Literature Collection

PURPOSE: To describe the development, implementation, and feasibility of a novel training program for community pharmacists transitioning to clinical ambulatory care positions. SUMMARY: A primary care-focused ambulatory care pharmacist training program was initiated in an integrated healthcare system in Utah in response to community pharmacy closures. The program aimed to transition community pharmacists into clinical ambulatory care positions utilizing a competency framework designed to cultivate skills in applying clinical knowledge, communication, managing clinic workflow, and professional development. Nine pharmacists in the program (trainees) were each paired with 1 to 2 pharmacists (mentors) with robust experience in ambulatory care practice. Trainees participated in independent study, didactic instruction, and hands-on experiences tailored to their roles as either embedded or telehealth pharmacist trainees. They worked toward meeting clinical skills and professional engagement objectives outlined in a competency framework, with the goal of progressing to independent practice within 6 to 12 months. While these objectives guided development, completion timelines were adapted in response to evolving roles and operational challenges. Embedded pharmacist trainees completed 70% of the clinical skills objectives after 6 months and 74% of the professional engagement objectives after 12 months. Telehealth pharmacist trainees completed 100% of the clinical skills objectives after 6 months and 56% of the professional engagement objectives after 12 months. Trainees reported increased confidence in most clinical skills areas but less motivation for professional engagement activities at 6 months. Mentors found the program design suitable but suggested a higher mentor-to-trainee ratio to manage workload. CONCLUSION: This program served as a novel, practice-based approach to train and transition community pharmacists into clinical ambulatory care positions. Its successful implementation demonstrates a feasible strategy for workforce redeployment, offering a model that may inform future training initiatives in evolving healthcare settings.

BACKGROUND: Although opioid agonist therapy is effective in treating opioid use disorders (OUD), retention in opioid agonist therapy is suboptimal, in part, due to quality of care issues. Therefore, we sought to describe the planning and implementation of a quality improvement initiative aimed at closing gaps in care for people living with OUD through changes to workflow and care processes in Vancouver, Canada. METHODS: The Best-practice in Oral Opioid agoniSt Therapy (BOOST) Collaborative followed the Institute for Healthcare Improvement's Breakthrough Series Collaborative methodology over 18-months. Teams participated in a series of activities and events to support implementing, measuring, and sharing best practices in OAT and OUD care. Teams were assigned monthly implementation scores to monitor their progress on meeting Collaborative aims and implementing changes. RESULTS: Seventeen health care teams from a range of health care practices caring for a total of 4301 patients with a documented diagnosis of OUD, or suspected OUD based on electronic medical record chart data participated in the Collaborative. Teams followed the Breakthrough Series Collaborative methodology closely and reported monthly on a series of standardized process and outcome indicators. The majority of (59%) teams showed some improvement throughout the Collaborative as indicated by implementation scores. CONCLUSIONS: Descriptive data from the evaluation of this initiative illustrates its success. It provides further evidence to support the implementation of quality improvement interventions to close gaps in OUD care processes and treatment outcomes for people living with OUD. This system-level approach has been spread across British Columbia and could be used by other jurisdictions facing similar overdose crises.

BACKGROUND: Single-session interventions offer a novel approach to improving access to evidence-based mental health services using a population-based framework for delivery. The current single-arm pilot study aimed to assess the feasibility, acceptability, and preliminary effectiveness of a single-session intervention in Mayo Clinic's primary care Integrated Behavioral Health program.. METHODS: Participants were recruited from Mayo Clinic's Integrated Behavioral Health program and participated in a therapist-delivered single-session therapy intervention in primary care. The intervention could be delivered by video or in-person and was based on acceptance and commitment therapy and solution-focused brief therapy principles. Descriptive statistics and 2-tailed paired sampled t-tests were used to examine outcomes. RESULTS: Less than 20% of the patients contacted expressed interest in the study; however, the majority who expressed interest and screened eligible completed the single-session therapy visit (N = 34). Acceptability was high, as indicated by study participants expressing generally high levels of satisfaction with the single visit. Participants experienced significant increases from pre- to post-intervention in readiness for change and in self-reported capacity to generate pathways toward goals. From pre-intervention to two-week follow-up, participants experienced significant reductions in depression and anxiety symptoms, significant increases in psychological flexibility and values progress, and significant decreases in values obstruction. CONCLUSIONS: Single-session interventions may be one helpful approach among a menu of stepped care options in primary care. Future work will benefit from ongoing exploration of the most appropriate processes for implementation of single-session interventions in primary care. TRIAL REGISTRATION: The study is registered at ClinicalTrials.gov (NCT06347822); Registration Date: 03/29/2024.

OBJECTIVES: To integrate a computerized adaptive test for depression into the electronic health record (EHR) and establish systems for administering assessments in-clinic and via a patient portal to improve depression care. MATERIALS AND METHODS: This article reports the adoption, implementation, and maintenance of a health information technology (IT) quality improvement (QI) project, Patient Outcomes Reporting for Timely Assessment of Life with Depression (PORTAL-Depression). The project was conducted in a hospital-based primary care clinic that serves a medically underserved metropolitan community. A 30-month (July 2017-March 2021) QI project was designed to create an EHR-embedded system to administer adaptive depression assessments in-clinic and via a patient portal. A multi-disciplinary team integrated 5 major health IT innovations into the EHR: (1) use of a computerized adaptive test for depression assessment, (2) 2-way secure communication between cloud-based software and the EHR, (3) improved accessibility of depression assessment results, (4) enhanced awareness and documentation of positive depression results, and (5) sending assessments via the portal. Throughout the 30-month observational period, we collected administrative, survey, and outcome data. RESULTS: Attending and resident physicians who participated in the project were trained in depression assessment workflows through presentations at clinic meetings, self-guided online materials, and individual support. Developing stakeholder relationships, using an evaluative and iterative process, and ongoing training were key implementation strategies. CONCLUSIONS: The PORTAL-Depression project was a complex and labor-intensive intervention. Despite quick adoption by the clinic, only certain aspects of the intervention were sustained in the long term due to financial and personnel constraints.

In the last 15 years, demand has surged among college students for mental health care and many campuses are struggling to keep up with the demand for services. Primary care services represent a pathway where individuals can receive mental health care without accessing specialty mental health services. There is evidence that integrating mental health services into primary care can reduce racial disparities in access to mental health care and provide greater access to mental health care for underserved persons. This paper describes the development and implementation of a fully integrated model of mental health care services into Xavier University's (XU) primary care clinic. In partnership with TriHealth, a local healthcare provider, and following the primary care behavioral care model, XU integrated supervised psychology doctoral students as behavior health consultants into a campus primary care clinic. Administrative, clinical care, and training processes together with preliminary findings and recommendations are shared.