Literature Collection

AIMS: To examine the effects of integrated health education programmes with physical activity among community-dwelling older adults at risk of atherosclerotic cardiovascular disease (ASCVD). DESIGN: Integrative review. DATA SOURCES: A systematic search of experimental studies was conducted in six electronic databases and one registry from inception to December 2022. METHODS: Two researchers independently conducted the eligibility screening, quality appraisal and data extraction. A total of 11 studies, which were published between 1996 and 2021, were included in the review and were analysed by narrative synthesis. RESULTS: The 11 included studies involved 1973 participants. The findings indicate that integrated health education programmes with physical activity have potential benefit in short-term weight management among community-dwelling older adults at risk of ASCVD. Nevertheless, the programmes appear ineffective on body mass index, short-term lipid profiles, diastolic blood pressure (BP) and blood glucose. Further investigation is recommended to confirm the programme effects on physical activity level, exercise self-efficacy, systolic BP, waist circumference, long-term lipid profiles, long-term weight management and cardiac endurance. The findings suggest that body mass index may not be a sensitive indicator of obesity in the elderly population and should be measured along with waist circumference to better predict the risk of ASCVD. The available evidence is restricted in its robustness and generalisability. As most included studies were conducted in the United States, more studies should be implemented in other countries to enhance study generalisability. CONCLUSIONS: The effects of integrated health education programmes with physical activity among community-dwelling older adults at risk of ASCVD remain inconclusive. Further research with adequate statistical power and good methodology is warranted. IMPACT: The findings provide insights into whether health education programmes with physical activity effectively improve various outcomes, and suggest that researchers should include exercise self-efficacy and cardiac endurance in future studies. REPORTING METHOD: Adhered to PRISMA reporting guidelines. NO PATIENT OR PUBLIC CONTRIBUTION: This review was conducted without patient or public participation.

BACKGROUND AND OBJECTIVES: Migrant families have reduced access to universal child and family health (CFH) services, including CFH nursing visits, wherein infant and maternal surveillance offers a key opportunity to identify maternal health and child developmental concerns. Evidence is emerging on the effectiveness of integrated health and social care hubs (Hubs) to improve access to CFH services. Our aim was to evaluate the impact of Hubs at 2 sites in Sydney, Australia for migrant women and their infants on attendance to CFH nursing visits until 12 months postpartum for infant and maternal surveillance. METHODS: We conducted a nonrandomized trial to compare Hubs (intervention) with routine CFH nursing services (control). Pregnant and/or recently birthed migrant women were allocated to Hubs (n = 119) or routine care (n = 120), with allocation based on residential proximity to the Hubs. Mothers and their infants were followed until the child was aged 12 months. RESULTS: Compared with routine care, the Hub group demonstrated a more than 4-fold higher rate of attendance at CFH nursing visits (12-month visit: adjusted relative risk, 4.68; 95% CI, 2.48-8.84) and a 2-fold increase in completion of maternal postnatal depression and psychosocial surveillance at visits. There was no difference in completion of infant surveillance between Hubs and routine care at visits. CONCLUSIONS: There was a significant improvement in attendance of CFH nursing visits for migrant women and their infants attending Hubs compared with routine CFH nursing services. Completion of maternal surveillance was higher in Hubs. Hubs are important service models to be considered when addressing disparities in access to CFH nursing services for migrant communities.

Integrated healthcare models combining behavioral and primary care provide solutions for vulnerable pediatric populations, especially youth in foster care, facing disproportionately high rates of chronic conditions and mental health issues. This review synthesizes current literature to assess the impact of integrated care on health outcomes for youth in foster care. Findings suggest integrated care can reduce healthcare barriers, improve coordination, and improve health outcomes for these youth. However, literature gaps indicate a need for more research. Clinical practice implications include adopting coordinated, multidisciplinary care. Future research should standardize definitions and approaches to support the sustainability of these care models.

Background and Objectives: One of the challenges of modern healthcare systems, in terms of economic and organizational sustainability and the impact on patients' quality of life, is the progressive increase in chronicity and care complexity. In this scenario, hospital-community integration models represent possible strategies to ensure the continuity of care, reduce readmission rates, and improve clinical outcomes. This study aims to map integrated care models for patients with chronic diseases, with active involvement of the family and community nurse, describing their functions and associated clinical, organizational, and economic outcomes, as well as barriers and facilitators to their implementation. Materials and Methods: The review was conducted using the JBI methodology and the PRISMA-ScR protocol and identified 26 studies with a publication range from 2000 to 2025. Results: The emerging results highlight the use of integrated and personalized organizational models in the post-discharge phases, with a leading role for the family and community nurse in the assessment, planning, and coordination of various steps. Conclusions: The interventions are associated with an increase in patient and caregiver satisfaction, a reduction in outcomes such as the rehospitalization rate, and greater continuity of care.

BACKGROUND: Liaison psychiatry services provide mental health care for patients in physical healthcare (usually acute hospital) settings including emergency departments. Liaison work involves close collaboration with acute hospital staff so that high quality care can be provided. Services however are patchy, relatively underfunded, heterogeneous and poorly integrated into acute hospital care pathways. METHODS: We carried out in-depth semi-structured interviews with 73 liaison psychiatry and acute hospital staff from 11 different acute hospitals in England. The 11 hospitals were purposively sample to represent hospitals in which four different types of liaison services operated. Staff were identified to ensure diversity according to professional background, sub-specialism within the team, and whether they had a clinical or managerial focus. All interviews were audio-recorded and transcribed. The data were analysed using a best-fit framework analysis. RESULTS: Several key themes emerged in relation to facilitators and barriers to the effective delivery of integrated services. There were problems with continuity of care across the secondary-primary interface; a lack of mental health resources in primary care to support discharge; a lack of shared information systems; a disproportionate length of time spent recording information as opposed to face to face patient contact; and a lack of a shared vision of care. Relatively few facilitators were identified although interviewees reported a focus on patient care. Similar problems were identified across different liaison service types. CONCLUSIONS: The problems that we have identified need to be addressed by both liaison and acute hospital teams, managers and funders, if high quality integrated physical and mental health care is to be provided in the acute hospital setting.

INTRODUCTION: Using patient-reported outcome measures (PROM) in a shared-space mental health-integrated specialty clinic, we explored the feasibility, acceptance, and experience of youth with asthma and diabetes, their families, and the healthcare team. METHOD: Using mixed methods, we examined feasibility, acceptability, and experience of PROM inclusion in caring for youth with asthma (n = 7) and diabetes (n = 11), their families (n = 18), and healthcare providers (n = 13). Completion and receipt of PROM (feasibility), postvisit surveys (acceptance), and structured interviews (experience) between June 2019 and February 2020. RESULTS: Targeted PROM met feasibility goals (80%) and exceeded youth and family acceptance (70%). Time and low confidence using PROM affected healthcare team acceptance (64%). Families' experiences included increased learning, trust, and partnership with the clinic team. Providers appreciated partnerships, resources, and mental health support for families. DISCUSSION: Integrating PROM into clinical services promoted engagement, partnership, and individualized, strength-based care among youth, their parent/guardian (family), and their healthcare team.