Availability Of Services Research Articles

Changes in Availability of Later Abortion Care Before and After Dobbs v. Jackson Women's Health Organization

OBJECTIVE: To examine changes in availability of procedural abortion, especially in the second and third trimesters of pregnancy, since the U.S. Supreme Court ended federal protections for abortion in its Dobbs v. Jackson Women’s Health Organization decision in 2022. METHODS: We used the Advancing New Standards in Reproductive Health Abortion Facility Database, a national database of all publicly advertising abortion facilities, to document trends in service availability from 2021 to 2023. We calculated summary statistics to describe facility gestational limits for procedural abortion for the United States and by state, subregion, and region, and we examined the number and proportion of facilities that offer procedural abortion in the second or third trimester of pregnancy. RESULTS: From 2021 to 2023, the total number of publicly advertising facilities providing procedural abortion decreased 11.0%, from 473 to 421. Overall, one-quarter of facilities (n=115) that had been providing procedural abortion in 2021 ceased providing services, and an additional 99 decreased their gestational limits. In contrast, 73 facilities increased their gestational limits, and 64 new facilities began providing or publicly advertising procedural abortion services. The number of facilities offering procedural abortion later in pregnancy decreased (327 to 309 providing 14 weeks of gestation or later, 60 to 50 providing 24 weeks of gestation or later), although the proportion of all facilities providing these services held steady. The greatest changes were in the South, where many facilities closed. CONCLUSION: There have been substantial reductions in the number and distribution of facilities offering procedural abortion since the Dobbs decision, with critical decreases in the availability of later abortion services. Some facilities are positioning themselves to meet the needs of patients by opening new facilities, publicly advertising their services, or extending their gestational limits.

Power, data and social accountability: defining a community-led monitoring model for strengthened health service delivery.

Despite international commitment to achieving the end of HIV as a public health threat, progress is off-track and existing gaps have been exacerbated by COVID-19's collision with existing pandemics. Born out of models of political accountability and historical healthcare advocacy led by people living with HIV, community-led monitoring (CLM) of health service delivery holds potential as a social accountability model to increase the accessibility and quality of health systems. However, the effectiveness of the CLM model in strengthening accountability and improving service delivery relies on its alignment with evidence-based principles for social accountability mechanisms. We propose a set of unifying principles for CLM to support the impact on the quality and availability of health services. Building on the social accountability literature, core CLM implementation principles are defined. CLM programmes include a community-led and independent data collection effort, in which the data tools and methodology are designed by service users and communities most vulnerable to, and most impacted by, service quality. Data are collected routinely, with an emphasis on prioritizing and protecting respondents, and are then be used to conduct routine and community-led advocacy, with the aim of increasing duty-bearer accountability to service users. CLM efforts should represent a broad and collective community response, led independently by impacted communities, incorporating both data collection and advocacy, and should be understood as a long-term approach to building meaningful engagement in systems-wide improvements rather than discrete interventions. The CLM model is an important social accountability mechanism for improving the responsiveness of critical health services and systems to communities. By establishing a collective understanding of CLM principles, this model paves the way for improved proliferation of CLM with fidelity of implementation approaches to core principles, rigorous examinations of CLM implementation approaches, impact assessments and evaluations of CLM's influence on service quality improvement.

Barriers and facilitators for universal gestational diabetes Mellitus screening in a low resource setting: a cross-sectional study in Sri Lanka

Gestational Diabetes Mellitus (GDM) is associated with adverse maternal and perinatal outcomes and increased risk of developing diabetes in later life. Sri Lanka adopted universal GDM screening at two time points in pregnancy (before 12 weeks and between 24 and 28 weeks) in 2014 and its utilization has not been assessed. This study assessed the utilization of GDM screening services and associated factors among antenatal mothers in Southern Sri Lanka. A cross-sectional study was carried out in a consecutive sample of 420 postpartum mothers who delivered at three major hospitals in Sri Lanka. Data were collected on socio-demographics, pregnancy, availability and utilization of screening services and logistics using an interviewer-administered questionnaire and a data record sheet. Data was analysed using SPSS software. Chi-square test and binary logistic regression was used to assess the association between variables. The coverage of first and second screening tests were 91.4% and 94.5% and timeliness were 72.4% and 59.5%, respectively. The median period of amenorrhoea at the first and second screening were 10.0 (inter-quartile range: 2.5) weeks and 28.0 (inter-quartile range: 1.5) weeks. A higher utilization was associated with higher income (OR = 3.4, 95% CI: 1.1–10.5) and planned pregnancy (OR = 4.9, 95% CI: 2.2–10.7) for the first screening test. Primiparity (OR = 0.3, 95% CI: 0.1–0.9) and proximity of the nearest laboratory (OR = 3.5, 95% CI: 1.0–12.0) were positively associated with the second screening test. The timeliness of both screening tests was associated with planned pregnancy (OR = 2.1, 95% CI: 1.1-4.0 and OR = 2.3, 95% CI: 1.1–4.5) and being non-employed during the pregnancy (OR = 2.5, 95% CI: 1.4–4.3 and OR = 2.3, 95% CI: 1.3–4.1). A high utilization of GDM screening was observed. Timeliness should be ensured through improved availability and accessibility of screening facilities.

Latency‐Sensitive Service Function Chains Intelligent Migration in Satellite Communication Driven by Deep Reinforcement Learning

ABSTRACTSatellite communication technology solves the problem that the traditional wired network infrastructure is difficult to achieve global communication coverage. However, factors such as satellite orbits introduce frequent changes to the network topology, and challenges like satellite failures and communication link interruptions are prevalent. In the face of these issues, service function chain (SFC) migration becomes a crucial method for swiftly adjusting SFCs during faults, maintaining service continuity and availability. This article proposes a latency‐sensitive SFC migration algorithm tailored to satellite networks. The algorithm first models the satellite network as a multi‐domain virtual network, capturing the constraints faced during SFC migration. Subsequently, a deep reinforcement learning algorithm integrated attention mechanism is designed to more accurately capture and understand the complex network environment and dynamic satellite network topology and derive optimal SFC migration strategies for superior performance. Finally, through experimentation and evaluation of the deep reinforcement learning‐driven latency‐sensitive service function chain intelligent migration algorithm (LS‐SFCM) in satellite communication, this study validates the effectiveness and superior performance of the algorithm in latency‐sensitive scenarios. It provides a new avenue for enhancing the service quality and efficiency of satellite communication networks.

Mapping and Identification of Ecosystem Services Hotspots in the Brazilian Pampa Biome.

The intensification and expansion of changes in land use and land cover (LULC) can reduce the availability and quality of natural habitats and ecosystem services (ES). These changes have generated environmental damage in different parts of the world, especially in biomes more susceptible to modifications, such as the Pampa biome in the extreme south of Brazil. The Pampa biome has been neglected by environmental protection laws, despite its broad ecosystem and social importance. In this study, we used InVEST models to map and quantify five ES provided (i.e., water supply, carbon stock, groundwater stock, sediment retention and habitat quality) by 14 watersheds distributed in the Brazilian Pampa biome as well as determine ES hotspots by summing the areas with high provision of ES. We identified low availability of water supply and groundwater stock in practically the entire study area. High sediment retention and carbon stock were reported in areas with the presence of native vegetation. In addition, despite the large degraded areas, we observed high habitat quality associated with native vegetation in all studied watersheds. The hotspots varied spatially in the study area according to the proposed scenarios, the supply and the overlap of ES. Scenario 1 (>50% of ES) presented a larger area of high provision of ES. In contrast, scenario 2 (>75% of ES) presented smaller patches of areas with high provision of ES distributed across different watershed. We observed that large territorial extensions with high and medium provision of ES are vulnerable to the negative effects of LULC. Our study presented scenarios that indicate areas of high provision of ES, contributing to a more practical application, being a simplified and useful tool that can assist conservation and sustainable policies.

Enhancing service quality in the insurance industry with AI-powered humanoid chatbots

PurposeThis study aims to explore the potential of artificial intelligence with AI-powered humanoid Chatbots (AIPHC) as transformative tools to improve customer service quality in the insurance sector. The usability and efficiency of integrating advanced AI chatbots that can replicate human-like interactions in insurance services will be examined by taking into consideration customers’ technological readiness and chatbots’ anthropomorphism.Design/methodology/approachThis empirical study analysed 688 customer responses collected through purposive sampling using structural equation modelling. With the help of SmartPLS 4.0, the study determines whether anthropomorphism, that is AIPHC system-specific and customer personality-specific dimensions, can influence the acceptance of AIPHC in the insurance sector.FindingsThe results show that the chatbot’s anthropomorphism positively influenced customers’ optimism and innovativeness but negatively impacted discomfort and security. Further optimism and innovativeness favourably impact AIPHC adoption. Insecurity had a significant negative impact, while discomfort was insignificant for AIPHC adoption.Research limitations/implicationsThe study determines how people will react to AI-powered information systems. The results could help us better understand how the technological readiness of customers can be used in emphasizing the significance of system-specific theories like anthropomorphism in sectors like insurance, where customer interactions and delivery of quality services are important.Practical implicationsThe results highlight chatbots’ potential to raise the quality of service, simplify processes and enhance customers’ overall experiences in the insurance sector. This study contributes to the continuing discussion on using AI technologies in customer service by considering the interplay between technology readiness and anthropomorphism. It also provides insightful information for insurance professionals and technology developers.Social implicationsAnthropomorphic humanoid chatbots can increase the availability, affordability and accessibility of essential services. They have the potential to increase users’ competence, autonomy and—possibly counterintuitively social relatedness.Originality/valueThis empirical research explores the link between anthropomorphism and technology readiness to enhance service quality provided by AI powered chatbots in the insurance sector.

The nexus between maternal antenatal care attendance, newborn postnatal care and neonatal mortality in India: a matched case-control study

IntroductionOur study examines the relationship between newborn postnatal care and neonatal mortality stratified by maternal antenatal care attendance under a matched case-control framework.MethodsData from the fifth round of the National Family Health Survey was used. A total of 172,079 recent births to eligible women (15–49 years) in five years preceding the survey were included in the study. We used the conditional logistic regression model, a commonly used regression model to fit matched case-control data to examine the effects of newborn postnatal care on neonatal mortality. The mother’s age at birth of the newborn, previous birth intervals, birth order of the newborn, and birthsize of the newborn were included as the matching variables.ResultsNewborns receiving postnatal care within two days or more than two days of birth are less likely to die during the neonatal period. Preferences for newborn postnatal care were also observed to increase with more maternal antenatal care visits. Our study also found a lower risk of neonatal mortality among those newborns whose umbilical cord was examined within two days of birth, regardless of the number of maternal antenatal care visits. Similarly, the risk of newborn deaths was lower among babies whose body temperature was measured within two days of birth. The tendency to breastfeed their newborns within an hour after delivery was considerably higher among those births that occurred to mothers who had a higher number of maternal antenatal care visits. The risk of newborn deaths was also observed to be lower among those born in public or private healthcare facilities.ConclusionConsidering the cohesive nature of the relationship between neonatal mortality and maternal and child healthcare utilisation, strategic planning and management of the existing policies and programmes related to accessibility, availability, and affordability of maternal and child healthcare services is needed to achieve goal 3.2 of the Sustainable Development Goals. Promoting cost-effective measures such as continuous monitoring of the baby’s body temperature and umbilical cord care could also effectively help reduce neonatal mortality.

Predicting the Impact of Distributed Denial of Service (DDoS) Attacks in Long-Term Evolution for Machine (LTE-M) Networks Using a Continuous-Time Markov Chain (CTMC) Model

The way we connect with the physical world has completely changed because of the advancement of the Internet of Things (IoT). However, there are several difficulties associated with this change. A significant advancement has been the emergence of intelligent machines that are able to gather data for analysis and decision-making. In terms of IoT security, we are seeing a sharp increase in hacker activities worldwide. Botnets are more common now in many countries, and such attacks are very difficult to counter. In this context, Distributed Denial of Service (DDoS) attacks pose a significant threat to the availability and integrity of online services. In this paper, we developed a predictive model called Markov Detection and Prediction (MDP) using a Continuous-Time Markov Chain (CTMC) to identify and preemptively mitigate DDoS attacks. The MDP model helps in studying, analyzing, and predicting DDoS attacks in Long-Term Evolution for Machine (LTE-M) networks and IoT environments. The results show that using our MDP model, the system is able to differentiate between Authentic, Suspicious, and Malicious traffic. Additionally, we are able to predict the system behavior when facing different DDoS attacks.

Open climate science is brave climate science

Abstract The pivotal role of climate science in advancing the UN Sustainable Development Goals underscores the urgent need for ample and open climate data sharing. While numerous large-scale endeavours highlight the efficacy of open climate data, we often encounter personal reservations in our scientific community. Here, we argue that beyond infrastructure and service availability, a framework of
acceptance and courage is needed in progressing data visibility.

Exploring factors affecting adherence to multiple micronutrient supplementation during pregnancy in Cambodia: A qualitative analysis.

For decades, iron-folic acid (IFA) supplements have been provided to pregnant women in Cambodia through antenatal care (ANC) services. However, mounting evidence suggests that multiple micronutrient supplements (MMS) are superior to IFA supplements in achieving positive pregnancy outcomes. The possibility of transitioning from IFA supplements to MMS in government-run health centres is currently being assessed in Cambodia. A crucial component of this assessment involves identifying factors that can influence adherence to MMS, as low adherence can reduce supplement effectiveness. Consequently, this study aimed to explore the potential barriers and enablers to MMS adherence and identify the strengths and challenges of current ANC services. Data were collected through nine focus group discussions with pregnant women (n = 19), family members (n = 18) and midwives (n = 18) and three in-depth interviews with maternal and child health chiefs (n = 3) in Cambodia and analysed via content analysis. Factors found to influence MMS adherence included attitudes, perceptions and beliefs about MMS; knowledge related to supplementation; ANC counselling; family influence; physical health; access to ANC; supply of MMS; and supplementation norms. Noted strengths of ANC services were the quality of ANC materials, tailored patient education, midwife-patient relationships and flexibility of provided services. Primary challenges related to poor availability of ANC materials, inadequate midwife training, heavy workload, limited funding and suboptimal physical spaces for delivering ANC services. To effectively promote MMS adherence, strategies must involve pregnant women, family members and community leaders; seek to address knowledge gaps and misconceptions related to MMS; and enhance the availability and accessibility of ANC services.

FORCED INTERNAL DISPLACEMENT OF THE UKRAINIAN POPULATION: RISKS RAISED BY WAR

The large-scale war forced millions of Ukrainians to leave their homes in search of safety. The mass displacement of the population led to an increase in the level of uncertainty and raised risks for both individuals and the whole of society. This article aims to assess the scale of internal migration in Ukraine during the war and to investigate the impact of this phenomenon on the quantitative and qualitative characteristics of the labor potential and the possibilities of its use. Our assessment of the number of internally displaced persons (IDPs), and our examination of the state of their adaptation and integration in the new territories of residence are based on administrative data about the registration of citizens as IDPs provided by social services as well as the surveys and research findings by international organizations and domestic sociological institutions. We present an overview of individual challenges and risks raised by the forced displacement of the population, and highlight the specific features of their manifestation. In particular, we single out an increase in the demographic burden, a decrease in the number of people of reproductive age, a reduction in the number of jobs, an increase in the burden on the budget, a drop in labor productivity, a loss or reduction in the income of a large part of the population, a limit of access to quality social services, as well as unemployment, deterioration of the quality of employment, increased social vulnerability, and weakening of social cohesion. Risks increase the probability of negative changes that lead to uncertainty, deterioration of the demographic situation, weakening of the stability of the economy, decline in the level and quality of life of the population, deepening of social inequality, growth of social tension, decline in the consumption capacity of the population, complete or partial loss of social ties and jobs. We offer recommendations regarding priorities and specific measures of the national state policy aimed at avoiding risks and minimizing their possible consequences. The implementation of this policy should be focused on establishing legal, economic, and institutional frameworks for easing tensions in the areas of material security and employment, improving the demographic situation as well as the quality and availability of social services, and improving living conditions.

Усовершенствование первичной медико-санитарной помощи с применением цифровых технологий: методология разработки инструментария оценки «цифровой зрелости» и научно обоснованные рекомендации

The digitalization of the economy, especially within the framework of the concept of Industry 4.0, has a significant impact on the medical field. In healthcare, digital technologies such as telemedicine technologies, decision support systems and artificial intelligence increase the availability and quality of medical services. The purpose of the study is to develop scientifically based recommendations for improving primary health care using the developed tools for assessing the «digital maturity» of primary care organizations. Materials and methods. To develop recommendations, a methodology was used to assess the «digital maturity» of medical organizations providing primary health care. Experts assessed the indicators of «digital maturity», and their significance was determined through a weighted average. The results of the assessment made it possible to identify the main, additional and excluded indicators, which became the basis for further development of recommendations. Results. Based on the developed methodology, classifications of the levels of «digital maturity» of medical organizations providing primary health care, ranging from low to high levels, were created. These classifications made it possible to identify key aspects that need improvement, including digital infrastructure, information system functionality, the use of artificial intelligence, as well as digital literacy of medical personnel. Conclusions. The digital transformation of primary health care contributes to improving the quality and accessibility of medical services, especially in remote regions. The developed methodology makes it possible to objectively assess the level of digitalization and formulate recommendations for individual digital transformation strategies in the regions of Russia. It is important to continue monitoring and research to assess the long-term effects of digitalization.

Elderly Care Provision under National Policy on Older Persons 2013: A Cross-Sectional Study in Dhaka City, Bangladesh

Bangladesh is undergoing a notable demographic transition, characterized by a substantial rise in the proportion of elderly individuals within its population. This demographic transition presents a range of economic, social and cultural issues that necessitate prompt attention and intervention. The aim of this study was to examine the current state of elderly care services and facilities available for older adults in urban landscape by taking into account the ‘National Policy on Older Persons 2013.’ This study was conducted in Dhaka city by employing a cross-sectional study design. The study population covers elderly people aged 60+ years, living in Dhaka City for more than five years continuously and are able to speak well with someone. The study was based on a sample of 240 and the respondents were chosen using convenient sampling technique. The data were collected through face-to-face interview using structured questionnaire and they were analyzed utilizing descriptive statistics. This study found that the existing elderly care services and available opportunities are below the satisfactory level for most of the older adults of the city, even though the ‘National Policy on Older Persons 2013’ was adopted a decade ago. The elderly people in Dhaka city encountered a number of difficulties considering their physical health, psychological and social well-being. In the case of availability of the affordable and quality healthcare services for older adults in their community, 30.4% of the respondents said that the availability, accessibility and affordability of quality healthcare services are very poor, followed by 24.6% below average and 26.3% at the average level. Nearly 75% of the study people said that they had ever experienced unfair treatment for being aged. Indeed, they receive care and support in an inconsistent, disorganized and incoherent manner. The study clearly revealed that there is a need to prioritize person-centered care as well as integrated care system for the effective management of the ageing population in Bangladesh. Jagannath University Journal of Science, Volume 11, Number 1, June 2024, pp. 118−134

Analysis of the Availability of Laboratory Tests to the Number of Requests for Tests and Its Implications on Patient Satisfaction

This study aims to analyze the availability of laboratory tests based on the number of test requests and their implications for patient satisfaction. Health laboratories are a vital component of healthcare services, providing accurate laboratory test results to support patient diagnosis and treatment. The availability of fast and accurate laboratory tests plays a crucial role in speeding up diagnosis and treatment, which ultimately impacts patient satisfaction. However, many healthcare facilities face challenges in providing adequate laboratory test availability, such as limitations in equipment, expertise, and inefficient procedures. This study employs a literature review approach to collect, analyze, and synthesize information from various relevant sources. The findings reveal that the availability of fast and accurate laboratory services can enhance patient satisfaction, while limitations in availability can lead to dissatisfaction and increased waiting times. Therefore, effective laboratory management is essential to improve service quality and patient experience in hospitals. This research is expected to provide valuable insights for improving the healthcare system, particularly in laboratory management.

Are people with HIV at advanced disease stages being left behind? A global survey.

A substantial percentage of people with HIV are still admitted for care at advanced disease stages. Here, we investigate the availability of the supplies and infrastructure required to provide care for this population in healthcare facilities and explore correlations with local demand. AIDS Healthcare Foundation's partner facilities were invited to respond to a survey addressing the availability of services to support clients with advanced HIV. We present results per continent and according to gross national income per capita using frequencies and percentages. We generated country-level scores taking the average percentage of facilities with available resources on 10 key items and used Spearman's correlation to investigate relationships between country scores and local demand, depicted by the percentages of people with HIV newly enrolled in care with a CD4 T-cell count <200/mm3 in 2022. A total of 643 facilities from 37 countries responded to the survey between September and December 2021. Overall, services requiring more costly equipment and/or supplies were less frequently available. Facilities in Africa, Asia, and Latin America/Caribbean and those with lower gross national income had a somewhat lower availability of diagnostic and therapeutic resources. Availability of services was not correlated with local demand: 14 countries (42%) had scores below the 50% percentile despite having >20% of newly enrolled people with HIV with a CD4 T-cell count <200/mm3. Appropriate care can mitigate the morbidity and mortality associated with advanced HIV. We found that the healthcare services recommended by the World Health Organization as essential to support clients with advanced HIV are often unavailable in facilities providing HIV care, despite high local demand.

Challenges and Barriers to Utilizing Eye Care Services Among Urban Population Globally: A Scoping Review

Objective: Eye health is crucial for overall well-being, relying on eye care services for the prevention and treatment of vision disorders. Increasing blindness rates underscore the need for early detection. Despite known urban-rural disparities in eye care utilization, urban challenges are underexplored. This scoping review summarized and determined the challenges and barriers to utilizing eye care services specifications in urban populations globallyMaterial and Methods: A search was conducted on multiple databases such as Scopus, ScienceDirect, WOS, PubMed, and Google Scholar, covering the period of 2000 to 2023. The criteria were selected based on the PRISMA statements. The search focuses on challenges and barriers in utilizing eye care services.Results: The search identified 464 studies, and 18 were included in the final review. Person-related and service-related barriers can be distinguished from the review. The most common challenges were lack of felt need the eye care services and cost. Person-related barriers were found to be higher compared to service-related barriers among urban populations. Conclusion: The scoping review highlights significant person-related and service-related barriers to utilizing eye care services in urban populations globally. Despite the availability of services, person-related barriers were more pronounced, indicating a critical need for targeted interventions. Addressing these barriers is essential to enhance eye care services and reduce the prevalence of vision disorders in urban settings.

Experiences of Sexual and Gender Minorities with Health Care in the Philippines: A Qualitative Study.

There is limited availability and accessibility of health care facilities and services tailored to the specific health care needs of sexual and gender minorities (SGMs) in the Philippines. The purpose of this study was to describe SGMs' experiences with health care services in the Philippines. Using a phenomenological design, interviews were conducted with participants recruited online through SGM networks and organizations. Individual, online-recorded interviews were conducted with 14 participants who were at least 18 years old, were Filipino nationals residing in the Philippines, self-identified as SGM, could comprehend and write in Filipino, and received any health care service within the past year. Data were entered and analyzed using the NVivo software. Three major themes emerged: patient-centered communication and relationship, holistic care, and caring environment. Participants identified the significance of genuine, affirming, and respectful communication in building positive relationships and continuing engagement with health care. Holistic care is embedded in clinical competence, gender sensitivity, continuity of care, and collaborative practice with other disciplines. A caring environment minimizes gender-related stigma and discrimination and promotes acceptance of diverse sexual identities. Filipino SGMs face several multifaceted health care concerns and challenges stemming at the individual, institutional, and societal levels. Sexual and gender biases, stigma, and discrimination are major barriers to health care among SGMs. Promotion of culturally and gender-sensitive care among Filipino SGMs should involve training of health care providers and creation of programs and policies to understand and respect SGMs while considering social, cultural, and political influences on their health and well-being.

Improved access and care through the implementation of virtual Hallway, a consultation platform in Nova Scotia: preliminary findings from a feasibility evaluation

BackgroundWhile previous studies have examined various platforms that enable providers to connect, Virtual Hallway (VH) stands out with its unique features. The value add is that this online platform connects primary care providers and specialists for synchronous phone-based conversations and aims to reduce referrals and enhance the quality of referrals. VH allows providers to easily log in, select the required specialty, book call times, receive reminders, and have calls documented, ensuring a high connection rate. In May 2022, the provincial health authority in Nova Scotia, a Canadian province, and VH initiated a feasibility study facilitated through the Health Innovation Hub in Nova Scotia. The goal was to enable primary care providers to connect with specialists, thereby reducing wait times and unnecessary referrals, and facilitating timely access to relevant clinical direction for patients. The current evaluation assessed utilization, value for money in economic analysis, and consultation experiences.MethodsThe study used post, cross-sectional, and cost-benefit study designs. We collected data through various methods, including administratively recorded utilization, theory-driven surveys, and cost data. Utilization was measured by the number of completed consults and the number of healthcare professionals using the VH platform. We analyzed the data using a combination of descriptive statistics and a cost-benefit analysis, which also involved conducting probabilistic sensitivity analysis.ResultsThe study found that approximately 84% of the VH consultations avoided needing in-person specialist referrals. The return on investment was 1.8 (95% CI: 0.8 to 3.0), indicating that the monetary value of the measurable benefits associated with VH exceeded the value of the resources invested. The provider experience survey revealed high satisfaction levels with VH across user groups, with 92% of specialists and 96% of primary care providers reporting being satisfied or highly satisfied with their experience. These positive indicators of provider experience were further supported by the fact that 97% of respondents agreed or strongly agreed that they intended to continue to use VH in their practice, and 97% of respondents agreed or strongly agreed that they would recommend VH to a colleague.ConclusionsThe study suggests that VH was well-received by users, with high levels of satisfaction reported and a reduced need for in-person referrals. It also represented value for money. Further research could explore how the availability of virtual health services can lead to reduced utilization of healthcare resources among different groups of patients.

Assessing the utilization of Current Procedural Terminology codes in pharmacists' services using MarketScan data.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. The Medicare Prescription Drug, Improvement, and Modernization Act and Centers for Medicare and Medicaid Services affirmation enabled pharmacists to use Current Procedural Terminology (CPT) codes for documentation and billing of clinical services. Despite legislative support and potential availability of pharmacists' clinical services, a gap may exist between the reported availability and actual prevalence of these services in real-world settings. The objective was to assess the prevalence of selected CPT codes (99605-99607, 98966-989968, and 99211-99215) in documenting and billing potential pharmacists' clinical services using recent available data. This retrospective study utilized the Merative MarketScan Medicare database from the period January 1, 2016, to December 31, 2020. The dataset included deidentified patient information and CPT codes. Patients with CPT codes for face-to-face medication therapy management (MTM) services (99605-99607), codes for telephonic assessment and management (A/M) services (98966-98968), and/or codes for evaluation and management (E/M) services (99211-99215) were identified from outpatient claims. Descriptive statistics, including prevalence rates, were calculated. This study was approved by an institutional review board and followed STROBE guidelines. There were claims data for 2,784,629 enrollees from 2016 through 2020. Prevalence rates varied during this period, with lower rates for MTM face-to-face CPT codes (0.06%) and telephonic A/M codes (0.58%), while E/M CPT codes showed higher prevalence rates (87%). Study findings exhibited a limited adoption rate for MTM CPT codes for billing pharmacists' clinical services. Future research may focus on assessing pharmacists' perceptions and identifying facilitators and barriers to using CPT codes in billing clinical services.

Impact of Internet and mobile communication on cyber resilience: A multivariate adaptive regression spline modeling approach

The spread of broadband Internet and the availability of mobile communication services expand access to digital services for businesses and the public alike. However, at the same time, it aggravates the problem of ensuring digital space security, protection against cyber threats, and the fight against cybercrime. This research aims to calculate the index of a country's resilience to cyber-hacking for 143 countries, to divide these countries into groups based on this resilience (high, above-average, average, below-average, and low), compare these results with those obtained on the basis of National Cyber Security Index (NCSI), and to identify the impact of the Internet and mobile communication prevalence in a country on this level. The selection of the countries is based on the availability of statistical data for 2022 in the databases of the Surfshark VPN service, and the International Telecommunication Union. The integral index of a country's resilience to cyber-hacking is calculated through the multiplicative convolution (with weighted geometric mean) of the number of breached accounts, the Internet penetration probability (penetration into users’ data through the Internet), and the breach density per thousand users. The influence of active mobile broadband subscriptions (per 100 inhabitants), mobile broadband basket (% of Gross National Income Per Capita), mobile cellular subscriptions (per 100 inhabitants), and total fixed broadband subscriptions on the integral index of a country's resilience to cyber-hacking is investigated using multivariate adaptive regression spline. According to the calculations, France, Iceland, Montenegro, the United States, and the United Arab Emirates were the least resistant to cyber hacking in 2022. For countries with high, above-average, and below-average levels of resilience to cyber-hacking, the most relevant factor is the number of active mobile broadband subscriptions (per 100 inhabitants). For countries with an average level, it is total fixed broadband subscriptions.