Literature Collection

Objective: To identify how Family Integrated Care (FICare) affected maternal stress and anxiety. Study Design: This secondary analysis of the FICare cluster randomised controlled trial included infants born between 1 April 2013 and 31 August 2015 at ≤33 weeks' gestation. Mothers completed the PSS:NICU and STAI questionnaires at enrolment and study day 21. Results: 1383 mothers completed the surveys at one or both time-points. The mean PSS:NICU and STAI scores at day 21 were significantly lower in the FICare mothers than controls (PSS:NICU mean [standard deviation] FICare 2.32 [0.75], control 2.48 [0.78], p = 0.0005; STAI FICare 70.8 [20.0], control 74.2 [19.6], p = 0.0004). The sights and sounds, looks and behaviour, and parental role PSS:NICU subscales and the state and trait STAI subscales were all significantly different between FIC are and controls at day 21. The magnitude of change in all stress and anxiety subscales was greater in the FICare group than controls. These differences remained significant after adjustment for confounders with the greatest change in the parental role (least-squares mean [95% confidence interval] FICare -0.65 [-0.72, 0.57], control -0.31 [-0.38, -0.24], p < 0.0001) and state anxiety subscales. Conclusion: FICare is effective at reducing NICU-related maternal stress and anxiety.

BACKGROUND: Capitation payments account for approximately half of core funding for General Practitioner (GP) practices in England, allocated via the Global Sum Allocation (‘Carr-Hill’) formula. The formula has not been updated since 2004 and lacks adjustments for clinical diagnoses, patient communication difficulties, and deprivation which are factors known to influence workload and health outcomes. In July 2021, Leicester, Leicestershire, and Rutland (LLR) Integrated Care Board introduced the Health Equity Payment (HEP), a top-up funding scheme based on a locally developed formula incorporating these additional factors. METHOD: We conducted a retrospective observational study using national public data to evaluate the impact of HEP between July 2021 and April 2023. Practices receiving HEP were matched to similar practices outside LLR using Genetic Matching on demographics, disease prevalence, and baseline outcomes. Seven outcomes were assessed: three patient experience measures from the GP Patient Survey, three staffing metrics (GP, nurse, and administrative full-time equivalents per 1000 weighted patients), and Quality and Outcomes Framework (QOF) achievement. Causal effects were estimated using doubly robust regression models with g-computation to estimate the average treatment effect. RESULTS: Sixty-two LLR practices received HEP and were matched to 62 control practices. Practices receiving HEP achieved a 3.2% point higher QOF score (95% CI: 0.5 to 5.9; p = 0.02) compared to controls. No statistically significant differences were found in patient experience or staffing outcomes. Sensitivity analyses confirmed robustness to alternative time periods and outcome specifications but revealed sensitivity to missing staffing data from atypical practices. DISCUSSION: This study provides the first causal evaluation of a capitation funding model incorporating clinical and sociodemographic factors in England. The modest improvement in QOF achievement suggests that targeted funding could be linked to enhanced care quality. The absence of effects on staffing and patient experience may reflect data limitations, short follow-up, or heterogeneity in how funds were used. These findings provide the the first evidence that locally tailored funding models could address inequalities in primary care provision and inform ongoing national reviews of the general practice capitation funding. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-025-03136-x.

There has been a persistent underutilization of mental health (MH) services among Asian Americans. Many researchers have attempted to explore possible etiologies and to find more effective solutions for the considerable ethnic disparities in MH. Several studies have found that integrated psychiatry and community health primary care increases treatment engagement and access to specialty MH services for low-income Asian Americans. As a result, integrated care models may serve as a crucial preventative model for proper MH care within this population. By evaluating the data from a primary care clinic, Northeast Medical Services (NEMS), which utilizes the integrated care model to serve a predominantly Asian American population, we hope to determine the impact interprofessional collaboration between primary care physicians and psychiatrists has on patients' MH outcomes. Consequently, this helps inform our understanding of help-seeking pathways that could serve Asian American immigrants in the United States.

OBJECTIVES: This study aims to compare primary care providers and medical assistants in degrees of comfort, confidence, and consistency when addressing behavioral health concerns with patients before and after the implementation of a model of integrated behavioral health in primary care (IBHPC), and evaluate whether these perceptions differ based on increased access to behavioral health clinicians. METHODS: This longitudinal study was conducted at 2 primary care clinics in Northern California while implementing an IBHPC model. The Integrated Behavioral Health Staff Perceptions Survey was administered to assess the comfort, confidence, and consistency of behavioral health practices. Confidential online surveys were distributed to primary care faculty and staff members before and post-implementation. Responses from providers and medical assistants were compared between pre- and post-implementation with linear regression analyses. The relationships between accessibility to behavioral health clinicians and a change in comfort, confidence, and consistency of behavioral health practices were explored using a linear mixed-effects model. RESULTS: A total of 35 providers and medical assistants completed the survey both before and post-implementation of IBHPC. Over time, there were increasingly positive perceptions about the consistency of behavioral health screening (P = .03) and overall confidence in addressing behavioral health concerns (P = .005). Comfort in addressing behavioral health concerns did not significantly change for either providers or staff over time. Medical assistants were initially more confident and comfortable addressing behavioral health concerns than providers, but providers' attitudes increased post-IBHPC implementation. Improved access to behavioral health clinicians was associated with greater consistency of screening and referral to specialty mental health care (P < .001). CONCLUSION: The present study is the first to explore differences in provider and medical assistant perceptions during the course of an IBHPC implementation. Findings underscore the importance of integrating medical assistants, along with providers, into all phases of the implementation process.

AIMS AND METHOD: DIALOG is a patient-reported outcome and experience measure. We analysed anonymised DIALOG scores routinely collected from East London NHS Foundation Trust. We aimed to (a) examine changes in DIALOG scores through the patient journey ('assessment', 'review' and 'discharge'); and (b) assess the impact of community mental health (CMH) transformation by comparing pre- and post-DIALOG scores. We analysed 11 198 DIALOG scores from 5007 patients in 2018-2019 and 2021-2022. RESULTS: DIALOG scores improved across treatment stages in both years. There was no clear difference pre- and post-CMH transformation, although in 2021-2022 there were lower satisfaction scores at referral. CLINICAL IMPLICATIONS: DIALOG showed sensitivity to change, supporting the utility of this scale in the evaluation of mental health services. The impact of CMH transformation was difficult to assess, due to potential confounders such as the COVID-19 pandemic. Routinely collected DIALOG data can help evaluate patient outcomes over time and inform service improvements.