Literature Collection

Integrated care facilitates better outcomes for patients and their family, health workforce and health and social care systems. Accordingly, integrated care is a global and inherent area of work for health professionals. Despite this, formal learning programmes for workforce development in integrated care are still rare. In this paper, I have shared lessons about developing an innovative and sustainable integrated care learning programme for teachers, practitioners and learners in integrated care discipline. These lessons are drawn from my experience of leading an integrated care specialisation programme (that sits at Australian Qualification Framework Level 9) at a public university in Australia. An integrated care learning programme should be designed with appropriate philosophies (e.g., social constructivism and connected learning) and relevant multidisciplinary content that addresses deficiencies in practices of integrated care. Moreover, the programme should aim for sustainability, through financial feasibility and continuity with offering of creative and effective solutions in integrated care. Similarly, the programme should have a suit of curriculum development and teaching initiatives to promote genuine and collaborative learning. Throughout this learning journey, it would be critical for teachers to engage in 'walking-the-talk', that is, genuinely collaborate with patients, practitioners and students, for successful delivery of an innovative and sustainable learning programme.

BACKGROUND: Distinguishing emotional distress from mental health problems such as anxiety and depression can be difficult for clinicians. Both commonly present and are managed in primary care. There are likely to be important differences in the management of emotional distress compared with anxiety and/or depression, but the current nature of assessment and management is unclear. AIM: To explore how emotional distress is understood and how people are managed by a range of practitioners in primary care settings in the UK. DESIGN AND SETTING: A qualitative study using semi-structured interviews with primary care practitioners in the UK. METHOD: Online interviews were conducted with practitioners who directly assess patients with mental health symptoms, including GPs, nurse practitioners, social prescribers, and mental health practitioners. Recruitment was via a digital poster circulated by research delivery networks. Interviews covered how practitioners understood and identified distress, the support provided to patients, and challenges assessing and managing emotional distress. Verbatim transcriptions were analysed using an inductive thematic approach. RESULTS: In total, 29 interviews were conducted and four themes were developed in collaboration with the wider team, including public contributors: the multifaceted nature of distress; 'We're all doing very different things'; managing and understanding distress is challenging; and demedicalising distress in the face of increasing societal pressures. Complexity was driven by the wide-ranging professionals involved, complex patient circumstances, systemic challenges, and societal contexts. CONCLUSION: Identifying and managing emotional distress is complex, variable, and challenging. Complexity appears to be increasing through the systemic challenges and range of professionals involved.

Background: Jails in Massachusetts are among the first nationwide to provide correctional populations with medications to treat opioid use disorder (MOUD). The COVID-19 pandemic caused jails to pivot and adapt MOUD programming. We aimed to identify adaptations and barriers to MOUD access that COVID-19 exacerbated or created, and document new elements that staff wish to sustain as COVID-19 recedes. Methods: We conducted semi-structured in-depth interviews and focus groups in 2020-2021 with 29 jail staff who implement MOUD programming in two Massachusetts jails. We conducted qualitative data analysis in Atlas.ti 8 using an inductive approach. Results: Participants shared that access to MOUD among correctional populations is understood by jail staff to be an essential health service. Thus, to facilitate continued access to MOUD, both during incarceration and also at community reentry, jail staff quickly implemented changes in MOUD regulations and dosing protocols and established telehealth capacity. Despite these program adaptations, participants identified how COVID-19 increased health and social needs among correctional populations, reduced availability of community-based healthcare and recovery-supportive services, and introduced new factors that could undermine recovery. Innovations that participants wished to sustain as COVID-19 receded included telehealth capacity, smaller-sized therapeutic groups, and application of a public health approach to treat opioid use disorder among correctional populations. Conclusions: During disruptive events, jails can adapt MOUD programming to ensure access for people living in jail and upon release. Findings identify factors for understanding the outcomes of jail-based MOUD programming during COVID-19 and highlight opportunities to improve service delivery after COVID-19.