Literature Collection

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.

Background: This proof-of-concept trial examined a 6-month Prevention Plus (PP) intervention implemented in a federally qualified health center on child standardized BMI (ZBMI), using a planned clinical effect threshold of -0.16 ZBMI. The relationship between food security status and PP delivered with caregiver goals (PP+) and without caregiver goals (PP-) on energy balance behaviors (i.e., fruits and vegetables, physical activity) and child ZBMI was explored. Methods: Seventy-three, underserved children, 4-10 years of age with a BMI ≥85th percentile, were randomized to one of two interventions, PP+ and PP-, both providing 2.5 hours of contact time, implemented in five clinics by behavioral health consultants (BHCs). Outcomes were child anthropometrics (included 9-month follow-up), implementation data collected from electronic health records, and caregiver and BHC evaluations. Results: Children were 57.5% female and 78.1% Hispanic, with 32.9% from food-insecure households and 58.9% from households with an annual income of less than $20,000. Child ZBMI significantly (p < 0.05) decreased at 6 and 9 months (-0.08 ± 0.24 and -0.12 ± 0.43), with only PP+ reaching the clinical threshold at 9 months (PP+: -0.20 ± 0.42 vs. PP-: -0.05 ± 0.42). Sixty-four percent of families attended ≥50% of the sessions, and BHCs delivered 78.5% ± 23.5% of components at attended sessions. Caregivers were satisfied with the intervention and BHCs found the intervention helpful/useful. No relationship with food insecurity status and outcomes was found. Conclusions: PP+ when delivered by a primary care provider to underserved families showed promise for producing a clinically meaningful effect. Families and providers felt the intervention was a viable treatment option.

CONTEXT: The proportion of US adolescents experiencing mental health or substance use disorders continues to rise. Pediatricians are expected to deliver evidence-based screening and counseling, but multiple barriers impede implementation. OBJECTIVE: This systematic review assessed the effectiveness of implementation strategies-activities to enhance implementation, service, and health outcomes-to support integration of screening and counseling for mental health and substance use disorders (MHSUD) into primary care for children and adolescents. DATA SOURCES: We searched multiple databases for literature published since 2010. STUDY SELECTION: Eligible studies compared any strategy to support implementation of a recommended intervention to prevent MHSUD among individuals aged 18 years or younger in primary care with another strategy or no strategy. DATA EXTRACTION: We extracted data on study designs, populations, settings, clinical interventions, barriers and facilitators to implementation, implementation interventions and comparators, and results. RESULTS: Eleven studies focused on implementing screening and counseling for depression, eating disorders, substance use disorders, and general behavioral health risk factors. Implementation approaches were multifaceted and consisted of incorporating behavioral health providers into primary care, facilitating learning collaboratives, providing support to clinicians, and using technology. These approaches generally resulted in increased screening, taking steps to address a positive screen, and initiation of treatment compared with using only minimal or no strategy. LIMITATIONS: Multifaceted and overlapping implementation approaches evaluated in few studies with limited evidence on patient outcomes constrained our ability to make inferences. CONCLUSIONS: The identified implementation approaches may improve some aspects of identifying and addressing MHSUD in primary care. The evidence, however, is limited.

BACKGROUND: Most mental health difficulties (MHD) emerge during adolescence and early adulthood, placing young people at an increased risk for co-occurring physical and sexual health challenges. Shared models of care (SMOC) to connect specialist mental health care with physical and/or sexual health have been developed to address these health needs among young people with MHD. We aimed to identify and characterise SMOC that integrate physical and/or sexual healthcare for young people with MHD, and to synthesise SMOC implementation determinants using the Consolidated Framework for Implementation Research (CFIR) for policy makers, commissioners and practitioners seeking to strengthen youth-integrated service delivery. METHODS: Five electronic databases and key grey literature sites were searched in October 2024. Studies were eligible for inclusion if they predominantly included young people (aged 10–25) with an MHD. SMOC had to address MHD as a primary concern or have parity with the physical and/or sexual health concern(s) being addressed. Key study details were extracted and were appraised using the mixed methods appraisal tool. Screening was conducted in duplicate, with extraction and appraisals conducted by one team member and verified by a second. Findings were thematically synthesised and mapped to CFIR domains to inform implementation planning in youth health systems. RESULTS: Search results identified 25 relevant SMOC to include in the review. Almost all models (n = 23/25) addressed shared care between mental and physical health, while nine addressed mental and sexual health and seven addressed mental, physical and sexual health needs. Reporting quality varied but most SMOC included referral pathways, assessment, treatment and external support components. Barriers frequently mapped to the inner and outer setting CFIR domains, with high staff turnover (n = 9) and societal stigma towards mental health (n = 7) common concerns. Enablers frequently mapped to the process and innovation constructs, including offering youth-specific care models (n = 7) and clear communication between services (n = 5). CONCLUSIONS: Despite evidence supporting the need for an integrated care approach, implementation remains limited by setting-specific barriers. Findings highlight the need for service planning and developing tailored, youth-specific models to ensure a holistic approach to care is available to young people experiencing MHD. REGISTRATION: Open Science Framework (osf.io/rj783). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-026-14178-x.

Syringe services programs are community-based prevention programs that provide evidence-based, lifesaving services for people who use illicit drugs, including access to syringes, naloxone, fentanyl test strips, infection screening, and linkage to treatment. Historically, syringe services programs did not exist within the Veterans Health Administration owing to many factors, including lack of clarity regarding legality for federal agency-purchased syringes. Three champions at Veterans Affairs facilities in Danville, IL, Orlando, FL, and San Francisco, CA, worked to clarify legal considerations, address barriers, and implement syringe services programs that are integrated in the health care systems. Since 2017, these 3 programs have engaged approximately 400 Veterans and distributed nearly 10,000 syringes, 2500 fentanyl test strips, 50 wound care kits, and 45 safer sex kits. These programs, both led by and in collaboration with clinical pharmacist practitioners, paved the way for nationwide implementation within the Veterans Health Administration. This commentary describes successes, challenges, and proposed next steps to increase Veteran access to syringe services programs, written from the perspective of 3 facility-based champions.