Literature Collection

Background: The opioid epidemic continues to erode communities across Pennsylvania (PA). Federal and PA state programs developed grants to establish Hub and Spoke programs for the expansion of medications for opioid use disorders (MOUD). Employing the telementoring platform Project ECHO (Extension for Community Health Outcomes), Penn State Health engaged the other seven grant awardees in a Collaborative Health Systems (CHS) ECHO. We conducted key informant interviews to better understand impact of the CHS ECHO on health systems collaboration and opioid crisis efforts. Methods: For eight one-hour sessions, each awardee presented their unique strategies, challenges, and opportunities. Using REDCap, program characteristics, such as number of waivered prescribers and number of patients served were collected at baseline. After completion of the sessions, key informant interviews were conducted to assess the impact of CHS ECHO on awardee's programs. Results: Analysis of key informant interviews revealed important themes to address opioid crisis efforts, including the need for strategic and proactive program reevaluation and the convenience of collaborative peer learning networks. Participants expressed benefits of the CHS ECHO including allowing space for discussion of challenges and best practices and facilitating conversation on collaborative targeted advocacy and systems-level improvements. Participants further reported bolstered motivation and confidence. Conclusions: Utilizing Project ECHO provided a bidirectional platform of learning and support that created important connections between institutions working to combat the opioid epidemic. CHS ECHO was a unique opportunity for productive and convenient peer learning across external partners. Open dialogue developed during CHS ECHO can continue to direct systems-levels improvements that benefit individual and population outcomes.

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.