Literature Collection

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.

OBJECTIVE: In this naturalistic study, the authors examined clinical outcomes among patients treated for new episodes of depression in an integrated multisite outpatient behavioral health care model. Psychotherapy, medication management (MM), and transcranial magnetic stimulation (TMS) were provided at each clinic location. METHODS: Utilization rates, treatment adherence, and outcomes were measured with the Patient Health Questionnaire and Generalized Anxiety Disorder scales and evaluated over 6 months for 2,160 patients (mean age=37.4 years, 63% female) treated between January 2022 and January 2024. Chi-square, Fisher's exact, and Kruskal-Wallis tests as well as analysis of variance were used for descriptive statistics. Kaplan-Meier, mixed modeling for repeated measures, and multivariable Cox proportional hazards regression analyses were used to evaluate outcomes, temporal trends, and associations with treatment modalities and adjusted for potential confounders. RESULTS: Most patients received MM+psychotherapy (44%), followed by MM only (24%), psychotherapy only (13%), TMS+MM+psychotherapy (10%), TMS+MM (4%), TMS+psychotherapy (3%), and TMS only (2%). Depression severity was associated with the number of treatments, and treatment utilization and adherence levels were high. Clinical improvement and response were observed among 76% and 58% of patients, respectively. TMS and a higher number of treatment modalities were associated with greater clinical improvement. CONCLUSIONS: The integrated behavioral health care service delivery model studied was associated with high rates of treatment utilization and adherence and meaningful clinical outcomes among adult patients with depression. Although only limited causal inferences can be made, this evaluation provides support for a service model of colocated evidence-based treatments to optimize engagement in care, clinician collaboration, and clinical outcomes.