Standard Model Of Care Research Articles

The effectiveness of enhanced reality simulation on postmastectomy patient care management provided by nursing students: a quasi-experimental study

AimThe aim of this study was to evaluate the effect of enhanced reality simulation on nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care. BackgroundBreast cancer is a common disease with increasing incidence and mastectomy is the treatment of choice. Postmastectomy patient care is a multidimensional and complex process. For various reasons, nursing students today graduate with inadequate clinical skills and do not have experience with many cases. DesignThis quasi-experimental study was conducted using a pretest–posttest design with a nonequivalent control group. MethodsThis study was conducted with fourth-year nursing students (78 students). Students were allocated to each group through a simple random allocation using IBM SPSS Statistics version 24. Research data were collected at the Clinical Simulation Training Center of the university in 2020–2021 academic year. The study group (n=39) learned using a scenario-based learning approach with moulage in a real clinical setting using enhanced reality simulation, while the control group (n=39) learned using the same scenario-based approach with the routine practice adult standard patient care model. The data were collected through the “Student Sociodemographic and Descriptive Characteristics Data Collection Form”, the “Student Satisfaction and Self-Confidence in Learning Scale”, the “Postmastectomy Patient Care Skills Checklist” and the “Pre–Post Knowledge Test on Postmastectomy Patient Care Management”. ResultsAll 78 participants completed the training course. The training significantly increased the Student Satisfaction and Self-Confidence in Learning Scale subdimension scores of both groups (p<0.05). The Postmastectomy Patient Care Management scores of the study group students who received enhanced reality simulation training significantly increased (p<0.05), while there was no significant effect on the scores of the control group students (p>0.05). While most the students in the study group increased their rates of correct answers to Postmastectomy Patient Care Management questions significantly (p<0.05) after the enhanced reality simulation training, the students in the control group showed no significant improvement (p>0.05). The training significantly (p<0.001) increased the mean postmastectomy patient care skills control scores. This increase had a high effect size on the study group. ConclusionEnhanced reality simulation is a learning method that increases nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care. Learning with enhanced reality simulation is an effective approach for nursing education that improves nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care.

Exploring the Opportunities and Barriers of Implementing the Health Focused Physical Therapy Model

The Health-Focused Physical Therapy Model integrates lifestyle behavior management into physical therapy practice using a standardized care model and motivational patient interviewing. The purpose of this study was to identify the perceived opportunities and barriers physical therapists, physical therapist assistants, and rehab administrators may face when implementing the model. This study included a survey of 19 physical therapy clinicians, and interviews with four rehabilitation administrators from one healthcare system. All participants attended a continuing education course covering the model and then completed a survey detailing their perceptions. Participants included female (100%), physical therapists (78.9%) and physical therapy assistants (21.1%), with variable educational degrees, and at least 16 years of clinic experience (73.7%). Four rehabilitation administrators, 100% female with at least 11 years of PT practice, participated in a semi-structured interview. Survey analysis revealed participants were confident in their understanding of the model and believed the model would positively impact the health of patients. However, over half perceived time limitations as a barrier. Meanwhile, three themes from the interview emerged including holistic care, implementation barriers, and needed resources. This study demonstrated time limitations and productivity standards could limit the implementation of health-focused physical therapy care. Future research should analyze opportunities and barriers of the model with broadened participant sampling methods and triangulation across healthcare practitioner roles to guide implementation and realistic practice standards.

Costs Saved by Visiting a Nurse-Led Primary Care Facility Comparison of Primary Care Models.

Nurse-led primary care is a relatively rare model for primary care, but given nurses more holistic approach to medicine, can prove effective in both reducing costs and disparities in access and outcomes. The present study compares cost adjusted quality of care between a nurse-led primary care facility and the standard primary care. To compare the cost adjusted quality of care between the standard primary care model and a nurse led primary care model the outcomes from a population of patients that visited each (control and experimental, respectively) are compared with respect to three complications of hypertension (stroke, heart attack, and coronary heart disease). The number of three complications (stroke, heart attack, and coronary artery disease) from hypertension for the experimental population is estimated using time-to-event distributions estimated from the control population. Costs are estimated using the control population data. It is found that the population that visited the nurse-led primary care facility had better cost adjusted outcomes than the population that visited the physician led facilities. We can attribute, at least, $3.7 million in costs not realized due to the quality of care provided by the nursing center. Nurse-led primary care is one way that the U.S. healthcare system could reduce costs while providing consistent quality of care.

Breakout Session and Report Back: Collaboration of Rheumatologists and Dermatologists for the Care of Patients With Psoriatic Disease.

Multidisciplinary care is essential for the management of patients with psoriatic disease (PsD), considering the great range of cutaneous and musculoskeletal symptoms and the potential for associated comorbidities and extraarticular manifestations. Consequently, combined rheumatology/dermatology clinics represent a gold standard model of care for patients with PsD. Many challenges are associated with the establishment of these clinics in routine clinical practice. In this report, we describe the thoughts and debates within a collaborative care breakout session during the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2023 annual meeting. The breakout discussion focused around 3 main topics: (1) challenges of dermatologist-rheumatologist collaboration; (2) innovative approaches to encourage collaboration; and (3) how to identify patients with psoriasis at high risk of developing PsA.

Feasibility and Acceptability of a Video Group Psychoeducational Intervention with Latina Immigrant Mothers to Enhance Infant Primary care.

Standard models of well-child care may not sufficiently address preventive health needs of immigrant families. To augment standard individual well-child care, we developed a virtual group-based psychoeducational intervention, designed to be delivered in Spanish as a single, stand-alone session to female caregivers of 0-6 month-olds. The intervention included a video testimonial of an individual who experienced perinatal depression followed by a facilitated discussion by the clinic social worker and an orientation to relevant community resources by a community health worker. To assess feasibility and acceptability of the intervention, we conducted an open pilot within an academic pediatric practice serving predominantly Latinx children in immigrant families. Participants included 19 female caregivers of infants attending the practice, of whom 16 completed post-intervention measures and 13 completed post-intervention semi-structured interviews. Quantitative measures of acceptability and satisfaction with the intervention were high. We found preliminary effects of the intervention on postpartum depression knowledge and stigma in the expected direction. In interviews, participants described increases in their familiarity with postpartum depression and about relevant community resources, including primary care for caregivers. Participants reported an appreciation for the opportunity to learn from other caregivers and provided suggestions for additional topics of interest. Trial registration: Registered 6/21/22 as NCT05423093.

Strategies for General Practitioners to Enhance Cancer Care: Insights from a Patient-Centered Questionnaire Survey in Southern China.

The incidence of cancer is increasing, and cancer survivors are also growing exponentially. Cancer is defined as a new chronic disease. Nevertheless, the management of cancer in the form of chronic diseases in China is still in its infancy, without a standardized care model. This study aimed to explore the current status of management of cancer care from the patient's perspective. This cross-sectional study was a questionnaire survey of patients diagnosed with cancer, including information of the current situation of daily medical consultation, status of comorbidity, and expectations of seeking cancer care in future. Chi-square test and logistic regression analysis were used to explore the factors influencing patients' choice of cancer management mode. A total of 200 cancer patients were included in the study. The majority (n = 150) of cancer patients chose an oncologist in a tertiary hospital for cancer care. Difficulty in registration (45%), time-consuming (34.5%), repeated examinations (34.5%) and different treatment opinions (12.0%) were the main difficulties they encountered currently during tertiary hospital visits. In community hospital, lack of trust in general practitioners (n = 33) and the necessary drugs or testing items in community hospitals (n = 47) were the main difficulties during their visits. Logistic regression analysis showed that male (OR = 2.737, 95% CI, 1.332-5.627, p = 0.006) and elderly patients (OR = 3.186, 95% CI, 1.172-8.661, p = 0.023) were more likely to choose general practitioners (GPs) in community hospitals. Twenty-nine (14.5%) patients hope to have an integrated multidisciplinary management in tertiary and community hospitals with the active participation of GPs for cancer care. Improving drug availability, equipment and quality of cancer care services can help to increase cancer patients' recognition of community hospital. In addition, the multidisciplinary management integrated tertiary hospitals and communities with the participation of GPs is a worth exploring mode that improves the management of cancer care.

Impact of staffing an inpatient oncology consult service with dedicated hospital-based oncologists.

e13538 Background: No standard care model for hospitalized patients with cancer currently exists. The majority of oncology care is provided in the outpatient setting. Consequently, for many oncologists, inpatient care is a secondary responsibility. To address this issue, several U.S. institutions have changed their inpatient oncology models to include dedicated inpatient oncology-trained attendings (hospital-based oncologists). In this study, we investigate outcomes following such a change on an inpatient solid oncology consult service. Methods: This is a single-institution retrospective study of the University of California, San Francisco (UCSF)’s inpatient solid oncology consult service, which switched from a rotating outpatient oncologist attending model to a dedicated inpatient oncologist model in 2018. Since data prior to the switch were not available, we compared all inpatients who received an oncology consult (n=3974) with a comparison group (CG) of all inpatients with a solid tumor diagnosis who did not receive an oncology consult (n=3200) between fiscal years 2018 and 2023. We analyzed trends in case mix index (case complexity), in-hospital mortality index (observed/expected), 30-day unplanned readmission rate, length of stay index, and direct cost index using the Pearson correlation coefficient. In 2022, we conducted an anonymous retrospective pre/post-switch survey of hospitalists who had worked on the hospital medicine service both before and after the switch and compared mean satisfaction with oncology consultation (5-point scale) using Student’s t test. Results: Following the switch, the number of weeks per year covered by dedicated inpatient oncologists increased from seven (2018) to 39 (2023) out of 52. From 2018 to 2023, we found a significant increase in annual consults (495 to 919, r=0.95, p&lt;0.01) and case mix index (2.30 to 3.30, r=0.90, p=0.01; CG 1.60 to 1.70, r=0.60, p=0.20), and a significant decrease in mortality index (1.59 to 0.70, r=-0.98, p&lt;0.01; CG 0.90 to 0.48, r=-0.66, p=0.15). There were non-significant decreases in 30-day unplanned readmission rate (35.8% to 30.5%, r=-0.77, p=0.07), length of stay index (1.45 to 1.32, r=-0.75, p=0.08), and direct cost index (2.2 to 1.8, r=-0.61, p=0.20), similar to the CG. Mean (standard deviation) satisfaction increased from 3.27 (1.22) pre-switch to 4.53 (0.92) post-switch ( p=0.02, response rate 15/51, 29%). Conclusions: Switching to a dedicated inpatient oncologist model on a consult service was associated with decreased in-hospital mortality and increased satisfaction with oncology consultation despite growing case volume and complexity, while readmission rate, length of stay, and cost remained unchanged. This study adds to growing literature supporting dedicated inpatient oncologist attending models of care and is in line with recent literature from other specialties supporting similar inpatient care models.

Midwifery continuity of care for women with perinatal mental health conditions: A cohort study from Australia.

Perinatal mental health (PMH) conditions are associated with adverse outcomes such as maternal suicide, preterm birth and longer-term childhood sequelae. Midwifery continuity of care (one midwife or a small group of midwives) has demonstrated benefits for women and newborns, including a reduction in preterm birth and improvements in maternal anxiety/worry and depression. To determine if midwifery care provided through a Midwifery Group Caseload Practice model is associated with improved perinatal outcomes for women who have anxiety and depression and/or other perinatal mental health conditions. An EPDS ≥ 13, and/or answered the thought of harming myself has occurred to me and/or women who self-reported a history compared to standard models of care (mixed midwife/obstetric fragmented care). A retrospective cohort study using data routinely collected via an electronic database between 1 January 2018 31st of January 2021. The population were women with current/history of PMH, who received Midwifery Caseload Group Practice (MCP), or standard care (SC). Data were analysed using descriptive statistics for maternal characteristics and logistic regression for birth outcomes. One-to-one matching of the MCP group with the SC group was based on propensity scores. 7,359 births were included MCP 12% and SC 88%. Anxiety was the most common PMH with the same proportion affected in MCP and SC. Adjusted odds of preterm birth and adverse perinatal outcomes were lower in the MCP group than the SC group (aOR (95%CI): 0.77 (0.55, 1.08) and 0.81 (0.68, 0.97), respectively) and higher for vaginal birth and full breastfeeding (aOR (95% CI): 1.87 (1.60, 2.18) and 2.06 (1.61, 2.63), respectively). In the matched sample the estimate of a relationship between MCP and preterm birth (aOR (95% CI): 0.88 (0.56, 1.42), adverse perinatal outcomes (aOR (95% CI): 0.83 (0.67, 1.05)) and breastfeeding at discharge (aOR (95% CI): 1.82 (1.30, 2.51)), stronger for vaginal birth (aOR (95% CI): 2.22 (1.77, 2.71)). This study supports positive associations between MCP and breastfeeding and vaginal birth. MCP was also associated with lower risk of adverse perinatal outcomes, though in the matched sample with a smaller sample size, the confidence interval included 1. The direction of the association MCP and preterm birth was negative (protective). However, in the matched sample analysis, the confidence interval was wide, and the finding was also consistent with no benefit from MCP. Randomised controlled trials are required to answer questions around preterm birth and adverse perinatal outcomes and further research is being planned.

Retrolaminar block for opioid-free anaesthesia and enhanced recovery after posterior lumbar discectomy: A randomised controlled study.

Intraoperative regional analgesia and enhanced recovery are standard care models aimed at reducing perioperative opioid use following spine surgeries. This study aimed to examine the analgesic effect of retrolaminar block in promoting recovery and pain relief after posterior lumbar discectomy. The patients undergoing elective posterior lumbar discectomy were randomised into the retrolaminar group (n = 36) (received an intra-operative bilateral retrolaminar block with 15 mL of bupivacaine 0.25%, 2 mL (8 mg) of dexamethasone, and 2 mL of magnesium sulphate 10% (200 mg) on each side) and control group (n = 36) (received standard general anaesthesia). Primary outcomes were recovery time (time from isoflurane discontinuation to the first response to verbal command) and time to discharge (time from admission to the post-anaesthesia care unit (PACU) to discharge from the PACU, when Aldrete score was ≥9). P values < 0.05 were considered statistically significant. The extubation, recovery, and discharge times were significantly shorter in the retrolaminar group compared to the control group (P < 0.001). Postoperative pain scores were significantly lower in the retrolaminar group for up to 8 h compared to only 2 h in the control group (P < 0.001). The time to first administration of ketorolac post-operatively was significantly longer in the retrolaminar group compared to the control group (P < 0.001). The total consumption of ketorolac post-operatively was significantly reduced in the retrolaminar group compared to the control group (P < 0.001). Intra-operative retrolaminar block is an easy and effective opioid-free regional anaesthesia technique that improves recovery after posterior lumbar discectomy.

Are integrated care models associated with improved drug safety in Swiss primary care? an observational analysis using healthcare claims data.

Integrated care models (ICMs) might be an effective strategy to improve patients' quality of care. The aim of this study was to compare different ICMs such as family-doctor models, and a standard care model (SCM) regarding patients' drug safety in Swiss primary care. We performed an observational study using health insurance claims data from patients who were continuously enrolled in an ICM or in a SCM between 2020 and 2021. ICMs included family-doctor model (FDM), family-doctor model light (FDM-light) and the telemedicine model (TM). Drug safety was assessed by the prescription of potentially inappropriate proton pump-inhibitors (PIPPI), opioids (PIO), medications (PIM), and polypharmacy. Propensity-score-weighted multiple logistic regression models were used to examine the association between different types of ICMs and drug safety. Patients in FDM had significantly lower odds of receiving PIPPI (OR, 0.86; CI 95%, 0.83-0.89), PIO (OR, 0.81; CI 95%, 0.76-0.85), PIM (OR, 0.94; CI 95%, 0.91-0.97), and polypharmacy (OR, 0.94; CI 95%, 0.91-0.97) compared to patients in SCM. Potentially inappropriate prescribing was also lower in patients in TM and partly in FDM-light than in SCM. Persons enrolled in FDM were less likely to receive PIM (OR, 0.93; CI 95%, 0.89-0.97) and polypharmacy (OR, 0.94; CI 95%, 0.90-0.99) than those in FDM-light, whereas the odds of receiving PIPPI and polypharmacy were higher in FDM than in TM. ICMs were significantly associated with higher drug safety compared to SCM for most outcomes. Findings suggest that patients may benefit most from ICMs with a high degree of coordination or gatekeeping. ICM may represent an effective approach to improve patients' drug safety and, thus, to reduce the risk of adverse events.

Genetics Adviser: The development and usability testing of a new patient digital health application to support clinical genomic testing

PurposeIncreasing demand for genomic testing coupled with genetics workforce shortages has placed unsustainable pressure on standard models of care. Digital tools can offer improved access, efficiency, and cost savings. We created a patient-facing digital health application to support genomic testing. MethodsWe developed the digital application through user-centered design, guided by an advisory board. We tested its usability and acceptability with patients, practitioners, and members of the general public using mixed methods; data were analyzed using qualitative description and descriptive statistics. ResultsThe “Genetics Adviser” delivers pre-test education, counseling, and post-test return of results adaptable to any population, test platform, and setting. Usability testing with 25 patients, the general public, and genetics practitioners (15/25 female; mean age range 40-49 years) demonstrated enthusiasm about the application; users found it easy to navigate and comprehend. Acceptance testing with 19 patients and the public (13/19 female; mean age range 40-49 years) indicated high acceptability of the application and moderate knowledge of genomic sequencing after use. ConclusionThe Genetics Adviser is a comprehensive, interactive, patient-centered application found to have high acceptability and usability for pre- and post-test genomic testing, counseling, and return of results adaptable for multiple testing platforms, populations, and settings.

Exploring six successful nurse-led transition clinics: Experiences and outcomes

Background and purposeIn the Netherlands, the 2022 Quality Standard 'Youth in transition from paediatric to adult care' underscores the importance of structured transitional care for young adults with chronic health conditions. Despite this emphasis, detailed knowledge about transition programs and their successful elements remains sparse. This study aims to bridge this gap by exploring nurse-led transition clinics that had successfully implemented core interventions such as a transition coordinator, warm handover, and individual transition plans. MethodsEmploying a mixed-methods approach, this study integrated semi-structured interviews with 15 healthcare professionals from both paediatric and adult care across six transition clinics, and surveys from 54 young adults who had transitioned within the last three years. The ‘On Your Own Feet Framework’ guided the evaluation of transitional care practices. Thematic analysis was applied to qualitative data, while descriptive and inferential statistics were used to analyse quantitative data. ResultsThe study revealed a strong dedication among healthcare professionals to ensuring smooth transitions and effective collaboration between paediatric and adult care. The young adults reported high satisfaction with their transitions, particularly appreciating the continuity of care and the pivotal role of nurses and nurse practitioners as transition coordinators. However, challenges such as engaging young adults, resource allocation, and financial complexities were noted, alongside areas for improvement including shared decision-making and managing parental involvement. Motivation and collaboration among staff were identified as facilitating factors. Discussion and conclusionOur findings emphasize the vital role of nurse-led transition clinics in enhancing healthcare transitions for young adults in the Netherlands, aligning with the principles outlined in the Quality Standard and the On Your Own Feet Framework. While high satisfaction levels with current practices suggest a positive impact, they also highlight that ongoing improvement and adaptation are needed to overcome identified challenges. Successful healthcare transition requires a comprehensive, collaborative approach involving patients, families, and healthcare professionals, supported by organizational and systemic frameworks. This study contributes to a nuanced understanding of transitional care, suggesting a path forward for integrating these practices into standard care models.

Evaluating Antiretroviral Therapy Service Delivery Models Through Lot Quality Assurance Sampling in Central Uganda.

This study evaluated the effectiveness and responsiveness of differentiated Human Immunodeficiency Virus (HIV)/Acquired Immuno-Deficiency Syndrome (AIDS) service delivery models (DSDMs) implemented to enhance antiretroviral therapy (ART) access and outcomes for patients while addressing Tuberculosis (TB)-HIV integration, focusing on four of the five DSDMs currently implemented in Uganda. A descriptive cross-sectional survey was conducted in eight districts of central Uganda using Lot Quality Assurance Sampling approach from 7th to 23rd March 2023. We randomly sampled 2668 patients who have been on ART for at least 1 year in a Facility-Based Individual Management (FBIM) model or in a non-FBIM DSDM for at least one year. Data were collected through patient interviews and review of records in ART and DSDM registers as well as ART cards. We analyzed the data in proportions, comparing the selected ART outcome and responsiveness indicators between Community Client Led ART Distribution (CCLAD), Community Drugs Distribution Point (CDDP) and Fast-Track Drug Refill (FTDR) DSDMs with the standard care (FBIM) model. The ART outcome variables include patients retained in the 1st line of the ART regimen, patients in World Health Organization clinical stage 1 during the last facility visit, patients who had no CD4 request during the past 12 months, viral load suppression, ART adherence, and patients who reported that they did not experience HIV/AIDS-related symptoms in the past 6 months. The variables on TB care include screening for TB using the intensified case finding form and patients tested positive for TB. Responsiveness variables include the perceived; travel time for ART refill, travel distance for ART refill, convenience and flexibility during ART refill, cost of travel for ART refill, fear of being seen at ART refill point, waiting time before service, adequacy of service time, crowding and risk of infections, social support, ability to address ART treatment challenges, HIV status disclosure and barriers to access. Non-overlap in 95% confidence interval in indicator proportion between non-FBIM DSDM and FBIM means a statistically significant difference in proportion, or otherwise non-significant. Higher proportions of ART patients in the CCLAD and CDDP DSDMs adhered to ART, had suppressed viral load, and a lower TB prevalence than those in FBIM model. Additionally, more CCLAD and CDDP clients reported shorter travel time and distance to access ART than their counterparts in the FBIM model. Compared to FBIM model, higher proportions of those in CCLAD and CDDP also reported flexibility in ART refill scheduling, reduced transport costs, fewer privacy concerns, less HIV/AIDS-related stigma, shorter waiting times, more efficient services, decreased congestion at ART pickup sites, enhanced peer support, improved problem-solving assistance, and increased HIV status disclosure. The FTDR model outperformed FBIM in proportions with fewer requests for CD4 testing, viral load suppression, as well as proportions of clients who reported; shorter travel time, lower transportation cost, decreased privacy concerns, shorter waiting time, and efficient service provision. Compared to both CDDP and FTDR, the FBIM had a higher proportion of clients remain on the first-line ART regimen. Community-based DSDMs show responsiveness to clients' needs without compromising the effectiveness of ART care for patients. Although FTDR also demonstrates high effectiveness and responsiveness for clients on ART, there is potential for further improvement. Planners and implementers of ART programs should consider both demand- and supply-side innovations to sustain the continuation of DSDMs.

Examining the Benefits of Water Births in a Hospital Setting: Perspectives from Midwives and Nurses

Objective: This study aimed to investigate the impact of midwifery-led care on maternal outcomes, maternal satisfaction, and newborn health in a hospital setting. Specifically, the study sought to compare the effects of midwifery-led care to standard care models, assess maternal preparedness for childbirth, explore rates of medical interventions, evaluate maternal satisfaction, and examine newborn health outcomes. Methods: A total of 200 expectant mothers receiving prenatal care at a tertiary hospital were recruited and randomly assigned to two groups: Group A (midwifery-led care) and Group B (standard care). Participants' demographic information, medical history, and preferences related to prenatal care were collected using a structured questionnaire. Validated surveys, including the Edinburgh Postnatal Depression Scale (EPDS), were used to assess postpartum depression. Medical records and prenatal visits were reviewed throughout the pregnancy, and postpartum follow-ups were scheduled to assess maternal outcomes. Statistical analyses were performed to compare outcomes between the two groups. Results: Participants in the midwifery-led care group reported significantly higher levels of birth preparedness (p &lt; 0.001), and rates of medical interventions during childbirth, including cesarean sections, were significantly lower compared to the standard care group (p &lt; 0.05). Maternal satisfaction scores were significantly higher in the midwifery-led care group (p &lt; 0.001). Additionally, the midwifery-led care group showed lower rates of postpartum depression (p &lt; 0.01) and higher rates of exclusive breastfeeding at six weeks postpartum (p &lt; 0.05). Neonates born to mothers in the midwifery-led care group had significantly lower rates of neonatal complications (p &lt; 0.01). Conclusion: The findings of this study provide strong evidence for the positive impact of midwifery-led care on maternal outcomes, maternal satisfaction, and newborn health. The personalized and woman-centered approach of midwifery-led care contributes to improved maternal preparedness, reduced medical interventions, increased maternal satisfaction, lower rates of postpartum depression, and better newborn health outcomes. These results highlight the potential benefits of integrating midwifery-led care models into maternity services, aiming to enhance the overall birthing experience and improve maternal and infant health outcomes.

Assessing health outcomes of ART Differentiated Care Models in Migori County, Kenya

Background : HIV remains a substantial global health challenge. In Kenya, the prevalence is approximately 6%, with Migori County experiencing notably high rates. Despite this, only a small portion of its population receive antiretroviral therapy (ART). Differentiated care, an individualized approach to HIV treatment, enhances outcomes and eases strain on health systems. This study assesses health outcomes of ART differentiated care in Migori County, Kenya, focusing on retention and viral load results for stable individuals living with HIV.&#x0D; Methodology :We employed a pre-post evaluation descriptive mixed methods study design to assess health outcomes following Differentiated Care Model (DCM) implementation. One hundred and ninety-two (192) stable HIV patients from Migori's rural sugar belt, meeting DCM inclusion criteria, were enrolled using single-stage cluster and systematic sampling. DCM outcomes were compared with the standard care model (control). Data sourced from patient records and key informant interviews were analyzed using Chi-square, Fisher's exact tests, logistic regression and thematic analysis.&#x0D; Results : We observed notable statistical significance (p &lt; 0.05) in the association between DCM and health outcomes, including patient activity at 6 and 12 months (p &lt; 0.001), transfer-out retention at 6 and 12 months (p = 0.02), loss to follow-up retention at 6 and 12 months (p = 0.006 and p = 0.005, respectively), and deceased patient retention (p = 0.033). However, the viral load suppression post-DCM did not show statistical significance.&#x0D; Conclusion : To conclude, Differentiated Care Models positively impact retention outcomes for stable HIV-positive patients, notably reducing lost-to-follow-up and deceased cases. Although not significant at 6 and 12 months, DCM shows promise in early-stage viral load suppression. Gender disparities exist in suppression rates. Patient adherence and viral load awareness are favourable

TELE-ANC model in public sector in India: a feasible option to sustain quality antenatal care

Introduction: Prenatal care is one of the most widely used preventive strategies in healthcare. Despite rapid advances in medical practice over a century, obstetric care remains ‘traditional’. It is resource intensive with heavy footfall in public sector antenatal OPD leading to compromise in quality of care. Therefore, hybrid ‘TELE-ANC model’ is a feasible option to sustain quality care in limited resource setting. We assessed feasibility of this model in reducing ‘in-person visits’ in terms of provider, process and recipient and determined barriers and facilitators to implementation and robustness of process in delivering the model. Methods: Single center prospective feasibility study, composed of 50 low-risk women within 20 weeks of pregnancy; recruited from outpatient obstetric department. Model had 5 in-person and 4 virtual visits. During in-person visits; history, general and systemic examination, ANC investigations and ultrasounds were done and clubbed; counseling and treatment were advised. During virtual visit, patients monitored blood pressure, pulse, weight and fetal movements at home. Pictures of prescription were sent on patients’ phones with records maintained by provider. Patients and provider filled detailed Satisfaction Performa after each virtual visit and last antenatal visit which were measured through Likert scale. Results: Each pregnant woman on an average made 5 physical and 5 virtual visits (one extra than proposed 4 in the model). Each patient saved approximately 10 productive hours and 700 Rupees during their antenatal period. Doctor was able to implement services readily. Adequacy to conduct virtual visits, successful decision making, technical issues faced, ease and safety of process and overall improvement in access to healthcare and positive change, demonstrates high levels of Provider satisfaction score of &gt;80% overall. There was high patient satisfaction score of 80 to 90% in areas assessed i.e., satisfaction with the care received, doctor-patient rapport, knowledge about pregnancy, convenience of self-monitoring and ability to contact provider during emergencies. Nearing term, patients had satisfaction score of 85-90% overall in ability to express, continuation of visits post COVID, reduction in overall cost and time, desire for such a model in future and positive change. Minimal technological barriers were identified which did not adversely impact the quality of care. It is ‘Good’ in terms of its robustness. 96% of patients desired hybrid model as mode of future antenatal care. Discussion: Due to rapid increase in use of telehealth during COVID-19 pandemic, we were encouraged to test feasibility of a reduced in-person visit hybrid model; ‘The TELE-ANC model’ in a tertiary care public hospital. It is feasible in delivering an efficient antenatal care with additional advantages of lower cost, greater doctor-patient rapport, increased patient’s productivity, increased patient satisfaction, better continuity of care, better time management and increased provider engagement and satisfaction. It has potential to be standard care model for antenatal services in future leading to a more flexible and patient centered care

Learnings from the implementation of standardized content and processes for integrated behavioral health prevention visits.

Integrated behavioral health (IBH) in pediatric primary care has spread significantly over the past two decades. However, a crucial component of advancing the state of science is articulating specific intervention models and their associated outcomes. Foundational to this research is the standardization of IBH interventions; however, limited scholarship exists. This is particularly true for IBH prevention (IBH-P) interventions, which pose unique challenges to standardization. The present study presents the development of a standardized IBH-P model, processes to ensure fidelity, and fidelity outcomes. The IBH-P model was delivered by psychologists in two large, diverse pediatric primary care clinics. Extant research and quality improvement processes supported the development of standardized criteria. Fidelity procedures were developed through an iterative process, resulting in two measures: provider self-rated fidelity and independent rater fidelity. These tools assessed fidelity to IBH-P visits and comparison of self and independently rated fidelity. Data from both self and independent ratings indicated 90.5% of items were completed across all visits. The agreement between independent rater coding and provider self-coding was high (87.5%). Results indicated a high level of concordance between provider self-ratings and independent coder ratings of fidelity. Findings suggest that a prevention-based, universal, standardized model of care with a psychosocially complex population was feasible to develop and adhere to. Learnings generated from this study may guide other programs seeking to develop standardization interventions and fidelity processes that can ensure high-quality, evidence-based care. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining the Benefits of Water Births in a Hospital Setting: Perspectives from Midwives and Nurses

Objective: This study aimed to investigate the impact of midwifery-led care on maternal outcomes, maternal satisfaction, and newborn health in a hospital setting. Specifically, the study sought to compare the effects of midwifery-led care to standard care models, assess maternal preparedness for childbirth, explore rates of medical interventions, evaluate maternal satisfaction, and examine newborn health outcomes. Methods: A total of 200 expectant mothers receiving prenatal care at a tertiary hospital were recruited and randomly assigned to two groups: Group A (midwifery-led care) and Group B (standard care). Participants' demographic information, medical history, and preferences related to prenatal care were collected using a structured questionnaire. Validated surveys, including the Edinburgh Postnatal Depression Scale (EPDS), were used to assess postpartum depression. Medical records and prenatal visits were reviewed throughout the pregnancy, and postpartum follow-ups were scheduled to assess maternal outcomes. Statistical analyses were performed to compare outcomes between the two groups. Results: Participants in the midwifery-led care group reported significantly higher levels of birth preparedness (p &lt; 0.001), and rates of medical interventions during childbirth, including cesarean sections, were significantly lower compared to the standard care group (p &lt; 0.05). Maternal satisfaction scores were significantly higher in the midwifery-led care group (p &lt; 0.001). Additionally, the midwifery-led care group showed lower rates of postpartum depression (p &lt; 0.01) and higher rates of exclusive breastfeeding at six weeks postpartum (p &lt; 0.05). Neonates born to mothers in the midwifery-led care group had significantly lower rates of neonatal complications (p &lt; 0.01). Conclusion: The findings of this study provide strong evidence for the positive impact of midwifery-led care on maternal outcomes, maternal satisfaction, and newborn health. The personalized and woman-centered approach of midwifery-led care contributes to improved maternal preparedness, reduced medical interventions, increased maternal satisfaction, lower rates of postpartum depression, and better newborn health outcomes. These results highlight the potential benefits of integrating midwifery-led care models into maternity services, aiming to enhance the overall birthing experience and improve maternal and infant health outcomes.

Impact of a teen club model on HIV outcomes among adolescents in rural Neno district, Malawi: a retrospective cohort study

ObjectiveTo compare the impact of a teen club model to the standard care model on HIV treatment outcomes among adolescents (10–19 years of age).DesignRetrospective cohort study.SettingHIV clinics in Neno district,...

Improving Pathways to Care for Patients at High Psychosis Risk in Switzerland: PsyYoung Study Protocol.

Psychotic disorders are one of the main causes of chronic disability in young people. An at-risk mental state (ARMS) is represented by subclinical symptoms that precede the first episode of psychosis (FEP). The PsyYoung project aims to optimize the detection of an ARMS while reducing unnecessary psychiatric treatments. It investigates the effects of service changes on the referrals and outcomes of young people with ARMS or a FEP. Six psychiatric outpatient clinics in three cantons (Basel-Stadt, Vaud, and Geneva) participated in the project. They passed through an implementation phase including service changes and the adaptation of a standardized stepped care model for diagnosis and assessment, in addition to measures for increasing the awareness, networking and training of local professionals. All participating cantons had entered the implementation phase. By March 2023, there were 619 referrals to participating sites. A total of 163 patients (37% FEP and 31% ARMS) and 15 close relatives had participated in individual longitudinal assessments, and 26 patients participated in qualitative interviews. This national collaborative project addresses the issue of early intervention for emerging psychoses, and creates spaces for fruitful reflections and collaboration in Switzerland. The ultimate aim of PsyYoung is to harmonize clinical practices in early intervention of psychosis on a national level.