Literature Collection

The aim of this mixed methods systematic review was to synthesize contemporary evidence on effectiveness of community-based allied health (AH) services on acute care utilizations and views from relevant stakeholders. An a priori protocol was registered with PROSPERO [CRD42023437013]. Inclusion criteria were: (a) stand-alone interventions led by practitioners/graduates from one or more target AH professions (audiology, exercise physiology, diabetes educator, nutrition and dietetics, occupational therapy, physiotherapy, podiatry, psychology, social work, and speech pathology); (b) examined acute care utilization-related outcomes with/without perceptions of relevant stakeholders; and (c) published after 2010 and in English. Eligible studies were identified from: (a) bibliographic databases (MEDLINE, Embase, EmCare, PsycINFO, CINAHL complete, and the Cochrane Library) (September 19, 2023); (b) online databases (ProQuest Central and ProQuest Dissertations & Theses Global) and theses repository (Trove) (September 20, 2023); (c) Google and Google Scholar (October 17-18, 2023); and (d) citation searching. A modified version of McMaster Critical Appraisal Tools and McGill Mixed Methods Appraisal Tool were used to assess methodological quality. Data synthesis was through convergent segregated approach. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation. There were 67 included papers. The integrated quantitative and qualitative findings demonstrated mixed evidence, likely influenced by the heterogeneity of the evidence base, for the effectiveness of AH services on acute care utilizations. Patients and their carers were largely positive about these services, highlighting opportunities to build on these experiences. The certainty of evidence for patient-important outcomes was however "very low", emphasizing cautious interpretation. The findings of this review shed light on the breadth and scope of AH in the community sector, and its potential impact on the acute sector. Further investment in, and ongoing research on, community-based AH can strengthen primary healthcare and relieve pressure on the acute sector.

Pregnant women with opioid use disorder show elevated rates of comorbid mental health problems, both of which are associated with negative health outcomes for mothers and children. There is substantial evidence supporting the benefits of treatment of perinatal opioid use disorder, as well as perinatal depression and anxiety, but there are gaps in knowledge about the effectiveness of perinatal behavioral health interventions in the context of co-occurring substance use disorder. The current study seeks to address this gap by examining outcomes of a behavioral activation treatment in a group of peripartum women with opioid use disorder (N = 68). Behavioral activation has shown promise in treating co-occurring depression and substance use problems. The intervention was delivered as part of an integrated care treatment model, in which patients received co-located obstetric, substance use, and mental health care in a hospital-based clinic. Hierarchical linear modeling was used to assess change in symptoms over time. Results suggest that the group behavioral activation intervention was associated with reduced depression and anxiety symptoms, demonstrated by significant reductions in PHQ-9 and GAD-7 scores over the course of treatment. Moreover, there were indications that increased attendance was associated with further reductions in depressive symptoms. Results contribute to understanding the effectiveness of behavioral activation in the context of peripartum opioid use disorder. Findings also add to the evidence supporting integrated care models and offer a potential blueprint for improving outcomes and reducing barriers to care in this population.

OBJECTIVE: The authors sought to determine the effectiveness of a self-administered computerized mental health screening tool in a general acute care emergency department (ED). METHODS: Changes in patient care (diagnosis of a past-year psychiatric disorder, request for psychiatric consultation, psychiatric referral at discharge, or transfer to psychiatric facility) and patient ED return visits (3 months after discharge vs. 3 months before) were assessed among ED physicians (N=451) who received patients' computerized screening reports (N=207) and those who did not (N=244). All patients received copies of screening results. RESULTS: The computerized mental health screening tool identified previously undiagnosed psychiatric problems. However, no statistically significant differences were found in physician care or patient ED return visits. CONCLUSIONS: Computerized mental health screening did not result in further psychiatric diagnoses or treatment; it also did not significantly reduce patient ED return visits. Collaboration among EDs and mental health treatment agencies, organizations, and researchers is needed to facilitate appropriate treatment referrals and linkage.