Literature Collection

BACKGROUND AND AIMS: For achieving an effective integrated primary health care, communication between healthcare providers is a key element. This study aimed to identify general practitioners' reported barriers to communication within referral systems and propose actionable strategies for improvement. METHODS: Guided by PRISMA 2020 guidelines, 22 qualitative studies from PubMed, Web of Science, Scopus, and ProQuest were analyzed using inductive thematic synthesis. Quality assessment followed Standards for Reporting Qualitative Research (SRQR) criteria. RESULTS: Four central themes emerged: structural barriers (subthemes: inefficient health system, shortages in the number of specialists and heavy workload), regulatory and procedural barriers (subthemes: lack of comprehensive communication protocols, unclear delineation of roles and responsibilities, inadequate economic incentives, lack of continuity between providers, lack of interest in specialists, time consuming communication process), technological barriers (subthemes: ineffective methods for communication, challenges in using electronic medical records), and personal and interpersonal barriers (subthemes: having different approaches to healthcare, inappropriate specialists' perceptions of general practitioners' roles, lack of professional trust and respect, social anxiety disorder in the workplace). CONCLUSION: Health policymakers must prioritize structural and procedural reforms, including standardized communication frameworks, interoperable digital infrastructure, and interprofessional training programs. Addressing these gaps can enhance referral system efficiency, reduce diagnostic delays, and strengthen health system resilience, particularly in low-resource settings. TRIAL REGISTRATION: The protocol of the review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on December 20, 2023 (Supporting Information S1).

BACKGROUND: Suicide is a major public health issue. Up to a third of patients will visit their General Practitioner (GP) in the month leading up to a suicide attempt, thus highlighting the key role GPs play in suicide prevention. AIM: This systematic scoping review aimed to explore the qualitative research on GPs' perspectives of suicide prevention in primary care. DESIGN & SETTING: A systematic scoping review of qualitative studies relating to the research question. METHOD: This review is reported in accordance with PRISMA-ScR guidance. Articles at full-text review were assessed for inclusion in the study against eligibility criteria (english language, qualitative research, focus on GPs perspectives of suicide prevention). Data were extracted using a standardised form and a thematic synthesis approach was used to describe the themes elicited from the studies. RESULTS: 2210 abstracts were screened. Twelve studies from seven countries were included at full text review. Four main themes were elicited: challenges to managing suicidal behaviour, fragmented relationships with mental health services, personal attitudes of GPs regarding suicidal behaviour and identified needs to improve suicide prevention in primary care. CONCLUSION: Understanding GPs' perspectives can lead to improved training, resources, and support for primary care professionals, who are frontline providers of mental healthcare. This scoping review suggested there is a lack of evidence around what approaches GPs find effective in managing suicidality and how relationships can be strengthened with mental health services to deliver person-centred integrated care for those identified at risk of suicide.

Methadone for Opioid Use Disorder (OUD) treatment is only dispensed at Opioid Treatment Programs (OTPs). Little is known about the geographic variation in OTP availability and community characteristics associated with the availability across smaller geographic communities in the U.S. To (1) describe geographic distribution of OTPs and (2) examine OTP availability by community characteristics in the contiguous U.S. at Zip Code Area Tabulation (ZCTA) level. Logistic regression was used to examine community characteristics associated with OTP availability (N = 30,367). Chi-square and t-tests were conducted to examine statistically significant differences in OTP availability. Maps and descriptive statistics were used to examine geographic variation in OTP availability. Only 5% (1,417) of ZCTAs had at least one OTP for a total of 1,682 OTPs. Rural ZCTAs had 50% lower odds of having an OTP compared to urban ZCTAs [AOR 0.5; (95% CI: 0.41-0.60)]. ZCTAs in the lowest income quartile had higher odds of having an OTP compared to ZCTAs in the highest income quartile [AOR 3.4; (95% CI: 2.71-4.18)]. Further, ZCTAs with OTPs had a higher proportion of minority residents [Black: 17.5% vs. 7.2%; Hispanic: 19.2% vs. 9%] and a lower proportion of White residents [55.1% vs. 78.2%]. Nationally, OTPs are extremely scarce with notable regional and urban-rural disparities. Potential solutions to address these disparities are discussed.

Methadone for Opioid Use Disorder (OUD) treatment is only dispensed at Opioid Treatment Programs (OTPs). Little is known about the geographic variation in OTP availability and community characteristics associated with the availability across smaller geographic communities in the U.S. To (1) describe geographic distribution of OTPs and (2) examine OTP availability by community characteristics in the contiguous U.S. at Zip Code Area Tabulation (ZCTA) level. Logistic regression was used to examine community characteristics associated with OTP availability (N = 30,367). Chi-square and t-tests were conducted to examine statistically significant differences in OTP availability. Maps and descriptive statistics were used to examine geographic variation in OTP availability. Only 5% (1,417) of ZCTAs had at least one OTP for a total of 1,682 OTPs. Rural ZCTAs had 50% lower odds of having an OTP compared to urban ZCTAs [AOR 0.5; (95% CI: 0.41-0.60)]. ZCTAs in the lowest income quartile had higher odds of having an OTP compared to ZCTAs in the highest income quartile [AOR 3.4; (95% CI: 2.71-4.18)]. Further, ZCTAs with OTPs had a higher proportion of minority residents [Black: 17.5% vs. 7.2%; Hispanic: 19.2% vs. 9%] and a lower proportion of White residents [55.1% vs. 78.2%]. Nationally, OTPs are extremely scarce with notable regional and urban-rural disparities. Potential solutions to address these disparities are discussed.