Literature Collection

OBJECTIVE: The purpose of this study was to understand the barriers and facilitators that affect engagement with Project ECHO (Extension for Community Healthcare Outcomes) to implement medication-assisted treatment (MAT) in primary care settings. METHODS: A 12-session weekly curriculum was delivered to participating primary care providers and clinic staff (N=24 participants from 13 clinics). Participants completed attendance logs and a qualitative interview in order to identify factors that influence engagement in the ECHO sessions and the potential integration of MAT. RESULTS: Primary care providers and staff valued the ECHO sessions, but overall attendance was low and variable. Participants generally valued the didactic and interactive nature of the sessions but identified system-level constraints that limited engagement. Major barriers to participation included competing demands in patient care and the low degree of endorsement by clinic leadership. CONCLUSIONS: This brief report identifies key systematic challenges that may directly limit primary care providers' engagement in telementoring models such as Project ECHO.

Integrating behavioral health into primary care can increase patient access to treatments for behavioral health disorders, especially in rural areas. The first step of integrated care implementations is the need to identify at-risk patients and effectively communicate patient screening results to the care team. The use of technology can facilitate patient screening and incorporate screening data into electronic health records. This paper describes the development of a tablet-based screening system to facilitate behavioral health integration in a rural primary care clinic, discusses the preliminary impact of digital screening on workflows, and provides recommendations for the use of technology for screening. A tablet-based assessment was developed to screen patients for behavioral health concerns and was implemented within a rural primary care clinic. The system was created using the Visual Signature Capture system, which integrates directly with the electronic health record. Following the initial assessment, patients are screened as frequently as every 30 days with a mini-screen assessment, consisting of multiple screening tools for mental health and substance use. The tablet-based screening system had a positive impact on clinician workflows and the overall effectiveness of clinic operations. This system supports providers in addressing the behavioral health needs of patients that often go unrecognized in primary care.

BACKGROUND: A three-phase implementation program was carried out to support Indigenous primary healthcare organisations in Australia to integrate e-mental health approaches into the day-to-day practice. The present study aimed to evaluate the process and the effectiveness of the program. METHODS: A concurrent triangulation design was employed to collect and compare quantitative and qualitative data from organisations that participated in the implementation program (case studies) to those that participated in training only (non-case studies). Quantitative methods, i.e., t-tests and descriptive statistics, were used to measure outcomes relating to the frequency of e-mental health usage and levels of organisational readiness. Qualitative data were analysed separately, using theoretical thematic analysis, to gain an in depth understanding of the implementation process. The findings were integrated and interpreted within the implementation science literature. RESULTS: The case studies evidenced greater use of e-mental health approaches than the non-case studies. They also demonstrated increased organisational readiness over the course of the implementation program. The program helped organisations to work and improve on essential aspects within the organisation so that they better supported e-mental health adoption. The key areas addressed were Information Technology resources and infrastructure, leadership and support, policy and protocols around e-mental health utilisation and its integration into practice. CONCLUSIONS: By addressing and improving essential aspects relating to e-mental health implementation, the program helped organisations to increase organisational readiness and enhance uptake of e-mental health approaches.