Literature Collection

Our review examines the operational dynamics and effectiveness of integrated healthcare models in Australia, focusing on their relevance for older rural adults with preventable chronic diseases. Using Whittemore and Knafl's (2005) systematic integrative review methods, we conducted a search across five databases, including Medline-EBSCO, PubMed, CINAHL, EMBASE, and SCOPUS. The Sustainable Integrated Chronic Care Models for Multimorbidity (SELFIE) framework, established by Leijten et al. (2018), was used for reflexive thematic synthesis. A two-stage screening process identified 15 integrated healthcare models, with five RCTs evaluating their effects on chronic conditions. The analysis revealed two key themes: aspects of care integration (service delivery, leadership, workforce, technology, and finance) and changes in patient and healthcare outcomes. Care coordination and multidisciplinary team care were common features, bridging gaps between health and social services for older patients. Despite challenges such as irregular funding and underutilisation of technology, several models demonstrated positive patient and healthcare outcomes. Virtual care platforms and remote monitoring systems have shown promise in improving patient engagement and enabling real-time care adjustments, particularly in rural areas with limited healthcare access. Our review highlights the need for integrated healthcare for older rural Australians with preventable chronic conditions, revealing the complexity of service models. Policy shifts towards coordinated services and changes in leadership and healthcare practices are essential to ensure this demographic receives integrated care that meets their needs.

Migrants are at a higher risk for common mental health problems than the general population but are less likely to seek care. To improve access, the World Health Organization (WHO) recommends the integration of mental health services into primary care. This scoping review aims to provide an overview of the types and characteristics of mental health services provided to migrants in primary care following resettlement in high-income countries. We systematically searched MEDLINE, EMBASE, PsycInfo, Global Health, and other databases from 1 January 2000 to 15 April 2020. The inclusion criteria consisted of all studies published in English, reporting mental health services and practices for refugee, asylum seeker, or undocumented migrant populations, and were conducted in primary care following resettlement in high-income countries. The search identified 1627 citations and we included 19 studies. The majority of the included studies were conducted in North America. Two randomized controlled trials (RCTs) assessed technology-assisted mental health screening, and one assessed integrating intensive psychotherapy and case management in primary care. There was a paucity of studies considering gender, children, seniors, and in European settings. More equity-focused research is required to improve primary mental health care in the context of global mental health.

COPD is a chronic condition that comes with a significant symptoms burden and healthcare utilization. It is the fourth leading cause of death worldwide and its prevalence is expected to rise in the years to come. We know that pharmacological treatment has a preponderant role to play in the management of this disease, but we also know that the non-pharmacological aspect of care is the cornerstone. In the last years, it has been increasingly recognized that education, self-management and integrated care are key components of COPD patients care trajectory. This review article presents the evolution of integrated care throughout the years and highlights the evidence of randomized clinical trials and on patient perspective behind this care model as well as the challenges healthcare professionals are still facing. This review also presents an illustrative example of integrated care in COPD which has been implemented over 2 decades, building on evidence from RCT to real-world evidence adoption in healthcare settings for broader reach and sustainability.

BACKGROUND: Depression in older adults is mainly treated in general practice but is often constrained by limited resources in primary healthcare services and suboptimal access to assistance from specialized care. This study aimed to evaluate the effectiveness of a structured collaborative model between GPs and geriatric psychiatrists compared to standard follow-up for individuals aged ≥ 65 with depression. METHODS: Patients with moderate depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] scores of 10-19) were invited to participate in a cluster-randomized controlled trial evaluating a structured collaborative intervention model involving GPs and geriatric psychiatrists. The core component of the intervention consisted of two consecutive joint consultations with the GP, patient, and geriatric psychiatrist, supplemented by individual GP-patient consultations. PHQ-9 assessments were conducted at baseline and at 6, 12, and 18 months. The primary outcome was a ≥ 50% reduction in PHQ-9 scores. RESULTS: 35 general practitioners initially agreed to participate, yet only 19 managed to recruit one or more depressed patients. Consequently, a total of 34 patients were enrolled in the study, with 30 providing survey responses during the follow-up period for subsequent analysis. Binary analysis (≥ 50% symptom reduction) showed a greater likelihood of improvement in the intervention group compared to the control, though this difference did not reach statistical significance. Notably, both groups showed significant mean PHQ-9 score reductions (3.4 and 4.0, respectively) at 18 months, but differences in mean PHQ-9 scores between the groups across all time points were not statistically significant. CONCLUSION: This study did not yield significant results for the collaborative model implemented. Major challenges in the recruitment process likely contributed to the low participation rate, which may explain the absence of positive findings. TRIAL REGISTRATION: The study was registered the 15.09.2019 in ClinicalTrials.gov with ID: NCT04078282.