Literature Collection

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.

OBJECTIVES: The multidisciplinary team approach improves adverse drug reaction (ADR) reporting and management. Our study aims to integrate a pharmacovigilance (PV) and Response Team within the general medicine department to improve ADR reporting and management. MATERIALS AND METHODS: We conducted a prospective cross-sectional study for seven months in four general medicine wards. We proposed a PV and response unit team (PRUT), comprising a nursing student, and a Doctor of Pharmacy (intern). After the team received interventional educational training, we integrated them with the physician and head nurse of each general medicine inpatient ward. We then evaluated the effectiveness of the team in ADR reporting and management using a feedback survey. RESULTS: In this study, comorbidities (30.69%) and polypharmacy (≥5 drugs) (26.25%) were major predisposing factors. Among drug-related problems in 125 patients, inappropriate drug use (28.80%) and unclear dose timing (21.60%) were predominant. Gastrointestinal disorders were common (44.73%), with dose adjustment being the top management strategy (36.84%). Over 71% supported the PRUT for improving patient safety and reducing medication errors, noting high effectiveness in consultation (85.92%) and in reducing the ADR reporting burden (87.32%). There is a statistically significant association between the level of agreement on the effectiveness of PRUT among healthcare professionals (p<0.01). Most healthcare professionals agreed on PRUT's effectiveness without any reports of low agreement levels. CONCLUSION: The PRUT effectively reported and managed ADRs. A multidisciplinary approach improves ADR reporting and management.

There is an increasing prevalence of people living with multiple long-term conditions (MLTC), defined as two or more long-term conditions. People with MLTC have reduced life expectancy and increased healthcare usage compared to people without MLTC. Most hospital healthcare systems have developed to deal with single conditions in isolation. For people with MLTC, this results in fragmentation of their care across multiple different specialty clinics, which can waste resources and is often unsatisfactory for patients and for their primary care clinicians. Clinical trials are commonly undertaken on patients with only a single condition and there is little evidence about care for patients with MLTC. We have developed an integrated multi-specialty clinic in which multiple specialists meet the patient in a single room at the same time to develop a realistic consensus management plan. Further research is needed to determine the most effective ways to deliver integrated healthcare for people with MLTC.

Depression is a prevalent mental health disorder that significantly impacts primary care settings. This editorial explores the potential of artificial intelligence (AI)-powered chatbots in managing depression within primary care environments. AI chatbots offer innovative solutions to challenges faced by healthcare providers, including limited appointment times, delayed access to specialists, and stigma associated with mental health issues. These digital tools provide continuous support, personalized interactions, and early symptom detection, potentially improving accessibility and outcomes in depression management. The integration of AI chatbots in primary care presents opportunities for round-the-clock patient support, personalized interventions, and the reduction of mental health stigma. However, challenges persist, including concerns about assessment accuracy, data privacy, and integration with existing healthcare systems. Successful implementation requires systematic approaches, stakeholder engagement, and comprehensive training for healthcare providers. Ethical considerations, such as ensuring informed consent, managing algorithmic biases, and maintaining the human element in care, are crucial for responsible deployment. As AI technology evolves, future directions may include enhanced natural language processing, multimodal integration, and AI-augmented clinical decision support. This editorial emphasizes the need for a balanced approach that leverages the potential of AI while acknowledging its limitations and the irreplaceable value of human clinical judgment in depression management within primary care settings.

INTRODUCTION: Asthma is one of the most common chronic respiratory diseases globally. Despite national and international asthma care guidelines, gaps persist in primary care. Knowledge translation (KT) electronic tools (eTools) exist aiming to address these gaps, but their impact on practice patterns and patient outcomes is variable. We aimed to conduct a nonsystematic review of the literature for key asthma care gaps and identify limitations and future directions of KT eTools optimised for use in electronic medical records (EMRs). METHODS: The database OVID Medline was searched (1999-2024) using keywords such as asthma, KT, primary healthcare and EMRs. Primary research articles, systematic reviews and published international/national guidelines were included. Findings were interpreted within the knowledge-to-action framework. RESULTS: Key asthma care gaps in primary care include under-recognition of suboptimal control, underutilisation of pulmonary function tests, barriers to care delivery, provider attitudes/beliefs, limited access to asthma education and referral to asthma specialists. Various KT eTools have been validated, many with optimisation for use in EMRs. KT eTools within EMRs have been a recent focus, including asthma management systems, decision support algorithms, data standards initiatives and asthma case definition validation for EMRs. CONCLUSIONS: The knowledge-to-action cycle is a valuable framework for developing and implementing novel KT tools. Future research should integrate end-users into the process of KT tool development to improve the perceived utility of these tools. Additionally, the priorities of primary care physicians should be considered in future KT tool research to improve end-user uptake and overall asthma management practices.