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BACKGROUND: The Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 authorized a major expansion of purchased care in the community for Veterans experiencing access barriers in the Veterans Affairs (VA) health care system. OBJECTIVE: To estimate changes in primary care, mental health, and emergency/urgent care visits in the VA and community fiscal years (FY) 2018-2021 and differences between rural and urban clinics. DESIGN: A national, longitudinal study of VA clinics and outpatient utilization. Clinic-level analysis was conducted to estimate changes in number and proportion of clinic visits provided in the community associated with the MISSION Act adjusting for clinic characteristics and underlying time trends. PARTICIPANTS: In total, 1050 VA clinics and 6.6 million Veterans assigned to primary care. MAIN MEASURES: Number of primary care, mental health, and emergency/urgent care visits provided in the VA and community and the proportion provided in the community. KEY RESULTS: Nationally, community primary care visits increased by 107% (50,611 to 104,923), community mental health visits increased by 167% (100,701 to 268,976), and community emergency/urgent care visits increased by 129% (142,262 to 325,407) from the first quarter of 2018 to last quarter of 2021. In adjusted analysis, after MISSION Act implementation, there was an increase in community visits as a proportion of total clinic visits for emergency/urgent care and mental health but not primary care. Rural clinics had larger increases in the proportion of community visits for primary care and emergency/urgent care than urban clinics. CONCLUSIONS: After the MISSION Act, more outpatient care shifted to the community for emergency/urgent care and mental health care but not primary care. Community care utilization increased more in rural compared to urban clinics for primary care and emergency/urgent care. These findings highlight the challenges and importance of maintaining provider networks in rural areas to ensure access to care.

Background: This study aimed to review the activities of the Kobe City Initial‐phase Intensive Support Team for Dementia pre‐ and during the coronavirus disease 2019 (COVID‐19) pandemic, to compare the characteristics of the target population and the performance of the team's activities, and determine the impact of the pandemic on the team's project. Methods: The summary data obtained at the time of consultation, team activities, and participants' characteristics were extracted from 662 participants who started to receive support between April 2018 and March 2022. Statistical analysis was performed by dividing the participants into the following two groups: pre‐ and during COVID‐19 pandemic groups. Results: There was no significant difference in the number of new cases or cases that led to a dementia diagnosis between the pre‐ and during COVID‐19 pandemic groups. However, there were significant differences in the number of home visits and rate of introduction of medical care between the two groups. In our study population, the number of participants with financial management difficulties and delusions increased and the number of participants who refused visitations slightly decreased. Conclusion: The Kobe City Initial‐phase Intensive Support Team was able to continue its activities during the pandemic partly because the team is an independent, dedicated team. During the pandemic, there was an increase in the number of participants who were isolated because they were deprived of opportunities to interact with others, and who developed delusions and other psychiatric symptoms. Despite this situation, the professional team responded quickly through individual assessment of the individual needs by continuous outreach, taking into account the infection situation, and thus this outreach team functioned well even under the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

This paper examines the tensions and struggles over elder care that are happening in South Africa between family caregivers, care workers and the state. These struggles are experienced and expressed at the familial and community level but are best understood by examining how the state has de-funded facilities in favour of 'ageing in place' without any additional investment in community and home-based care support. The findings reveal that stresses on unpaid and paid carers are expressed in terms of individual failings and interpersonal conflict rather than through a socio-political contextual lens. These findings contribute to how a familialist care regime impacts the everyday personal relationships between paid and unpaid carers of older persons. [ABSTRACT FROM AUTHOR]

The Veterans Health Administration (VA) increasingly purchases community-based care (CC) to improve healthcare access, including behavioral health. In 2018, VA introduced standardized episodes of care (SEOCs) to guide authorization and purchase of CC services for specific indications in a defined timeframe without bundling payment. In this retrospective cross-sectional study, we describe trends in VA and CC behavioral healthcare utilization using the VA Outpatient Psychiatry SEOC definition. Counts of Outpatient Psychiatry SEOC-allowable service and procedure codes during fiscal years 2016–2019 were organized according to four SEOC-defined service types (evaluation and management, laboratory services, psychiatry services, transitional care) and measured as percentages of all included codes. Trends comparing behavioral healthcare utilization between Veterans using any CC versus VA only were analyzed using a linear mixed effects model. We identified nearly 3 million Veterans who registered 60 million qualifying service and procedure codes, with overall utilization increasing 77.8% in CC versus 5.2% in VA. Veterans receiving any CC comprised 3.9% of the cohort and 4.7% of all utilization. When examining service type as a percent of all Outpatient Psychiatry SEOC-allowable care among Veterans using CC, psychiatry services increased 12.2%, while transitional care decreased 8.8%. In regression analysis, shifts in service type utilization reflected descriptive results but with attenuated effect sizes. In sum, Outpatient Psychiatry SEOC-allowable service utilization grew, and service type composition changed, significantly more in CC than in VA. The role of SEOCs and their incentives may be important when evaluating future behavioral healthcare quality and value in bundled services. [ABSTRACT FROM AUTHOR]

COVID-19 outbreak produced an unprecedented crisis in care sectors. Nursing home workers, healthcare, social care, and clinical social workers (HSCW) often took the burden of managing the crisis in their facilities, risking increased stress, trauma, and burnout. As a response to this issue, increased interest in self-care in health and social work literature could be observed. Yet, the concept of self-care is problematic, as it focuses attention on the individual responsibility to care for oneself, regardless of organisational and structural factors and obstacles. The article provides a critical literature review, focused on risk factors and psychological consequences of the pandemic in health and social care and clinical social work, and on the proposed response, namely, self-care. The aim of the article is to systematise knowledge about approaches to self-care in these sectors and to critically review those approaches. Critiques of self-care are considered, including those informed by Foucauldian perspective of governmentality and responsibilization. The concept of community care is introduced as an implication and an answer to these critiques. [ABSTRACT FROM AUTHOR]

Activism inherently involves emotional engagement, often stemming from personal experiences, connections to the issue, or fuelled by emotions like anger, frustration, and a drive for positive social change. This article builds upon Hochschild's concept of emotional labour, expanding its scope to encompass the emotional dimensions of activism among college students. We delve into the lived experiences of 67 college student activists in the mid-Atlantic region of the USA, uncovering the emotional impetuses driving their activism, the challenges of activist burnout resulting from their emotional labour, and the strategies employed to navigate its emotional toll. By analysing the emotional narratives shared by these student activists, this article seeks to contribute to the understanding of academics and practitioners by constructing a comprehensive framework that illuminates how emotions affect their activism toward effecting transformative social change. [ABSTRACT FROM AUTHOR]

Background: Effective medication management is crucial for ensuring timely pain and symptom control at the end of life. Dying in pain is a major concern for patients, yet some find less effective pain control at home. Family caregivers (FCGs) play a vital role in managing pain and symptom control for dying patients. However, the experience of administering medications at home for terminal-stage patients has not been widely recognized or understood. Our study aimed to explore the experiences of FCGs in administering medications to adult dying patients. Methods: We conducted a directed content analysis of data from 73 semi-structured interviews with FCGs across 19 Chinese provinces from 2021 to 2023. FCGs were recruited through the Voluntary Cooperative Network Research. We asked, "Could you recall the end-of-life care process for the patients?" We aligned the themes with the five issues identified by Wilson et al. (2018): administration, organizational skills, empowerment, relationships, and support. Results: FCGs in China exhibit concerns about over-engagement and empowerment in medication administration, concealing medication information from the patient, and medication accessibility. FCGs faced significant challenges in accurately identifying and addressing pain and symptoms, determining appropriate dosages, accessing effective medications, and managing the emotional stress associated with potential medication errors. Financial burden, medication regulatory restrictions, geographical inequality, and travel restrictions during COVID impeded patients and FCGs from accessing medication. A culturally specific finding is the use of alternative medicine at the end of life. Conclusion: Our findings build upon Wilson et al.'s framework and extend their insights on empowerment, highlighting the need for policies to support home-based palliative care professionals in training FCGs for effective medication administration. [ABSTRACT FROM AUTHOR]

Background: Most people living with dementia live in their own home supported by family carers. One of the most challenging problems they face is managing toilet-use and continence. Carers have repeatedly asked for better advice from healthcare professionals. The purpose of this systematic review was to inform the development of an intervention to support healthcare professionals to provide existing continence management advice to the carers of people living at home with dementia. It aimed to identify and synthesise lessons from the development and evaluation of interventions, involving primary or community healthcare professionals, to support the provision of management advice aimed at supporting people living at home with dementia and their carers with activities of daily living. Due to a lack of relevant continence or toilet-use interventions, this included, but was not limited to, toileting or continence care. Methods: Literature (February 2009-November 2022) was searched using five databases: MEDLINE (Ovid); PsycINFO (Ovid); EMBASE (Ovid); Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO); and Cochrane Central Register of Controlled Trials (CENTRAL). Empirical studies using a variety of methodologies were included and thus the quality of papers appraised using the Mixed-Methods Appraisal Tool. No studies were excluded based on quality. A narrative synthesis was undertaken. Results: Twelve articles reporting on 10 interventions were included. Most comprised the provision of online resources only, although some combined these with online or face-to-face contact with healthcare professionals. A variety of methodologies was utilised including randomised controlled trials. The quality of included studies was variable. Six main themes were identified: mode of delivery; targeted and tailored resources; content, design and navigation; credibility; user involvement in the development and evaluation of information resources; and role of professionals and organisations. Conclusions: Despite the urgent need to better support people living at home with dementia and their carers, this review highlights the paucity of studies reporting on interventions delivered within primary and community healthcare contexts to provide management advice aimed at supporting this population with activities of daily living. This review has identified important considerations that will potentially aid the development, delivery and evaluation of such interventions. Systematic Review Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022372456. [ABSTRACT FROM AUTHOR]

The rise of smart technology, endorsed by government institutions and recognised for its societal benefits and potential for urban management, has carved a niche for smart eldercare. However, discourses around smart care vary among stakeholders, leading to a constant (re)production of it. This paper investigates three overlapping and sometimes converging stakeholders' (governments, corporations and capital investors) discourses in defining ‘smart eldercare’, arguing that these discourses significantly influence the promotion, implementation and acceptance of smart eldercare in urban Chinese communities. Government entities view smart eldercare as an efficient tool for facilitating community‐based population governance and providing a social safety net. In contrast, eldercare corporations view smart eldercare as a powerful narrative to attract investment and secure government funding, while also serving as a means of surveilling in‐home care labour. For capital investors, eldercare stands out as a burgeoning and resilient sector, encompassing latent values that warrant careful consideration, especially during periods of economic downturn. Through the lens of discourse analysis, this study underscores the tensions between different discourses and the ways it produces ‘smartness’ in urban China. This paper advocates for understanding ‘smartness’ as a complex, multifaceted concept shaped by diverse stakeholder discourses and socio‐economic‐political contexts, necessitating flexible, context‐sensitive interpretations through discourse analysis. To advance ongoing debates in geography on smart care, smart cities and ageing, this paper reveals how these stakeholder discourses co‐produce the notion of ‘smartness’ in urban eldercare, while highlighting the socio‐political dynamics underlying technology‐driven governance in China. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusion Implications for the Profession and/or Patient Care Impact Reporting Method Public Contribution To examine community nurses' experiences of caring for people with dark skin tones at high risk of developing a pressure injury.Qualitative descriptive design.Focus groups and individual semi‐structured interviews were conducted among registered nurses working in the community between November 2023 and March 2024. Thematic analysis was used.The findings reveal the lack of nurse education on diverse skin tones, how community nurses gain knowledge on skin tone diversity in the context of pressure injuries and the topics community nurses believe are crucial to improve the management of pressure injuries in patients with dark skin tones.The study highlights the gap in nurse education regarding diverse skin tones, revealing how community nurses acquire knowledge related to pressure injuries in patients with dark skin tones.This research could inform the development of targeted educational programmes and training initiatives, ultimately preventing patient harm and enhancing the quality of care and health outcomes for patients with dark skin tones.It provides valuable insights into key topics that community nurses consider essential for improving the early recognition and management of pressure injuries in people with darker skin tones.The research adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.A project steering group contributed to the concept of the study and checked the interview questions were relevant and suitable. [ABSTRACT FROM AUTHOR]

Objective: This qualitative study sought to explore patient experiences with technologies used in the Community Health in a Virtual Environment (Co-HIVE) pilot trial. Technology is becoming increasingly prevalent in mental healthcare, and user acceptance is critical for successful adoption and therefore clinical impact. The Co-HIVE pilot trialled a model of care whereby community-dwelling patients with symptoms of depression utilised virtual appointments and remote monitoring for the assessment and management of their condition, as an adjunct to routine care. Methods: Using a qualitative descriptive design, participants for this study were patients with symptoms of moderate to severe depression (based on the 9-item Patient Health Questionnaire, PHQ-9), who had completed the Co-HIVE pilot. Data was collected via semi-structured interviews that were audio-recorded, transcribed clean-verbatim, and thematically analysed using the Framework Method. Results: Ten participants completed the semi-structured interviews. Participants reported experiencing more personalised care, improved health knowledge and understanding, and greater self-care, enabled by the remote monitoring technology. Additionally, participants reported virtual appointments supported the clinician–patient relationship and improved access to mental health services. Conclusions: This experience of participants with the Co-HIVE pilot indicates there is a degree of acceptance of health technologies for use with community mental healthcare. This acceptance demonstrates opportunities to innovate existing mental health services by leveraging technology. [ABSTRACT FROM AUTHOR]

Critical nursing shortages and experiences of burnout present a significant challenge in the home and community care (HCC) health sector. Determining what factors influence resiliency could inform HCC organizations in developing recruitment and retention resources and strategies. This scoping review identified factors that influence professional resilience in nurses working in the HCC sector. From 1819 documents identified from database searches, using a librarian-informed strategy, eight articles were included. Two domains emerged for HCC nurses, that is, i) professional and work-related characteristics of being resilient; and ii) strategies to promote professional nurse resilience. One domain emerged addressing organizational infrastructure, policy and practices contributing to professional nurse resilience in the HCC sector. The findings revealed that resiliency in HCC nurses extends beyond individual characteristics as nurse professionals, and their personal "self-care" strategies as individual people. Further research is needed to disentangle personal and professional resilience in nurses working in the HCC sector. [ABSTRACT FROM AUTHOR]

Background: Research suggests that in both France and the UK, between 5% and 10% of appointments with GPs are unattended. A comprehensive Irish study linked missed appointments with an increased short-term risk of mortality, prompting further investigation into the reasons behind absenteeism. Aim: To delve into the underlying causes of missed appointments, within the context of an urban health centre. Design & setting: Using a mixed-method approach, this study combines qualitative telephone interviews with quantitative analysis of medical records. The study focuses on patients who failed to attend appointments at an urban health centre in France over a 15-day period. Method: The interview guide collected data on circumstances leading to missed appointments and explored patients' social determinants of health. Additionally, quantitative data, including patients' socioeconomic backgrounds, were extracted from medical records. Results: Among 53 missed appointments (4.9% of all scheduled), 22 patients were interviewed. State health coverage (SHC) beneficiaries (68.2% of the sample) cited socioeconomic instability, including precarious work hours, social isolation, and multiple commitments, as reasons for non-attendance. For non-SHC beneficiaries, forgetting the appointment or failing to cancel it after self-resolution of the health issue was one of the main causes. Remarkably, 36.4% disclosed that they had experienced domestic violence. During the qualitative interview, patients were offered the opportunity to reschedule appointments, and a retrospective analysis by physicians found that over a quarter of the missed appointments were classified as 'capital appointments', meaning their absence could have significantly harmed the patient's health. Conclusion: The findings indicate that missed appointments can highlight social inequality, emphasising the need to align health care with patients' temporal realities. The identification of patients who have experienced violence and the use of missed appointments as triggers for follow-up calls seem to be promising strategies to enhance care and mitigate health inequalities. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Design Data Sources Methods Results Conclusion No Patient or Public Contribution Reporting Method Aging populations require adapting healthcare systems for older adult's specific needs. Numerous initiatives to improve older‐patient care have emerged, but the field lacks a unified framework. The current study aims to provide a systematic concept analysis of ‘age‐friendly healthcare’, examining its characteristics, components and structure.Rodger's evolutionary concept analysis.Searches were conducted in ProQuest, CINAHL, PubMed and Scopus databases between November 2022 and October 2023, utilising the PRISMA 2020 reporting checklist.A literature search using specific terms relevant to age‐friendly healthcare retrieved 1407 articles. After screening for duplicates and relevance, 140 articles were examined for eligibility based on inclusion criteria for age‐friendly care, language and full‐text availability. Following full‐text screening, 65 articles were included for data extraction by multiple researchers to synthesise theoretical, methodological and design elements.Our findings highlight key attributes of age‐friendly healthcare: Respect for older adults' autonomy and needs; leadership and organisational knowledge and support; Proactive policies and processes of care; holistic care environments; and communication and follow‐up with awareness of challenges and barriers as well as prioritisation of continuity‐of‐care.The concept of age‐friendly healthcare is still developing, with much research focused on development and implementation rather than evaluation of real‐world patient and health‐system outcomes. Our analysis of the concept may help unify the field and clarify future research directions through identification of areas requiring further study and enable development of improved practices and policies for implementing age‐friendly healthcare in a variety of settings.This concept analysis did not include any patient or public involvement.This study utilised the PRISMA reporting checklist. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Design Methods Results Conclusion Relevance to Clinical Practice Patient or Public Contribution Reporting Method To explore risk factors for Coronary Heart Disease (CHD) in secondary prevention for patients with the disease in China.Cross‐sectional study.A two‐stage sampling method was used (stratified sampling and systematic sampling). Patients who met WHO diagnostic criteria for CHD, had the capacity to give informed consent and volunteered to participate were recruited from five districts in Hengyang city, Hunan province, China. Six instruments were used: A general socio‐demographic questionnaire, Coronary Heart Disease Self‐Management Scale, International Physical Activity Questionnaires, Chinese Eight‐Item Morisky Medication Adherence Scale, Zung's Self‐Rating Anxiety Scale and Sexual Health Questionnaires. Participants completed the questionnaires in person or via telephone. Single‐factor correlation analysis, Pearson correlation analysis and multiple linear regression analysis were carried out.A total of 373 patients were recruited with a mean age of 66.25 years (standard deviation = 9.98). The mean score was 57.00 (14.23) for self‐management, 5.41 (1.82) for medication adherence, 53.61 (9.26) for anxiety, 8.66 (3.18) for sexual knowledge and 22.20 (9.68) for the need for sexual health education. The median was 1563.90 MET‐min/day for total energy consumption of physical activity. Self‐management, physical activity, medication adherence, anxiety and sexual health were significantly correlated with a range of demographic variables (age, gender, marital status, occupation, education levels, types of medical insurance, personal monthly income, living arrangements) and illness‐related variables (illness duration, number of hospital admissions, type of therapy, number of other chronic diseases, cardiac function grading and BMI).This research has showed the risk factors related to self‐management skills, medication adherence, anxiety, physical activity, sexual knowledge and the need for sexual health education in secondary prevention for patients with CHD. Health professionals play an important role in helping patients reduce risk factors for CHD to minimise its reoccurrence and mortality.Both hospital‐based and community‐based health professionals, especially nurses, have an important role to play in developing and implementing health promotion interventions to help patients with CHD reduce risk factors for the disease and thus reduce mortality.No patient contribution. Community nursing staff contributed to the design of the general socio‐demographic questionnaire for this study.The STROBE checklist was used to ensure comprehensive reporting (Appendix S1). [ABSTRACT FROM AUTHOR]

Background: China's government has invested a great deal of resources to improve the coverage rate of community care facilities for the elderly. However, the facilities that have been built are underutilized. Methods: Referring to the Anderson model, a framework for analyzing the utilization of community care facilities for the elderly was constructed. Descriptive statistics on survey data from 17 communities demonstrated the status of the utilization, and binary logistic regression analysis examined the influencing factors of the utilization. Results: Built community care facilities for the elderly are underutilized and there are significant differences in the influencing factors of the utilization between daily care facilities, medical care facilities, recreation facilities, and spiritual comfort facilities. Conclusions: The main reasons for the underutilization can be delineated as follows: (1) The demand for community care facilities is outstripped by the supply, resulting in a surplus; (2) Complex constraints on demand for facilities due to insufficient enabling resources; (3) Inadequacy of community care facilities in meeting expectations. (4) High substitutability of community care facilities; (5) Bureaucratic pressure hindering facility development. To address the underutilization of community care facilities, it is recommended to clarify the community responsibility boundaries for elderly care and the role that the market plays in community care facilities for the elderly. [ABSTRACT FROM AUTHOR]

Background: This paper describes a study protocol for co-producing and co-assessing a new sustainable and scalable service solution that enhances health and social integration by involving providers and volunteers delivering services for elderly people in the province of Cremona (Italy), where the elderly population will reach 27% in 2023. Methods: This upcoming study involves mixed-method participatory research and is structured in three study phases and related objectives. First, it will co-produce a new, accessible and sustainable service solution using an iterative design and management method, Plan-Do-Check-Act by involving professionals and volunteers of a heterogeneous group of health, social and third sector organizations located in the city of Cremona (Italy). Second, the study protocol will co-assess the outcomes of the new service solution using a mixed-method approach for measuring the outcomes on: professionals and volunteers (micro level) and their health, social and third sector organizations (meso level). Third, this study will co-investigate the scalability of the new solution promoting health and social integration in other similar urban areas of the Province of Cremona via the Intervention Scalability Assessment Tool (macro level). The data will be collected through the analysis of official documents, websites, policies and participatory workshops. Discussion: This protocol proposes an innovative intervention, a novel participatory approach, and an unexplored scalability assessment tool in the context of health and social care integration. This study aims to support professionals from health and social care service providers and volunteers from third-sector organizations to collaborate and integrate each other's resources. In doing so, the participatory approach will facilitate the co-creation of an effective response to the need of health and social integration, and the development of trustful relationships between health and social care service providers. Moreover, the adoption of Plan-Do-Check-Act and Intervention Scalability Assessment Tool will ensure the quality, scalability and sustainability of the new service solution in other settings. [ABSTRACT FROM AUTHOR]

This article provides an account of using reflexive participatory methods including study advisory group membership to evaluate a perinatal wellbeing service in an economically deprived area of Scotland. There is little qualitative research that explores the experiences of women accessing perinatal mental health services. This article draws on feminist values and narrative theory to explore the practice, process and ethics of using participatory methods with women in the perinatal period. We explore the blurring of intervention and research group boundaries to consider the service and study advisory group as a space which provided the conditions for collective care and re-storying the self. We explore the study advisory group as an extension of the intervention itself, highlighting the role of community in research practices and in interventions, for women who experience perinatal mental health difficulties. We reflect on the 'sticky' practice of navigating epistemic and decision-making power in participatory research, including the dual positionalities of being two academic researchers who come to research with therapeutic training in counselling, psychotherapy and social work. We call for reflexive, community-oriented and flexible approaches when using participatory methods with populations that might be considered vulnerable, marginalised or stigmatised. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To re-examine the evidence base that underpins the management of nasogastric tube safety in children • To recognise the consequences of delayed or missed feeds in children who receive nasogastric tube feeding • To enhance your understanding of what checks can be used to ensure a nasogastric tube is safe to use. Nasogastric tube feeding is generally considered safe provided a nasogastric aspirate with a pH ≤5.5, which indicates that the end of tube is correctly located in the stomach, can be obtained. When this is not possible, hospital attendance or admission is usually required so that an X-ray can be undertaken to check the tube’s position. This practice is based on an interpretation of the evidence that places undue importance on nasogastric aspirate pH testing before every use of a tube that is already in place, with potential negative consequences for children cared for in the community and their families. Following a re-examination of the evidence base, a revised approach is proposed in this article: when a child has a tube in place, provided its position has been confirmed as correct on initial placement using aspirate pH testing, nurses can use checks other than aspirate pH testing, alongside their clinical judgement, to determine whether it is safe and appropriate to use the tube. This proposed revised approach would reduce delayed or missed administration of fluids, feeds and medicines and enable more children to remain at home. [ABSTRACT FROM AUTHOR]

Background: Prior research documented racial and ethnic disparities in health care experiences within the Veterans Health Administration (VA). Little is known about such differences in VA-funded community care programs, through which a growing number of Veterans receive health care. Community care is available to Veterans when care is not available through the VA, nearby, or in a timely manner. Objective: To examine differences in Veterans' experiences with VA-funded community care by race and ethnicity and assess changes in these experiences from 2016 to 2021. Design: Observational analyses of Veterans' ratings of community care experiences by self-reported race and ethnicity. We used linear and logistic regressions to estimate racial and ethnic differences in community care experiences, sequentially adjusting for demographic, health, insurance, and socioeconomic factors. Participants: Respondents to the 2016–2021 VA Survey of Healthcare Experiences of Patients-Community Care Survey. Measures: Care ratings in nine domains. Key Results: The sample of 231,869 respondents included 24,306 Black Veterans (mean [SD] age 56.5 [12.9] years, 77.5% male) and 16,490 Hispanic Veterans (mean [SD] age 54.6 [15.9] years, 85.3% male). In adjusted analyses pooled across study years, Black and Hispanic Veterans reported significantly lower ratings than their White and non-Hispanic counterparts in five of nine domains (overall rating of community providers, scheduling a recent appointment, provider communication, non-appointment access, and billing), with adjusted differences ranging from − 0.04 to − 0.13 standard deviations (SDs) of domain scores. Black and Hispanic Veterans reported higher ratings with eligibility determination and scheduling initial appointments than their White and non-Hispanic counterparts, and Black Veterans reported higher ratings of care coordination, with adjusted differences of 0.05 to 0.21 SDs. Care ratings improved from 2016 to 2021, but differences between racial and ethnic groups persisted. Conclusions: This study identified small but persistent racial and ethnic differences in Veterans' experiences with VA-funded community care, with Black and Hispanic Veterans reporting lower ratings in five domains and, respectively, higher ratings in three and two domains. Interventions to improve Black and Hispanic Veterans' patient experience could advance equity in VA community care. [ABSTRACT FROM AUTHOR]

This article explores the implementation of a digital verification system known as Electronic Visit Verification (EVV) across homecare services for older and disabled adults within the US Medicaid program. EVV systems are used to conduct daily check-ins through GPS tracking and biometric identity verification. While touted as a means to identify and deter "fraud, waste, and abuse," the digital monitoring also generates detailed data trails on the lives and habits of service recipients, as well as constraining their daily movements. Drawing on qualitative interviews with workers and clients, I argue that this case study calls attention to how harms from digitalization of social welfare provision emerge from workplace surveillance and labor management, and how EVV becomes a tool for more finely tuning classifications of different types of paid and unpaid care. The burdensome digital compliance hurdles reinforced older employment tensions between the state, care workers, and public benefits recipients. [ABSTRACT FROM AUTHOR]

Background: Patient participation is fundamental in nursing care and has yielded benefits for patient outcomes. However, despite their compassionate care approach, nurses do not always incorporate patients' needs and wish into evidence‐based practice, quality improvement or learning activities. Therefore, a shift to continuous quality improvement based on evidence‐based practice is necessary to enhance the quality of care. The patient's opinion is an essential part of this process. To establish a more sustainable learning culture for evidence‐based quality improvement, it is crucial that nurses learn alongside their patients. However, to promote this, nurses require a deeper understanding of patients' care preferences. Objective: To explore patients' needs and wishes towards being involved in care processes that nurses can use in developing an evidence‐based quality improvement learning culture. Methods: A qualitative study was conducted in two hospital departments and one community care team. In total, 18 patients were purposefully selected for individual semi‐structured interviews with an average of 15 min. A framework analysis based on the fundamental of care framework was utilised to analyse the data deductively. In addition, inductive codes were added to patients' experiences beyond the framework. For reporting this study, the SRQR guideline was used. Results: Participants needed a compassionate nurse who established and sustained a trusting relationship. They wanted nurses to be present and actively involved during the care delivery. Shared decision‐making improved when nurses offered fair, clear and tailored information. Mistrust or a disrupted nurse–patient relationship was found to be time‐consuming and challenging to restore. Conclusions: Results confirmed the importance of a durable nurse–patient relationship and showed the consequences of nurses' communication on shared decision‐making. Insights into patients' care preferences are essential to stimulate the development of an evidence‐based quality improvement learning culture within nursing teams and for successful implementation processes. [ABSTRACT FROM AUTHOR]

Children living in disadvantaged communities have substantially increased risk for deleterious health and developmental outcomes. A considerable proportion of developmental delay is avoidable; however if children do not receive appropriate treatment within this critical period, damage can be irreparable. Community paediatric clinics provide medical and developmental assessment; deliver health promotion services, counselling, and advice to caregivers; and referral to services. The aim of this study was to systematically search, appraise, and synthesise the literature exploring the role of community paediatric clinics in supporting developmental outcomes and services for children living in disadvantaged communities. Electronic databases were searched using a carefully developed search strategy. Validated tools and appropriate guidelines assessed quality and confidence in evidence. Data analysis and mixed-methods synthesis was guided by the Segregated Framework for Mixed-Method Systematic Reviews. Eighteen studies were selected for inclusion. Areas of emphasis in the literature include the identification and monitoring of developmental delay; engagement of vulnerable families; relational working with children, families, and local services; referral to early intervention services; parental empowerment, practitioner capacity building; and tackling barriers to healthcare access. Through use of a child and family-centred model of care, community paediatric clinics can better meet the needs of vulnerable populations. [ABSTRACT FROM AUTHOR]

Abstract Background Effective medication management is crucial for ensuring timely pain and symptom control at the end of life. Dying in pain is a major concern for patients, yet some find less effective pain control at home. Family caregivers (FCGs) play a vital role in managing pain and symptom control for dying patients. However, the experience of administering medications at home for terminal-stage patients has not been widely recognized or understood. Our study aimed to explore the experiences of FCGs in administering medications to adult dying patients. Methods We conducted a directed content analysis of data from 73 semi-structured interviews with FCGs across 19 Chinese provinces from 2021 to 2023. FCGs were recruited through the Voluntary Cooperative Network Research. We asked, “Could you recall the end-of-life care process for the patients?” We aligned the themes with the five issues identified by Wilson et al. (2018): administration, organizational skills, empowerment, relationships, and support. Results FCGs in China exhibit concerns about over-engagement and empowerment in medication administration, concealing medication information from the patient, and medication accessibility. FCGs faced significant challenges in accurately identifying and addressing pain and symptoms, determining appropriate dosages, accessing effective medications, and managing the emotional stress associated with potential medication errors. Financial burden, medication regulatory restrictions, geographical inequality, and travel restrictions during COVID impeded patients and FCGs from accessing medication. A culturally specific finding is the use of alternative medicine at the end of life. Conclusion Our findings build upon Wilson et al.‘s framework and extend their insights on empowerment, highlighting the need for policies to support home-based palliative care professionals in training FCGs for effective medication administration.

Abstract Background This paper describes a study protocol for co-producing and co-assessing a new sustainable and scalable service solution that enhances health and social integration by involving providers and volunteers delivering services for elderly people in the province of Cremona (Italy), where the elderly population will reach 27% in 2023. Methods This upcoming study involves mixed-method participatory research and is structured in three study phases and related objectives. First, it will co-produce a new, accessible and sustainable service solution using an iterative design and management method, Plan-Do-Check-Act by involving professionals and volunteers of a heterogeneous group of health, social and third sector organizations located in the city of Cremona (Italy). Second, the study protocol will co-assess the outcomes of the new service solution using a mixed-method approach for measuring the outcomes on: professionals and volunteers (micro level) and their health, social and third sector organizations (meso level). Third, this study will co-investigate the scalability of the new solution promoting health and social integration in other similar urban areas of the Province of Cremona via the Intervention Scalability Assessment Tool (macro level). The data will be collected through the analysis of official documents, websites, policies and participatory workshops. Discussion This protocol proposes an innovative intervention, a novel participatory approach, and an unexplored scalability assessment tool in the context of health and social care integration. This study aims to support professionals from health and social care service providers and volunteers from third-sector organizations to collaborate and integrate each other’s resources. In doing so, the participatory approach will facilitate the co-creation of an effective response to the need of health and social integration, and the development of trustful relationships between health and social care service providers. Moreover, the adoption of Plan-Do-Check-Act and Intervention Scalability Assessment Tool will ensure the quality, scalability and sustainability of the new service solution in other settings.

Abstract Background China’s government has invested a great deal of resources to improve the coverage rate of community care facilities for the elderly. However, the facilities that have been built are underutilized. Methods Referring to the Anderson model, a framework for analyzing the utilization of community care facilities for the elderly was constructed. Descriptive statistics on survey data from 17 communities demonstrated the status of the utilization, and binary logistic regression analysis examined the influencing factors of the utilization. Results Built community care facilities for the elderly are underutilized and there are significant differences in the influencing factors of the utilization between daily care facilities, medical care facilities, recreation facilities, and spiritual comfort facilities. Conclusions The main reasons for the underutilization can be delineated as follows: (1) The demand for community care facilities is outstripped by the supply, resulting in a surplus; (2) Complex constraints on demand for facilities due to insufficient enabling resources; (3) Inadequacy of community care facilities in meeting expectations. (4) High substitutability of community care facilities; (5) Bureaucratic pressure hindering facility development. To address the underutilization of community care facilities, it is recommended to clarify the community responsibility boundaries for elderly care and the role that the market plays in community care facilities for the elderly.

Objective: To evaluate nationwide implementation of a Guidebook designed to standardize safety practices across VA‐delivered and VA‐purchased care (i.e., Community Care) and identify lessons learned and strategies to improve them. Data Sources and Study Setting: Qualitative data collected from key informants at 18 geographically diverse VA facilities across 17 Veterans Integrated Services Networks (VISNs). Study Design: We conducted semi‐structured interviews from 2019 to 2022 with VISN Patient Safety Officers (PSOs) and VA facility patient safety and quality managers (PSMs and QMs) and VA Facility Community Care (CC) staff to assess lessons learned by examining organizational contextual factors affecting Guidebook implementation based on the Consolidated Framework for Implementation Research (CFIR). Data Collection/Extraction Methods: Interviews were conducted virtually with 45 facility staff and 10 VISN PSOs. Using directed content analysis, we identified CFIR factors affecting implementation. These factors were mapped to the Expert Recommendations for Implementing Change (ERIC) strategy compilation to identify lessons learned that could be useful to our operational partners in improving implementation processes. We met frequently with our partners to discuss findings and plan next steps. Principal Findings: Six CFIR constructs were identified as both facilitators and barriers to Guidebook implementation: (1) planning for implementation; (2) engaging key knowledge holders; (3) available resources; (4) networks and communications; (5) culture; and (6) external policies. The two CFIR constructs that were only barriers included: (1) cosmopolitanism and (2) executing implementation. Conclusions: Our findings suggest several important lessons: (1) engage all collaborators involved in implementation; (2) ensure end‐users have opportunities to provide feedback; (3) describe collaborators' purpose and roles/responsibilities clearly at the start; (4) communicate information widely and repeatedly; and (5) identify how multiple high priorities can be synergistic. This evaluation will help our partners and key VA leadership to determine next steps and future strategies for improving Guidebook implementation through collaboration with VA staff. [ABSTRACT FROM AUTHOR]

Background: There has been significant focus in the past decade on reducing admissions to assessment and treatment units for people with intellectual disabilities experiencing mental health or behavioural concerns. This has included the development of intensive support functions of National Health Service Learning Disability services to bolster community support and treatment for people at risk of admission. However, in recent years, there has been increased consideration of service development to include rehabilitation functions which would aim to proactively provide medium‐term additional input to individuals with a complexity of need. This input would aim to improve future trajectories and support the individuals to remain living a good life in their own community. This review focuses on community and in‐patient approaches to meeting a complexity of need. Method: A scoping review was carried out according to established best practice guidelines. Papers returned from the search were screened by the following inclusion criteria (a) Models or Outcomes of Rehabilitation; (b) Intellectual Disability Population; (c) Sample being 18 or above and (d) longer than short‐term stay/treatment, defined as 6 months or longer; and (e) Mental health and/or behaviour complexities. The search was conducted in electronic databases CINAHL, PsycInfo, Medline, Embase and Social Policy & Practice. Here, 3790 articles were initially identified and 27 were ultimately included in the review. Findings: There are few studies evaluating rehabilitation for people with intellectual disabilities and mental health or behavioural concerns. There was some evidence that accessing assessment and treatment inpatient provision resulted in clinical improvements. Some studies demonstrated initial evidence that longer term rehabilitation was beneficial as a step‐down from inpatient care. Some key principles were identified in terms of rehabilitation approaches: the need for person‐centred creative approaches, suitable staff training, focus on building skills, and a focus on increasing quality of life. Conclusion: There are some indicators of what good rehabilitation services might comprise for people with an intellectual disability, who have rehabilitation needs. However, far more research and guidance are required in this area. In particular, it is unclear whether rehabilitation is best provided within an inpatient or community model, and further detail is required about optimal components of such rehabilitation. Accessible Summary: Some people with an intellectual disability will need extra help with their mental health. People with more complicated needs might need support for a longer period of time.Longer term services can be in hospitals or in the community. These are called rehabilitation services.There is some research to show that rehabilitation services should be person‐centred and help the person learn new skills. The staff should have the right training and should help the person improve their quality of life. Much more research needs to be done on rehabilitation services for people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Caring for patients with dementia at risk of getting lost is challenging for community healthcare providers. Through semi-structured interviews with 25 participants, we examined the challenges faced by these providers and the strategies they employed. We identified the following themes of challenging parts: (a) the disturbance caused by behavioral and psychological symptoms in dementia; (b) difficulty in helping older family caregivers to keep the patient from going out; (c) difficulty in changing the attitudes of the family members; families' unawareness of the risk of getting lost. We also identified the following strategies to mitigate these themes: (a) detecting the risk of getting lost through early assessment; (b) encouraging the family to use resources or devices to prevent the patient from getting lost; (c) educating the family to manage behavior and psychological symptoms of dementia; (d) strengthening the patient's crisis awareness. [ABSTRACT FROM AUTHOR]

Abstract Background With the rapidly aging population in China, there is an urgent need to understand and address the community care needs of older adults. This study sought to examine these unmet community care needs of older adults in China and the factors influencing them, with the goal of providing essential groundwork for the development of community care health policies. Methods This study used data from the 2018 China Longitudinal Healthy Longevity Survey of 8,870 adults aged 65 years and older. Logistic regression analysis was performed to identify factors related to unmet community care needs. Results The results showed that lower number of children, increased years of schooling, poorer self-perceived economic and health status, residing in an institution rather than living with household members, not having public old-age pensions, and not having activity due to daily living impairments were associated with a higher likelihood of unmet community care needs among older adults. Conclusions These findings indicate the necessity for crafting policies that consider the factors affecting unmet community care needs of older adults, including their health vulnerabilities and individual needs. Implementing national initiatives aimed at enhancing the quality of services delivered to older adults is crucial, along with establishing programmes to proactively address their vulnerabilities and individual needs. This study can contribute to the formulation of policy measures aimed at enhancing community care services of older adults in China.

Abstract Background Togo's National Malaria Control Programme has initiated an active home-based malaria management model for all age groups in rural areas of Bassar Health District. This report describes the model, reports its main results, and determines the factors associated with positive rapid diagnostic test results. Methods From 2014 to 2017, in three peripheral care units of Bassar Health District (Binaparba, Nangbani, and Baghan), community health workers visited residents' homes weekly to identify patients with malaria symptoms, perform rapid diagnostic tests in symptomatic patients, and give medication to positive cases. Univariate and multivariate logistic regression models were used to determine the factors associated with positive tests. Results The study covered 11,337 people (817 in 2014, 1804 in 2015, 2638 in 2016, and 6078 in 2017). The overall mean age was 18 years (95% CI 5–29; min–max: 0–112 years). The median age was 10 years (SD: 16.9). The proportions of people tested positive were 75.3% in Binaparba, 77.4% in Nangbani, and 56.6% in Baghan. The 5–10 age group was the most affected category (24.2% positive tests). Positive tests were more frequent during the rainy than during the dry season (62 vs. 38%) and the probability of positive test was 1.76 times higher during the rainy than during the dry season (adjusted OR = 1.74; 95% CI 1.60–1.90). A fever (37.5 °C or higher) increased significantly the probability of positive test (adjusted OR = 2.19; 95% CI 1.89–2.54). The risk of positive test was 1.89 times higher in passive than in active malaria detection (adjusted OR = 1.89; 95% CI 1.73–2.0). Conclusions This novel experimental community and home-based malaria management in Togo suggested that active detection of malaria cases is feasible within 24 h, which allows rapid treatments before progression to often-fatal complications. This PECADOM + program will help Togo's National Malaria Control Programme reduce malaria morbidity and mortality in remote and hard-to-reach communities.

Abstract Background The Collaborative Care Model (CoCM) increases access to mental health treatment and improves outcomes among patients with mild to moderate psychopathology; however, it is unclear how effective CoCM is for patients with elevated suicide risk. Methods We examined data from the Penn Integrated Care program, a CoCM program including an intake and referral management center plus traditional CoCM services implemented in primary care clinics within a large, diverse academic medical system. In this community setting, we examined: (1) characteristics of patients with and without suicidal ideation who initiated CoCM, (2) changes in suicidal ideation (Patient Health Questionnaire-9 [PHQ-9] item 9), depression (PHQ-9 total scores), and anxiety (Generalized Anxiety Disorder Scale-7 scores) from the first to last CoCM visit overall and across demographic subgroups, and (3) the relationship between amount of CoCM services provided and degree of symptom reduction. Results From 2018 to 2022, 3,487 patients were referred to CoCM, initiated treatment for at least 15 days, and had completed symptom measures at the first and last visit. Patients were 74% female, 45% Black/African American, and 45% White. The percentage of patients reporting suicidal ideation declined 11%-7% from the first to last visit. Suicidal ideation severity typically improved, and very rarely worsened, during CoCM. Depression and anxiety declined significantly among patients with and without suicidal ideation and across demographic subgroups; however, the magnitude of these declines differed across race, ethnicity, and age. Patients with suicidal ideation at the start of CoCM had higher depression scores than patients without suicidal ideation at the start and end of treatment. Longer CoCM episodes were associated with greater reductions in depression severity. Conclusions Suicidal ideation, depression, and anxiety declined following CoCM among individuals with suicidal ideation in a community setting. Findings are consistent with emerging evidence from clinical trials suggesting CoCM’s potential for increasing access to mental healthcare and improving outcomes among patients at risk for suicide.

Background: Studies examining the outcome of the camp approach in the treatment of alcohol dependence are limited in India. Aim: The aim of the study was to compare the outcomes of the community-based camp (CBC) approach and the hospital-based camp (HBC) approach in the treatment of persons with alcohol dependence. Methods: The study used a non-randomized controlled study design (quasi-experimental research design before and after with a control group). In total, 60 respondents were selected through the census method (30 in the study group and 30 in the control group). Thirty respondents from the CBC formed the experimental group, and another 30 from the HBC formed the control group. The CBC was held for 7 days, and the HBC was held for 10 days. The tools used are the Alcohol Use Disorders Identification Test and the World Health Organization quality of life (QoL)-BREF. Statistical Analysis: Independent t-test and effect size analysis were used. Kasturba Hospital Institute Ethics Committee, Manipal, had given the ethical clearance. Results: The majority (73%) of the respondents in the CBC and 57% of the HBC participants maintained complete abstinence during the post-test. The relapse rate was lower in the CBC (27%) than in the HBC (43%). CBC is effective at increasing the number of follow-ups and decreasing alcohol intake during relapse. The effect of the camp intervention on increasing the number of follow-ups was medium (d = 0.36). The CBC had a small effect on enhancing the QoL of treated individuals with alcohol dependence syndrome during the post-test (d = 0.27). Conclusion: The CBC approach is more effective than the hospital one at increasing follow-up and QoL and reducing the relapse rate.

Background: With the rapidly aging population in China, there is an urgent need to understand and address the community care needs of older adults. This study sought to examine these unmet community care needs of older adults in China and the factors influencing them, with the goal of providing essential groundwork for the development of community care health policies. Methods: This study used data from the 2018 China Longitudinal Healthy Longevity Survey of 8,870 adults aged 65 years and older. Logistic regression analysis was performed to identify factors related to unmet community care needs. Results: The results showed that lower number of children, increased years of schooling, poorer self-perceived economic and health status, residing in an institution rather than living with household members, not having public old-age pensions, and not having activity due to daily living impairments were associated with a higher likelihood of unmet community care needs among older adults. Conclusions: These findings indicate the necessity for crafting policies that consider the factors affecting unmet community care needs of older adults, including their health vulnerabilities and individual needs. Implementing national initiatives aimed at enhancing the quality of services delivered to older adults is crucial, along with establishing programmes to proactively address their vulnerabilities and individual needs. This study can contribute to the formulation of policy measures aimed at enhancing community care services of older adults in China. [ABSTRACT FROM AUTHOR]

AbstractAfter the reform of mental health care system approved in 1978, the structure and organization of Italian mental health care has represented an innovative model of care, shifting from the asylum-based system to the community-based model, with the gradual closure of all mental hospitals. According to the 2023 Mental Health Report, issued every year by the Italian Ministry of Health, more than 700.000 Italian people is suffering from severe mental disorders. The burden on mental health services is highly demanding, with an estimate of more than 9 million of health services provided to patients. With the shift to community-based care, the responsibility for healthcare was moved to regional level. Therefore, a significant heterogeneity and variation in the provision of care has been observed, which is still one of main reasons for concern. In this review we aim to provide an overview on the quality of care in Italy, highlighting the main benefits of the mental healthcare system as well as limitations and pitfalls. [ABSTRACT FROM AUTHOR]

Background: Neuropsychiatric symptoms are a robust risk factor for caregiver burden in family dementia caregivers. By grouping these symptoms, clinical interpretations regarding neuropsychiatric symptoms may facilitated because different groups of symptoms may require a different approach for intervention, thereby reducing caregiver burden. Objective: As clustering of neuropsychiatric symptoms could be clinically relevant, we aimed to explore the effects of these clusters on burden in family dementia caregivers. Methods: 152 family dementia caregivers were included. Caregiver burden was measured using the Ervaren Druk door Informele Zorg (EDIZ)/Self-Perceived Pressure from Informal Care, a Dutch questionnaire. Caregivers also reported the neuropsychiatric symptoms and functional impairments in daily activities of the people with dementia they cared for. Multiple regression analyses were used in this cross-sectional study. Results: Adjusted for functional impairments and sociodemographic variables, neuropsychiatric symptoms were associated with more caregiver burden (p < 0.001). However, this association did not differ between the three neuropsychiatric symptom clusters (p = 0.745). Conclusions: Neuropsychiatric symptoms were associated with more family caregiver burden, but no conclusive evidence was found that this association differed for the three clusters. Clustering of neuropsychiatric symptoms is, however, worth exploring further in future studies with more participants. If specific links are found, these could be targeted in clinical practice in order to prevent, reduce and/or postpone caregiver burden. [ABSTRACT FROM AUTHOR]

Aim: Expanding and sustaining student nurse placements outside of the acute sector is a universal challenge. This paper aims to evaluate the Care Home Education Facilitator Role introduced in one area of Wales, United Kingdom, and to report on the outcomes achieved from this novel role. Methods: Semi‐structured interviews were undertaken with key stakeholders including the Care Home Education Facilitator postholder leading the pilot, care home managers, higher education institutions' placement managers/coordinators, student nurses and national health service staff. Results: Five key areas were identified, which included timing of introducing the post and establishing a clear rationale and understanding of the intention of the role. The benefits, challenges and suggested improvements to the Care Home Education Facilitator initiative are provided. Conclusion: Introducing the role of the Care Home Education Facilitator to work closely with key stakeholders resulted in increased placements for student nurses, but investing time in developing relationships with these stakeholders was critical to the success of the role. Summary statement: What is already known about this topic? There is a universal shortage of clinical placements for nursing students, particularly within a care home setting.The number of studies exploring how we might grow the number of nurses needed in this setting is limited. What this paper adds? This study evaluated a novel initiative introduced in South Wales, United Kingdom, that focuses on the development of nursing placements in the care home setting.Engaging with stakeholders involved in the development and implementation of the Care Home Education Facilitator initiative, a roadmap was provided to illustrate the stepped approach required to support an active care home placement including key governance arrangements. The implications of this paper: For those involved in identifying and developing student placements, this study provides valuable insight to a role that can help increase student numbers in a care setting often overlooked.It identifies viable career options for nurses at the point of registration.The role assists with widening networks for the care homes across health and social care sectors. [ABSTRACT FROM AUTHOR]

The article focuses on the re-traumatization experienced by individuals seeking justice after a traumatic event. Topics include the mental well-being threats faced by Moira and family, the flaws in the judicial system, and the importance of raising awareness about these issues. It reports that the process of seeking justice can exacerbate trauma, and it mentions the need for judicial reform to better support victims.

This case report is to help raise awareness of a rare autoimmune disorder, cold agglutinin disease (CAD), which is characterised by the premature destruction of red blood cells (haemolysis) (National Organisation for Rare Disorders [NORD], (2020). It can have a severe physical and psychological impact on those suffering with it. Caring for patients with CAD can also be extremely challenging and even traumatic for clinicians. The importance of good multidisciplinary team (MDT) working both within hospital and when discharging a patient to a community healthcare setting is also highlighted (NORD, 2020), as well as the importance of clear communication for the patient from medical staff on the expectations of treatment and prognosis. Approximately one person in 300,000 gets CAD, which is more prevalent in those aged 60 years and older. Women are also more likely to get it than men (Smith, 2021). [ABSTRACT FROM AUTHOR]

Self-care of patients with chronic noncommunicable diseases is an essential component of contemporary healthcare. The purpose of this paper is to present a novel self-care process model and place it in the broader context of professional care. The extended Event-driven Process Chain approach to process modelling was used, focusing on a detailed overview of sequences of events, connections and activities and other elements/building blocks. A self-care process model was designed. The model is divided into two parts. The first part represents the self-care process when patients are able to manage their symptoms and be independent. The second part includes the process when patients are unable to perform self-care and/or need professional support. By identifying the essential elements of this process and incorporating them into the patients' care process, we can ensure that professional support for self-care creates a dynamic balance in the patients' ecosystems. Patients with chronic noncommunicable diseases need to make timely decisions about individual aspects of their health and seek professional help. In this way, an optimal level of health and well-being of patients can be achieved. Focusing on the patients' self-care process could also reduce treatment costs and improve the quality of life of patients. The novel designed model of the process of self-care, with all its essential elements, can be supported by digital technology, especially in the decision-making process and needs to become an important part of healthcare and long-term care systems. [ABSTRACT FROM AUTHOR]

Despite record investment in Scotland's National Health Service, ever-increasing numbers of people remain in hospital despite being clinically fit for discharge. This paper curiously explores two of the whole-system problems ensuring discharges are delayed and argues that greater investment in, and contractual changes to, social care commissioning is required to support more people to live their best lives in their own homes. A more creative perspective is required to ensure better outcomes for the population. [ABSTRACT FROM AUTHOR]

Cardiac implantable electronic devices (CIEDs), such as pacemakers and implantable cardiac defibrillators, are an increasing popular treatment for arrhythmias. Patients with CIEDs are likely to appear in many clinical areas, with pacemakers being the most common type. As healthcare support workers are likely to find these patients in their care, it is vital that they understand the reasons why CIEDs are implanted and how to prepare/care for them. This article will cover the conduction system of the heart and introduce the most common types of CIED. The article also explores how the healthcare assistant and assistant practitioner can support senior staff in preparation, post procedural and community care. [ABSTRACT FROM AUTHOR]

Academic Medical Centers (AMCs) and Federally Qualified Health Centers (FQHCs) are similarly tasked with managing the health of their local community, yet they each face unique challenges in their ability to do so. Integrating AMCs and FQHCs into novel care delivery models can leverage both organizations strengths, providing care in a comprehensive and sustainable fashion. Johns Hopkins Medicine (JHM) implemented this model with a large East Baltimore medical center, creating an AMC-FQHC collaboration focused on providing care to the East Baltimore patient population. This system provided various improvements in care delivery, including increased staffing, new wraparound services, improved access to funding dollars, and decreased out of pocket costs for patients qualifying for financial assistance. The academic missions of research and training were preserved, serving as the primary continuity clinic for several residency programs and as a community site for research. These changes resulted in more robust care for patients while improving the financial standing of the clinic. Through AMC and FQHC partnership, progress can be made toward providing holistic and financially sustainable primary care services in underserved areas while preserving the tripartite mission of academic medicine, with significant pedagogical and research opportunities. [ABSTRACT FROM AUTHOR]

Background: Togo's National Malaria Control Programme has initiated an active home-based malaria management model for all age groups in rural areas of Bassar Health District. This report describes the model, reports its main results, and determines the factors associated with positive rapid diagnostic test results. Methods: From 2014 to 2017, in three peripheral care units of Bassar Health District (Binaparba, Nangbani, and Baghan), community health workers visited residents' homes weekly to identify patients with malaria symptoms, perform rapid diagnostic tests in symptomatic patients, and give medication to positive cases. Univariate and multivariate logistic regression models were used to determine the factors associated with positive tests. Results: The study covered 11,337 people (817 in 2014, 1804 in 2015, 2638 in 2016, and 6078 in 2017). The overall mean age was 18 years (95% CI 5–29; min–max: 0–112 years). The median age was 10 years (SD: 16.9). The proportions of people tested positive were 75.3% in Binaparba, 77.4% in Nangbani, and 56.6% in Baghan. The 5–10 age group was the most affected category (24.2% positive tests). Positive tests were more frequent during the rainy than during the dry season (62 vs. 38%) and the probability of positive test was 1.76 times higher during the rainy than during the dry season (adjusted OR = 1.74; 95% CI 1.60–1.90). A fever (37.5 °C or higher) increased significantly the probability of positive test (adjusted OR = 2.19; 95% CI 1.89–2.54). The risk of positive test was 1.89 times higher in passive than in active malaria detection (adjusted OR = 1.89; 95% CI 1.73–2.0). Conclusions: This novel experimental community and home-based malaria management in Togo suggested that active detection of malaria cases is feasible within 24 h, which allows rapid treatments before progression to often-fatal complications. This PECADOM + program will help Togo's National Malaria Control Programme reduce malaria morbidity and mortality in remote and hard-to-reach communities. [ABSTRACT FROM AUTHOR]

Background: The Collaborative Care Model (CoCM) increases access to mental health treatment and improves outcomes among patients with mild to moderate psychopathology; however, it is unclear how effective CoCM is for patients with elevated suicide risk. Methods: We examined data from the Penn Integrated Care program, a CoCM program including an intake and referral management center plus traditional CoCM services implemented in primary care clinics within a large, diverse academic medical system. In this community setting, we examined: (1) characteristics of patients with and without suicidal ideation who initiated CoCM, (2) changes in suicidal ideation (Patient Health Questionnaire-9 [PHQ-9] item 9), depression (PHQ-9 total scores), and anxiety (Generalized Anxiety Disorder Scale-7 scores) from the first to last CoCM visit overall and across demographic subgroups, and (3) the relationship between amount of CoCM services provided and degree of symptom reduction. Results: From 2018 to 2022, 3,487 patients were referred to CoCM, initiated treatment for at least 15 days, and had completed symptom measures at the first and last visit. Patients were 74% female, 45% Black/African American, and 45% White. The percentage of patients reporting suicidal ideation declined 11%-7% from the first to last visit. Suicidal ideation severity typically improved, and very rarely worsened, during CoCM. Depression and anxiety declined significantly among patients with and without suicidal ideation and across demographic subgroups; however, the magnitude of these declines differed across race, ethnicity, and age. Patients with suicidal ideation at the start of CoCM had higher depression scores than patients without suicidal ideation at the start and end of treatment. Longer CoCM episodes were associated with greater reductions in depression severity. Conclusions: Suicidal ideation, depression, and anxiety declined following CoCM among individuals with suicidal ideation in a community setting. Findings are consistent with emerging evidence from clinical trials suggesting CoCM's potential for increasing access to mental healthcare and improving outcomes among patients at risk for suicide. [ABSTRACT FROM AUTHOR]

In this article, we analyze the meanings of community care (hereafter CC), understood as the set of social care practices that are articulated from spaces managed by the community and involve various daily actions essential to sustaining life. The identification of the CC deployed, especially by immigrant women, shows the state's neglect of foreigners. Our research aims to understand the meanings of CC of Latin American women who participate in non-institutionalized groups in Spain, from where they carry out various practices of co-management of "their" (self) care in contexts of migration. Based on a qualitative methodology, we show how these experiences involve survival and agency strategies at different levels. We conclude by highlighting how migrant women's knowledge in this field allows us to explore new places and ways of thinking about CC. [ABSTRACT FROM AUTHOR]

The performance of home care globally is significantly impacted by the political reforms in the public and private sectors. This research investigated the Australian contexts of home care quality and the use of "brokerage" during times of change. The research utilised a qualitative post‐structural approach to gather data about home care service provision through conducting semi‐structured interviews of 10 Australian home care business leaders. What emerged in the discourse was how central to everyday practices was the need for business leaders to network and 'dance a political tango' to ensure quality in service provision. Illuminated was how the leaders pushed back against governmental and economic structures by using models of brokerage to compensate for economic and staffing deficiencies. This is essential for the ongoing improvement and performance of home care in the Australian social arena of caring for our most vulnerable consumers. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to identify and synthesize the contents and the psychometric properties of the existing instruments measuring home‐based care (HBC) nurses' competencies. Design: A hybrid systematic narrative review was performed. Review Methods: The eligible studies were reviewed to identify the competencies measured by the instruments for HBC nurses. The psychometric properties of instruments in development and psychometric testing design studies were also examined. The methodological quality of the studies was evaluated using the Medical Education Research Study Quality Instrument and COSMIN checklist accordingly. Data Sources: Relevant studies were searched on CINAHL, MEDLINE (via PubMed), EMBASE, PsychINFO and Scopus from 2000 to 2022. The search was limited to full‐text items in the English language. Results: A total of 23 studies reporting 24 instruments were included. 12 instruments were adopted or modified by the studies while the other 12 were developed and psychometrically tested by the studies. None of the instruments encompassed all of the 10 home‐based nursing care competencies identified in an earlier study. The two most frequently measured competencies were the management of health conditions, and critical thinking and problem‐solving skills, while the two least measured competencies were quality and safety, and technological literacy. The content and structural validity of most instruments were inadequate since the adopted instruments were not initially designed or tested among HBC nurses. Conclusion: This review provides a consolidation of existing instruments that were used to assess HBC nurses' competencies. The instruments were generally not comprehensive, and the content and structural validity were limited. Nonetheless, the domains, items and approaches to instrument development could be adopted to develop and test a comprehensive competency instrument for home‐based nursing care practice in the future. Impact: This review consolidated instruments used to measure home‐based care nurses' competency. The instruments were often designed for ward‐based care nurses hence a comprehensive and validated home‐based nursing care competency instrument is needed. Nurses, researchers and nursing leaders could consider the competency instruments identified in this review to measure nurses' competencies, while a home‐based nursing care competency scale is being developed. Patient or Public Contribution: No patient or public contribution was required in this review. [ABSTRACT FROM AUTHOR]

Background Dementia encompasses neurodegenerative disorders that account for a global estimated healthcare expenditure of 1.3 trillion US dollars. In Australia, one in 12 people aged ≥65 has a diagnosis of dementia and it is the second leading cause of death. Paramedics play a crucial role in person-centred dementia care, particularly in the community. While consensus has been established on paramedicine's integration into interdisciplinary care teams, there remains a lack of clarity regarding the paramedic role in dementia care. Objective This study aimed to examine and report paramedic interactions with people living with dementia in the out-of-hospital setting. Design and Setting This was a scoping review study of paramedics and people living with dementia within the out-of-hospital setting. Methods This study was guided by the Joanna Briggs Institute (JBI) scoping review framework. Databases were searched without date limits, up to 4 April 2023. These encompassed OVID Medline, CINAHL, Scopus, APA PsycInfo and OVID Embase. Articles were included if they were primary, peer-reviewed studies in English and reporting on paramedic-specific interactions with people living with dementia in the out-of-hospital setting. Data extraction was performed based on study setting, design, population and key findings. Results Twenty-nine articles were included in the thematic analysis. Four themes emerged: need for training, patterns of attendances, patterns of documentation and the integrative potential of paramedicine. Paramedics reported feeling ill-equipped and unprepared in caring for patients living with dementia due to challenges in assessment and management of caregiver tensions. They were often called as a last resort due to poor service integration and a lack of alternative care pathways. Despite high conveyance rates, there was low incidence of paramedic interventions initiated. Underdocumentation of dementia and pain was found. Conclusion Emergency ambulance conveyance of people living with dementia is a surface reaction compounded by a lack of direction for paramedics in the provision of out-of-hospital care. There is a pressing need for establishment of research and educational priorities to improve paramedic training in dementia-specific skillsets. [ABSTRACT FROM AUTHOR]

This study aimed to analyze the long-term care insurance for older adults in South Korea in terms of community care. An analytical framework was designed for the study, focusing on comprehensiveness, adequacy, and integration. The findings suggest that Korean LTCI is significantly limited for the development of community care. First, in terms of comprehensiveness, the use of visiting nurses and the availability of short-stay services have been significantly reduced, and the supporting services for informal caregivers are at the beginning stage of their introduction. Second, in terms of adequacy, the quantity of benefits, such as three to four hours of care a day, are insufficient to meet older adults' substantial needs. Furthermore, the overall quality of home care services is low, particularly with regard to short-stay services and welfare equipment. Finally, in terms of integration, basic linkage of organizations has not been properly conducted in local areas, and there remains an absence of care managers in the LTCI system. To cope with these challenging issues, the following policy measures are suggested: the activation of rehabilitation services, the expansion of benefit quantities, the improvement of service quality, and the creation of organizational linkages through local authorities and long-term care centers. [ABSTRACT FROM AUTHOR]