Literature Collection

ObjectivesHorizontal integration of health and social care in England is frequently supported by multi-disciplinary (MDT) case management focused on high-risk older people with multiple chronic conditions living in the community. This paper analyses MDT working in two of the 25 areas participating in the Integrated Care and Support Pioneer Programme in England. The analysis aims to understand the experience of frontline staff in such MDTs of working with professionals and staff from multiple sectors, and their perceptions of their roles and the benefits of integrated working.MethodsWe conducted semi-structured interviews with a purposive sample of 54 frontline staff from a range of professional backgrounds working in 11 community-based MDTs in two Integrated Care and Support Pioneers. A largely inductively developed coding frame was used to thematically code and guide analysis of verbatim interview transcripts from audio recordings.FindingsStaff conceptualised the team as a cohesive yet 'porous' entity, able to evolve a shared sense of purpose to deliver holistic care that helped to level traditional professional hierarchies, enable collective problem-solving and share responsibility for patient care. MDT working was seen as benefiting staff and patients. Despite strong similarities between the MDTs in members' understandings of the role and purpose of a MDT, each MDT was adapted to its context and the needs of the population served. The process of working through inter-professional tensions seemed to strengthen relationships within the team and enhance its ability to work effectively in the local health and care system. However, without performance or outcome measures, these perceptions were driven by 'soft' intelligence alone.ConclusionsFrontline staff accounts of MDT working demonstrate their strong commitment to this way of working, as a mechanism enabling them to deliver more holistic care with perceived benefits to patients.

Background: While primary care clinicians are being trained to use buprenorphine for the treatment of Opioid Use Disorder (OUD) in order to increase access to addiction treatment, it is not known what impact such training and subsequent experience treating patients with OUD has on full agonist opioid prescribing. Methods: This retrospective cohort study compares the full agonist opioid prescribing patterns of Drug Addiction Treatment Act (DATA)-waivered ("X-waivered") primary care clinicians to non-trained, non-waivered clinicians in a rural health network. X-waivered clinicians also received Project ECHO training and telementoring support for one year. Using prescriber data generated by an electronic medical record system, opioid prescribing and morphine milligram equivalents (MME) per day per patient were calculated. A between-group analysis was used to compare the study groups six months pre-versus post-training. Results: Although the mean number of full agonist opioid prescriptions per clinician and per 100 patient encounters decreased among all clinicians, there was no change in full agonist opioid prescribing MME. As expected, buprenorphine prescribing by X-waivered, trained clinicians increased significantly post-training. Conclusions: X-waivers plus Project ECHO support for the treatment of OUD using buprenorphine had no effect on full agonist opioid prescribing by primary care clinicians.