Literature Collection

INTRODUCTION: Person centred care planning and models of care coordination across levels of care reduce fragmentation and unnecessary resource use. Our objectives were to assess the impact of implementing a coordinated care model between intermediate care and primary care, as determined by the identification of complex patients, and recording their individualized care plans in the shared medical record and to assess its effectiveness in relation to the use of health resources. METHODS: A pre-post quasi-experimental study of 160 complex patients with dementia who were discharged from intermediate care between April 2022 and July 2024. RESULTS: A 31.4% (from 63 to 106 patients) increase in the identification of complex patients with dementia and a 23.6% (from 19 to 44 patients) increase in the development of care plans were found at 3 months of discharge. Of the patients who had visited emergency department in the six months preceding hospitalisation, 54.4% (n = 31) did not visit it in the six months post-discharge (p = 0.026). CONCLUSION: Our coordinated care model may have contributed to improved identification of patients with dementia and complex conditions, the development of individualized care plans, and reduced emergency department use.

Most youth do not experience a coordinated and planned transition out of child and youth mental health services, which often results in discontinuity in mental health care. This gap in care has led to the development and uptake of novel interventions, such as the transition navigation model, to facilitate mental health care transitions. The transition navigation model is a research-informed intervention that aims to assess and improve youth's transition readiness, identify their transition needs and goals, and support the transfer of care to adult or community mental health services. To evaluate the ongoing implementation of this model, we conducted a pre-post mixed-methods study involving youth participants accessing transition navigation services at two hospitals. Participants (n = 43) completed self-report measures on transition readiness, daily functioning, and mental health service use at baseline and 6-month follow-up. Twenty participants also completed qualitative interviews focused on understanding their experiences and satisfaction with the navigation service. Results indicate a significant increase in participants' mean transition readiness score and a decrease in the number of emergency department visits from baseline to the 6-month follow-up. However, there were no significant changes in mean functioning scores or self-reported mental health symptoms. The quantitative and qualitative findings converged, indicating overall high satisfaction with the navigation service, with the primary gap in the service being the lack of communication maintained with youth while in the program.

INTRODUCTION: Reducing substance-related morbidity requires an educated and well-supported workforce. The New England Office Based Addiction Treatment Extension for Community Healthcare Outcomes (NE OBAT ECHO) began in 2019 to support community-based addiction care teams through virtual mentoring and case-based learning. We sought to characterize the program's impact on the knowledge and attitudes of NE OBAT ECHO participants. METHODS: We conducted an 18-month prospective evaluation of the NE OBAT ECHO. Participants registered for 1 of 2 successive ECHO clinics. Each 5-month clinic included ten 1.5-hour sessions involving brief didactic lectures and de-identified patient case presentations. Participants completed surveys at Month-0, -6, -12, and -18 to assess attitudes about working with patients who use drugs and evidence based practices (EBPs), stigma toward people who use drugs, and addiction treatment knowledge. We compared outcomes using 2 approaches: (i) between-groups, which involved comparing the first intervention group to the delayed intervention (comparison) group, and (ii) within-groups, which involved comparing outcomes at different time points for all participants. In the within-group approach, each participant acted as their own control. RESULTS: Seventy-six health professionals participated in the NE OBAT ECHO, representing various roles in addiction care teams. Approximately half (47% [36/76]) practiced primary care, internal, or family medicine. The first intervention group reported improved job satisfaction and openness toward EBPs compared to the delayed intervention group. Within-group analyses revealed that ECHO participation was associated with increased positive perceptions of role adequacy, support, legitimacy, and satisfaction 6 months following program completion. No changes were identified in willingness to adopt EBPs or treatment knowledge. Stigma toward people who use drugs was persistent in both groups across time points. CONCLUSIONS: NE OBAT ECHO may have improved participants' confidence and satisfaction providing addiction care. ECHO is likely an effective educational tool for expanding the capacity of the addiction workforce.