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.

BACKGROUND: Virtual wards (VWs) have been rapidly adopted within the National Health Service (NHS) in England, showing promise for reducing hospital admissions and length of hospital stays. Additionally, VWs are reportedly highly acceptable to patients and may be preferable to physical wards (PWs) in some instances. However, little research exists on how to optimise the implementation of VWs from a strategic perspective. The current study aimed to investigate commissioners' perceptions and experiences of implementing VWs in integrated care systems (ICSs) in England, with a particular focus on changes and continuities in implementation influences over time. METHODS: A longitudinal qualitative design was adopted. Semi-structured interviews were conducted via Teams with commissioners involved in the implementation of VWs at two timepoints (TP) six months apart; TP1 (n = 20) and TP2 (n = 14). Interviews focused on perceptions and opinions of the VWs programme, including barriers and facilitators to successful implementation. Data were analysed using the Consolidated Framework for Implementation Research (CFIR) in line with the Framework Method. The CFIR comprises five domains: Innovation, Outer Setting, Inner Setting, Individuals, and Implementation Process. RESULTS: Implementation progress diverged across sites at follow-up, with some scaling back due to challenges while others expanded their VW programs. On a domain level, Inner Setting (ICS) constructs appeared most influential on implementation over time, with constructs in the Individuals domain seemingly becoming less important. The main barriers to implementation included: limited staff capacity, recruitment issues, and inefficient communication and interoperability of systems (Inner Setting); uncertainty around long-term funding (Outer Setting); inequalities in patients' home circumstances and lack of buy-in from clinicians (Individuals); and lack of detailed implementation planning (Implementation processes). Key facilitators included: building on existing similar services (Innovation); collaborative working (Inner Setting); and national guidance (Outer Setting) with flexibility to adapt to local contexts (Implementation Process). Commissioners perceived patient acceptability to be generally high, with a reported preference for receiving care at home. CONCLUSIONS: Buy-in from clinicians, collaboration, detailed advanced planning on an ICS level, and sustainable funding are particularly important for implementation of VWs. To avoid generating inequalities, tailored additional support should be provided to disadvantaged patients. Directions for future research includes exploring the perspectives of clinicians.

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.