Literature Collection

Perinatal mental illness is an important public health issue, with one in five birthing persons experiencing clinically significant symptoms of anxiety and/or depression during pregnancy or the postpartum period. The purpose of this study was to develop a consensus-based model of integrated perinatal mental health care to enhance service delivery and improve parent and family outcomes. We conducted a three-round Delphi study using online surveys to reach consensus (≥75% agreement) on key domains and indicators of integrated perinatal mental health care. We invited modifications to indicators and domains during each round and shared a summary of results with participants following rounds one and two. Descriptive statistics were generated for quantitative data and a thematic analysis of qualitative data was undertaken. Study participants included professional experts in perinatal mental health (e.g., clinicians, researchers) (n = 36) and people with lived experience of perinatal mental illness within the past 5 years from across Canada (e.g., patients, family members) (n = 11). Consensus was reached and all nine domains of the proposed model for integrated perinatal mental health care were retained. Qualitative results informed the modification of indicators and development of an additional domain and indicators capturing the need for antiracist, culturally safe care. The development of an integrated model of perinatal mental health benefitted from diverse expertise to guide the focus of included domains and indicators. Engaging in a consensus-building process helps to create the conditions for change within health services.

Patient-generated health data (PGHD) encompass health-related information created, recorded, and gathered by patients in their daily lives, and are distinct from data collected in clinical settings. PGHD can offer insight into patients' everyday health behaviors and conditions, supporting health management and clinical decision-making. The Veterans Health Administration (VHA) has developed a robust infrastructure to collect PGHD, including automatically collected data from digital sensors and patient-entered data. This effort is guided by comprehensive policy and strategy documents to ensure the secure storage and effective use of PGHD. This paper describes the development and implementation of an infrastructure to support PGHD within the VHA and highlights envisioned clinical and research uses of PGHD to advance health care for US veterans. The PGHD database was built to Fast Healthcare Interoperability Resources standards, facilitating secure data storage and exchange of PGHD. Clinical tools, such as the provider-facing dashboards, make PGHD accessible from the electronic health records. Research and evaluation efforts focus on evaluating PGHD's impact on patient engagement, clinical outcomes, and health care equity. The VHA's comprehensive PGHD infrastructure represents a significant advancement in personalized health care and patient engagement. The integration of PGHD into clinical practice can enhance shared decision-making and self-management, while research and evaluation efforts can address how to maximize the benefits of PGHD for veterans. The VHA's approach sets a benchmark for other US health care systems in leveraging PGHD to achieve the broad aims of enhancing stakeholder health care experiences, improving population health and health equity, and reducing costs.

Integrated healthcare models show great promise for addressing health disparities affecting Indigenous people, which are often rooted in the enduring effects of colonisation. These models align with Indigenous holistic views of health, recognizing the importance of community, cultural knowledge, and connection to land. To understand how these models are being developed and implemented, we conducted a systematic scoping review. Guided by Indigenous methodologies and community needs, we searched four databases (Web of Science, PubMed, Scopus and ProQuest) for peer-reviewed literature on integrated healthcare for Indigenous communities in Australia, Canada, the United States, and New Zealand. Included articles were appraised using the Indigenous quality appraisal tool and analysed from a relational perspective supported by the Joanna Briggs Institute's convergent integrated method. Nineteen publications met the inclusion criteria. Most studies were from Australia (53%) and Canada (26%), and most (74%) were published in the last five years, indicating a recent surge in interest. The review identified several key factors critical to the effective implementation of these models. These included strong community leadership and ownership, culturally and contextually relevant approaches, meaningful partnerships with stakeholders, and flexible service delivery. The review further highlights the importance of having motivated and well-trained health providers, as well as adequate funding. The wide variety of methods found in the studies reflects the complexity of integrated care and the influence of distinct cultural, disciplinary and contextual factors. The findings suggest that to improve healthcare and well-being for Indigenous populations, it is crucial to strategically address these key elements.

Primary health care teams are a key strategy in providing integrated care, particularly for patients with multiple chronic conditions. Despite a strong commitment to improving primary health care through team-based care globally, challenges to its implementation remain. A comparative policy analysis was conducted in four Canadian provinces (British Columbia, Alberta, Ontario, and Quebec) to examine the policies and structures supporting service integration for patients with two or more chronic conditions through primary health care teams. Results are reported on Phase 3 of the project, including a national knowledge translation event to refine recommendations and develop actions for implementing recommendations related to team-based primary health care in policy and practice. Our virtual knowledge translation event took place in June 2022; with 25 participants including policymakers, decision-makers, providers, patients and researchers. Eight key recommendations were discussed and revised with feedback and strategies for implementation developed. Five themes were identified from the discussions: 1) composition of the team and access; 2) communication and electronic health records; 3) remuneration; 4) patient engagement; and performance measurement. Recommendations for policy and practice are outlined and compared to existing Canadian and international literature.