Literature Collection

High-income countries face the challenge of providing effective and efficient care to the relatively small proportion of their populations with high health and social care needs. Recent reports suggest that integrated health and social care programs target specific high-needs population segments, coordinate health and social care services to meet their clients' needs, and engage clients and their caregivers. We identified thirty health and social care programs in eleven high-income countries that delivered care in new ways. We used a structured survey to characterize the strategies and activities used by these programs to identify and recruit clients, coordinate care, and engage clients and caregivers. We found that there were some common features in the implementation of these innovations across the eleven countries and some variation related to local context or the clients served by these programs. Researchers could use this structured approach to better characterize the core components of innovative integrated care programs. Policy makers could use this approach to provide a common language for international policy exchange, and this structured characterization of successful programs could play an important role in spreading them and scaling them up.

The fragmented nature of Australian health and social care systems present a barrier to integrated care. Culturally and linguistically diverse (CALD) communities are recognised as a priority population with unmet health and social needs. This study describes policy supports for programs that promote health and social care integration with a CALD focus, including governance and partnerships; workforce and staffing; funding and payment; and data sharing and use. The research question was 'what innovative policy supports to integrate health and social programs?'. Qualitative interviews of participants involved in the implementation of health and social care programs in the Sydney using the Innovative Policy Supports For Integrated Health And Social Care Programs Framework, were conducted. Twenty-seven participants from 24 health and social programs based in Sydney participated in the study. Six programs serviced CALD communities only. Ten had majority of CALD clients, with the remaining having a mixture of clients. Ten programs had a formal coordinator role. Most programs did not report new approaches to data sharing. Two out of the 6 CALD targeted programs reported data-sharing via teleconference in the context of emergency. These were 2 health programs addressing COVID-19 disparities and the humanitarian needs of refugees, respectively. Only 2 reported a special funding to assist vulnerable families and common emergency department presenters, respectively. This study demonstrated the lack of integration of services in health and social care. Policy development and implementation should consider bringing stakeholders together (informed by CALD groups) to advance the generation of technology for adopting universal standards and the integration of funding to better support health and social care for CALD communities in multicultural Australia.

OBJECTIVE: To educate health care professionals and nurses on buprenorphine initiations in pregnancy, establish a mutual care agreement to promote therapeutic partnership, and standardize buprenorphine initiation using the Epic electronic health record (EHR) order set. PROJECT SUMMARY: This project provides resources that can be adapted and implemented at other institutions to perform inpatient buprenorphine initiations for pregnant patients with opioid use disorder (OUD). The toolkit includes educational PowerPoint presentations, a mutual care agreement template, and a comprehensive order set. This project begins by addressing the gap in health care professional knowledge about medications for opioid use disorder (MOUD) in pregnancy. We supply educational resources in PowerPoint format. The presentations cover the role of buprenorphine in pregnancy, micro-dose initiation pharmacology, and the use of ancillary supportive medications to manage withdrawal symptoms. Clear expectations and goals help facilitate smooth integration of buprenorphine initiation into inpatient care. The toolkit includes a templated "Mutual Care Agreement" for patients and health care professionals to sign on admission. Lastly, this toolkit addresses the technical barrier of prescribing by providing an order set. The Epic EHR order set, which can be replicated or adapted for other systems, includes dosing and timing for buprenorphine micro-dosing initiation, supportive medications, and comprehensive care considerations. These considerations include treatments for co-occurring substance use, consultations with social workers and psychiatrists, infectious disease screening, and vaccinations. OUTCOME: Disseminating this program will improve pregnant patients' access to MOUD and empower clinicians to provide for patients with OUD. RELEVANCE TO WOMENS HEALTH AND PHYSICIANS IN PRACTICE: Due to the opioid epidemic, pregnancy-related overdose deaths have risen significantly and are becoming a leading cause of maternal mortality. Medications for opioid use disorder decrease mortality. Despite the American College of Obstetricians and Gynecologists' recommendation to treat OUD with MOUD during pregnancy, many health care professionals lack the education and tools to initiate MOUD for pregnant patients with active substance use.

INTRODUCTION: Burnout affects the primary care workforce and their educators. Health Education England (HEE) offered resources to Training Hubs to support their primary care educators, through identifying a burnout champion and offering appropriate educational support. This study evaluates these initiatives. METHODS: Data about the educational support was collected through observation of targeted training events and an Integrated Care System (ICS) educational day. The experience of burnout and the support options for educators was explored through a focus group and semi-structured interviews with key stakeholders. RESULTS: Primary care educators identified the following factors as causing or exacerbating their burnout: excessive workload, insufficient time, isolation, lack of debrief, generational differences and the COVID-19 epidemic. Multiprofessional educators expressed concern about a lack of support and protected time in their working day to attend training in contrast to their perception of the situation for GP educators. Identification of and terminology around multiprofessional educators further exacerbates this disparity. Individuals and their managers had difficulty identifying burnout. Practice managers were seen as central to preventing burnout. RECOMMENDATIONS AND CONCLUSIONS: Recognising, identifying and supporting the range of educators in primary care is key to offering appropriate help to prevent and manage burnout. Peer networks and multiprofessional faculty groups were considered supportive to all the professionals. Practice managers, training hubs and educational approval processes have a role to play in supporting primary care educators in the constantly changing environment.

The year 2021 was the most deadly year for overdose deaths in the USA and Canada. The stress and social isolation stemming from the COVID-19 pandemic coupled with a flood of fentanyl into local drug markets created conditions in which people who use drugs were more susceptible to accidental overdose. Within territorial, state, and local policy communities, there have been longstanding efforts to reduce morbidity and mortality within this population; however, the current overdose crisis clearly indicates an urgent need for additional, easily accessible, and innovative services. Street-based drug testing programs allow individuals to learn the composition of their substances prior to use, averting unintended overdoses while also creating low threshold opportunities for individuals to connect to other harm reduction services, including substance use treatment programs. We sought to capture perspectives from service providers to document best practices around fielding community-based drug testing programs, including optimizing their position within a constellation of other harm reduction services to best serve local communities. We conducted 11 in-depth interviews from June to November 2022 via Zoom with harm reduction service providers to explore barriers and facilitators around the implementation of drug checking programs, the potential for integration with other health promotion services, and best practices for sustaining these programs, taking the local community and policy landscape into account. Interviews lasted 45-60 min and were recorded and transcribed. Thematic analysis was used to reduce the data, and transcripts were discussed by a team of trained analysts. Several key themes emerged from our interviews: (1) the instability of drug markets amid an inconsistent and dangerous drug supply; (2) implementing drug checking services in dynamic environments in response to the rapidly changing needs of local communities; (3) training and ongoing capacity building needed to create sustainable programs; and (4) the potential for integrating drug checking programs into other services. There are opportunities for this service to make a difference in overdose deaths as the contours of the drug market itself have changed over time, but a number of challenges remain to implement them effectively and sustain the service over time. Drug checking itself represents a paradox within the larger policy context, putting the sustainability of these programs at risk and challenging the potential to scale these programs as the overdose epidemic worsens.

INTRODUCTION: Doctor of pharmacy programs are encouraged to proactively promote well-being for students, faculty, and staff. In addition, a need has been highlighted to place greater focus on reducing mental health stigma within the promotion of patient-centered care. Mental Health First Aid (MHFA) is an evidence-based, early-intervention course that teaches participants how to support individuals experiencing a mental health challenge. Incorporation of MHFA into healthcare education has become an interest for many programs to address these needs, however, limited research is available regarding implementation of MHFA into pharmacy curricula. This study aimed to assess the current state of MHFA within existing PharmD programs and present opportunities to facilitate MHFA integration. METHODS: An online survey was administered to all Accreditation Council for Pharmacy Education (ACPE)-accredited pharmacy programs within the United States (US). Survey questions collected information on institution demographics, whether MHFA training is currently offered, and specifics of the MHFA training program. Questions assessing barriers and successes with MHFA implementation were also included. RESULTS: Twenty-six of the 52 programs that responded to the survey indicated that they offer MHFA to pharmacy students, with thirteen programs incorporating it as a core requirement within their curriculum. The top identified barriers to implementation included time requirements for training, cost, and curricular structure. CONCLUSION: Implementation of MHFA is feasible as a required element of pharmacy curricula and aligns with ACPE standards 2025. MHFA training can assist student pharmacists with developing competency in providing care for persons with mental health and substance use challenges.

BACKGROUND: In the last decade there has been an increase in the development and marketing of digital therapeutic (DTx) products aiming to prevent, manage, or treat a medical disorder or disease. Health insurance coverage for these products is not well established, and payers are facing increasing pressure to include these products as a covered benefit. OBJECTIVE: To examine factors and characteristics that could drive health insurance coverage of DTx products from US payers' and coverage decision-makers' perspectives. METHODS: This was a qualitative noninterventional, cross-sectional study conducted from August 2022 to October 2022. Virtual focus group meetings with pharmacy benefit managers/directors or medical directors representing a range of health insurance organizations were held following a semistructured interview guide. Convenience and snowball sampling techniques were used to identify participants. Transcripts were coded and analyzed with Atlas.ti software to identify common themes and subthemes. RESULTS: Five focus group meetings and 1 individual interview were held from August to October 2022. Participants (n = 22) were mostly pharmacists (n = 18, 85%) with more than 15 years of experience (n = 18, 85%). Some participants indicated that DTx products for diabetes (n = 6, 29%), mental/behavioral health (n = 3, 14%), and substance abuse disorders (n = 3, 14%) were already covered by their organizations. The topics generating the most comments grouped by code were issues around the evidence for DTx (67 unique comments) and barriers for coverage (60 unique comments). Participants indicated they want to have evidence of effectiveness that is similar to traditional pharmaceutical products. Barriers for coverage included a need to revise benefit policies, exclusion of nonprescription products, and mechanisms for billing. DTx products with an indication for mental/behavioral health were viewed as most likely to be reimbursed. Coverage of DTx products may occur under either the pharmacy or medical benefit. CONCLUSIONS: Health care payers stated that evidence of effectiveness was a necessary condition for health insurance coverage of DTx products. Given these are relatively new in health care, payers had more questions than answers regarding how these products will be integrated into health benefits.

Egypt is experiencing an increasing drug problem (cannabis, heroin, amphetamines, pharmaceutical opioids, synthetic cannabinoids). Whilst harm reduction and addiction treatment are provided by government and non-governmental organizations in Egypt, very little is known about physicians experience of handling patient substance use and substance use disorder (SUD) in primary care. A cross-sectional national study of 392 Egyptian Family Physicians (FPs) & General Practitioners (GPs) explored their knowledge, attitude and professional practice regarding management of SUD in primary care, as a first step toward identifying professional development support needs and informing general practice. Findings underscore the need for greater depth of addiction training during undergraduate medical education and in continuing professional development, so that Egyptian FPs/GPs can better prevent harmful substance use, detect patients with SUD, intervene and support those in treatment. This study provides unique information which will inform further development and scale of evidence based SUD brief intervention and treatment within Egyptian primary care.