates (macro), poor local treatment and service capacity (exo), divergent staff views of program goals (exo), overdose survivors' prior negative experiences with law enforcement (meso), difficulty locating overdose survivors (meso), and police officers' lack of qualifications or training in providing psycho-social services (micro). Most post-overdose outreach programs in this study were dependent on funding and data-sharing partnerships, which police agencies largely controlled. Yet, police participation, especially during outreach visits presented numerous challenges for engaging overdose survivors and establishing non-coercive linkages with evidence-based services, which may undermine the public health goals of these programs. These findings should inform state and federal efforts to expand the role of law enforcement in behavioral health initiatives.

Telemedicine vs Face-to-Face for Nursing Home Residents With Acute Presentations: A Noninferiority Study.

Telemedicine and face-to-face outreach services to nursing homes (NHs) have been used to reduce hospital utilization rates for acute presentations. However, how these modalities compare against each other is unclear. This article examines if the management of acute presentations in NHs with care involving telemedicine is noninferior to care delivered face-to-face. A noninferiority study was conducted on a prospective cohort. Face-to-face intervention involved on-site assessment by a geriatrician and aged care clinical nurse specialist (CNS). Telemedicine intervention involved on-site assessment by an aged care CNS with telemedicine input by a geriatrician. A total of 438 NH residents with acute presentations from 17 NHs between November 2021 and June2022. Between-group differences in proportion of residents successfully managed on-site and mean number of encounters were evaluated using bootstrapped multiple linear regression; 95% CIs were compared against predefined noninferiority margins with noninferiority P values calculated. In the adjusted models, care involving telemedicine demonstrated noninferiority in the difference in proportion of residents successfully managed on-site (95% CI lower limit-6.2% to-1.4% vs-10% noninferiority margin; P < .001 for noninferiority) but not in the difference in mean number of encounters (95% CI upper limit 1.42 to 1.50 encounters vs 1 encounter noninferiority margin; P= .7 for noninferiority). In our model of care, care that involved telemedicine was noninferior to care delivered face-to-face in managing NH residents with acute presentations on-site. However, additional encounters may be required. Application of telemedicine ought to be tailored to fit the needs and preferences of stakeholders.

A situational analysis of ear and hearing care in South Korea using WHO ear and Hearing Care Situation Analysis tool.

The WHO emphasizes lifelong management of hearing diseases such as hearing loss and advocates for prevention. The Ear and Hearing Care Situation Analysis (EHCSA) tool was designed by the WHO for assessment and quality improvement of state-led management of hearing loss prevention and management programs. The purpose of this study was to use the EHCSA to assess the ear and hearing management program in Korea and to establish goals consistent with best practices for improving policies and services related to ear and hearing care. The EHCSA was used as a need assessment of the ear and hearing management services in the country. The EHCSA consists of two sections. Section 1 consists of 41 questions to evaluate health policies and support services. Section 2 consists of 203 questions to evaluate human resources and services of the ear and hearing management sector. There are an estimated 800,000 people with hearing loss in Korea. Policies such as hearing aid support are in place, and outreach services such as free hearing tests are also being actively conducted. In all medical institutions, ear and hearing management treatment and medication prescriptions could be received without barriers. Workers in the fields of ear and hearing management, such as audiologists, language therapists, special education teachers, and sign language interpreters, are specialized and have well-established guidelines for training. Overall, the domestic ear and hearing management sector has confirmed that policies and services are well-prepared in comparison with advanced countries such as the United States, Iran, and China. The use of the EHCSA was functional in collecting data on the current state of domestic ear and hearing management policies and services in Korea, can be used for continuous quality improvement and expansion of medical services, and can be used as a reporting mechanism to the WHO.

The Relationship Between Serious Mental Illness and Criminal Offending in Persons Experiencing Homelessness: The Role of Substance Use Disorder.

Individuals who live with mental illness are encumbered by related risk factors that increase the probability of legal involvement. The goal was to determine how homelessness and substance use disorder are intervening factors in the relationship between symptoms of serious mental illness (SMI) and criminal offending. A sample of 210 chronically homeless adults receiving SAMHSA-funded outreach and psychiatric rehabilitation services between 2014 and 2016 was recruited in a study of interventions to address housing in homeless persons with a SMI. Participants were interviewed and data collected were analyzed using structural equation modeling. Statistical analysis showed that homelessness severity mediated the relationship between SMI symptom severity and criminal offenses committed in the past 30 days in participants with a substance use disorder but not in those with no substance use diagnosis. Results show that homelessness and substance use are important to address to possibly alter trajectories for criminal justice involvement.

Barriers and enablers to access and utilization of mental health care services across Southeast Asia: A preliminary scoping review.

While the importance of mental health and its impact on overall health and well-being has been widely recognized, there continue to be ongoing barriers to accessing mental health services. This is particularly poignant in countries in Southeast Asia (SEA) where there may be further stigma in accessing mental health services. As no reviews have been undertaken on this topic, this review aims to outline the barriers and enablers to access and utilization of mental health care services in SEA. Searches were undertaken in commercially produced and gray literature sources. Two independent reviewers screened the results. The data were then independently extracted, which was then collated and synthesized, using the Health Belief Model (HMB) as a framework. Twelve studies were included in the review. Under the HBM, barriers were grouped into: stigma, poor health literacy, internalized reasons, cultural beliefs, lack of training of health professionals, quality of service, and poor distribution of resources. Enablers included: social support, outreach services, structural stigma, self-awareness, resources and information, accessibility and affordability, and positive attitudes and beliefs about health professionals. Those accessing mental health care in SEA are confronted by complex barriers and few enablers. Ongoing stigma and a distinct lack of resources pose the greatest challenges, which are even more amplified for those in rural areas and minority groups. A multifaceted strategy that improves the structures, processes, and outcomes of mental health is required within these communities.

Recruiting the next generation of rural healthcare practitioners: the impact of an online mentoring program on career and educational goals in rural youth.

There is increasing recognition that encouraging and supporting rural youth to pursue healthcare careers could be a promising strategy for addressing shortages of rural healthcare practitioners. Although rural students in health science programs often return to their home communities to practice, they continue to be underrepresented in these programs. Geographic isolation and small community sizes create barriers to entry for rural students, including a lack of educational and outreach services and a smaller pool of role models with experience in pursuing health science careers. Online mentoring has the potential to overcome these barriers by connecting rural youth with experienced role models from outside their communities; therefore, we tested whether this type of intervention could be used to increase interest in and guide rural youth towards rural healthcare careers. From 2016 to 2020, our intervention, Rural eMentoring BC, matched 364 youth in rural British Columbia to near-peer mentors enrolled in health science programs. Through an online platform, dyads discussed career and educational options and pathways through a semistructured curriculum consisting of eight units. To determine the likelihood of mentees pursuing a career in rural health care after participating in the program, we deployed pre- and post-unit surveys that evaluated their interest in the following areas: healthcare careers, post-secondary education, working rurally, and finding allies. After completing the program, 209 mentees were invited to complete a program evaluation, which consisted of short-answer questions intended to capture their overall impressions of the program. After completing the career exploration unit, 63 students (out of the 103 who completed the unit) indicated that they were interested in healthcare careers, compared to 37 before. However, students' attitudes towards post-secondary education and finding allies did not change after completing those units, nor did their opinion of working rurally (although there was no unit dedicated to this topic). Encouragingly though, most already held positive opinions of these areas before entering the program. Of the 41 students who took our program evaluation, most viewed the program and their mentors favorably; discussion topics they found most useful included career exploration, learning life skills, and learning how to prepare for, and what to expect from, post-secondary education. This study suggests that online mentoring can direct rural youths' career interests toward, and provide a refreshing approach to imparting information about, healthcare professions. Although its longitudinal impacts need to be studied, the changes in attitudes and gains in knowledge observed while participating in this program put these students on the right track for eventually transitioning to health science programs. Arming rural youth with the knowledge and motivation to pursue healthcare careers through near-peer mentorship could be a unique strategy for increasing rural student representation in health science programs, and ultimately the number of rural healthcare professionals.

Evaluation of role of mobilizers (ASHA &amp; AWW) on village health and nutrition day (VHND) –Mamta day of study district

Introduction and Aim: Mamta Abhiyaan is one of the major approaches towards reaching the MDGs of reduction of MMR from present 178 to 100 and IMR from present 42 to 30 in India. Mamta Day is celebrated as an outreach services provision to each single beneficiary at grassroots level. Functionaries of Mamta day are FHW, ASHA, and AWW mainly. ASHA &amp; AWW acts as community personnel which helps in counselling and mobilization for all services provided on Mamta day. The aim of the study was to evaluate the role of ASHA and AWW on VHND (Village health and nutrition day) i.e., Mamata day of study district. Materials and Methods: Quantitative and qualitative research method, cross sectional study was conducted in rural areas of western Gujarat covering 40 Mamta days. Every participant was clearly explained the purpose of study and their consent was taken. It was an anonymous study using pre structured proforma from available literature. Results: At 82.5 % sites, AWW was present whereas 77.5% sites ASHA workers were present. At 10 session sites ASHA did not have a due list of any beneficiary. Most sessions were conducted at Anganwadi and sub centre. At all 31 session sites, ASHA was mobilizing beneficiaries to the site; and at 6 (15%) session sites, there was not any mobiliser available. At 30 out of 31 session sites, ASHA was reminding beneficiaries for the next visit. AWW was involved in various services which varied from one session to another. Conclusion: The presence of all three frontline workers (AWW, ASHA, and ANM) is essential for comprehensive VHND services, but there are notable challenges, including incomplete beneficiary lists and inadequate tracking of left-out children, hampering effective growth monitoring.

COVID-19 Pandemic Planning and Management: The Case of New Zealand General Practice Medical Centres

The objective of this study was to explore the potential enhancement of response within GP medical centres in New Zealand when facing heightened healthcare demand during a pandemic. This investigation sheds light on effective crisis management and leadership. By elucidating the contributions of this research, we gain a deeper appreciation of its importance in advancing our understanding of pandemic management. This study has yielded fresh insights and knowledge, beneficial to both academic and real-world applications, particularly concerning the adoption and effects of leadership and management within the healthcare domain amidst crisis situations. Using a multiple case study design, we conducted 86 in-depth interviews with staff from 16 General Practice centres in New Zealand. The critical activities delivered during the first six months of the COVID pandemic to keep New Zealand communities safe during the initial COVID-19 outbreak were (a) leadership in health service planning, including workforce planning, new operational processes, and expansion in the use of Information Communication Technology systems by the GP medical centres; (b) environment disinfection using national guidelines, education and establishment of respiratory clinics and expanding testing sites in GP medical centres; and (c) education and outreach to the patients including the protection of Māori, Pasifika, and remote communities. The decision to adopt a localised response to the pandemic, centralise testing, and better understand local-level needs prompted GP medical centres to communicate and engage early and effectively with patients. This enabled centres to lead and manage the COVID-19 pandemic with greater efficiency in the first six months of the outbreak. The New Zealand government’s “team of 5 million” COVID-compliance campaign program provided clear and persistent communication by the Ministry of Health. This campaign assisted in a better national understanding and compliance with the regulation of the COVID-19 pandemic. The dedication of medical centre managers to forward planning using contingency and accrued funding and setting up Community-Based Assessment Centres and respiratory clinics, including walk-in and outreach services, proved to be highly effective. GP centres led the way in COVID-19 pandemic planning, response, and management.

321 The barriers and enablers to an effective integrated care programme for older persons: a qualitative study

Abstract Background In line with Slaintecare goals, the Integrated Care Programme for Older Persons (ICPOP) South Lee Hub, Cork, was developed to provide onsite access to geriatrician and specialist nurse-led clinics, allied healthcare professionals, and an outreach service. ICPOP aims to avoid unnecessary hospital admissions and maximise collaboration between primary and secondary healthcare teams locally. An effective interface between primary and secondary care is, therefore, fundamental to the functioning of ICPOP. However, no research to date has examined this interface from the perspective of the clinical staff in the hubs and primary care providers in the community. This study aims to explore the barriers and enablers to the effective functioning of an ICPOP service from the perspective of both Primary Care Team (PCT) members and the ICPOP hub team. Methods Semi-structured interviews were conducted with healthcare professionals working in the ICPOP service in Cork and in primary care. All interviews were analysed thematically by two independent researchers. Results 29 semi-structured interviews were conducted; 14 with members of the ICPOP team and 15 with GP’s and members of the PCT in the ICPOP catchment area. The challenges of communicating patient information both into and out of the ICPOP hub was highlighted by both primary and secondary care teams. The GPs and other members of the PCT felt ‘on the outside’ with all the contextual knowledge of the individual patient but without a clear understanding of the functioning of the ICPOP hub. Conversely, the clinical team in the ICPOP hub found it challenging to retrieve the contextual knowledge of the patient and were challenged by administrative frustrations. Conclusion In the context of a newly emerging ICPOP service, it is essential that collaboration between primary care and the clinical hub is maximised, to provide optimal patient care.

247 Assessing the impact of a new integrated care framework for nursing home residents

Abstract Background Nursing home residents represent the frailest patients in our community and are often referred to the Emergency Department (ED) for acute care. These referrals may have limited benefit and are associated with an increased risk of complications. This programme initiated a new acute outreach service providing urgent geriatric care in residential care settings, with the aim of avoiding unnecessary referrals. Methods A framework to deliver specialist acute geriatric care to 4 Residential Care Facilities (RCFs) (423 beds) was developed. Direct access by phone to a daily team lead was developed and provided on a Monday–Friday 8 am -5 pm basis. Referrals were triaged and acute response service provided through ANP and consultant geriatrician. Protocols to support iv fluid and antibiotic administration were agreed. Framework RCFs also engaged in specific Quality Improvement (QI) initiatives that focussed on falls reduction, skin integrity assessment, appropriate use of ED and safe staffing. Outcome measures for hospital admissions and 90-day mortality over a 7 month period (April—Oct 2022) was collected from patient’s medical records, electronic data and RCF records. Results 174 urgent referrals were seen. Of these reviews, 5 (2.9%) required subsequent admission to hospital. Treatment with antibiotics was initiated in 9.8%. 1.7% required iv fluids and palliative measures recommended in 20.7%. The 90-day mortality was 12.9%. A total of 132 patients were referred directly to ED from the same 4 nursing homes over the same time period (4% reduction from 2021). QI initiatives demonstrated improvements in compliance with falls and continence risk assessments. Conclusion Specialist acute liaison care to nursing homes complimented with appropriate QI focus could present an opportunity for optimised care in RCF residents and mitigate risk of avoidable transfers.

SSPCA to expand its outreach service.

SSPCA to expand its outreach service.

Design of a service project that provides a model for interprofessional collaboration and layered learning within the refugee and asylum seeker community

Background: Development of an interprofessional service outreach within the refugee and asylum-seeker population gives pharmacy trainees the opportunity to develop healthcare skills and gain cultural awareness. Programme description: The interprofessional team prepared for the medical service trip through meetings, gathering supplies, and engaging in fundraising events. The team partnered with Siguiendo los Pasos de Jesús (SPJ) and Annunciation House while observing and partaking in service. A retrospective review of medical records was completed to develop the research project. Evaluation: A team of nine participated in a service project providing medical care and support for asylum-seekers. Layered learning and the importance of interdisciplinary communication were demonstrated within the team. The most common medical ailments for patients were respiratory, gastrointestinal diagnoses and headache/pain. Future plans: Service outreach offers the experience of caring for underserved populations and increases awareness of cross-cultural development, which is transferable in any clinical setting.

Service intensity of community mental health outreach among people with untreated mental health problems in Japan: A retrospective cohort study.

This study aimed to clarify the association between treatment status (untreated or treated) at the start of community mental health outreach services and service intensity. This retrospective cohort study was conducted using the Tokorozawa City mental health outreach service users' data. Treatment status at the start of service (exposure variable) and the service intensity (outcome variables) were taken from clinical records. Poisson regression and linear regression analyses were conducted. The frequency of medical or social service use 12 months after service initiation was also calculated. This study was approved by the Research Ethics Committee at the National Center of Neurology and Psychiatry (No. A2020-081). Of 89 people, 37 (42%) were untreated. Family members in the untreated group were more likely to be targets or recipients of services than in the treated group (b = 0.707, p < 0.001, Bonferroni-adjusted p < 0.001). Compared to the treated group, the untreated group received fewer services themselves (b = -0.290, p = 0.005), and also fewer services by telephone (b = -0.252, p = 0.012); by contrast, they received more services at the health center (b = 0.478, p = 0.031) and for family support (b = 0.720, p = 0.024), but these significant differences disappeared after Bonferroni adjustment. At least 11% of people in the untreated group were hospitalized and 35% were outpatients 12 months after service initiation. Family involvement may be a key service component for untreated people. The service intensity with and without treatment may vary by service location.

Academic detailing to improve appropriate opioid prescribing: a mixed-methods process evaluation.

Academic detailing, an educational outreach service for family physicians, was funded by the Ontario government to address gaps in opioid prescribing and pain management. We sought to evaluate the impact of academic detailing on opioid prescribing, and to understand how and why academic detailing may have influenced opioid prescribing. In this mixed-methods study, we collected quantitative and qualitative data concurrently from 2017 to 2019 in Ontario, Canada. We analyzed prescribing outcomes descriptively for a sample of participating physicians and compared them with a matched control group. We invited physicians to participate in qualitative interviews to discuss their experiences in academic detailing. Development and analysis of qualitative interviews was informed by the Theoretical Domains Framework. We triangulated qualitative and quantitative findings to understand the mechanisms that drove changes in opioid prescribing. Physicians receiving academic detailing (n = 238) achieved a greater reduction in opioid prescribing than matched controls (n = 238). Seventeen physicians completed interviews and reported that academic detailing addressed barriers to pain care, including lack of confidence, difficult interactions with patients and prescribing and tapering decisions. Academic detailing reinforced knowledge about opioid prescribing and pain management. Discussion of complex patients and talking points to use during challenging conversations were described as key drivers of practice change. The findings of this real-world, mixed-methods evaluation explain how an academic detailing service addressed key barriers and enablers to limit high-risk opioid prescribing in primary care. This nuanced understanding will be used to inform, spread and scale academic detailing.