Literature Collection

AIM: To tailor an existing Person-Centred Integrated Care (PC-IC) approach to the needs of patients with low socioeconomic status (LSES) and chronic conditions in primary care. BACKGROUND: While Disease Management Programs (DMPs) have been introduced to reduce the burden of chronic diseases, their effectiveness for patients with LSES remains uncertain due to insufficient attention to the individual context. A PC-IC approach may enhance patient outcomes by addressing patients' cultural backgrounds, values, and health literacy needs, because these factors are particularly relevant for patients with LSES. METHOD: A qualitative study was conducted using three co-creation sessions with patients with LSES and chronic conditions, along with general practitioners and practice nurses, to adapt, develop, and test specific elements of the PC-IC approach. Participatory learning and action (PLA) techniques incorporating visual materials were employed to ensure meaningful engagement and input by all participants, including those with limited reading and language skills. Following these sessions, we conducted a validation check by patients on the draft materials. FINDINGS: In the co-creation sessions, an existing PC-IC approach was tailored to the needs of LSES patients with chronic conditions in primary care. The adapted PC-IC approach emphasized key elements as trust, being seen as a person in the social context, shared decision-making, and access to clear and easily understandable information. Existing materials needed to be adapted, resulting in a visual conversation tool. This tool covers the physical, social, and mental health domains as well as daily life, each domain with six to eight topics. It helps to get better insight into the patient's daily life, wishes, and possibilities. It maps medical and psychosocial issues and supports the patient in gaining a better understanding. The adapted PC-IC approach with the conversation tool is being presented in a training for primary care professionals.

OBJECTIVE: Pregnant people receiving treatment for opioid use disorders (OUD) are at significant risk of return to use during the postpartum period. Recently, practice groups and other national organizations have called for the co-location of addiction medicine and obstetric care to reduce the burden on pregnant and postpartum people with OUD associated with engaging in treatment. This paper examines the effectiveness of co-locating services in retaining pregnant people with OUD in care following childbirth. METHODS: A records review of pregnant people receiving medication for OUD between 2012 and 2017 in stand-alone addiction medicine clinic (n = 23) and from 2017 to 2021 following the creation of an integrated addiction medicine-obstetric care clinic (n = 67) was conducted to compared rates of attendance in both obstetric and addiction medicine services. RESULTS: Findings from this study suggest that individuals receiving services in a co-located clinic had significantly fewer missed appointments during the postpartum period relative to individuals who sought care at separate addiction medicine and obstetric care clinics. CONCLUSIONS: Results from this study support the potential for co-locating clinics to reduce barriers to accessing obstetric and addiction medicine services, as well as support continued attendance in care across a vulnerable period.

BACKGROUND: Co-occurring substance use disorders (SUDs) among individuals with opioid use disorder (OUD) are associated with additional impairment, overdose, and death. This study examined characteristics of patients who have OUD with and without co-occurring SUDs in rural primary care clinics. METHODS: Secondary analysis used electronic health record (EHR) data from six rural primary care clinics, including demographics, diagnoses, encounters, and prescriptions of medication for OUD (MOUD), as well as EHR data from an external telemedicine vendor that provided MOUD to some clinic patients. The study population included all adult patients who had a visit to the participating clinics from October 2019 to January 2021. RESULTS: We identified 1164 patients with OUD; 72.6 % had OUD only, 11.5 % had OUD and stimulant use disorder (OUD + StUD), and 15.9 % had OUD and other non-stimulant substance use disorder (OUD + Other). The OUD + StUD group had the highest rates of hepatitis C virus (25.4 % for OUD + StUD, 17.8 % for OUD + Other, and 7.5 % for OUD Only; p < 0.001) and the highest rates of mental health disorders (78.4 %, 69.7 %, and 59.9 %, respectively; p < 0.001). Compared to the OUD Only group, patients in the OUD + StUD and OUD + Other groups were more likely to receive telehealth services provided by clinic staff, in-clinic behavioral health services, and in-clinic MOUD. The OUD + StUD group had the highest proportion of referrals to the external telemedicine vendor. CONCLUSIONS: More than 27 % of patients with OUD in rural primary care clinics had other co-occurring SUDs, and these patients received more healthcare services than those with OUD only. Future studies should examine variations in outcomes associated with these other services among patients with OUD and co-occurring SUDs.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder resulting in negative long-term outcomes if untreated. Pathways to healthcare in the United Kingdom are complex, especially for those aged 16-25 transitioning between child and adult mental health services. We aimed to co-produce evidence-informed resources to improve accessibility of primary care for young people with ADHD. METHODS: We utilised co-production principles from the National Institute for Health and Care Research and findings from recent research to create evidence-informed resources which collate experiences of multiple stakeholders. Lived experience advisors (young people aged 16-25 with ADHD and their supporters) and healthcare professionals were recruited through previous research engagement and local collaborations. Research partners engaged in workshops or individual meetings to agree priorities, content, and language/visual appearance for outputs. RESULTS: Lived experience advisors (7), healthcare professionals (5), and researchers (3) co-produced a downloadable resource for young people and their supporters. The resource identifies key stages on ADHD healthcare pathways, common barriers, and top tips recommended by people with lived experience, and verified by healthcare professionals. Key messages for primary care professionals were co-produced. CONCLUSION: Co-produced resources can help address barriers to accessing ADHD treatment and support via stretched NHS services. Collaborative working also highlighted the need for national policy change to alleviate pressures faced by healthcare professionals and patients. PATIENT AND PUBLIC CONTRIBUTION: Two research advisory groups (RAGs) of healthcare professionals and lived experience advisors informed research methods and presentation of results. RAG members participated in co-production workshops, contributed to authorship, and disseminated outputs.