Literature Collection

Background: Group-based models of Office-Based Opioid Treatment with buprenorphine-naloxone (B/N) are increasingly being implemented in clinical practice to increase access to care and provide additional therapeutic benefits. While previous studies reported these Group-Based Opioid Treatment (GBOT) models are feasible for providers and acceptable to patients, there has been no literature to help providers with the more practical aspects of how to create and maintain GBOT in different outpatient settings. Case series: We present 4 cases of GBOT implementation across a large academic health care system, highlighting various potential approaches for providers who seek to implement GBOT and demonstrate "success" based on feasibility and sustainability of these models. For each case, we describe the pros and cons and detail the personnel and resources involved, patient mix and group format, workflow logistics, monitoring and management, and sustainability components. Discussion: The implementation details illustrate that there is no one-size-fits-all approach, although feasibility is commonly supported by a team-based, patient-centered medical home. This approach includes the capacity for referral to higher levels of mental health and addiction support services and is bolstered by ongoing provider communication and shared resources across the health system. Future research identifying the core and malleable components to implementation, their evidence base, and how they might be influenced by site-specific resources, culture, and other contextual factors can help providers better understand how to implement a GBOT model in their unique clinical environment.

BACKGROUND: As populations age worldwide, primary health care systems face increasing challenges in addressing the complex health and social needs of older adults. Integrated care offers a promising approach to promote healthy ageing by providing coordinated, person-centred services across care settings. However, there is a lack of synthesised evidence on integrated care implementation in primary health care, which limits our understanding of its full potential. OBJECTIVE: To map how integrated care for older adults has been implemented in primary health care worldwide, identify the most scalable components, and highlight practice and policy implications for strengthening primary health care systems. METHODS: We conducted a scoping review to synthesise evidence on the implementation and outcomes of integrated care interventions for older adults in primary health care settings. We systematically searched PubMed, Embase, and CINAHL for studies published in the past ten years. Eligible studies included interventional designs targeting individuals aged ≥60 years and implemented integrated care as defined by the WHO. Data were extracted and analysed using narrative synthesis and frequency analysis. RESULTS: A total of 181 studies across 26 countries were included. Most interventions were community- or primary health care-based, multidisciplinary (91%), and involved cross-sectoral integration (47%). Core components included care coordination/personalised care planning (67%), physical activity (40%), health education (38%), and psychosocial support (29%). Overall, 88% of studies reported positive outcomes, most often at the patient level. However, implementation outcomes such as acceptability (21%), feasibility (19%), and fidelity (9%) were inconsistently assessed. Evidence was dominated by high-income settings, with limited representation from low- and middle-income countries. CONCLUSIONS: Integrated care in primary health care shows broad potential to improve outcomes for older adults, particularly when built around care coordination, team-based delivery, and person-centred planning. Scalable models are those that use existing primary health care resources, integrate community health workers, and employ low-cost digital tools. Yet critical gaps remain in implementation fidelity, sustainability, and equity, especially in resource-limited settings. Embedding integrated care within quality improvement cycles can accelerate adoption and adaptation, offering a pathway for primary health care systems worldwide to promote healthy ageing.

BACKGROUND: New models of care that integrate health and social care provision around the patient require a supportive infrastructure, including interorganizational arrangements and information systems. While public policies have been designed to facilitate visions of integrated care, these often neglect the implementation of effective and efficient delivery mechanisms. METHOD: This study examines a decade of attempts to move from fragmented health and care delivery to integrated care at scale in NHS England by developing and implementing a support infrastructure. We undertook a longitudinal qualitative investigation -encompassing interviews and documentary analysis- of the implementation of interorganizational and digital interoperability infrastructures intended to support integrated care policies. FINDINGS: Our findings underscore the long-term symbiotic relationship between institutional interorganizational frameworks and the construction of interoperability infrastructures, emphasizing how they mutually reinforce each other to support their ongoing evolution. Iterative, flexible, and experimental approaches to implementation provide opportunities to adapt to local realities while learning in the making. CONCLUSION: This study underlines the importance of adaptable, locally-informed implementation strategies in supporting the vision of integrated care, and the need to understand such development as a long-term, ongoing process of construction and learning.