Continuity of care, measurement and association with hospital admission and mortality: a registry-based longitudinal cohort study

ObjectiveTo assess whether continuity of care (COC) with a general practitioner (GP) is associated with mortality and hospital admissions for older patients We argue that the conventional continuity measure may overestimate these associations. To better reflect COC as a GP quality indicator, we present an alternative, service-based measure.DesignRegistry-based, population-level longitudinal cohort study.SettingLinked data from Norwegian administrative healthcare registries, including 3989 GPs.Participants757 873 patients aged 60–90 years with ≥2 contacts with a GP during 2016 and 2017.Main outcome measureAll-cause emergency hospital admissions, emergency admissions for ambulatory care sensitive conditions, and mortality, in 2018.ResultsWe assessed COC using the conventional usual provider of care index (UPCpatient) and an alternative/supplementary index (UPCGP list) based on the COC for all other patients enlisted with the same preferred GP.For both indices, the mean index score was 0.78. Our model controls for demographic and socioeconomic characteristics, prior healthcare use and municipality-fixed effects. Overall, UPCGP list shows a much weaker association between COC and the outcomes. For both indices, there is a negative relationship between COC and hospital admissions. A 0.2-point increase in the index score would reduce admissions for ambulatory care sensitive conditions by 8.1% (CI 7.1% to 9.1%) versus merely 1.9% (0.2% to 3.5%) according to UPCpatient and UPCGP list, respectively. Using UPCGP list, we find that mortality is no longer associated with COC. There was greater evidence for an association between COC and all-cause admissions among patients with low education.ConclusionsA continuity measure based on each patient’s contacts with own preferred GP may overestimate the importance of COC as a feature of the GP practice. An alternative, service-based measure of continuity could be suitable as a quality measure in primary healthcare. Facilitating continuity should be considered a health policy measure to reduce inequalities in health.

Accessing needed sexual health services during the COVID-19 pandemic in British Columbia, Canada: a survey of sexual health service clients

ObjectivesWe assessed COVID-19 pandemic impacts on accessing needed sexual health services, and acceptability of alternative service delivery models, among sexual health service clients in British Columbia (BC), Canada.MethodsWe administered an online survey on 21 July–4 August 2020 to clients using a provincial STI clinic or internet-based testing service, GetCheckedOnline, in the year prior to March 2020. We used logistic regression to identify factors associated with having unmet sexual health needs (ie, not accessing needed services) during March–July 2020 and the likelihood of using various alternative service models, if available.ResultsOf 1198 survey respondents, 706 (59%) reported needing any sexual health service since March 2020; of these 706, 365 (52%) did not access needed services and 458 (66%) had avoided or delayed accessing services. GetCheckedOnline users (univariate OR (uOR)=0.62; 95% CI 0.43 to 0.88) or clients with more urgent needs (eg, treatment for new STI, uOR 0.40 (95% CI 0.21 to 0.7)) had lower odds of unmet sexual health needs. The most common factors reported for avoiding or delaying access were public messaging against seeking non-urgent healthcare (234/662, 35%), concern about getting COVID-19 while at (214/662, 32%) or travelling to (147/662, 22%) a clinic or lab and closure of usual place of accessing services (178/662, 27%). All factors were positively associated with having unmet sexual health needs, with public messaging showing the strongest effect (adjusted OR=4.27 (95% CI 2.88 to 6.42)). Likelihood of using alternative sexual health service models was high overall, with the most appealing options being home self-collection kits (634/706, 90%), receiving test kits or antibiotics at home (592/700, 85%) and express testing (565/706, 80%).ConclusionsOf BC sexual health service clients needing services during March–July 2020, many had unmet needs. Offering alternative service delivery methods may help to improve access during and beyond the COVID-19 pandemic.

Telehealth in paediatric occupational therapy: a scoping review

Background/Aims This study reviewed the use of telehealth in paediatric occupational therapy practice and its clinical outcomes over the past 20 years. Methods A scoping review following Arksey and O'Malley's five stages was undertaken using six databases and Google Scholar. The scoping review covered articles from January 2000 to April 2020. Results A total of 22 articles were reviewed. Most studies indicated positive outcomes of using telehealth in paediatric occupational therapy practice. Although there is insufficient evidence, the results indicated that telehealth can be more effective than face-to-face interventions when there are mobility or travel challenges for children. Conclusions The use of telehealth in paediatric occupational therapy is an alternative service delivery model, facilitating access for children and their families to the rehabilitation services. Further research is needed to address the difficulties and potential solutions to expand the use of telehealth services to help children with disadvantages alongside their families.

Faktor Jantina dan Kepuasan Klien dalam Perkhidmatan E-Kaunseling

Memandangkan kemampuan internet mewujudkan prasarana yang sesuai untuk membina hubungan, pengamal kaunseling telah mengambil inisiatif memaksimumkan ruang internet ini. Satu perkhidmatan alternatif menolong melalui interaksi maya ini diwujudkan. E-Kaunseling telah mula mendapat perhatian kaunselor sebagai satu perkhidmatan alternatif yang ditawarkan kepada klien.Kajian ini bertujuan untuk meneroka sejauh mana keberkesanan perkhidmatan E-Kaunseling terhadap jantina. Kajian eksperimental-kuasi ini menggunakan reka bentuk Kumpulan Kawalan Ujian Pra Dan Ujian Pasca. Data kuantitatif diperolehi menggunakan soal selidik Client’s Satisfaction Inventory Short-Form (CSI-SF). Seramai 60 subjek kajian terlibat dan dijalankan dalam dua kumpulan kajian iaitu kumpulan kawalan menggunakan kaedah Kaunseling Bersemuka dan kumpulan eksperimen pula menggunakan kaedah E-Kaunseling.Dapatan menunjukkan tiada perbezaan antara jantina dan Kepuasan Klien dalam kedua-dua kaedah dan hasil analisis Anova Dua Hala menunjukkan tiada perbezaan utama (main interaction) antara Jantina dan Kepuasan klien. Hasil analisis lanjut menggunakan Anova Sehala menunjukkan kesan interaksi (interaction effect) bahawa klien lelaki mendapat lebih kepuasan dalam kaedah E-kaunseling manakala klien perempuan mendapat lebih kepuasan dalam kaedah Kaunseling bersemuka. Implikasi kajian ialah kepada kaunselor sekolah dalam menawarkan perkhidmatan e-kaunseling bagi membantu pelajar yang ingin mendapatkan perkhidmatan kaunseling di luar waktu persekolahan. In view of the ability of the internet to create an appropriate relationship-building infrastructure, counselling practitioners have taken the initiative to optimize this internet space. An alternative service aims to establish this virtual interaction. E-Counselling has begun to catch the eye of counsellors as an alternative service offered to clients.This study aims to explore the effectiveness of E-Counselling services on gender.This quasi-experimental study uses the design of Pre-Test and Post-Test Control Groups. Quantitative data were obtained using the Client’s Satisfaction Inventory Short-Form (CSI-SF) questionnaire. A total of 60 participants were involved and conducted in two study groups, namely the control group using the Face-to-Face Counselling method and the experimental group using the E-Counselling method. Findings show no difference between gender and Client Satisfaction in both methods and the results of the Two-Way Anova analysis show no significant difference between Gender and Client Satisfaction. The results of further analysis using One-Way Anova show the interaction effect that male clients get more satisfaction in the E-counselling method while female clients get more satisfaction in the face-to-face counseling method. The implication of the study is for school counselors to provide e-counseling programs to support students who want to access counseling after school hours.

Local Government Communication: Reaching out through Facebook

The development of Web 2.0 technologies has led to the expansion of new technologies and services such as social media, which has become a new tool for public participation and alternative service delivery based on higher G2C (government to citizens) responsiveness. This ongoing development has caused governments to face expectations to adapt their communication channels to the changing environment of online social interactions. The main purpose of this paper is to investigate how local governments in the Czech Republic use social media in their communications with the public and the effects of these communications. To do so, this paper presents a comprehensive analysis of the Facebook communications of Czech regional capitals using multiple methodological approaches, including a survey, statistical analysis and an OLS model. The Facebook social networking site was chosen for this research because of its prevalent popularity over all relevant social media and the frequency of use in the Czech Republic both in general and by local governments, and because of its higher complexity of G2C interactions. The outcomes are given in the context of the relevant previous research.

A User's Guide for Understanding and Addressing Telepractice Technology Challenges via ZOOM

Purpose Telepractice has been used as an alternative service delivery model in speech-language pathology across various settings and the scope of practice. Despite its utility and increasing demands resulting from the COVID-19 global pandemic, some clinicians and clients continue to report apprehension to adopting telepractice service delivery model due to discomfort with technology. Among currently available telepractice platforms, “ZOOM” is one of the popular platforms among speech-language pathologists (SLPs) in the United States because of its usability and subscription cost. However, many challenges have been experienced by clinicians and clients when ZOOM is used. The purpose of this article was twofold. The first goal of this article was to address barriers and challenges to implement successful telepractice SLP services. The second goal of this article was to develop four step-by-step troubleshooting manuals (one for client and one for clinician in both English and Spanish) to enhance its utility for users. Conclusion Preliminary qualitative data showed that the manuals developed by the authors were useful and functional for graduate SLP students. Supplemental Material https://doi.org/10.23641/asha.14044091

OPTIMAL ADMISSION AND ROUTING WITH CONGESTION-SENSITIVE CUSTOMER CLASSES

This paper considers optimal admission and routing control in multi-class service systems in which customers can either receive quality regular service which is subject to congestion or can receive congestion-free but less desirable service at an alternative service station, which we call the self-service station. We formulate the problem within the Markov decision process framework and focus on characterizing the structure of dynamic optimal policies which maximize the expected long-run rewards. For this, value function and sample path arguments are used. The congestion sensitivity of customers is modeled with class-independent holding costs at the regular service station. The results show how the admission rewards of customer classes affect their priorities at the regular and self-service stations. We explore that the priority for regular service may not only depend on regular service admission rewards of classes but also on the difference between regular and self-service admission rewards. We show that optimal policies have monotonicity properties, regarding the optimal decisions of individual customer classes such that they divide the state space into three connected regions per class.

Pengembangan model manajemen Open Educational Resources (OER) Perpustakaan Institut Agama Islam Negeri Curup

Open education resources (OER) are an interesting and diverse source of information that is easily accessible. For the Institut Agama Islam Negeri (IAIN) Curup library, the OER is an alternative service to meet visitors' needs through resources offered are so diverse that it needs adjustment and development. This study was conducted to find out development an effective OER management model to meet IAIN Curup library users' needs. This research used a combination of qualitative and quantitative research types. This study used a research and development method, adoption of the Borg and Gall model. Results showed that the OER management model was selected and developed by testing users' and experts' needs and opinions following the IAIN. OER management model comprised four stages. Stage 1 planning, consisting of steps needs analysis, identification, and verification or preparation. Stage 2 of organizing namely processing activities. Stage 3 actualizing, which consisted of steps service, and promotion. Stage 4 was evaluation. The (OER) management model application was useful. The IAIN Library's OER application could be accessed via a browser at the address http://oer.iaincurup.ac.id; with this open-source platform, and each library could add specific features such as search features, usage statistics, and others. The study concludes that the development of an OER management model for the IAIN Library Curup is still essential so that effectiveness of library services is following the conditions of the community's needs.