Literature Collection

Opioid use disorders (OUDs) are receiving significant attention in the U.S. as a public health crisis. Access to treatment for OUDs is essential and was expected to improve following implementation of the federal parity law and the Affordable Care Act. This study examines changes in coverage and management of treatments for OUDs (opioid treatment programs (OTPs) as a covered service benefit, buprenorphine as a pharmacy benefit) before, during, and after parity and ACA implementation. Data are from three rounds of a nationally representative survey conducted with commercial health plans regarding behavioral health services in benefit years 2003, 2010, and 2014. Data were weighted to be representative of health plans' commercial products in the continental United States (2003 weighted N = 7,469, 83% response rate; 2010 N = 8,431, 89% response rate; and 2014 N = 6,974, 80% response rate). Results showed treatment for OUDs was covered by nearly all health plan products in each year of the survey, but the types and patterns varied by year. Prior authorization requirements for OTPs have decreased over time. Despite the promise of expanded access to OUD treatment suggested by parity and the ACA, improved health plan coverage for treatment of OUDs, while essential, is not sufficient to address the opioid crisis.

This research surveyed Tier 3 (specialist, multidisciplinary) adult weight management services in England commissioned for the National Health Service (NHS) by Integrated Care Boards (ICBs) across England in financial year 2022-2023. A survey of public health services commissioned by ICBs gathered via freedom of information requests. All 42 ICBs in England surveyed between September and December 2023. Outcome measures were: whether or not there was Tier 3 provision, the type of Tier 3 services provided, the estimated number of patients referred and treated, and the relation of referral rates to measures of deprivation. We had a 100% response rate; five reported no Tier 3 provision. Using regional data and estimates of eligibility for referral to Tier 3 management, only 0%-1.1% of those eligible were referred. Referral rates exclusively to Tier 3 services showed no correlation with the Index of Multiple Deprivation IMD (R (2) = 0.27; p = 0.21). Four services commissioned appeared not to meet the definition of a Tier 3 service. Provision of Tier 3 services in England is inadequate and variable and currently fails to meet the needs of the population. Many areas with high levels of deprivation provide the most limited access. Even where commissioned, some services do not meet commissioning guidelines. Action is required to implement Health Service Policy and to ensure obesity services conform with clinical need and national guidelines.

INTRODUCTION: The components of integrated care for children, young people and families (CYPF) listed across existing authoritative guidance is generally consistent; the guidance suggests a list of components that should ideally be considered for implementation. Local system managers report specific challenges around integrating system-wide funding, trusted workforce relationships, and CYPF engagement. We aimed to systematically generate a list of components of integrated care from existing systems and models for CYPF, assess their commonality, intended target(s) of impact, and compare these findings with guidance and local system managers' concerns. METHODS: PubMed, CINHAL and Cochrane CENTRAL were systematically searched (01/01/2016 to 31/12/2023) for studies of any design, conducted in high-income countries, describing components of an integrated care system or model for CYPF. Following data extraction, individual components within studies were coded a) using the framework method to generate Component Themes b) for their intended target(s) of impact; system (S), users (U) and/or workforce (W). Simple analytic methods were used to rank and map the commonality of Component Themes and their intended target(s) of impact. Subgroup analysis was conducted for four public health priorities: mental health, learning disabilities and autism, obesity, and early years. RESULTS: From 170 studies, 1057 components nested in one or more 25 Component Themes of integration were identified. None of the studies identified all Component Themes (median 5, range 1-16). Most commonly identified were 'shared professional responsibility and practices' (in 58% of studies; intended targets of impact S and W), 'stronger connections and partnerships' (52%; SUW), 'empowerment of service users' (36%; U), 'early detection and prevention' (32%; SUW) and 'training of parents' (32%; SUW). Those not commonly identified were 'finance/budgeting' (8%; S), 'family engagement' (12%; U), 'leadership' (11%; W), 'empowering staff' (8%; SUW), and 'role of language and culture' (5%; SW). The commonality of Component Themes for all studies combined and for each of the four subgroups was very similar and is described in visual representations. Alignment with guidance and local system managers' concerns is discussed. CONCLUSION: We suggest this list of Component Themes and their intended target(s) of impact be considered when updating guidance on integrated care for CYPF. Existing guidance may benefit from additional implementation support around the integration of finance across the system; leadership, empowerment, language and culture across the workforce; and embedding meaningful CYPF engagement.