Mode Of Service Delivery Research Articles

Remote consultations in the era of COVID-19 pandemic: Preliminary experience in a regional Australian public acute mental health care setting.

In the wake of the recent pandemic of Corona Virus Disease 2019 (COVID-19), with confirmed cases having crossed 750,000, health systems across the world are getting overwhelmed; making it strenuous to maintain essential health services. Several changes were implemented in our acute mental health care service using a collaborative approach to maintain a balance between preventive measures to ‘flatten the curve’ and to provide care to those who were in need. Mode of service delivery was changed predominantly to tele-medicine, amongst others. It was found to be a workable model, albeit further follow up will be required to better understand its viability and feasibility to withstand the COVID-19 cataclysm.

Taxonomy of Seniors' Needs for Food and Food Assistance in the United States.

Food insecurity results in poor health among seniors. Food and nutrition assistance targeted to seniors experiencing or at risk of food insecurity prevents poor health outcomes and enables seniors to age in place. Currently, the primary modes of service delivery are targeted to seniors who are older and frailer than average, rendering these modes less responsive to the needs of the broader population of food-insecure seniors and limiting the preventive potential of food assistance. This study aimed to understand needs among seniors for food and food assistance and to develop a comprehensive taxonomy for these needs. The taxonomy depicts seniors' self-identified needs that relate to their ability to access and use food and nutrition assistance across three domains: physical abilities, consuming food, and access and use of transportation. The results of this study are intended to provide in-depth information to support effective alignment of programs with seniors' needs.

Integrated management of multiple water sources for multiple uses: rural communities in Limpopo Province, South Africa

This study fills a knowledge gap about low-income rural communities’ holistic management of multiple water resources to meet their multiple needs through multiple or single-use infrastructure. Six low-income rural villages in Limpopo Province were selected with a diversity in: service levels, surface and groundwater resources, public infrastructure (designed for either domestic uses or irrigation but multiple use in reality) and self-supply (people’s individual or communal investments in infrastructure). Focusing on water-dependent livelihoods and water provision to homesteads, distant fields and other sites of use, three policy-relevant patterns were identified. First, most households have two or more sources of water to their homesteads as a vital buffer to irregular supplies and droughts. Second, infrastructure to homesteads is normally for domestic uses, livestock and, for many households, irrigation for consumption and sale. Public infrastructure to irrigate distant fields is multiple use. Exceptionally, self-supply point sources to distant fields are single use. Water bodies to other sites of use are normally multiple use. As for large-scale infrastructure, multiple-use infrastructure is cost-effective and water-efficient. Third, in four of the six villages people’s self-supply is a more important water source to homesteads than public infrastructure. In all villages, water provided through self-supply is shared. Self-supply improves access to water faster, more cost-effectively and more sustainably than public services do. In line with international debates, self-supply is there to stay and can be supported as a cost-effective and sustainable complementary mode of service delivery. A last potential policy implication regards community-driven planning, design and construction of water infrastructure according to people’s priorities. This may sustainably harness the above-mentioned advantages and, moreover, communities’ ability to manage complex multiple sources, uses and multiple-use infrastructure, whether public or self-supply, as a matter of daily life.

What ails the urban slums - morbidity profile of urban slum dwellers from three major cities of India

Background: India today has over 61 million people residing in urban slums. Slums, on one hand, lack the basic requirements of housing, sanitation, and water supply that are detrimental for good health and on the other hand subject its residents to extreme poverty, unemployment and stress. Exposure to these environmental factors is expected to cause a distinct sort of morbidity pattern, which this study seeks to explore.Methods: This cross-sectional study was a secondary data analysis of aggregated data of patients who availed health services at the mobile medical unit (MMU) of the Ujjivan program run by Piramal Swasthya in the last one year. The project has a fleet of MMUs that makes at least one predestined monthly visit to each service point in urban slums of Bangalore (42 sites), Pune (18 sites) and Mumbai (19 sites).Results: Musculoskeletal disorders (30.69%) and cardiovascular diseases (25.56%) together accounted for 56.25% of the total disease burden. The analysis of blood pressure readings of all the registrations showed that the mean systolic and diastolic pressures were 129.71 and 84.92 mmHg respectively. 51.58% of all individuals had hypertension and 23.51 % had diabetes.Conclusions: According to the study a major proportion of urban populous seeking healthcare at the MMU are women and elderly and do so for non-communicable diseases. Hypertension and diabetes are major health threats among them. MMU could be used as an effective mode of service delivery for women and the elderly especially, for chronic diseases.

VetConnect: A Quality Improvement Program Delivering Palliative Care Services via Telehealth to Veterans Residing in Nursing Homes (QI645)

•Describe telehealth palliative care for veterans in nursing homes, an innovative mode of service delivery, and its impact.•Discuss implications and applications for future use and expanded roll-out. Beginning in June 2017, the VetConnect program launched, providing palliative, geriatrics, and mental health specialty care via telehealth to veterans in contracted community nursing homes (CNH) and state veterans nursing homes (SVHs) across Colorado and Oklahoma. This model of care allows for increased access to care for veterans who frequently have difficulty accessing specialty care services, as well as efficiency in healthcare delivery by reducing travel and wait times. Implement and evaluate the impact of VetConnect, which provides care to nursing home veterans via telehealth in palliative care, with the specific goal of increasing quality veteran end-of-life and serious disease care. A palliative care physician conducted telehealth visits using secure video conferencing technology. Visit data including technological success metrics, resulting consults and recommendations, and field notes were recorded by project nurses who were also present during the telehealth visits at the nursing homes. Qualitative interviews were conducted with project providers (physicians, social workers nurses, and nursing home staff) to better understand project implementation. Since the program start, 90 visits have been conducted in palliative care among 78 veterans in 14 nursing homes. Thematic analysis of interviews has revealed that telehealth palliative care through VetConnect a.) meets the need for palliative specialty care, and b.) positively impacts Veteran's quality of life. The evaluation indicates that VetConnect serves as a feasible and effective service particularly in providing support to frail veterans at end of life or managing serious diseases. The VetConnect program offers insights as to best practices regarding palliative specialty care delivery via telehealth to veterans in nursing homes.

83. Improving Access to Care and Wellness among Sexually Active Adolescent Substance Users by Assessing Barriers to Care, the Acceptability of Health Promotion Activities, and Preferred Service Delivery Modalities

83. Improving Access to Care and Wellness among Sexually Active Adolescent Substance Users by Assessing Barriers to Care, the Acceptability of Health Promotion Activities, and Preferred Service Delivery Modalities

“We’ve got rights and yet we don’t have access”: Exploring patient experiences accessing medication abortion in Australia

ObjectivesAcross Australia, multiple strategies have emerged to decentralize abortion care and increase access to mifepristone, including incorporating medication abortion into primary care and offering the mifepristone and misoprostol regimen via telemedicine. We aimed to explore the experiences of patients accessing medication abortion care across these different health service delivery formats and different geographic areas. Study designWe conducted in-depth interviews with 22 people from across Australia who had used mifepristone for abortion. We audio-recorded and transcribed all interviews and managed our data with ATLAS.ti. We used deductive and inductive techniques to analyze these data for content and themes. ResultsAlthough participants were generally satisfied with the abortion care they received, many described medication abortion care in Australia as inaccessible and confusing to find. Our participants incurred variable and often significant financial costs when obtaining their abortion and many reported that their interactions with general practitioners when trying to locate an abortion provider were uninformative and stigmatizing. Participants were enthusiastic about obtaining medication abortion through a variety of service delivery modalities, including telemedicine, and believed these strategies could increase equitable and affordable access. ConclusionsBarriers to finding and accessing abortion care persist across Australia. Efforts to challenge the over-regulation of mifepristone, increase the affordability of medication abortion, and enhance training opportunities to educate a variety of clinicians about medication abortion and support provision from a range of providers appear warranted. ImplicationsThe continued over regulation of mifepristone creates barriers for incorporating medication abortion into primary care settings and has significant implications for patient access and abortion stigma. Regulatory reform and provider education and training have the potential to improve abortion patients’ experiences with medication abortion.

Prophylactic swallowing therapy for patients with head and neck cancer: A three-arm randomized parallel-group trial.

Intensive prophylactic swallowing therapy can mitigate dysphagia in patients with oropharyngeal (OP) SCC, however, presents service challenges. This trial investigated the clinical efficacy of three service models delivering prophylactic swallowing therapy during (chemo)radiotherapy ([C]RT). Patients (n = 79) with OPSCC receiving (C)RT were were randomized to: (a) clinician-directed face-to-face therapy (n = 26); (b) telepractice therapy via "SwallowIT" (n = 26); or (c) patient self-directed therapy (n = 27). Swallowing, nutritional, and functional status were compared at baseline, 6-weeks, and 3-months post-(C)RT. Patients' perceptions/preferences for service-delivery were collated posttreatment. Service-delivery mode did not affect clinical outcomes, with no significant (P > .05) between-group differences or group-by-time interactions observed for swallowing, nutrition, or functional measures. Therapy adherence declined during (C)RT in all groups. SwallowIT and clinician-directed models were preferred by significantly (P = .002) more patients than patient-directed. SwallowIT provided clinically equivalent outcomes to traditional service models. SwallowIT and clinician-directed therapy were preferred by patients, likely due to higher levels of therapy support.

Effects of Reneging, Server Breakdowns and Vacation on a Batch Arrival Single Server Queueing System with Three Fluctuating Modes of Service

This article examines the effects of reneging, server breakdown and server vacation on the various states of the batch arrivals queueing system with single server providing service to customers in three fluctuating modes. In this queueing system, any batch arrival joins the queue if the server is busy or on vacation or under repair. However, if the server is free, one customer from the arriving batch joins the service immediately while others join the queue. In case of server breakdown, the customer whose service is interrupted returns back to the head of the queue. As soon as the server has is repaired, the server attends to the customer in mode 1. For this queueing system, customers that are impatient due to breakdown and server vacation may renege (leave the queue without getting service). Due to fluctuating modes of service delivery, the system may provide service with complete or reduced efficiency. Consequently, we construct the mathematical model and derive the probability generating functions of the steady state probabilities of several states of the system including the steady state queue size distribution. Further, we discuss some particular cases of the proposed queueing model. We present numerical examples in order to demonstrate the effects of server vacation and reneging on the various states of the system. The study revealed that an increase in reneging and a decrease in server vacation results in a decrease in server utilization and an increase in server’s idle time provided rates of server breakdown and repair completion are constant. In addition, the probability of server vacation, the probability of system is under repair and the probabilities that the server provides service in three fluctuating modes decreases due to an increase in reneging and a decrease in vacation completion rates.

Government Size and Quality of Governance: Does State Size Matter?

Purpose: Small state studies has emerged as a discipline, and this discipline has been initially dominated mainly by the issues of vulnerability and a lack of capacities of small states, although these issues have been gradually replaced by the discussions on the potential opportunities of small states, not just their challenges. Within this framework, the consideration needs to be done also on the effect of the state size on the economics, governance and public management, among others. Design/methodology/approach: The current theorizing in small state studies focuses on the specifics of the small economy modelling and governance. The existing economic literature has occasionally stressed the relations between the size of the state and size of government, but with rather mixed empirical results. Moreover, relations between state size and quality of governance has also been emerging issue. This study would like to integrate both approaches. The empirical research utilizes cross-national comparative investigation based on the data for 44 European states; and we specifically assess, in addition to the existing approaches, how budgetary and non-budgetary scope of government differentiates among smaller and larger states. Findings: The results of the study suggest that the effect of the size of the state does not necessary favour larger states in respect to the smaller size of government and quality of governance. Thus, although potential scale economies matter regarding the public services’ provision, the structure of spending, institutional context, and innovations in public service delivery modes also have the role in shaping scope and functions of the government, whereas quality of governance seems to be independent regarding the state size, at least in the European context. Research limitations/implications: Analysis is limited to the cluster of European states, and the results should be interpreted within this context. Originality/value: After the World War II the number of states has increased substantially, in fact, it has tripled. We are currently living in the era of small states, as more than one third of the existing two hundred and more states around the globe are actually small, if we assess the multiple criteria combination. In this context, this paper would like to add to the development of the field of small state studies.

Exploring User-Related Drivers of the Early Acceptance of Certified Digital Stress Prevention Programs in Germany.

Electronic mental health services represent innovative instruments to increase the dissemination of stress programs in primary prevention. However, little is known about facilitators of their uptake. This study aimed to explore determinants of the acceptance of centrally certified digital stress coping programs and preferences for service delivery modes among adult members of German statutory health insurances. Participants completed a multi-construct 45-item questionnaire covering acceptance of digital stress prevention (behavioral use intention) and potential predictors we assessed using hierarchical regression analysis—(1) socio-demographic variables and time spent online, (2) openness to experience, (3) perceived stress, and (4) attitudes toward e-mental health. Preferences in terms of the willingness to use online, face-to-face and blended programs were analyzed using paired t-tests. Participants (N = 171, 66% female, 18-69 years) reported a moderate acceptance of digital stress management (M = 2.76, SD = 1.16, range: 1-5). We identified younger age (ß = -0.16, P = .009), openness to experience (ß = 0.17, P = .003), and positive attitudes (ß = 0.61, P < .001) as predictors of acceptance (R2 = .50, P < .001). Face-to-face was preferred over online (d = 0.40) and blended (d = 0.33), and blended over stand-alone online delivery mode (d = 0.19; all P < .001). Our findings indicate that promoting favorable attitudes toward digital stress prevention through tailored information may be a starting point to facilitate their adoption.

Reviving permanent contraception: New medical procedures or new service delivery modalities?

Despite the prevalent increase of permanent contraception, there are still 222 million women with unmet needs for contraception; a large proportion of these women could opt for permanent contraception. New approaches to permanent contraception are in development; in the meantime, services need to be accessible, affordable, safe, and convenient to allow women, men, and couples to realize their reproductive intentions. Among the available approaches, we recommend minilaparotomy and no-scalpel vasectomy. These are proven as safe, effective, and feasible surgical techniques that can be offered through a wide range of service modalities such as static clinics, mobile outreach, and using task sharing. Both of these approaches have low complication rates, these being mostly minor complications, and low failure rates. Programs must ensure that they address the provision of these services under a human rights-based approach that will allow services to thrive and individual needs will be fulfilled.

The Emphasis on Secondary Transition Services in Rehabilitation Counseling Journals Revisited

A content analysis was conducted of articles (n = 1,024) published between 2010-2017 in five major rehabilitation counseling journals, pertaining to transition-age students and youth with disabilities, in order to extend the findings of Plotner, Shogren, and Strauser (2011). Specifically, there was a focus on quantifying the number of publications in each of the five journals to determine how existing transition-focused publications are related to the seven domains within the Vocational Rehabilitation Transition Process Domain Structure (Plotner, Trach, &amp; Strauser, 2012), and to measure the change in transition-focused publications within all five journals compared to the findings of the previous analysis. Four out of five journals showed a slight increase in the amount of transition-focused articles compared to the previous analysis. Frequencies of transition-specific articles by journal were as follows: Journal of Vocational Rehabilitation (16%), Journal of Rehabilitation (10%), Journal of Applied Rehabilitation Counseling (8%), Rehabilitation Counseling Bulletin (5%), and Rehabilitation Research, Policy, and Education (1%). Transition-focused articles were then categorized into one of the following domains: Career Planning and Counseling, Career Preparation Experiences, Access and Opportunity for Success, Program Improvement Activities, Nonprofessional Support and Relationships, and Collaborative Partnerships. Developing and Maintaining Collaborative Partnerships accounted for the greatest overall frequency of each of the domains (n = 21). The largest gaps in the literature were observed in Facilitating Nonprofessional Support and Relationships and Facilitating Allocation of Resources, which had the fewest articles (n = 2, 3, respectively). Aligning and prioritizing the domains, needs, and research efforts can target areas of high priority. The information generated is timely and pertinent for transition services for out-of-school youth and students with disabilities, including the delivery of preemployment transition services. Implications for practice and recommendations for future research directions are presented.

Mapping transitional care pathways among young people discharged from adolescent forensic medium secure units in England.

This study tracked young offenders transitioning from national adolescent forensic medium secure units to adult services in the UK within a six-month period. We used a mapping exercise to identify eligible participants moving during the study period from all national adolescent forensic medium secure units in England. Young people older than 17.5 years or those who had turned 18 years (transition boundary) and had been referred to adult and community services were included. Of the 34 patients identified, 53% moved to forensic adult inpatient services. Psychosis was the most prevalent symptom among males (29%), and emerging personality disorder symptomatology was commonly reported among females (18%) followed by learning disability (24%). The mean time for transition to adult mental-health services and community settings was eight months. There were no shared transition or discharge policies, and only two hospitals had discharge guidelines. The findings highlight the need for consistency between policy and practice among services along with the development of individualised care pathways. Future qualitative research is needed to understand and reflect on young people’s and carers’ experiences to improve transition service delivery.

HOW DOES MODE OF SERVICE DELIVERY IMPACT CAREGIVER STRAIN? A MIXED-METHODS STUDY OF CAREGIVERS IN LOS ANGELES

As the number of people living with Alzheimer’s disease and related dementias increases, so too will the number of people who care for them. This growing population requires instrumental and emotional support as they fulfill their caregiving duties. CareJourney is an online platform that provides this support; it can be used either alone, or with traditional in-person and phone-mediated consultations with family care navigators (FCNs). The intent of CareJourney is to provide a greater opportunity for self-directed services, as well as flexibility for working caregivers and those who prefer using technology. Satisfaction surveys (N=222) were analyzed to evaluate caregivers’ perceptions of CareJourney and the traditional service delivery modes. Additionally, five 30-minute interviews with caregivers were coded by two researchers (kappa=0.84) for a more in-depth understanding. Ten percent of survey respondents used CareJourney, and preliminary results from both the interviews and the survey suggest that caregiver burden, lack of time, and desire for a personal connection with FCNs influence mode of service delivery. Although a quarter of users relied on CareJourney to find caregiving resources and email their FCNs because it was more convenient than traditional modes, the interviews and surveys revealed that the caregivers most valued the personal touch that came from interacting with FCNs. Speaking with FCNs over the phone or in-person allowed caregivers to feel “reassured,” “less isolated,” and “comforted” as they discussed caregiving strains. Future interventions and services for caregivers should be offered using multiple modes to accommodate a range of time-demands and preferences for personal connection.

Digital interface in Indonesia’s public service broadcasting: Its initiatives and regulatory challenges

Abstract The merging of broadcast platforms, the Internet and social media has challenged the former state-owned broadcasters of Indonesia to find new content strategies and forms suited to the networked media environment. Over the past decade, the arrival of digital technology and rapid growth of social media has broken down the previous linear model of service delivery in Indonesian broadcasting. However, national policy on this issue remains lacking. At present, the Indonesian Broadcast Law (Law No. 32 of 2002) only gives the country’s public radio an ability to use the spectrum in the analogue model. Digital migration, as well as legal protection of social media services, remains an ongoing debate among policy-makers, that will allow free market competition, in particular to opportune the interface of service providers and content producers. Drawing from semi-structured interviews, observations and regulatory reviews, this article broadly investigates the introduction of digital interfaces in the new public service broadcasters of Indonesia, with particular focus on the process through which Indonesian PSBs have embraced the digital media environment to enable the flow of information and public participation between the media entities and their publics. In this article, I present both technology and regulatory perspectives by emphasizing the dynamics of the digital media modes of public service delivery, particularly those through which analogue broadcasts and social media have sought new ways to intertwine. In detail, I will examine certain interactive services applied by Radio Republik Indonesia (RRI), the flagship of Indonesian national public radio, namely RRI-Play, RRI.co.id and RRI-Net, to manage audience participation. Since 2016, these digital platforms have mediated public access to RRI content, generated data on media users, and monitored technological performance. In inspecting these platforms, I refer firstly to the normative debate of public service broadcasters as ‘deliberative public sphere’ before segueing into the three public-service functions that are important in social network media landscape: curation, moderation and monitoring. Furthermore, this article analyses problems behind the regulatory design of Indonesian public-service media within the context of digital broadcasts in the country.

Mobile Phones as a Medium of Mental Health Care Service Delivery: Perspectives and Barriers among Patients with Severe Mental Illness.

Background:The use of mobile phone technology to support various components of health care delivery (often referred to as mHealth) is on the rise. Little systematic information, however, is available on user felt needs and barriers to mHealth approaches among people with severe mental illness (SMI). Our objectives were to elicit user needs, preferences, and barriers to using mobile phones for health care service delivery among people with SMI.Materials and Methods:A cross-sectional study was carried out among 75 subjects with SMI between August 2017 and October 2017. All patients had a minimum illness duration of two years or more and a Global Assessment of Functioning score of less than 70. Information on user perspectives was elicited using a 10-item structured questionnaire, to assess mobile phone usage patterns, felt needs, barriers, and preferences, developed for use in patients with SMI.Results:Majority of the patients reported using mobile phones and were favorably disposed to mHealth approaches. Voice calls (n = 47, 62.7%) were the most preferred mode of service delivery. The most preferred service frequency was twice-weekly (n = 31, 41.3%), followed by once-weekly (n = 22, 29.3%). Majority (n = 47, 62.7%) reported no barriers to mobile phone usage, whereas 14 (18.6%) perceived a lack of necessity of mobile phones as a service delivery medium. Reminders about medication and appointments through mobile phones (n = 35, 46.6%) were the most felt needs, followed by crisis helplines (n = 27, 36.0%) and information about mental health services (n = 22, 29.3%).Conclusion:These findings support the use of mHealth approaches in resource-constrained settings and provide specific inputs to refine the modalities of mHealth service delivery.

Systematic review of patient and caregivers' satisfaction with telehealth videoconferencing as a mode of service delivery in managing patients' health.

Telehealth is an alternative method of delivering health care to people required to travel long distances for routine health care. The aim of this systematic review was to examine whether patients and their caregivers living in rural and remote areas are satisfied with telehealth videoconferencing as a mode of service delivery in managing their health. A protocol was registered with PROSPERO international prospective register of systematic reviews (#CRD42017083597) and conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic search of Ovid Medline, Embase, CINAHL, ProQuest Health Research Premium Collection, Joanna Briggs Institute and the Cochrane Library was conducted. Studies of people living in rural and remote areas who attended outpatient appointments for a health condition via videoconference were included if the studies measured patient and/or caregivers’ satisfaction with telehealth. Data on satisfaction was extracted and descriptively synthesised. Methodological quality of the included studies was assessed using a modified version of the McMaster Critical Review Forms for Quantitative or Qualitative Studies. Thirty-six studies of varying study design and quality met the inclusion criteria. The outcomes of satisfaction with telehealth were categorised into system experience, information sharing, consumer focus and overall satisfaction. There were high levels of satisfaction across all these dimensions. Despite these positive findings, the current evidence base lacks clarity in terms of how satisfaction is defined and measured. People living in rural and remote areas are generally satisfied with telehealth as a mode of service delivery as it may improve access to health care and avoid the inconvenience of travel.

Analysis on Optimization Selection of Nursing Service Delivery Mode in Long-Term Nursing Insurance System

Analysis on Optimization Selection of Nursing Service Delivery Mode in Long-Term Nursing Insurance System

Shifting modes of service delivery in Dutch local government

ABSTRACT Analyzing shifts in the delivery mode of 12 municipal services between 2010 and 2018, in about 41% of the observations, shifts took place, with 54% toward outside production and 46% toward inside production. In the physical domain, most shifts were to cooperation, whereas in the operational domain reverse privatization and also cooperatization are dominant trends. Based on logit models, for services with high asset specificity, we find a lower likelihood of change, whereas for services with high measurement difficulty, we find a higher likelihood of change to outside and away from in-house, and a lower likelihood of change to inside.