Comparing Patients’ Experiences in Three Differentiated Service Delivery Models for HIV Treatment in South Africa

Differentiated service delivery for HIV treatment seeks to enhance medication adherence while respecting the preferences of people living with HIV. Nevertheless, patients’ experiences of using these differentiated service delivery models or approaches have not been qualitatively compared. Underpinned by the tenets of descriptive phenomenology, we explored and compared the experiences of patients in three differentiated service delivery models using the National Health Services’ Patient Experience Framework. Data were collected from 68 purposively selected people living with HIV receiving care in facility adherence clubs, community adherence clubs, and quick pharmacy pick-up. Using the constant comparative thematic analysis approach, we compared themes identified across the different participant groups. Compared to facility adherence clubs and community adherence clubs, patients in the quick pharmacy pick-up model experienced less information sharing; communication and education; and emotional/psychological support. Patients’ positive experience with a differentiated service delivery model is based on how well the model fits into their HIV disease self-management goals.

It’s time to eliminate the mismatch between pediatric training and practice

The quality of pediatric clinical practice is dependent on the training received during residency. It is assumed that the content of the training will adequately prepare pediatricians for the sorts of problems and issues they will be asked to manage in community settings. While over the past several decades there have been major changes in pediatric morbidity, there is evidence that training and service delivery models have not evolved; there is a significant mismatch between training and evidence-based clinical practice. A recent paper published in this journal (1) drew attention to the inadequacy of pediatricians’ training in child development. The reality of major gaps in the content and experiences of pediatric training in Israel are widely held, and there have been repeated calls for an increased focus on community child health and developmental and behavioural pediatrics. While it appears that finally there are some small initial steps to this end, it is strongly recommended that there be a long overdue, radical rethink of pediatric training programs.

Role of Occupational Therapy in Pediatric Primary Care: Promoting Childhood Development

Occupational therapy practitioners have the opportunity to promote development for all children as new service delivery models are established for pediatric primary care. Three action steps are identified: (1) advocacy for legislation that requires developmental screenings and surveillance, (2) support of culturally responsive developmental monitoring, and (3) building evidence for occupational therapy in primary care settings. This article describes the role of occupational therapy practitioners on pediatric interprofessional teams in encouraging family capacity within the scope of health promotion and universal developmental monitoring.

The experience of the Center for Medicare and Medicaid Innovation (USA)

Since 2010, the CMMI has been testing new payment and service delivery models, evaluating the results and advancing best practices, and engaging with a broad range of stakeholders to develop additional models for testing. This presentation will showcase over 10 years of experience in managing an innovation funding programme, allowing for an interesting comparison to their European counterparts.