Literature Collection

BACKGROUND: Health care for individuals experiencing homelessness is typically fragmented, passive, reactionary, and lacks patient-centeredness. These challenges are exacerbated for people who experience chronic medical conditions in addition to behavioral health conditions. The objective was to evaluate an innovative healthcare delivery model (The Mobile, Medical, and Mental Health Care [M3] Team) for individuals experiencing homelessness who have trimorbid chronic medical conditions, serious mental illness, and substance use disorders. METHODS: We assessed changes in study measures before and after M3 Team enrollment using multi-level mixed-effects generalized linear models. Data sources included primary data collected as part of the program evaluation and administrative records from a regional health information exchange. Program participants continuously enrolled in the M3 Team between August 13, 2019 and February 28, 2022 were included in the evaluation (N = 54). The M3 Team integrates primary care, behavioral health care, and services to address health-related social needs (e.g., Supplemental Nutrition Assistance Program benefits and Social Security/Disability benefits). Outcome measures included number and probability of emergency department (ED) visits and behavioral health symptom severity measured using the Behavior and Symptom Identification Scale (BASIS-24) and the Addiction Severity Index (ASI). RESULTS: M3 Team participants experienced a decrease of 2.332 visits (SE = 1.051, p < 0.05) in the predicted number of ED visits in a 12-month follow-up period, as compared to the 12-month pre-enrollment period. M3 Team participants also experienced significant reductions in multiple domains of mental health symptoms and functioning and alcohol and drug use severity. CONCLUSIONS: Individuals experiencing homelessness who received integrated, patient-centered care from the M3 Team saw reductions in ED use and improvements in aspects of self-reported psychosocial functioning and substance use symptoms after enrollment in this novel healthcare delivery model.

Caring for pregnant people with substance use requires knowledge about specific substances used, treatment options, and an integrated, trauma-informed care team. This chapter will discuss crucial information for clinicians regarding evidence-based practice for screening, intervention, and ongoing support for pregnant people and their families impacted by substance use.

COPD is a chronic condition that comes with a significant symptoms burden and healthcare utilization. It is the fourth leading cause of death worldwide and its prevalence is expected to rise in the years to come. We know that pharmacological treatment has a preponderant role to play in the management of this disease, but we also know that the non-pharmacological aspect of care is the cornerstone. In the last years, it has been increasingly recognized that education, self-management and integrated care are key components of COPD patients care trajectory. This review article presents the evolution of integrated care throughout the years and highlights the evidence of randomized clinical trials and on patient perspective behind this care model as well as the challenges healthcare professionals are still facing. This review also presents an illustrative example of integrated care in COPD which has been implemented over 2 decades, building on evidence from RCT to real-world evidence adoption in healthcare settings for broader reach and sustainability.

BACKGROUND: To better meet the growing demand and complexity of clinical need, there is a broad international trend towards greater integration of various elements of health- and social care. However, there has been a lack of research aimed at understanding how healthcare providers have experienced these changes, including facilitators and inhibitors of integration. AIMS: This study set out to generate new understandings of this from three UK staffing 'levels': 'micro' frontline workers, a 'meso' level of those leading a healthcare organisation and a 'macro' level of commissioners. METHOD: Using Rogers' Diffusion of Innovation framework, qualitative analysis of individual interviews from provider staff perceptions was undertaken at these three levels (total N = 33) in London. RESULTS: English legislation and policy captured the need for change, but fail to describe problems or concerns of staff. There is little guidance that might facilitate learning. Staff identity, effective leadership and culture were considered critical in implementing effective integration, yet are often forgotten or ignored, compounded by an overall lack of organisational communication and learning. Cultural gains from integration with social care have largely been overlooked, but show promising opportunities in enhancing care delivery and experience. CONCLUSIONS: Findings are mixed insofar as staff generally support the drivers for greater integration, but their concerns, and means for measuring change, have largely been ignored, limiting learning and optimisation of implementation. There is a need to emphasise the importance of culture and leadership in integrated care, and the benefits from closer working with social care.