Journal of evaluation in clinical practice
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Observational Study
Relative billing complexity of in-person versus telehealth outpatient encounters.
Video visits became more widely available during the coronavirus disease (COVID-19) pandemic. However, the ongoing role and value of video visits in care delivery and how these may have changed over time are not well understood. ⋯ In-person and video visits had differing proportions of complexity codes (typically skewing towards lower complexity for video visits). The complexity of video visits changed over time in many specialities. Observed patterns for both phenomena varied by speciality.
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We sought to examine specific care-seeking behaviours and experiences, access indicators, and patient care management approaches associated with frequency of emergency department (ED) visits among patients of Health Resources and Services Administration-funded health centres that provide comprehensive primary care to low-income and uninsured patients. ⋯ Findings underscore opportunities to reduce higher frequency of ED visits in health centres, which are primary care providers to many low-income populations. Our findings highlight the potential importance of improving patient retention, better access to providers afterhours or for urgent visits, and access to specialist as areas of care in need of improvement.
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Wait lists are common in the provision of publicly funded services in outpatient and community settings. ⋯ More consumer-centred approaches are needed for access systems for outpatient and community services, featuring honesty about what services can realistically be provided, early access to initial assessment and information and clear lines of communication.
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Challenges associated with translating evidence into practice are well recognised and calls for effective strategies to reduce the time lag and successfully embed evidence-based practices into usual care are loud and clear. While a plethora of nonpharmacological interventions for people with dementia exist; few are based on strong evidence and there is little consideration for programme operationalisation in the complex environment of long-term care. ⋯ The extended preparatory period for implementation, afforded by the COVID-19 pandemic on programme commencement, enabled time for widespread understanding of the programme and necessary upskill of staff. Comprehensive codesign with all stakeholders of programme components identified core and flexible elements necessary for fidelity of implementation.
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Veterans living with dementia in long-term care have complex needs, with variable manifestation of symptoms of dementia that interact with their lived experience. Best practice dementia care prioritises nonpharmacological interventions; of which few have strong evidence. Implementation of evidence is complex, with evaluation of outcomes and processes necessary. ⋯ Key components of programme success were the therapeutic leaders, adherence to core elements of programme design, and veterans' choice in meaningful activity. Cost analysis supports deliberations for upscale across further care homes.