Literature Collection

BACKGROUND: Low socio-economic status can lead to poor patient outcomes, exacerbated by lack of integration between health and social care and there is a demand for developing new models of working. AIM: To improve connections between patients, local services and their communities to reduce unscheduled admissions. DESIGN AND SETTING: A primary care cluster with areas of high deprivation, consisting of 11 general practices serving over 74,000 people. METHOD: A multi-disciplinary team with representatives from healthcare, local council and the third sector was formed to provide support for people with complex or social needs. A discharge liaison hub contacted patients following hospital discharge offering support, while cluster pharmacists led medicine reviews. Wellbeing Connectors were commissioned to act as a link to local wellbeing and social resources. Advance Care Planning was implemented to support personalised decision making. RESULTS: Unscheduled admissions in the over 75 age group decreased following the changes, equating to over 800 avoided monthly referrals to assessment units for the cluster. Over 2,500 patients have been reviewed by the MDT since its inception with referrals to social prescribing groups, physiotherapy and mental health teams; these patients are 20% less likely to contact their GP after their case is discussed. An improved sense of wellbeing was reported by 80% of patients supported by wellbeing connectors. Staff feel better able to meet patient needs and reported an increased joy in working. CONCLUSION: Improved integration between health, social care and third sector has led to a reduction in admissions, improved patient wellbeing and has improved job satisfaction amongst staff.

Background: A large number of low-intensity Internet-based interventions (IBIs) for the treatment of depression have emerged in Primary Care; most of them focused on decreasing negative emotions. However, recent studies have highlighted the importance of addressing positive affect (PA) as well. This study is a secondary analysis of a randomized control trial. We examine the role of an IBI focused on promoting PA in patients with depression in Primary Care (PC). The specific objectives were to explore the profile of the patients who benefit the most and to analyze the change mechanisms that predict a significantly greater improvement in positive functioning measures. Methods: 56 patients were included. Measures of depression, affect, well-being, health-related quality of life, and health status were administered. Results: Participants who benefited the most were those who had lower incomes and education levels and worse mental health scores and well-being at baseline (7.9%-39.5% of explained variance). Improvements in depression severity and PA were significant predictors of long-term change in well-being, F (3,55) = 17.78, p < 0.001, R(2) = 47.8%. Conclusions: This study highlights the importance of implementing IBIs in PC and the relevance of PA as a key target in Major Depressive Disorder treatment.

AIM: To explore the perceived impact of a nurse-led domestic and family violence service on access to care. BACKGROUND: Delivered from a metropolitan community based not for profit organisation, this nurse-led service provided a multidisciplinary response to meeting the needs of women, and or women and children experiencing the consequences of domestic and family violence and homelessness. This involved integration of specialist community services to support women's safety planning, housing, and mental health. DESIGN: A mixed methods single-site study was conducted. METHODS: Routine patient attendance data were analysed to identify service use. Semi-structured interviews with service providers and key stakeholders explored perceived service impact on access to care. RESULTS: Data were collected over 2.5 years from n = 233 women experiencing domestic and family violence, of whom 28% (n = 64) identified as First Nations, and 26% (n = 61) had at least one dependent child. The nurse facilitated access through referrals, and care navigation, often driving and accompanying women to their appointments. Person-centered and trauma sensitive approaches were highly effective in gaining trust. Qualitative data themes were, care environment, macro context, care outcomes and person centeredness. CONCLUSION AND IMPLICATIONS: Stakeholders' perspectives highlight the need to improve health professionals' capability to respond effectively when women disclose domestic and family violence. The success of this nurse-led service was its capacity for flexibility, which meant it could address women's unmet health needs in most environments and directly facilitate their access to mainstream healthcare and social supports. IMPACT: Accessing healthcare is extremely challenging for women experiencing domestic violence in Australia. The nurse-led specialist service provided much needed support to women experiencing domestic and family violence and to health professionals within the broader organisation, to improve access to care. Optimising the nurse's scope of practice in terms of authority to refer for investigations and prescribe medications, would further increase access to care. REPORTING METHOD: This study has been reported using the Consensus Reporting Items for Studies in Primary Care (CRISP) checklist. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Children and young people (CYP) with physical and mental health needs commonly present to acute hospitals. Although evidence shows liaison services providing mental health assessment and intervention to adult acute hospitals users improve outcomes, there is no evidence review for Paediatric Mental Health Liaison (PMHL). A mixed-methods, integrative, systematic review, using Joanna Briggs Institute (JBI) guidance, was conducted to identify evidence for PMHL service impacts on stakeholder experience and health and service level outcomes in the acute hospital setting.Keyword searches of relevant databases including Medline and PsycINFO plus citation searching identified 10,111 records; 415 papers were eligible for full-text screening. 53 papers describing mental health services/interventions provided to CYP aged 0-25 in acute hospital settings and reporting data on health and service-level outcomes, or stakeholder experiences were included. Service description, outcomes, and stakeholder experience data were extracted from included papers. Quantitative findings were 'qualitized' and analysed thematically. Quality appraisal used JBI tools.Studies were mostly cross-sectional (n = 27) or quasi-experimental (n = 13), from the US (n = 28) or England (n = 11). Service descriptions ranged from multidisciplinary teams covering entire hospitals to single mental health professionals integrated into one physical health department. Presence of PMHL services improve length of stay and healthcare costs/utilization, but evidence has methodological limitations. Evidence for PMHL services' impact on health outcomes is also positive but weak. PMHL services are valued by physical healthcare staff and parents/carers, but CYP views were underrepresented. Further work needs to establish outcomes important to CYP and families.Prospero Registration Number: CRD42022383611.

INTRODUCTION: Providing health care to rural communities is a challenge, particular for marginalised groups like people who use drugs. The ongoing COVID-19 pandemic further increases these challenges. The use of remote models of care, including telemedicine, help to mitigate the impact of COVID-19 and provide new opportunities to engage existing and new patients in treatment. It is recognised that people who used opioids have increased health needs and struggle to engage in health care compared to the general population. Opioid substitution treatment (OST) is effective at reducing these health inequalities but coverage is often inadequate. To increase access to OST during the pandemic, a national remote model of OST was developed in Ireland. An evaluation is being conducted 18 months after commencement to evaluate its effectiveness at engaging people in OST, its impact on their drug use, general health and quality of life. The evaluation also aims to describe the experiences of both services providers and users and report aspects that can be modified and improved. METHODS: A mixed-methods evaluation is being conducted. It consists of a chart review that collects demographic data (age, sex, family details and education and employment status). It also includes the collection and analysis of data on engagement in treatment, changes in drug use and general health. A series of one-to-one interviews are being conducted (service providers (n=12) and service users (n=10).Thematic analysis of the interview narratives will be conducted using NVivo 11. RESULTS AND DISCUSSION: The results will be ready in 2022.

BACKGROUND: Chronic kidney disease (CKD) affects 8-16% of adults worldwide, including nearly 4 million Canadians. As the disease progresses, patients often experience a significant decline in quality of life (QoL), driven by disease-related symptoms and the burden of renal replacement therapies (RRT) such as dialysis and transplantation. In addition to physical symptoms, up to 55% of patients report psychological distress, including depression and anxiety. Despite this, mental health needs are frequently under-identified and insufficiently addressed in nephrology care. There is limited understanding of how patients experience and cope with this distress, how staff perceive their role in responding to it, and how healthcare environments support or hinder psychosocial care. This study seeks to address these gaps within a single integrated nephrology care network. METHODS: This explanatory sequential mixed-methods study will be conducted in two phases. In the first phase, quantitative data will be collected from 200 patients with CKD and 40-50 nephrology staff members using validated questionnaires assessing psychological distress, anxiety, depression, and QoL. Group comparisons will assess differences across RRT modalities, and association analyses will explore relationships between psychological outcomes and demographic or clinical factors. In the second phase, semi-structured interviews and focus groups with patients and staff will explore experiences of psychological distress and care delivery in greater depth. Thematic analysis will be used for qualitative data. Integration of findings through triangulation will provide a comprehensive understanding of psychosocial needs and inform intervention development. DISCUSSION: This study uses a mixed-methods design to investigate psychosocial needs in CKD care from both patient and provider perspectives. It aims to identify modifiable clinical and organizational factors-such as staff preparedness, referral practices, and systemic barriers-that shape the delivery of mental health support. Findings will inform the development of person-centered interventions and may guide broader models for integrating psychological care into chronic disease management. STATUS OF TRIAL: The study began in June 2024. Participant recruitment and data collection are ongoing and will continue until June 2026. CLINICAL TRIAL NUMBER: Not applicable.