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Videoconferencing between general practitioners and hospitals has been developed to provide higher quality health care services in Norway by promoting interaction between levels of care. This article aims to explore the use of videoconferencing for information exchange and consultation throughout the patient trajectory and to investigate how collaboration affects learning and the patient's treatment.

The approach was interaction analysis supplemented by interviews. Medical discussions concerning the patient were observed for 15 days, creating a trajectory of seven videoconferences. Interviews were conducted to examine the collaboration.

General practitioners and specialists use a different repertoire of knowledge and experiences to report and consult throughout the course of treatment. Over time, new medical problems arose, and the treatment had to be adjusted. The activity remained continuous and contributed to an integrated knowledge and information exchange. Collaboration using videoconferencing across levels of care created opportunities for workplace learning in health services and can lead to continuity, improved coordination, and a higher quality of care.

In contrast to other studies, which state effects, the need for continuity and cooperation in health care, and the ways in which individual differences make it difficult to achieve seamless health care services, this study offers insight into how continuity and cooperation can be achieved. It includes both observations of interactions and interviews of the participants, providing analysis of collaborative work in situ. This provides insight into the content of the interaction over time as a resource for understanding the outcome of the use of technology and improving health care.

Extant research on strategic alliances has relied mainly on case and survey methodologies to examine strategic, structural and operational issues in alliance relationships. Demonstrates that experimental methodology can usefully be employed to examine important strategic and behavioural issues in ongoing alliances. Reports on an experiment involving role‐playing among 221 managers which was conducted to investigate determinants of satisfaction and continuity in a hypothetical marketing alliance. Indicates that alliance satisfaction and continuity are influenced positively by a partner′s commitment, competence and strategic compatibility. Finds commitment to be the strongest determinant of both satisfaction and continuity. Discusses implications of the findings and methodology employed and suggests future research directions.

Since the definition of objectives lies at the basis of any programme, an analytical system of classifying service organisation activities is proposed in which the focus is on internal characteristics of the activities, and differentiation among programmes and treatments. This taxonomy may be used by social welfare organisations who wish to know what they do, and to what extent they adhere to what they aim to do, as it makes both a conceptual and empirical contribution, increasing awareness of what the organisation and its professional staff do, and allowing examination of the consistency of any programme.

Almost 10 years ago, attention was drawn to the many pitfalls involved in the treatment of tuberculosis (TB) in prison settings, based on field experience from the ICRC (International Committee of the Red Cross) (Coninx et al., 1995). Since that time, the ICRC has continued working in the field of TB in prisons, either directly or by supporting the local programmes in different countries. Further experience gained since then has, if anything, confirmed and reinforced the worries caused by the specific problems posed both by the prison environment and by “prisoner‐patients” for the treatment of TB. Medical staff working in prisons need to be familiar with these issues if tuberculosis is to be managed and treated successfully. With the menace of drug‐resistant TB no longer merely a marginal problem but arguably becoming a direct menace to public health, it becomes all the more important to be aware of these pitfalls. This paper addresses the following: * why prison settings are especially difficult for TB detection and management; * why prisoners can be particularly difficult patients; * how different resistant strains of TB are produced or enhanced in prisons; * added difficulties in treating MDR‐TB in prisoners; and * how and why the association of TB and HIV complicate TB, and MDR‐TB, treatment in prisons even further. The photographs and additional illustrations are from the author’s collection. Permission was obtained from all persons photographed for reproduction.

The purpose of this paper is to examine the current provision of opioid substitution therapy (OST) during and immediately following release from detention in prisons in England and Wales.

A group of experts was convened to comment on current practices and to make recommendations for improving OST management in prison. Current practices were previously assessed using an online survey and a focus group with experience of OST in prison (Webster, 2017).

Disruption to the management of addiction and reduced treatment choice for OST adversely influences adequate provision of OST in prison. A key concern was the routine diversion of opiate substitutes to other prisoners. The new controlled drug formulations were considered a positive development to ensure streamlined and efficient OST administration. The following patient populations were identified as having concerns beyond their opioid use, and therefore require additional considerations in prison: older people with comorbidities and complex treatment needs; women who have experienced trauma and have childcare issues; and those with existing mental health needs requiring effective understanding and treatment in prison.

Integration of clinical and psychosocial services would enable a joint care plan to be tailored for each individual with opioid dependence and include options for detoxification or maintenance treatment. This would better enable those struggling with opioid use to make informed choices concerning their care during incarceration and for the period immediately following their release. Improvements in coordination of OST would facilitate inclusion of strategies to further streamline this process for the benefit of prisoners and prison staff.

The purpose of this paper is to analyse the extent of throughcare provision for prisoners with problematic drug use. Effective throughcare services have been recognised as important because they help to ensure that any progress in treatment made in prison is continued on release. Previous research demonstrates that examples of good practice in throughcare provision for prisoners with problematic drug use exist in many parts of the world. However, evidence from recent work carried out in Europe indicates that the implementation of throughcare services for this group of prisoners is limited and ineffective in some EU member states. This paper aims to explore the reasons for such failure and to identify the barriers to implementing effective throughcare for this particular group of prisoners.

This paper is drawn from research carried out as part of a European project funded by the Directorate General Justice of the European Commission. The project involved six partners from a range of different member states. The research involved a literature review, followed by in‐depth interviews and focus groups with key stakeholders. Each partner carried out the qualitative research within their own country, in order to enable the team to capture local nuances.

The findings indicate that key barriers to implementation of effective throughcare are resources which impacts on the availability of support services, attitudes and training of staff and ultimately the continuity of care.

This paper adds to the body of knowledge regarding the provision of effective throughcare to those with problematic drug use.

The purpose of this paper is to address the impact of affect (as opposed to cognition) on patient trust in high‐consequence exchanges. The authors also investigate the mediator's role of trust in the relationship between affect and cognition, and behavioural intentions.

Using undergraduate students from a large North American university, three between‐subjects experiments were performed.

Study 1 findings demonstrate that affect and cognition elements equally influence trust in high‐consequence decisions. Also, trust is an important mediator between affect and cognition and the intention to continue the relationship and to seek a second opinion. Study 2 reinforces the importance of trust for the patient's evaluations, showing that when trust is low, the second opinion influences patient satisfaction. However, when patient trust is high, the second opinion (the same or different, compared with the first diagnosis) does not affect patient satisfaction. Study 3 shows that, in low‐consequence choices, cognition is a more relevant antecedent of trust than affect. Affect is important when cognition aspects (e.g. the competence of the doctor) are perceived as low.

As an original contribution, this study addresses the different impacts of affect and cognition aspects on patient trust, in high‐ and low‐consequence exchanges. Also, it highlights the importance of patient trust in the doctor when a second opinion is sought: a different diagnosis depletes patient satisfaction only for patients with low levels of trust in the doctor.

The purpose of this paper is to identify risk factors for interruptions in opioid dependence treatment and barriers to (re) entering effective treatment through real-world insight on current opioid dependence treatment in the UK.

Project Access UK, a national survey deployed across multiple regions in England, Wales and Scotland, collected data on the perspectives of patients receiving medication-assisted treatment (MAT) for opioid dependence (n=248), out-of-treatment opioid users (n=196), and physicians (n=100).

Both patients and users reported multiple prior episodes of MAT and detoxification. Among patients, 57 per cent reported continuing illicit drugs use in addition to their treatment, 25 per cent had misused (injected or snorted) and 30 per cent had diverted (sold or given away) prescribed opioid medications. Diverted medications were currently being used by 26 per cent of out-of-treatment users; of these, 21 per cent used methadone. Supervised dosing was rated as the condition of treatment with the biggest impact on daily life. Daily supervision was a requirement for 44, 34 and 23 per cent of patients receiving methadone, mono-buprenorphine and buprenorphine-naloxone, respectively.

Interruptions to opioid dependence treatment in various forms can hamper the recovery of opioid-dependent patients. The benefits of MAT may not be fully realised if treatment is interrupted due to compliance failure, or inflexible treatment programmes leading to premature treatment exit. These findings serve to highlight areas in which treatment disruption can potentially be addressed.

Consideration of these findings may aid in the optimisation of treatment delivery practices to better meet the UK policy of recovery, and ultimately improve patient outcomes.

The purpose of this paper is to assess the impact of short-term incarceration on antiretroviral therapy (ART) adherence, virologic suppression, and engagement and retention in community care post-release.

A retrospective chart review of patients who attended the human immunodeficiency virus (HIV) Outreach Clinic at a Canadian remand center between September 2007 and December 2011 was carried out. Data extraction included CD4 lymphocyte count, HIV viral load, ART prescription refills, and community engagement and retention during and one-year pre- and post-incarceration.

Outpatient engagement increased by 23 percent (p=0.01), as did ART adherence (55.2-70.7 percent, p=0.01), following incarceration. Retention into community care did not significantly improve following incarceration (22.4 percent pre-incarceration to 25.9 percent post-release, p=0.8). There was a trend toward improved virologic suppression (less than 40 copies/ml; 50-77.8 percent (p=0.08)) during incarceration and 70. 4 percent sustained this one-year post-incarceration (p=0.70).

The impact of short-term incarceration in a Canadian context of universal health coverage has not been previously reported and could have significant implications in optimizing HIV patient outcomes given the large number of HIV-positive patients cycling through short-term remand centers.

The purpose of this study was to advance the knowledge of pharmaceutical supply chain (PSC) resilience using complex adaptive system theory (CAS).

An exploratory research design, which adopted a qualitative approach was used to achieve the study’s research objective. Qualitative data were gathered through 23 semi-structured interviews with key supply chain actors across the PSC in the UK.

The findings demonstrate that CAS, as a theory, provides a systemic approach to understanding PSC resilience by taking into consideration the various elements (environment, PSC characteristics, vulnerabilities and resilience strategies) that make up the entire system. It also provides explanations for key findings, such as the impact of power, conflict and complexity in the PSC, which are influenced by the interactions between supply chain actors and as such increase its susceptibility to the negative impact of disruption. Furthermore, the antecedents for building resilience strategies were the outcome of the decision-making process referred to as co-evolution from a CAS perspective.

Based on the data collected, the study was able to reflect on the relationships, interactions and interfaces between actors in the PSC using the CAS theory, which supports the proposition that resilience strategies can be adopted by supply chain actors to enhance this service supply chain. This is a novel empirical study of resilience across multiple levels of the PSC and as such adds valuable new knowledge about the phenomenon and the use of CAS theory as a vehicle for exploration and knowledge construction in other supply chains.