Literature Collection

OBJECTIVES: Integrated care models show promise in addressing the factors that lead to inequities in perinatal health outcomes. This report describes how Prenatal Care Coordination (PNCC) functions as an Equity Promoting Integrated Care (EPIC) model. STUDY DESIGN: A multi-method study aimed to evaluate the implementation and impact of PNCC, a Medicaid-funded perinatal program in Wisconsin. METHODS: In 2023, we conducted individual semi-structured interviews (N = 15) and focus groups (N = 4) with coordinators at five sites. Sites varied by geographic region, populations served, team size, and organizational differences. The parent study assessed PNCC implementation overall using the Consolidated Framework for Implementation Research (CFIR). The updated CFIR was used for initial deductive coding. We then applied concepts from the Equity-Promoting Integrated Care (EPIC) framework to develop themes and subthemes. RESULTS: A meta-theme was "integrated model of care," reflecting how participants discussed the complexity of the care they provide and the intersecting systems they navigate to meet clients' needs. Four themes illustrate how PNCC coordinators are leveraging components of EPIC models: "Enhancing clients' skills," "Bridging gaps in care," "Providing person-centered care to build trust," and "Having a broader community presence." CONCLUSIONS: Given persistent inequities in perinatal outcomes in the US, our findings represent critical insight into the potential impact of integrated care models. Clinicians should consider strengthening relationships to support patient participation in integrated care community services. Future research is needed to optimize the implementation and reach of integrated care models such as PNCC and leverage their potential to improve perinatal outcomes.

OBJECTIVES: Medication treatment for opioid use disorder (MOUD) is effective and recommended for outpatient settings. We implemented and evaluated the SUpporting Primary care Providers in Opioid Risk reduction and Treatment (SUPPORT) Center-a quality improvement partnership to implement stepped care for MOUD in 2 Veterans Health Administration (VA) primary care (PC) clinics. METHODS: SUPPORT provided a dedicated clinical team (nurse practitioner prescriber and social worker) and stepped care ([1] identification, assessment, referral; [2] MOUD induction; [3] stabilization; and [4] maintenance supporting PC providers [PCPs] to initiate and/or sustain treatment) coupled with ongoing internal facilitation (consultation, trainings, informatics support). Qualitative interviews with stakeholders (PCPs and patients) and meeting notes identified barriers and facilitators to implementation. Electronic health record and patient tracking data measured reach, adoption, and implementation outcomes descriptively. RESULTS: SUPPORT's implementation barriers included the need for an X-waiver, VA's opioid tapering policies, patient and PCP knowledge gaps and PCP discomfort, and logistical compatibility and sustainability challenges for clinics. SUPPORT's dedicated clinical staff, ongoing internal facilitation, and high patient and PCP satisfaction were key facilitators. SUPPORT (January 2019 to September 2021) trained 218 providers; 63 received X-waivers, and 23 provided MOUD (10.5% of those trained). SUPPORT provided care to 167 patients, initiated MOUD for 33, and provided education and naloxone to 72 (all = 0 in year before launch). CONCLUSIONS: SUPPORT reached many PCPs and patients and resulted in small increases in MOUD prescribing and high levels of stakeholder satisfaction. Dedicated clinical staff was key to observed successes. Although resource-intensive, SUPPORT offers a potential model for outpatient MOUD provision.

BACKGROUND: Citizens affected by substance use disorders are high-risk populations for both SARS-CoV-2 infection and COVID-19-related mortality. Relevant vulnerabilities to COVID-19 in people who suffer substance use disorders are described in previous communications. The COVID-19 pandemic offers a unique opportunity to reshape and update addiction treatment networks. MAIN BODY: Renewed treatment systems should be based on these seven pillars: (1) telemedicine and digital solutions, (2) hospitalization at home, (3) consultation-liaison psychiatric and addiction services, (4) harm-reduction facilities, (5) person-centered care, (6) promote paid work to improve quality of life in people with substance use disorders, and (7) integrated addiction care. The three "best buys" of the World Health Organization (reduce availability, increase prices, and a ban on advertising) are still valid. Additionally, new strategies must be implemented to systematically deal with (a) fake news concerning legal and illegal drugs and (b) controversial scientific information. CONCLUSION: The heroin pandemic four decades ago was the last time that addiction treatment systems were updated in many western countries. A revised and modernized addiction treatment network must include improved access to care, facilitated where appropriate by technology; more integrated care with addiction specialists supporting non-specialists; and reducing the stigma experienced by people with SUDs.

The underrepresentation of individuals with profound autism (who require 24/7 access to care) in autism research has resulted in limited knowledge about their service needs and a lack of evidence-based practices tailored to those needs. This study explored caregiver perspectives on service needs, barriers to accessing care, and treatment priorities to guide treatment development and improvement of service delivery. A sequential mixed-methods design integrated quantitative survey data (n = 423; Mage = 18.89 years; 26.7% female) with qualitative interviews (n = 20) with caregivers of adolescents and adults with profound autism. Quantitative findings indicated regular socialization opportunities were the most frequently endorsed unmet service need (60.3% of caregivers), followed by primary health care with autism-trained staff (59.3%), social skills instruction (55.8%), life skills instruction (51.3%), and behavioral support (47.3%). Higher likelihood of needing social activity groups was associated with elevated emotional reactivity, higher language level, minoritized ethnicity, and lower household income. Greater need for specialized primary health care was associated with lower income, while the need for social and life skills instruction was associated with increased age and elevated dysphoria. Qualitative analysis identified 10 themes that converged and expanded quantitative findings by highlighting a pervasive shortage of individualized, goal-oriented services, common barriers to care, and the priority of developing centralized treatment settings that coordinate care throughout adulthood. This study identified pressing service needs for adolescents and adults with profound autism in the United States. These insights are crucial for improving the accessibility and quality of clinical care.

BACKGROUND: Intentional or accidental drug-overdose is a leading cause of mortality in U.S. women of child-bearing age. Opioid use during pregnancy is not only associated with maternal overdose, but with low birth weight at term and neonatal abstinence syndrome (NAS). Buprenorphine was approved as a medication for opioid use disorder (MOUD) in the United States in 2002 and is for many women, a preferred treatment option versus methadone. Buprenorphine is relatively safe during pregnancy and is associated with lower rates of NAS than methadone. Given the importance of MOUD during pregnancy, relatively little information exists regarding patients' questions and concerns about buprenorphine treatment, including the psychological challenges they face. AIMS: The purpose of the study was to describe the perinatal concerns of women with opioid use disorder who posted to an online suboxone forum. METHODS: Qualitative descriptive design to analyze some 170 posts from mothers with OUD to an online Suboxone(®) support forum over the period 2016-2021. RESULTS: The analysis of the interview data revealed 4 important themes: (a) Stigma resulting in self-deprecation, low self-esteem, and low self-efficacy; (b) stigma from family members and loved ones; (c) stigma from the medical profession; and (d) stigma from the community at-large (social stigma). CONCLUSIONS: There is compelling evidence to emphasize the importance of open communication and support between medical personnel and patients to ensure optimal outcomes for mother and baby.

PURPOSE: International university students (ISs) experience elevated rates of psychological distress due to the unique challenges of living and studying in a new country. Nonetheless, their utilisation of mental health services tends to be low. This study aimed to explore ISs' experiences of help-seeking via the Scottish primary healthcare services. METHODS: A qualitative design using semi-structured interviews and interpretative phenomenological analysis (IPA) was employed. The sample included nine female ISs from a range of cultural backgrounds, who sought mental health support from the Scottish primary healthcare services within the previous year. RESULTS: Participants' help-seeking experiences, contextualised within the challenging, liminal reality of living and studying in Scotland as an IS, were hindered by challenges with navigating two healthcare systems simultaneously and culturally-mediated attitudes towards mental health. Positive and negative experiences of patient-GP interactions had a considerable impact on participants' subsequent help-seeking endeavours. CONCLUSIONS: Transnational and relational lenses are key for understanding ISs' help-seeking. Beyond individual factors, help-seeking trajectories hinge on perceived quality of patient-doctor relationships and the accessibility of both local and home-country systems. These findings highlight the need for universities to implement targeted mental wellbeing interventions for ISs, and primary care to improve the quality patient-GP interactions.