Literature Collection

In years past, an adolescent patient presenting to primary care with symptoms of opioid use disorder (OUD) would have been a highly rare event in most communities. With OUD and fatal overdoses rising among adolescents and young adults (termed youth) over the past 15 years, this scenario has unfortunately become more common. Fatal drug overdoses increased 3.5-fold for youth aged 15 to 24 years from 1999 to 2014.1 Amidst this epidemic, relatively little is known about how primary care clinicians treat youth with OUD. Of particular interest is whether youth receive medication-assisted treatments (MATs), which have been shown to improve quality of life and reduce overdose risk.2

BACKGROUND: Health care disparities in rural and underserved areas necessitate quality primary care, especially in behavioral health management. Family nurse practitioners (FNPs) are critical in these regions, which often lack psychiatric specialists. PROBLEM: Rural communities face unique challenges exacerbated by primary care and mental health provider shortages. The deficit in behavioral health specialists highlights the need to optimize FNP education programs. APPROACH: The Collaborative Academic Practice (CAP) program prepares FNP students for entry-to-practice through hybrid learning, immersive training, and comprehensive behavioral health integration, effectively training them to meet the health care needs of underserved populations. OUTCOMES: The CAP program prepares FNPs, resulting in increased practice in underserved areas and enhanced preceptor satisfaction. Key measures contribute to its effectiveness, including immersive training, telehealth education, and preceptor enhancement. CONCLUSIONS: Despite financial and communication challenges, the CAP program transforms FNP education, addressing mental health needs and bridging critical gaps in health care delivery.

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.

BACKGROUND: People with severe mental Illness (SMI) bear an excessive burden of periodontal disease, which can exacerbate their mental and physical multimorbidity. Therefore, improving and sustaining good oral hygiene is key. AIMS: To co-create a theory-driven oral hygiene intervention for people with SMI. METHOD: A two-stage, eight-step method was followed drawing on the Behaviour Change Wheel. Stage 1, understanding the problem, involved evidence review and stakeholder consultations. Stage 2 focused on identifying theoretical barriers and facilitators through semi-structured interviews (n = 20) and co-designing the intervention content alongside people with SMI, carers, primary care, mental health and dental professionals and clinical leads. Interview data were analysed using framework analysis. Identified barriers and facilitators were mapped to the Capability, Opportunity, Motivation-Behaviour model and Theoretical Domain Framework. Intervention functions, policy categories and behaviour change techniques were identified and mapped accordingly. RESULTS: The target behaviour of twice-daily toothbrushing was addressed through understanding the consequences of improving oral health and brushing, forming a brushing habit, brushing instructions and demonstration with consideration of cognitive capacity and exploring the need for financial and social support. Recommendations for intervention delivery included integrating it into the SMI physical health checks, training and remunerating primary care and mental health professionals to deliver it as part of a personalised and integrated care approach to rebuilding broader lifestyle routines; and maintaining engagement through follow-up appointments. CONCLUSIONS: This is the first study to co-create a theory-driven toothbrushing intervention for people with SMI, delivered by primary care and mental health professionals.

BACKGROUND: People living with neurological conditions have needs that require an integrated care approach. Existing models of integrated care have often emphasized system structures but neglected the micro-level interactions that matter most to people. OBJECTIVES: To develop a micro-level model for integrated care that represents the care components most valued by people affected by Huntington's disease (HD). METHODS: A mixed methods study with a co-designed approach was delivered through three phases. This paper reports on the latest two, where interviews and workshops were conducted with people with lived experience of HD and professionals, from January to October 2024. Patient and public contributors were involved from project design to data interpretation. RESULTS: Three themes were identified that position integrated care from the perspective of those affected by HD, representing these as the EC4Neuro model. Theme 1 identified the core components of micro-level integrated care: expert knowledge, person- and family-centred care, care coordination and continuity of care. Theme 2 underlined access inequities. Theme 3 highlighted people's responsibility to manage care without true agency to do so. The workshops prioritized strategies that enhance relational continuity between service users and providers. A tiered strategy was undertaken to support decision-making towards improving person-centred outcomes. CONCLUSIONS: EC4Neuro is the first integrated care model developed in HD. Its co-designed approach with end users successfully embedded people's perspective to guide what needs to be achieved at the micro-level. The EC4Neuro model offers prospective replication opportunities, particularly for stakeholders concerned with reducing access inequities and supporting relational continuity. PATIENT OR PUBLIC CONTRIBUTION: A group of 25 experts by lived experience of HD and other neurological disorders, co-designed this research project, working with the researchers from conception of the studies to analysis and interpretation of the data.