Literature Collection

BACKGROUND: More and more people suffer from concomitant chronic physical diseases and common mental disorders, calling for integrated self-management support in primary care. However, self-management support of chronic physical diseases and common mental disorders is not clearly operationalized by guidelines and is still conducted in silos by primary care nurses, especially in favour of chronic diseases. This study aims to better understand primary care nurses' experience of integrated self-management support for people with physical chronic diseases and common mental disorders. METHODS: An interpretive descriptive qualitative approach was conducted with 23 primary care nurses from family medicine groups in Quebec (Canada). They were selected through purposive and snowball sampling methods to participate in an individual interview. Data were analysed using an iterative inductive and deductive analysis (Rainbow Model of Integrated Care and the Practical Reviews in Self-Management Support (PRISMS) taxonomy). RESULTS: Nurses' experience of integrated self-management support for people with CD and CMD was structured around: (1) elements of the approach; (2) clinical integration through prevention and health promotion; and (3) operationalization of integrated self-management support. Several elements deemed essential to integrated self-management support were identified. Nurses offered integrated self-management support through prevention of risk factors and promotion of a healthy lifestyle for physical chronic diseases and common mental disorders. Nurses' self-management support activities included education, action plans, monitoring, and many practical, psychological, and social support strategies. A model of integrated self-management support for primary care nursing is proposed to better understand its clinical integration. CONCLUSION: This study presents clinical integration of self-management support and activities for people with physical chronic diseases and common mental disorders in primary care settings. Understanding integrated self-management support will help implement future interventions.

BACKGROUND: Individuals with fetal alcohol spectrum disorder (FASD) experience complex needs that often necessitate support from multiple systems. There is growing evidence that people with FASD may benefit from integrated service delivery (ISD), but little is known about ISD elements and processes for this population. METHOD: Using a multi-method approach involving a literature review, analysis of programme data, and staff interviews, we examined how ISD is enacted at a rural Canadian FASD centre, and identified facilitators, barriers, and potential impacts of ISD at the centre. RESULTS: We describe key elements of integrated FASD programming and identify important contextual factors and themes related to ISD barriers, facilitators, and impacts: (1) connection, (2) freedom and autonomy, (3) client-centred care, (4) learning and growth, (5) and reframing expectations. CONCLUSIONS: This study may help to inform a roadmap for enhancing FASD service delivery and guiding FASD research and policy in Canada and beyond.

The COVID-19 pandemic has directly impacted integrated substance use and prenatal care delivery in the United States and has driven a rapid transformation from in-person prenatal care to a hybrid telemedicine care model. Additionally, changes in regulations for take home dosing for methadone treatment for opioid use disorder due to COVID-19 have impacted pregnant and postpartum women. We review the literature on prenatal care models and discuss our experience with integrated substance use and prenatal care delivery during COVID-19 at New England's largest safety net hospital and national leader in substance use care. In our patient-centered medical home for pregnant and postpartum patients with substance use disorder, patients' early responses to these changes have been overwhelmingly positive. Should clinicians continue to use these models, thoughtful planning and further research will be necessary to ensure equitable access to the benefits of telemedicine and take home dosing for all pregnant and postpartum patients with substance use disorder.

Mental Health: [Formula: see text] GIM/FP/GP: [Formula: see text] Public Health: [Formula: see text].

BACKGROUND: Integrated treatment programs for pregnant and parenting people seek to provide wrap-around services and supports to overcome the barriers and constraints associated with the gendered contexts of substance use and help-seeking. We investigated retention in outpatient treatment among pregnant people and mothers, comparing integrated treatment programs with standard treatment programs in Ontario, Canada. METHODS: We conducted a population-based retrospective cohort study of females (n = 4440) admitted to 11 integrated treatment programs (cases) and 10 standard treatment programs (controls) between 2008 and 2015. Data sources included linked administrative health data merged with primary data on program characteristics. Exposure was program type and outcomes included days in treatment and number of visits. Multi-level negative binomial regression estimated the effects of program type on retention measures, controlling for individual- and program-level covariates. RESULTS: Relative to standard treatment, integrated treatment programs offered more services in-house or through partnerships, with specific advantages around the availability of prenatal or primary care and child-minding. Controlling for individual- and program-level covariates, individuals in integrated treatment programs spent more days in treatment (adjusted incidence rate ratio [aIRR] = 5.41, 95 % CI 4.10-7.13) and had more visits (aIRR = 5.18, 95 % CI 4.305-6.23) than did controls in standard treatment programs. CONCLUSIONS: This study contributes to a growing body of evidence on the implementation and effectiveness of wrap-around comprehensive service models, or integrated treatment programs, designed for pregnant and parenting people who use substances. Integrated treatment models constitute a promising approach to supporting families affected by substance use.