Need For Services Research Articles

Developing a comprehensive curriculum program for nurse practitioners delivering primary care in the long-term care setting.

In the Long-Term Care (LTC) setting, comprehensive primary care is often provided by Nurse Practitioners (NPs). NPs are uniquely positioned to meet the evolving primary care needs of LTC residents. However, caring for this population requires additional education and training due to its special considerations. To meet the learning needs of NPs entering the LTC workplace, a Certificate Program was designed to enhance primary care competencies within the LTC setting. The aim of the program is to increase knowledge, capacity, and confidence of NPs to deliver quality, evidence-based, integrated, and interprofessional primary care to LTC residents. This curriculum is anticipated to address the growing need for LTC services and improve the delivery of high-quality primary care.

"You might be nice, but where you take me, they're not gonna be": Preferences for field-based post-overdose interventions.

Emergency medical services (EMS) systems are piloting interventions to respond to overdoses with additional services such as leave-behind naloxone and medication for opioid use disorder, but little is known about the perspectives of people who use drugs (PWUD) on these interventions being delivered by EMS during an overdose response. The Consolidated Framework for Implementation Research guided the development of data collection tools, the analytic strategy and the organisation of results. A community engaged method was used which included both academically trained researchers and community trained researchers who are also PWUD. This study used semi-structured interviews to gather data from 13 PWUD in King County, Washington in June 2022. Data were analysed using thematic analysis. The people interviewed for this study viewed EMS distribution of leave-behind naloxone and field-based buprenorphine favourably. They viewed EMS facilitation of hepatitis C virus and HIV testing in the field less favourably and were concerned about stigmas associated with those results. Additional themes emerged regarding: the need for different approaches to post-overdose care; the need for new services, including post-overdose trauma counselling and an alternative destination to the emergency department; and the harms of law enforcement presence at overdose responses. This study found strong support for leave-behind naloxone and field-initiated buprenorphine. Further training for EMS should include trauma-informed care and strategies to address burnout and increase compassion. Alternatives to the emergency department as a post-overdose destination are needed. These strategies should be considered by jurisdictions revising overdose response protocols.

Differences and similarities in patient-reported outcomes among men and women with haemophilia.

Both men and women can be diagnosed with haemophilia and the experience with haemophilia may be different between men and women. This study aimed to compare patient-reported outcomes in men versus women with haemophilia. This cross-sectional study is a post-hoc analysis of data collected as part of the Haemophilia-related Distress Questionnaire validation study. Adults aged ≥18 years with haemophilia A or B were recruited from one of two haemophilia treatment centres between July 2017 and December 2019. Outcomes included quality of life, measures of mental and physical health, and overall health. Unadjusted and multivariable linear regression models were used to examine potential mediators of sex-based differences in outcomes. Of the 139 study participants included (21 women, 118 men), the mean age was 36.9 years and most (89.2%) had haemophilia A. Approximately 85.7% and 26.3% of women and men had mild haemophilia, respectively. PHQ-9 depression and PROMIS-29 Profile anxiety and fatigue scores were significantly higher in women than men in unadjusted and adjusted analyses. There were no statistically significant differences in other outcomes. Women with haemophilia are more likely to experience depression, anxiety, and fatigue than men with haemophilia. This study highlights the need for mental health services to be integrated into the care of women with haemophilia. Future research is needed to understand whether women with haemophilia are more or less likely to experience depression, anxiety, and fatigue than women without haemophilia as well as determine the impact of reduced mental health on clinical outcomes.

Health care needs and barriers to care among the transgender population: a study from western Rajasthan

BackgroundTransgender people comprise an estimated 0.3–0.5% (25 million) of the global population. The public health agenda focuses on understanding and improving the health and well-being of gender minorities. Transgender (TG) persons often have complex healthcare needs and suffer significant health disparities in multiple arenas. The international literature suggests that this community is at a higher risk of depression, and other mental health problems, including HIV. Many transgender people experience gender dysphoria and seek specific medical needs such as sex reassignment surgeries, implants, hormonal therapies, etc., but are unable to access these services due to financial or social reasons. The objective of this study was to assess the healthcare needs and associated barriers experienced by transgender people in Western Rajasthan. Methodology: A qualitative study was carried out in which multilevel stakeholder interviews were conducted using interview and focus group discussion guides. Data was analyzed using the qualitative thematic analysis technique. Results: Findings reveal that transgender people have expressed their need to access health services for general health needs, including but not limited to mental health, non-communicable diseases, and infectious diseases. Barriers to healthcare services were identified on 3 levels: health system, social and personal. Health system barriers include policy, accessibility, affordability, and acceptability issues. Social factors such as inadequate housing, education, and job opportunities also play an important role in affecting the individual’s health-seeking behavior. The knowledge of healthcare providers in this context was also limited in context of health insurance schemes, package of services available for transgenders and the importance of gender sensitive healthcare. Conclusion: Transgender people expressed the need for mental health services, programs targeting nutritional improvement, gender-affirmation procedures besides regular screening of non-communicable diseases as operational for males and females. Levels of barriers have been identified at various levels ranging from absence of targeted policies to individual behavior.

Factors leading to patient disengagement for unknown reasons in virtual collaborative care.

Collaborative care (CoCM) has been utilized as one strategy for improving access to behavioral health treatment through the primary care setting. However, despite the increased prevalence rates, need for services, and expansion of behavioral health into primary care, there are patients who initiate treatment but disengage for unknown reasons and without communication with their care team. This study analyzes treatment factors by comparing patients who disengage from CoCM for known versus unknown reasons to identify factors that may enhance the ability of providers to implement strategies for retaining those who have initiated care. The analysis utilizes clinical data from Concert Health, a national behavioral health medical group providing CoCM across 19 states. The full patient disengagement data set contains 3,317 patient-level observations. A backward stepwise logistic regression was used to analyze how patient characteristics and level of care impacted patient disengagement for unknown reasons relative to known reasons. The number of clinical touchpoints a patient receives has a significant association with disengagement for unknown reasons. Specifically, more touchpoints and touchpoints early in treatment appear to be important in preventing unknown disengagement. Other significant variables associated with disengagement for unknown reasons include age, primary diagnosis and comorbidities, and improvement as measured by Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 scores. This analysis sheds light on factors that impact patient disengagement from care for unknown reasons. The article concludes with a series of implications for enhancing care and patient retention based on these findings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cascade of care for substance use and mental health disorders for justice-involved populations

IntroductionJustice-involved populations have dramatically higher rates of substance use disorders (SUD) and mental health disorders (MHD) compared to the general population. Despite high rates of SUD and MHD, treatment for this population is often limited and not evidence-based. The cascade of care model estimates drop-offs in the continuum of care from screening to identification of need, referral, care initiation, care engagement, and care completion. Recently, healthcare providers have utilized the cascade of care to improve the continuity of care for people with SUD and MHD in justice settings. The purpose of the current study is to 1) identify typologies that explain the proportion of new intakes that pass through each level of the cascade of care for SUD and MHD, and 2) describe agency-level factors that predict typology assignments and agency ability to assess client flow through the levels of the care cascade. MethodUsing Latent Class Analysis, we classify 791 agencies serving justice-involved individuals into typologies according to utilization of each stage in the mental health and substance cascades of care. Then, we examined county and agency characteristics that affect three stages of the cascade process: identification of need for behavioral health services, referrals to appropriate services, and treatment initiation. We build on previous work by exploring these patterns for both SUD and MHD treatment. ResultsThe study identified four SUD/MHD treatment patterns: Low Access, SUD-Focused, High Need-High Access, and Lower Need-High Access classes. Factors influencing typology alignment include location, specialized staff availability, warm hand-off coordination, Medicaid reimbursement, and performance measure tracking. Thirty-nine percent (39 %) of agencies could not be classified because they were unable to report their rate of care along the cascade measures. ConclusionFocusing on factors influencing typology assignment can help counties in assessing service delivery, identifying barriers, and targeting areas for improvements in policies and practices, potentially facilitating long-term changes and overall improvement in the care of individuals with mental health and substance use disorders. Identification of these factors and typologies can improve mental health treatment and access in counties and agencies with large resource barriers or limited attention to mental health treatment.

Evaluating Airline Passengers’ Satisfaction during the COVID-19 Pandemic: A Case Study of AirAsia Services through Sentiment Analysis and Topic Modelling

AirAsia has emerged as a dominant force among prominent low-cost airlines in recent years. However, the COVID-19 pandemic outbreak has severely impacted airline services, including AirAsia. There is a strong need for airline services to monitor customer experience and satisfaction from online customer reviews on the website to keep pace with changing customer perceptions toward their service quality. A growing number of travelers choose to express their experiences and emotions on online customer review platforms, resulting in substantial online airline service evaluations. The research analyzes 796 online customer reviews from Skytrax, a well-known online airline review website. The information hidden in customer-generated reviews is analyzed with the text mining technique, including topic modeling and sentiment analysis. The research uses the Latent Dirichlet Allocation (LDA) model for topic analysis and the Valence Aware Dictionary for Sentiment Reasoning (VADER) model for sentiment analysis. The sentiment ratio for AirAsia’s online reviews is approximately 59% positive and 41% negative. Only four reviews are neutral. The findings indicate that the online review of AirAsia has a greater proportion of positive sentiments than negative sentiments. In addition, the topic modeling shows hidden topics with the top high-probability keywords concerned with interior and seat, baggage, online service, staff service, flight schedule, and refund. The research demonstrates using sentiment analysis and topic modeling on customer review data as a more thorough alternative to survey-based models for researching airline service. The research contributes to the methodological advancements in text mining analysis and expands the current knowledge of customer review data.

Primary health care in Nigeria: best practices and quality of care in Nigeria

IntroductionThe significance of Primary Healthcare Centers (PHCCs) in fostering health equity and enhancing health outcomes cannot be overstated, especially in low and middle-income countries. This paper’s primary area of interest is to create evidence and innovation for PHCs, with a particular emphasis on underserved groups. Thus, the study aimed to investigate the state of primary health care in Nigeria, with a particular emphasis on best practices, challenges to best practices, and quality of care.MethodologyA cross-sectional quantitative study was conducted to collect secondary data from 29 primary healthcare facilities. The data was collected using staff and facility activity indicators over a year (2022). Descriptive statistics and chi-square tests were used to analyze the collected data.ResultOur study data showed that all of the PHCCs have service rosters that can be utilized for follow-up with patients. About 85 (84.1%) respondents have reported that deliveries were taken by the reporting midwife, and 55 (54.5%) respondents indicated that their facilities provided on-the-job training to their staff. This is considered as the best practice in the facility. However, the majority of the PHCCs (71.3%) lacked assessment teams, which was found to have a negative impact on the quality of healthcare provided at these facilities (p < 0.05).ConclusionOur study underscores the pressing need for primary healthcare services in Nigeria. Government authorities and healthcare providers must take action to overcome the challenges of limited capacity, service delivery, and quality of care. By adopting effective strategies and ensuring access to primary healthcare, citizens’ health outcomes can be greatly enhanced. Thus, it is essential to revamp and optimize healthcare facilities to establish an efficient healthcare system that caters to the needs of all citizens.

Re-Designing Social Worker Role During World Inflation Spillovers

Inflation affects vulnerable groups more, governments and NGOs used to support them via social welfare system, where social workers did case studies and ensured fairness. However, with inflation; governments fail to keep up with it, the role of social workers will be more essential and complex. More people will need social workers to be proactive, where there is more need for services and social protection. Methodology is to re-evaluate the criteria of social worker's role to foresight demands and recommend an international governing guidance. Implication shows the need for re-evaluating to help stabilise families during inflation. A framework is proposed to utilise welfare to support vulnerable groups and social workers' roles, preparing them for crises such as inflation and having future foresight in social problems.

Analysis of The Quality of Physiotherapy Services For BPJS Patients In Hospitals On The Island of Java

The growing emphasis on patient-centered healthcare highlights the critical need for high-quality services that meet patient satisfaction, particularly in physiotherapy clinics. This study aims to explore the relationship between the quality of physiotherapy services and patient satisfaction, focusing on various dimensions such as tangibility, reliability, responsiveness, assurance, and empathy. A literature review was conducted, analyzing studies from 2013 to 2023 to assess the effectiveness of physiotherapy services in different settings. The findings indicate a significant correlation between service quality and patient satisfaction, with a substantial number of patients reporting satisfaction with the services received. However, certain areas, such as communication and facility conditions, were identified as needing improvement. The study underscores the importance of enhancing service quality to meet patient expectations and improve overall healthcare outcomes. The results are expected to contribute to the development of more effective physiotherapy services and serve as a reference for future research in this area.

Onestop Solution Healthcare Distribution Service Perusahaan Pedagang Besar Farmasi (PBF) Distributor Healthcare PT Jagat Pharma Abadi

The healthcare industry in Indonesia is experiencing rapid growth, which has triggered an increase in the need for efficient and effective health product distribution services. Pharmaceutical Wholesaler Companies (PBF) such as PT. Jagat Pharma Abbadi plays an important role in distributing health products from manufacturers to pharmacies and drug stores. This study aims to analyze the strategic planning of "OneStop Solution Healthcare Distribution Service" from PT Jagat Pharma Abadi in improving the efficiency of pharmaceutical product distribution. This study uses a qualitative research method with a case study approach. The data collection techniques in this study are literature studies, interviews and company documentation. The data analysis technique used in this study is thematic analysis. The results of the study show that the strategic planning of "OneStop Solution Healthcare Distribution Service" from PT Jagat Pharma Abadi uses the External Factor Evaluation Matrix (EFE), Internal Factor Evaluation Matrix (IFE), and Competitive Profile Matrix (CPM). PT JPA will adjust marketing activities with both pull and push strategies, using two concepts, namely: make to stock and make to order to reduce the risk of slow-moving products, dead goods, and the threat of substitution. PT JPA must be able to manage inventory according to estimates from the marketing team and remain flexible and dynamic to face competitive dynamics.

Two Approaches of ‘Proactive Consultation’: Towards Well-Functioning Clinical Ethics Consultation

AbstractIn recent years, the global need for clinical ethics consultation services (CECS) has increased to address ethical challenges, dilemmas, and moral distress in clinical environments. In Japan, many hospitals have introduced CECS over the past decade, but few such services work effectively because of the small number of consultations. To address this, we propose two proactive ethics consultation methods: inter-professional ethics rounds and patient note reviews. This paper provides a detailed explanation of these methods, complete with scenarios based on actual cases. These methods can make CECS ‘well-functioning’ by shifting the starting points of consultation from consultees to CECS providers. We then examine the impact and value of proactive ethics consultation as well as four critical factors for its success including attitude, positioning, and competency of proactive consultation teams. We believe our suggestions will provide valuable insights for future clinical ethics consultations and stimulate academic debate about what constitutes a ‘well-functioning’ CECS.

Competency development for pharmacy: adopting and adapting the FIP global advanced development framework.

Pharmacy education shifts toward competency-based training to meet healthcare demands. This study aims to develop and validate the Kuwait Advanced Competency Framework (KACF) for pharmacists. The study adopts the FIP Global Advanced Development Framework (GADF) to develop a country-specific framework, emphasizing the importance of aligning with global standards while adapting to local contexts. The developed framework builds upon the Kuwait Foundation Competency Framework to address the need for advanced pharmacy services. This is a mixed methods study that employed an "adopt and adapt" approach. The KACF was adopted from the FIP GADF and adapted following four phases. Phase one involved checking and validating the Arabic version of the FIP GADF. Phase two employed a series of focus groups to validate accuracy and relevancy of competency statements. Phase three utilized a workshop with different stakeholders as a final step of validation. Phase four involved a national survey to assess the national pharmacy workforce against the framework competencies. Qualitative feedback from focus groups and workshops informed competencies modifications. Quantitative data were analyzed using descriptive and multiple correspondence analyses (MCA). The translation phase verified a bilingual framework that could be utilized by pharmacists in Kuwait. The initial and final validation phases identified 20 behavioral statements (out of 22 in the original document) that are relevant to pharmacy practice in Kuwait. The national survey, comprising 169 respondents, validated the KACF's applicability, revealing variations in career stage progression across competency clusters. Findings highlighted associations between career stages and practice settings, offering insights for tailored workforce development strategies. The KACF emerges as a pivotal tool for advancing pharmacy services in Kuwait, aligning with global trends toward competency-based education. Findings underscored the necessity for context-specific approaches in advancing pharmacy practice, providing a comprehensive understanding of competency progression and readiness for advanced roles.

"Complete and Accurate, and Warmhearted Too": Telemedicine Experiences and Care Needs of Mandarin-Speaking Patients with Limited English Proficiency.

Despite greater care needs, patients with limited English proficiency (LEP) are less likely to use telemedicine. Given the expansion of telemedicine since the COVID-19 pandemic, identifying ways to narrow the telemedicine care gaps experienced by people with LEP is essential. Examine the telemedicine experiences of Mandarin-speaking adults with LEP, with a focus on perceived differences between in-person care, video, and telephone telemedicine. Random sample of Kaiser Permanente Northern California (KPNC) members who completed at least one primary care telemedicine visit in August 2021, aged 40years or older, and had electronic health record-documented need for a Mandarin interpreter. The sample was stratified by telemedicine visit type (video or phone). Semi-structured Mandarin-language telephone interviews with a bilingual and bicultural research assistant collected patient experiences with telemedicine in general and telemedicine visits assisted by interpreters. Two coders used rapid qualitative analytic techniques to capture themes. Among 20 respondents (n = 12, 60% women) age 41-81, all had prior experience with telephone visits and 17 (85%) had experience with video visits. Patients reported three major themes: (1) communication, language skills, and how patience impacts care quality; (2) the importance of matching patient preferences on communication modality; and (3) the need for comprehensive language services throughout the continuum of healthcare delivery. Mandarin-speaking adults with LEP see telemedicine as a convenient and necessary service. Issues with healthcare providers' and interpreters' communication skills and impatience were common. The lack of wrap-around language-concordant care beyond the visit itself was cited as an ongoing and unaddressed care barrier. Healthcare provider and interpreter training is important, as is availability of personalized and comprehensive language services in promoting patient autonomy, alleviating the burden on patients' families, and thus ensuring equitable healthcare access.

Crisis management: pathways to crisis pregnancy centers

ABSTRACT Crisis pregnancy centers (CPCs) provide social support, material aid, and counseling against abortion. We evaluated the perspectives of CPC clients to understand how they found the CPC that they attended for services. In 2019, we conducted in-depth interviews with 21 clients of 10 CPCs in Ohio, who were recruited from the CPC (n = 9) or an abortion clinic (n = 12), to understand their experiences attending the center. This analysis focused on the ways in which pregnant people end up as clients at a CPC seeking assistance instead of attending another setting, such as a medical center. We identified two pathways through which clients find CPCs. First, in the internet pathway, clients needing abortion services found CPCs via internet search for pregnancy symptoms, abortion care, or ultrasound services. Second, in the social safety network pathway, clients needing material aid found CPCs through recommendations from trusted others and due to the proximity of CPCs to their homes. Structural conditions influence the pathways clients pursue, such as the need for healthcare services and material aid. Future research should further explore the demographics of those who attend CPCs and motivations for attendance.

Evidence Over Ego: How Australian Private Digital Weight-Loss Services Need to Respond to Continual Scepticism from Prominent Medical Bodies

Evidence Over Ego: How Australian Private Digital Weight-Loss Services Need to Respond to Continual Scepticism from Prominent Medical Bodies

Health Service Utilization Patterns Among Medicaid Enrollees With Intellectual and Developmental Disabilities Before and During the COVID-19 Pandemic: Implications for Pandemic Response and Recovery Efforts.

To assess the impact of COVID-19 on health service utilization of adults with intellectual and developmental disabilities (IDDs) through an analysis of Medicaid claims data. Retrospective cohort study of Medicaid claims. Medicaid members aged 25 to 64years from January 1, 2018, to March 31, 2021, from the states of Louisiana, Pennsylvania, and Wyoming. We analyzed data from two 12-month time periods (pre-COVID-19 and during COVID-19) and assessed the potential impact of the COVID-19 pandemic on health service utilization and service intensity for 3 cohorts: (1) IDD with preexisting mental health diagnoses, (2) IDD without mental health diagnoses, and (3) all other Medicaid members. Health service utilization determined by specific claims data classifications. The analysis showed reduced utilization for nonmental health service types with differing utilization patterns for IDD with preexisting mental health diagnoses, IDD without mental health diagnoses, and all other Medicaid members. Change in utilization varied, however, for mental health service types. Measures of service intensity showed decreased numbers of members utilizing services across most service types and increased Medicaid claims per person across most mental health service categories but decreased Medicaid claims per person for most nonmental health services. Results suggest a need for mental health services among all Medicaid members during the COVID-19 pandemic. By anticipating these needs, communities may be able to expand outreach to Medicaid members through enhanced case management, medication checks, and telemedicine options.

Qualitative exploration of uterine cancer care for lesbian, gay, bisexual, trans and queer (LGBTQ+) patients in the UK: shifting from equality to equity

ObjectivePatients identifying as lesbian, gay, bisexual, transgender and/or queer/questioning (LGBTQ+) report significant disparities in cancer care and are disproportionally affected by a cancer diagnosis on a number of health-related indicators....

Identifying Under- And Overutilization Patterns For Idaho Youth With Serious Emotional Disturbance.

Children and adolescents with serious emotional disturbance represent 7-12percent of all youth in the United States. In 2017, the State of Idaho implemented the Youth Empowerment Service program, which allows youth with serious emotional disturbance who are younger than age eighteen living in households with income up to 300percent of the federal poverty level to qualify for Medicaid and receive intensive, community-based treatment. A uniquely detailed method was used to assess the need for services: the Child and Adolescent Needs and Strengths tool, a ninety-seven-indicator instrument administered by a clinician. We used these indicators and Idaho's 2018-22 administrative Medicaid claims data to study the association between children and adolescents' clinical needs complexity and their actual Medicaid behavioral and mental health service use. Our findings show that there was a substantial proportion of youth who were underusing Medicaid behavioral and mental health care services, and there were virtually no overusers. Our findings have implications for the appropriateness of Medicaid utilization management in behavioral health care and program efforts to maintain families with youth having serious emotional disturbance in the Youth Empowerment Service program.

Minding the gap: Assessing patient expectations versus experiences in drug information services at community health centers (Puskesmas) in Indonesia urban settings.

In pharmaceutical care, patients' perceptions of drug information provided by pharmacists are vital for assessing pharmaceutical services at community health centers (in Indonesian known as Puskesmas). The aim of this study was to determine the alignment between patients' expectations and experiences of drug information services by pharmacists at Puskesmas in Indonesia. This multicenter cross-sectional study utilized a validated questionnaire among outpatient patients aged 18 years and above across all 47 Puskesmas in Makassar, Indonesia. A total of 622 respondents were interviewed between September to December 2023. Significant gaps were observed between patients' expectations and experiences regarding all the drug information aspects such as quantity (median: 4 vs 3, p<0.001), drug effects (median: 4 vs 3, p<0.001), dosage form (median: 3 vs 3, p<0.001), proper administration (median: 4 vs 4, p<0.001), side effects (median: 4 vs 2, p<0.001), storage (median: 3 vs 2, p<0.001), drug-drug interactions (median: 4 vs 2, p<0.001), drug-food interactions (median: 4 vs 2, p<0.001), handling missed dose (median: 3 vs 2, p<0.001), managing accidental overdoses (median: 4 vs 2, p<0.001), history of drug use (median: 3 vs 2, p<0.001), co-medications (median: 3 vs 2, p<0.001), and previous drug allergies (median: 3 vs 2, p<0.001). Sociodemographic factors influencing patients' need for drug information services encompass age, sex, educational attainment, comorbidities, family size, number of visits, monthly income, and occupation. The quality of drug information services at Puskesmas in Indonesia still requires optimization and customization to meet the specific needs of patients, taking into account their sociodemographic characteristics.