Literature Collection

BACKGROUND: Globally, health and social care systems have been responding to the demand for better integrated service delivery to tackle complex public health and socioeconomic challenges. Similarly, services in the United Kingdom strive for comprehensive, person-centred care to support health equity and improved quality of life. This study took place in Blackpool and the Fylde Coast, United Kingdom, where socioeconomic deprivation and health inequalities persist and effective collaboration among health and social care providers offers an opportunity to tackle such complex challenges. The study used social network analysis (SNA) to investigate collaboration patterns between organizations to identify key characteristics and areas for improved integration. METHODS: Data were collected from March to June 2023. First, a comprehensive mapping exercise identified a total of 453 community-based providers who were invited to participate via email. Data on service provision were collected using an adapted version of the Template for Intervention Description and Replication (TIDieR) form from organizations' websites. Service descriptions were thematically categorized into 11 domains. A total of 44 organizations provided information on their collaborations through an online survey, reporting on collaborations across 321 organizations. SNA examined collaboration patterns via visualization and multivariate network regressions (MRQAP). RESULTS: The mapping identified a great range of community-based support. The network density indicated relatively low overall collaboration (2.2%) among 321 organizations. Within the subset of 44 organizations who completed the questionnaire, collaborations were more frequent (15%). Collaboration ties were unevenly distributed, where some organizations had more connections. MRQAP showed that organizations within the same domain were more likely to collaborate. Some combinations, such as collaborations between housing, shelter and nutritional support with child and family support and mental health were significantly overrepresented. DISCUSSION: The network had low density, highlighting the potential for more collaborations. The network appears fragmented, probably owing to a tendency for organizations to collaborate with others operating in the same service domain. The frequent collaborations between certain domains highlight the complex needs of local communities. Effective integrated care initiatives, data sharing and place-based partnership/voluntary, community, faith, social enterprise sector capacity-building programmes could build more resilient and interconnected networks that meet community needs.

PURPOSE: Little is known about the use of collaborative care models for patients with co-occurring chronic pain and substance use disorders (SUD). This study aimed to pilot test a collaborative care intervention delivered over telehealth to rural patients engaged with SUD treatment who experienced chronic pain. DESIGN: Single-arm, open-label pilot intervention trial. METHODS: Patients (N=88) were enrolled in SUD treatment at a single VA Medical Center and endorsed moderate-to-severe chronic pain. Patients received a nurse-led collaborative care intervention consisting of a comprehensive pain assessment, up to six follow-up appointments with the nurse care manager (NCM), and an optional 10-session pain education class. All patient encounters occurred remotely via telehealth. Baseline, 1- and 4-month follow up assessments measured outcomes of pain, depression, and substance use. Generalized estimating equations and intent-to-treat procedures modelled changes in outcomes over time. RESULTS: Patients were predominantly male (85%) and white (85%), with high mental health and substance use disorder comorbidities (92%). The most common substances of use at treatment initiation were alcohol (49%), opioids (17%), cannabis (17%), methamphetamine (11%), and cocaine (6%). By 4-month follow-up, patients who received the pain intervention endorsed significant reductions in pain intensity, pain interference, and depressive symptoms. Among patients using alcohol or cannabis at baseline, significant reductions in days using these substances were also observed. CONCLUSIONS AND CLINICAL IMPLICATIONS: An NCM-led collaborative care intervention delivered via telehealth may improve both pain and substance use outcomes for rural patients with these comorbidities. Large-scale clinical trials are needed to demonstrate intervention efficacy.