Impact of COVID-19 on Cancer Service Delivery; a follow up international survey of oncology clinicians

ObjectivesTo report clinician-perceived changes to cancer service delivery in response to COVID-19.DesignMultidisciplinary Australasian cancer clinician survey in collaboration with the European Society of Medical Oncology.SettingBetween May and June 2020 clinicians from 70 countries were surveyed; majority from Europe (n=196; 39%) with 1846 COVID-19 cases per million people, Australia (AUS)/New Zealand (NZ) (n=188; 38%) with 267/236 per million and Asia (n=75; 15%) with 121 per million at time of survey distribution.ParticipantsMedical oncologists (n=372; 74%), radiation oncologists (n=91; 18%) and surgical oncologists (n=38; 8%).ResultsEighty-nine per cent of clinicians reported altering clinical practices; more commonly among those with versus without patients diagnosed with COVID-19 (n=142; 93% vs n=225; 86%, p=0.03) but regardless of community transmission levels (p=0.26). More European clinicians (n=111; 66.1%) had treated patients diagnosed with COVID-19 compared with Asia (n=20; 27.8%) and AUS/NZ (n=8; 4.8%), p<0.001. Many clinicians (n=307; 71.4%) reported concerns that reduced access to standard treatments during the pandemic would negatively impact patient survival. The reported proportion of consultations using telehealth increased by 7.7-fold, with 25.1% (n=108) of clinicians concerned that patient survival would be worse due to this increase. Clinicians reviewed a median of 10 fewer outpatients/week (including non-face to face) compared with prior to the pandemic, translating to 5010 fewer specialist oncology visits per week among the surveyed group. Mental health was negatively impacted for 52.6% (n=190) of clinicians.ConclusionClinicians reported widespread changes to oncology services, in regions of both high and low COVID-19 case numbers. Clinician concerns of potential negative impacts on patient outcomes warrant objective assessment, with system and policy implications for healthcare delivery at large.

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Early implementation of guidelines for managing young infants with possible serious bacterial infection in Bangladesh

BMJ Global Health ◽

10.1136/bmjgh-2019-001643 ◽

2019 ◽

Vol 4 (6) ◽

pp. e001643 ◽

Cited By ~ 4

Author(s):

Jennifer A Applegate ◽

Sabbir Ahmed ◽

Marufa Aziz Khan ◽

Sanjida Alam ◽

Nazmul Kabir ◽

...

Keyword(s):

Service Delivery ◽

Bacterial Infection ◽

Antibiotic Treatment ◽

Health System Strengthening ◽

Family Welfare ◽

National Guidelines ◽

Young Infants ◽

Early Implementation ◽

Hospital Referral

Neonatal infections remain a leading cause of newborn deaths globally. In 2015, WHO issued guidelines for managing possible serious bacterial infection (PSBI) in young infants (0–59 days) with simpler antibiotic regimens if hospital referral is not feasible. Bangladesh was one of the first countries to adapt WHO guidance into national guidelines for implementation in primary healthcare facilities. Early implementation was led by the Ministry of Health and Family Welfare (MOHFW) in 10 subdistricts of Bangladesh with support from USAID’s MaMoni Health System Strengthening project. This mixed methods implementation research case study explores programme feasibility and acceptability through analysis of service delivery data from 4590 sick young infants over a 15-month period, qualitative interviews with providers and MOHFW managers and documentation by project staff. Multistakeholder collaboration was key to ensuring facility readiness and feasibility of programme delivery. For the 514 (11%) infants classified as PSBI, provider adherence to prereferral treatment and follow-up varied across infection subcategories. Many clinical severe infection cases for whom referral was not feasible received the recommended two doses of injectable gentamicin and follow-up, suggesting delivery of simplified antibiotic treatment is feasible. However, prereferral antibiotic treatment was low for infants whose families accepted hospital referral, which highlights the need for additional focus on managing these cases in training and supervision. Systems for tracking sick infants that accept hospital referral are needed, and follow-up of all PSBI cases requires strengthening to ensure sick infants receive the recommended treatment, to monitor outcomes and assess the effectiveness of the programme. Only 11.2% (95% CI 10.3 to 12.1) of the expected PSBI cases sought care from the selected service delivery points in the programme period. However, increasing trends in utilisation suggest improved awareness and acceptability of services among families of young infants as the programme matured. Future programme activities should include interviews with caregivers to explore the complexities around referral feasibility and acceptability of simplified antibiotic treatment.

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Long term follow-up and transition of care in anorectal malformations: An international survey

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2016.03.011 ◽

2016 ◽

Vol 51 (9) ◽

pp. 1450-1457 ◽

Cited By ~ 12

Author(s):

Stefano Giuliani ◽

Emily Decker ◽

Ernesto Leva ◽

Giovanna Riccipetitoni ◽

Pietro Bagolan

Keyword(s):

Anorectal Malformations ◽

Transition Of Care ◽

International Survey ◽

Long Term Follow Up

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Challenges, Distrust, and Understanding: Employing Communicative Action in Improving Trust in a Public Medical Sector in Uganda

SAGE Open ◽

10.1177/2158244019893705 ◽

2019 ◽

Vol 9 (4) ◽

pp. 215824401989370

Author(s):

Grace Akello ◽

Ulrike Beisel

Keyword(s):

Service Delivery ◽

Health Workers ◽

Communicative Action ◽

Care Delivery ◽

Participant Observation ◽

Health Sector ◽

Medical Sector ◽

Government Hospitals ◽

The Government

We assessed how the everyday work challenges that frontline health workers (FRHWs) face in the government health sector in northern Uganda influence their trust in the Ministry of Health (MOH). We employed qualitative research techniques, including interviews and participant observation, over a 9-month period to examine FRHWs’ viewpoints about how the MOH should address these challenges in service delivery. One hundred and sixty-five FRHWs, of whom 48 were recruited for extensive follow-up, participated in our study. Key findings include distrust in the MOH is prevalent among FRHWs, there is a lack of trust in the organization’s coordination role in service delivery and this affects health care delivery to patients, interrelations, and provider cooperation. Therefore, restoring trust in government hospitals will require a truthful non-violent response by the MOH in its contractual agreement with FRHWs. In our analysis, we employ Habermas’s Theory of Communicative Action.

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P080: Clinical lead nurse practitioner Strathcona Community Hospital

CJEM ◽

10.1017/cem.2018.278 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S85-S85

Author(s):

D. K. Klemmer ◽

C. Ziebel ◽

N. Sharif ◽

S. Grubb ◽

S. Sookram

Keyword(s):

Emergency Department ◽

Quality Improvement ◽

Patient Satisfaction ◽

Service Delivery ◽

Nurse Practitioner ◽

Community Hospital ◽

Clinical Care ◽

Family Physicians ◽

Lost To Follow Up

Introduction: Prior to opening Strathcona Community Hospital (STCH) site leadership were tasked to develop an innovative care model. The central aim was quality improvement and patient safety optimization in the emergency department (ED) utilizing a nurse practitioner (NP) model. They developed 3 pillars: collaboration, multidisciplinary approach, and integration with the plan of improving patient satisfaction and ensuring no patient gets lost to follow up. NPs work in the STCH ED and the NP led Emergency Department Transition (EDT) Clinic in Ambulatory Care. In the ED NPs provide direct clinical care, judicious review of DI and microbiology reports, and care coordination for patients at risk of lost to follow up. The EDT clinic is an innovative NP lead clinic with the purpose of providing timely, high-quality follow up care for ED patients. Methods: Data for the service delivery indicators came from data repository and manual data collection looking at the following outcomes: timely review of DI/micro results; decreased ED visits for non-urgent/emergent issues; safe transitions in care and improved patient satisfaction. Quantitative data from service delivery, patient and surveys were analyzed using Microsoft Excel and SPSS 19. Results: From June 2016 to January 2017 ED NPs at STCH reviewed 3000 positive microbiology reports and made 517 f/u calls to those patients, and reviewed 3181 DI results. This has freed up approximately 2 hrs per day of ED physician time. When NPs were working in the ED, the number of patients who left without treatment (LWT) was approximately 50% less, and improved STCH ED wait times to be among the lowest in the Edmonton Zone. From June 2016 to January 2017, EDT NPs completed 837 patient visits; 371 letters to family physicians (FPs); 215 referrals; and connected 520 patients to a new FP. Patient satisfaction survey show 88-90% of the patients were satisfied with their care. Conclusion: NPs are integral members of the ED team at STCH, providing direct clinical care and several valuable follow up services for ED patients. The EDT clinic provides urgent follow up for ED patients unable to get a timely appointment with their FP or no access to primary care. The clinic also prevents unnecessary returns to ED, and aids to bridge ED services to family physicians or specialist. NPs are the common thread through all departments at STCH, contributing to quality improvement and high patient satisfaction.

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Timeliness of Service Delivery for Children With Later-Identified Mild-to-Severe Hearing Loss

American Journal of Audiology ◽

10.1044/1059-0889(2013/13-0031) ◽

2014 ◽

Vol 23 (1) ◽

pp. 116-128 ◽

Cited By ~ 10

Author(s):

Elizabeth A. Walker ◽

Lenore Holte ◽

Meredith Spratford ◽

Jacob Oleson ◽

Anne Welhaven ◽

...

Keyword(s):

Hearing Loss ◽

Early Intervention ◽

Service Delivery ◽

Regression Models ◽

Neonatal Period ◽

Intervention Programs ◽

Newborn Period ◽

Dependent Variables ◽

Newborn Hearing

Purpose In this study, the authors examined diagnostic and intervention services for children identified with hearing loss (HL) after the newborn period. Method The authors compared ages at service delivery and length of delays between service delivery steps for 57 later-identified children with HL and 193 children who referred for assessment from the newborn hearing screen (NHS). For only later-identified children, regression models were used to investigate relationships among predictor variables and dependent variables related to service delivery. Results Children who referred from the NHS received follow-up services at younger ages than later-identified children. Later-identified children had significantly longer delays from HL confirmation to entry into early intervention, compared to children who referred from the NHS. For later-identified children, degree of HL predicted ages at follow-up clinical services. Children with more severe HL received services at younger ages compared to children with milder HL. Gender predicted the length of the delay from confirmation to entry into early intervention, with girls demonstrating shorter delays. Conclusions The current results lend support to the need for ongoing hearing monitoring programs after the neonatal period, particularly when children enter early intervention programs because of language/developmental delays.

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The INCENTIVE study: a mixed-methods evaluation of an innovation in commissioning and delivery of primary dental care compared with traditional dental contracting

Health Services and Delivery Research ◽

10.3310/hsdr04180 ◽

2016 ◽

Vol 4 (18) ◽

pp. 1-126 ◽

Cited By ~ 3

Author(s):

Claire Hulme ◽

Peter Robinson ◽

Gail Douglas ◽

Paul Baxter ◽

Barry Gibson ◽

...

Keyword(s):

Cost Effectiveness ◽

Service Delivery ◽

Primary Outcome ◽

Dental Service ◽

Service Delivery Model ◽

Delivery Model ◽

Related Quality ◽

Health Related

BackgroundOver the past decade, commissioning of primary care dentistry has seen contract currency evolving from payment for units of dental activity (UDAs) towards blended contracts that include key performance indicators such as access, quality and improved health outcome.ObjectivesThe aim of this study was to evaluate a blended/incentive-driven model of dental service provision. To (1) explore stakeholder perspectives of the new service delivery model; (2) assess the effectiveness of the new service delivery model in reducing the risk of and amount of dental disease and enhancing oral health-related quality of life (OHQoL) in patients; and (3) assess cost-effectiveness of the new service delivery model.MethodsUsing a mixed-methods approach, the study included three dental practices working under the blended/incentive-driven (incentive) contract and three working under the UDAs (traditional) contract. All were based in West Yorkshire. The qualitative study reports on the meaning of key aspects of the model for three stakeholder groups [lay people (patients and individuals without a dentist), commissioners and the primary care dental teams], with framework analysis of focus group and semistructured interview data. A non-randomised study compared clinical effectiveness and cost-effectiveness of treatment under the two contracts. The primary outcome was gingivitis, measured using bleeding on probing. Secondary outcomes included OHQoL and cost-effectiveness.ResultsParticipants in the qualitative study associated the incentive contract with more access, greater use of skill mix and improved health outcomes. In the quantitative analyses, of 550 participants recruited, 291 attended baseline and follow-up. Given missing data and following quality assurance, 188 were included in the bleeding on probing analysis, 187 in the caries assessment and 210 in the economic analysis. The results were mixed. The primary outcome favoured the incentive practices, whereas the assessment of caries favoured the traditional practices. Incentive practices attracted a higher cost for the service commissioner, but were financially attractive for the dental provider at the practice level. Differences in generic health-related quality of life were negligible. Positive changes over time in OHQoL in both groups were statistically significant.LimitationsThe results of the quantitative analysis should be treated with caution given small sample numbers, reservations about the validity of pooling, differential dropout results and data quality issues.ConclusionsA large proportion of people in this study who had access to a dentist did not follow up on oral care. These individuals are more likely to be younger males and have poorer oral health. Although access to dental services was increased, this did not appear to facilitate continued use of services.Future workFurther research is required to understand how best to promote and encourage appropriate dental service attendance, especially among those with a high level of need, to avoid increasing health inequalities, and to assess the financial impact of the contract. For dental practitioners, there are challenges around perceptions about preventative dentistry and use of the risk assessments and care pathways. Changes in skill mix pose further challenges.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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871. Sexual Health Service Experience and Preferences for Non-Traditional Service Delivery Among a Predominately Immigrant Latino MSM Population in Miami

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1066 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S527-S527

Author(s):

Samantha Herbert ◽

Katie Klose ◽

Liz Rivera ◽

Brahian Erazo ◽

Brian Baez Leon ◽

...

Keyword(s):

Health Services ◽

Service Delivery ◽

Sexual Health ◽

Healthcare Access ◽

The United States ◽

Latino Msm ◽

Home Based ◽

Populations At Risk ◽

Black And Latino

Abstract Background Miami-Dade County (MDC) has the highest rate of new HIV diagnoses in the United States (US), with highest incidence among Black and Latino men who have sex with men (MSM). Immigrants may be especially vulnerable to HIV acquisition and may lack or avoid accessible sexual health services. The University of Miami Mobile PrEP (MP) Clinic provides sexual health services including STI and HIV testing as well as PrEP initiation and follow-up in four highly impacted areas of MDC. The majority of MP clients are immigrant Latino MSM. We evaluated sexual healthcare access, preferences, and facilitators or barriers to receiving sexual health services through non-traditional platforms. Methods A brief survey was offered to clients at four MP locations from September 2020 to June 2021. Multiple-choice questions addressed healthcare access, usage, and experience as well as preferences for service receipt including home-based, mobile clinic, and telehealth options. Brief qualitative short answer responses were also elicited. Results were tabulated and presented descriptively. Results A total of 115 clients were surveyed. Mean age was 36; 82.6% identified as male. Most respondents were either White/Caucasian (56.5%) or Black/African-American (19.1%) and 78 (67.8%) identified as Hispanic/Latinx. Of the 66% that reported being born outside the US, 34.2% had immigrated in the past 5 years. Only 41.7% of respondents had a primary care provider. Before coming to the MP clinic, 27% had not been seen for sexual health services in over 2 years. Most clients indicated satisfaction with MP services. The most important characteristics for a care site identified included comfort with staff, location, and affordability. 43.5% preferred a clinic time outside of 9am-5pm. Only 13% of clients preferred home-based labs using a self-collection kit with a majority preference for in-person follow-up at the MP clinic. Conclusion Key populations at risk for HIV infection including immigrants and Black and Latino MSM may experience barriers to traditional clinic care. Clients expressed satisfaction with MP services, and a preference for clinic-collected rather than self-collected specimens. Further research to tailor service delivery to client preferences is needed. Disclosures All Authors: No reported disclosures

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