Literature Collection

INTRODUCTION: Despite effective treatment for opioid use disorder, access to care is limited. Increased availability of evidence-based medication for opioid use disorder (MOUD) treatment within primary care is urgently needed. This study describes efforts to increase MOUD services within a large urban primary care practice. METHODS: After an internal assessment of barriers to MOUD services, a two-phase approach was used to educate providers and to implement MOUD services within a primary care practice over 2.5 years. Physicians became X-waiver certified in the education phase and completed four internal training sessions. Physicians completed pre-post surveys to assess their intention to prescribe MOUD. In the implementation phase, an interdisciplinary team designed accessible MOUD clinical hours. The RE-AIM model guided the evaluation of the MOUD training and services. The clinic evaluation included a medical records review, a provider focus group (n = 6), and patient interviews (n = 6). RESULTS: Pre-post surveys indicated that providers did not increase their intentions to prescribe MOUD. Once MOUD clinical hours were operational, the number of providers treating patients with MOUD increased substantially. Patients who received these services found them low-barrier, non-stigmatizing, and effective. The clinical team was satisfied with service delivery but offered suggestions for improvement for the whole primary care team. CONCLUSIONS: Increasing access to MOUD services within primary care may require iterative efforts to overcome practice-specific barriers, and gains may still be moderate. Training in MOUD services should focus on the whole primary care team as it requires interdisciplinary coordination to deliver high-quality services.

BACKGROUND: Qualitative methodologies offer a nuanced approach to understanding stakeholder perspectives, preferences, and context in implementation research. However, traditional qualitative data analysis can be time consuming and create barriers to responsive implementation of interventions. Rapid qualitative methods that yield timely, actionable results have emerged to expedite the evidence-to-practice gap, but often require all analysts to have implementation science expertise and resources for interview transcription. This study describes a novel rapid qualitative method to identify participant-driven social care recommendations in real time. METHODS: Caregivers of pediatric patients were enrolled onsite at two primary care clinics and one emergency department affiliated with a large urban pediatric healthcare system. A semi-structured interview guide was developed using the Health Equity Implementation Framework and Integrated Behavioral Model in partnership with multidisciplinary implementation stakeholders. Telephone interviews explored 60 caregivers' experiences with and perceptions of receiving social resources from healthcare. For traditional analysis, NVivo12 was used to code the first 10 verbatim transcripts to generate themes in an integrated inductive/deductive approach. In the rapid approach, a summary notes template designed to capture implementation-related data was completed immediately following the same 10 interviews. A secondary analyst used the templates to create participant-level summaries and identify implementation-related themes. Themes found in each method were quantified and mapped onto each other using an analytic matrix to compare the number and consistency of themes. RESULTS: Themes generated in both methods mapped consistently onto each other; 92.8% of themes found in traditional analysis were accounted for within our rapid method. The quantity of themes was similar between the two methods: the traditional approach generated 69 themes and 22 subthemes, while our rapid approach generated 72 themes and 21 subthemes. CONCLUSIONS: Our interview notes-based rapid qualitative method was successful in producing themes consistent with the traditional approach in both content and quantity. This approach is also pragmatic, as it does not require analysts to have deep implementation science expertise and saves transcription costs. By balancing rigor with time to actionable results, this rapid method provides a tool for implementation researchers to generate qualitative findings on an accelerated timeline to inform policy and practice. CLINICAL TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov, #NCT05251311, https://www. CLINICALTRIALS: gov/study/NCT05251311 , on September 30, 2021.

BACKGROUND/OBJECTIVES: The pediatric mental health crisis in the United States has reached unprecedented levels. Severe shortages in specialized health care professionals, particularly child and adolescent psychiatrists (CAPs), exacerbate the challenge of delivering timely and quality mental health care, especially in rural areas like Kansas. Innovative models such as Pediatric Mental Health Care Access (PMHCA) programs and School-Based Health Clinics (SBHCs) aim to integrate mental health expertise into primary care settings to address this gap. METHODS: This paper examines an integrated care model to support SBHCs developed by the Kansas PMHCA. The Interprofessional Child-Centered Integrated Care Model (ICX2) was implemented within an SBHC in Haysville, KS. ICX2 utilizes biweekly collaborative team meetings (CTMs) via zoom involving primary care, psychology, child psychiatry, social work, and school resource coordinators to discuss patient cases and enhance the primary care management of pediatric mental health. This descriptive study analyzes data from January 2023 to June 2023, focusing on patient demographics, case characteristics discussed during CTMs, and recommendations made by the interprofessional team. RESULTS: Findings illustrate the complex biopsychosocial needs of patients seen and define themes of case consultation and recommendations. CONCLUSIONS: Integrated care programs like ICX2 can be feasibly implemented through PMHCA programs and may be an efficient intervention to bridge resource gaps.

BACKGROUND: Care transitions represent vulnerable events for patients newly initiating medications for opioid use disorder (MOUD). Multidisciplinary primary care-based transition clinics may improve care linkage and retention in MOUD treatment. Additionally, these interventions may help primary care clinicians (PCPs) overcome barriers to adopting MOUD into practice. In this evaluation, we assessed the impact of a primary care-based transition clinic for patients newly initiating buprenorphine for opioid use disorder (OUD) in the emergency department. METHODS: We conducted a retrospective program evaluation within a single academic health system involving adults who newly initiated buprenorphine for OUD through an emergency department-based program and were referred to follow up in either a dedicated multidisciplinary primary care-based transition clinic (SPARC) vs referral to usual primary care (UPC). We performed descriptive analyses comparing patient demographics, referral volume, linkage to care, treatment retention, and markers of high-quality care between the 2 groups. A log-rank test was used to determine the difference in probabilities of retention between SPARC and UPC over 6 months. RESULTS: Over 12 months, the number of referrals to SPARC was greater than to UPC (N = 64 vs N = 26). About 58% of patients referred to SPARC attended an initial visit vs 38% referred to UPC. Treatment retention was consistently greater in SPARC than UPC (1 m: 90% vs 60%; 3 m: 76% vs 40%; 6 m: 60% vs 30%). Markers of care quality including naloxone provision (100% vs 80%) and infectious screening (81% vs 40%) were greater in SPARC clinic. SPARC was associated with a statistically significant increased probability of retention in treatment as compared to UPC (P < .01). CONCLUSIONS: In this observational evaluation, a primary care-based multidisciplinary transition clinic for patients initiating buprenorphine MOUD was associated with expanded access to longitudinal OUD treatment and superior linkage to care, retention in care, and quality of care compared to referral to usual primary care. Further research using a more rigorous research design is required to further evaluate these findings.

BACKGROUND: A three-phase implementation program was carried out to support Indigenous primary healthcare organisations in Australia to integrate e-mental health approaches into the day-to-day practice. The present study aimed to evaluate the process and the effectiveness of the program. METHODS: A concurrent triangulation design was employed to collect and compare quantitative and qualitative data from organisations that participated in the implementation program (case studies) to those that participated in training only (non-case studies). Quantitative methods, i.e., t-tests and descriptive statistics, were used to measure outcomes relating to the frequency of e-mental health usage and levels of organisational readiness. Qualitative data were analysed separately, using theoretical thematic analysis, to gain an in depth understanding of the implementation process. The findings were integrated and interpreted within the implementation science literature. RESULTS: The case studies evidenced greater use of e-mental health approaches than the non-case studies. They also demonstrated increased organisational readiness over the course of the implementation program. The program helped organisations to work and improve on essential aspects within the organisation so that they better supported e-mental health adoption. The key areas addressed were Information Technology resources and infrastructure, leadership and support, policy and protocols around e-mental health utilisation and its integration into practice. CONCLUSIONS: By addressing and improving essential aspects relating to e-mental health implementation, the program helped organisations to increase organisational readiness and enhance uptake of e-mental health approaches.

PURPOSE: The purpose of this clinical study was to evaluate the efficacy of a collaborative care model in the reduction of depression severity and the improvement of quality of life (QOL) of older adults. METHODS: Individual participant encounters were conducted approximately every 2 weeks over 4 months with nineteen participants. Average participant age was 73 years. A pre-experimental single pretest-posttest group was conducted in which the Patient Health Questionnaire 9 (PHQ-9) and Quality of Life Assessment (QOLA) scores respectively measured depression severity and QOL of participants. RESULTS: The average PHQ-9 score (0-27; higher indicates worse depression) decreased from 14 pre-intervention to 8.3 post-intervention (p < .001), while the average QOLA score (0-10; higher indicates better QOL) increased from 5.7 pre-intervention to 6.5 post-intervention (p = .342). CONCLUSION: The adapted collaborative care model provided an affordable, effective method of older adult depression management within the contexts of this clinical study.