Literature Collection

BACKGROUND: The treatment gap for mental and behavioral health (MBH) in the United States (US) remains a major public health concern. Given the growing need for a robust MBH workforce, particularly for underserved populations, calls for integrated MBH in primary care have been mounting. Family medicine providers, who know and can treat all members of a family within the same setting, are uniquely positioned to manage MBH conditions. OBJECTIVES: With HRSA funding, the University of Utah Family Medicine Residency (UUFMR) seeks to address gaps in mental health services by enhancing or developing MBH training and partnerships. This protocol describes the project's evaluation. The evaluation aims to identify areas to improve training content, describe training capacity, and assess intermediate outcomes of improved trainings. METHODS: The evaluation consists of three components: analyzing current curriculum and best practices, developing or enhancing trainings with partners, and assessing residents' and graduates' confidence in providing MBH care. RESULTS: The results from this protocol fill gaps in the current literature regarding evaluation methods for provider- and organizational-level outcomes of increased quality and capacity of residency training in MBH. Further, the results provide practical guidance for other residencies seeking to integrate MBH training into their curriculum. CONCLUSION: Considering the resources committed to the ongoing enhancement of resident education, it is crucial to evaluate the implementation and outcomes of improvements to ensure that limited resources are well-utilized. Assessing the training capacity developed through collaboration supports progress toward creating a high-quality, accessible, and integrated mental and behavioral healthcare system in primary care.

BACKGROUND: Methadone and buprenorphine are the most prevalent types of opioid maintenance programs in Andalusia. The main objective is comparing the functional status of patients with pharmacological opioid maintenance treatments according to different socio-demographic characteristic, health and disabilities domains and sexual difficulties. METHODS: A total of 593 patients from the Andalusia community, 329 were undergoing methadone treatment and 264 were undergoing buprenorphine treatment. The patients were interviewed by socio-demographic and opioid-related variables, assessed by functioning, disability and health domains (WHODAS 2.0.) and for sexual problems (PRSexDQ-SALSEX). RESULTS: We found significant differences in the socio-demographic and the opioid-related variables as the onset of opioid use, being on previous maintenance programs, opioid intravenous use, the length of previous maintenance programs, polydrug use and elevated seroprevalence rates (HCV and HIV) between the methadone group and the buprenorphine group. Regarding health and disability domains there were differences in the Understanding and communication domain, Getting around domain, Participation in society domain and in the WHODAS 2.0. simple and complex score, favoring buprenorphine-treated patients. The methadone group referred elevated sexual impairments compared with the buprenorphine group. Opioid-related variables as seroprevalence rates, other previous lifetime maintenance program, the daily opioid dosage and the daily alcohol use are the most discriminative variables between both groups. Participation in society variables and sexual problems were the most important clinical variables in distinguishing the methadone group from the buprenorphine group regarding their functional status. CONCLUSIONS: The methadone group showed higher prevalence in opioid dependence-related variables, elevated disabilities in participation in society activities and sexual problems compared with the buprenorphine group. This study shows the importance of carry out a functional evaluation in the healthcare follow-up, especially in those areas related with social activity and with sexual problems.