POLICY IMPLEMENTATION ON INTEGRATED REFERRAL SERVICE SYSTEM PROGRAM OF POVERTY ALLEVIATIONIN BANDUNG CITY, WEST JAVA, INDONESIA

Integrated Referral Service System (IRSS) program is a service system to assist the poor in their needs through poverty reduction and social protection programs. One of them is the government makes a program or policy to be able to serve various social services in reducing poverty. It was found that the implementation of the Integrated Referral Service System program policy in its implementation involved legal rules and other regional regulations. This study aims to determine and describe the extent of policy implementation in the Integrated Referral Service System program at the Bandung City Social Service. This research report discusses the implementation of policies regarding the Integrated Referral Service System program, the obstacles faced and the efforts made by the Bandung City Social Service through the Puskesos assistant for Integrated Referral Service System implementation or facilitators in the Maleber village. The research method used in this method is a qualitative research method. Data collection techniques used are observation, interviews, and documentation. This research is a comparison in policy implementation is the theory of David L. Weimer and Aidan R. Vining (2014) namely Policy Logic, Environment in which Policy is Operated, and Implementor Capability. There were four informants in this study, namely the Head of Protection and Social Security, Head of the Service and Referral Section, Integrated Referral Service System of Implementing Facilitators and people who use Integrated Referral Service System. The conclusions drawn in this study are based on indicators that the Policy Implementation regarding the Integrated Referral Service System program in Bandung City through the Social Health Center in Maleber Village from 2019 to 2020 experienced a fairly high increase. Due to the large number of poor and underprivileged people who need assistance in the form of complaints about social problems, especially the impact of the covid 19. Poverty Reduction at the Bandung City Social Service is quite optimal, it's just that there are some obstacles regarding infrastructure and understanding in carrying out various complaints and services to the public. Integrated Referral Service System Health Center Scores.

Improving services for those who serve: A private practice initiative to improve psychiatric care for first responder and military patients

Objectives Professional isolation and limited opportunities for multidisciplinary collaborations are well-recognised challenges for psychiatrists in private practice. This narrative paper describes the development of a private practice group to assist first responders (FRs) and military patients located in Adelaide, South Australia. The aims included both peer review, and interdisciplinary communication and collaboration. Relevant personnel in the ambulance, police and fire services, military and veterans’ groups, and the compensation system, participated in monthly meetings. Lack of timely access to psychiatric care for FR and military patients was identified as a problem and an expedited referral service was established. Conclusions The Closing the Gap Group was established in 2017. The terminology refers to the gap between treating psychiatrists and the complex organisations that manage the workplace context for FR/military patients. This initiative provides a template for private practice innovations to improve psychiatrists’ skills and knowledge, along with better engagement and understanding between private psychiatrists and relevant community organisations.

Literature Review: Analysis of Factors Related to User Satisfaction on The Online Reference System for BPJS Health Participants in Semarang City

An online referral system is an innovation from BPJS Health in digitizing the tiered referral system. An online referral system is expected to increase the participants' satisfaction and convenience in obtaining the referral service. However, there was no evaluation in satisfaction measurement on an online referral system until this time, especially in Semarang City. This study aims to evaluate the implementation of an online referral system by analyzing factors related to the satisfaction of BPJS Health participants in Semarang City. This was a quantitative research with a cross-sectional approach involving 100 respondents chosen by accidental sampling technique. The results of the study showed that the percentage of respondents who felt satisfied was only 54%, which was caused by the administrative efficiency and system effectivity of an online referral system that is still not optimal in reducing queues. Besides that, there is a relationship between performance expectancy, effort expectancy, facilitating condition, information quality, and user satisfaction towards the implementation of an online referral system in the BPJS Health of Semarang City with a p-value < 0,05. The results of the study suggest for BPJS Health determine the participants' satisfaction indicators towards the implementation of the online referral system and integrate the online referral system with the registration system at secondary and tertiary health facilities in Semarang City.

EP.WE.453Impact of COVID 19 pandemic on colorectal rapid access investigations

Aim The impact of the COVID-19 pandemic on delays in diagnosis of cancer has been highlighted at a national level. Such a delay represents an ongoing source of mortality and morbidity missing from the COVID-19 statistics. This study examines the delay in investigation of patients referred to the urgent colorectal cancer referral service at a single centre. Method Retrospective data was collated from prospective database for all 1,894 referrals to the urgent colorectal cancer referral service for the period 21 January to 24 December 2020. The time to appointment (TTA) was compared by date of referral and outcome type (endoscopy, CT abdomen pelvis (CT-AP), CT colonography (CT-C), clinic appointment). Results Across 2020, fewer than 25% of patients met the NICE recommendation of appointment within 14 days (median TTA 30 days, first quartile 19). TTA increased dramatically in the first months of the pandemic (February median: 19; March: 80.5). TTA remained high, not falling below a median wait of 28 days until November. CT-C tests were particularly delayed (median TTA: 86) due to concerns regarding aerosol generation and COVID-19 transmission. Patients were offered CT-AP tests while awaiting their delayed CT-C, as CT-AP had a significantly better wait of 15 days. Conclusion COVID-19 was a major disruptor of colorectal cancer diagnosis in 2020, with patients waiting more than twice as long as NICE recommends. This will likely continue into 2021, with further research required to assess the impact of this disruption on mortality and morbidity.

Feasibility and acceptability of a community pharmacy referral service for suspected lung cancer symptoms

BackgroundLung cancer survival rates in the UK are among the lowest in Europe, principally due to late-stage diagnosis. Alternative routes to earlier diagnosis of lung cancer are needed in socioeconomically deprived communities that are disproportionately affected by poor lung cancer outcomes. We assessed the feasibility and acceptability of a community-based pharmacy referral service to encourage earlier symptomatic referral for chest X-rays.MethodsSeventeen community pharmacies located in a deprived area of Wales participated between March 2019 and March 2020. Stakeholder interviews were conducted with four patients, seven pharmacy professionals and one general practitioner. Four focus groups were conducted, including one with healthcare professionals (n=6) and three with members of the public who were current and former smokers (n=13). Quantitative data regarding patient characteristics and clinical outcomes were collected from hospital records and patient referral questionnaires completed by pharmacists and analysed using descriptive statistics. Qualitative data sets were analysed thematically and triangulated.ResultsTwelve patients used the pharmacy referral service, all of whom were male. Average length of the pharmacy consultation was 13 min, with a mean 3 days to accessing chest X-rays in secondary care. Patients experienced a mean 46-day wait for results, with no lung cancer detected. Participants found the service to be acceptable and considered the pharmacy element to be broadly feasible. Perceived barriers included low awareness of the service and concerns about the role and capacity of pharmacists to deliver the service. Facilitators included perceived approachability and accessibility of pharmacists. A well-publicised, multifaceted awareness campaign was recommended.ConclusionsA community pharmacy referral service for lung symptoms was considered an acceptable alternative pathway to symptomatic diagnosis of lung cancer in deprived communities. Wider implementation of the service would require workforce capacity and training to be addressed to ensure optimum utilisation and promotion of the service.

Oral verrucous carcinoma: a 24-year epidemiological study and case report

Introduction: Verrucous carcinoma is a non-metastatic variant of squamous cell carcinoma. It was first reported by Ackerman in 1948. It is a verrucous exophytic tumor and, although it is a rare lesion, it mainly affects the oral cavity, with slow growth and can be locally invasive. Objective: To report a case and present an observational and retrospective analysis of medical records containing biopsy data from patients diagnosed with oral verrucous carcinoma (OVC) in an oral diagnostic referral service for a period of 24 years. Material and methods: The following data were collected: age, sex, ethnicity, anatomical location and management. Result: Eight cases of OVC were found, all in Caucasian patients (n = 8, 100%), aged between 57 and 102 years. 62% of the injuries affected women. The most affected region was the jugal mucosa (n = 4, 50%). In addition, Smoking patients were not found. In all cases, incisional biopsy was performed and referral to the head and neck surgeon. Conclusion: Caucasian women in the sixth and seventh decades of life were the most affected by OVC. The absence of smoking patients corroborates the literature, which reports that cigarettes appear to be unrelated to this injury. The dentist's role is to recognize the disease early, diagnose it and refer it for medical treatment.

Scaling up a National Extracorporeal Membrane Oxygenation Referral Service for adult patients in acute severe respiratory failure at the time of a pandemic

The National ECMO Service for patients in acute severe respiratory failure in England responded to the challenge of the coronavirus pandemic by implementing a central electronic referral system within days. Prior to this, each ECMO centre managed independently around 20 ECMO referrals per month. Early during the pandemic, we recognised the need for a referral system to co-ordinate the anticipated increased number of referrals. We implemented rapidly a referral system with universal access across England. This allowed the five National ECMO centres to manage over 1000 referrals in the first seven weeks of the pandemic. Key benefits of the new system included facilitated communication and collaboration between centres; data on demand; and capacity shared in real-time. We believe this was instrumental in allowing us to continue to provide for the whole country, respond at scale, and facilitate our collaborative work as a multidisciplinary team.