Literature Collection

BACKGROUND AND OBJECTIVES: Opioid use and overdose remain a central and worsening public health emergency in the United States and abroad. Efforts to expand treatment have struggled to match the rising incidence of opioid use disorder (OUD), and treating patients in primary care settings represents one of the most promising opportunities to meet this need. Learning collaboratives (LCs) are one evidence-based strategy to improve implementation of medication treatment for opioid use disorder (MOUD) in primary care. METHODS: We developed and studied a multidisciplinary MOUD learning collaborative involving six underserved primary care clinics. We used a mixed-methods approach to assess needs, develop curriculum, and evaluate outcomes from these clinics. RESULTS: We recruited six clinics to participate in the collaborative. Half had an established MOUD program. Approximately 80% of participants achieved their organizational quality improvement goals for the collaborative. After the collaborative, participants also reported a significant increase in their perceived competence to implement/improve a MOUD program (pre-LC competence=2.80, post-LC competence=6.33/10, P=.02). The most consistent barrier we identified was stigma around OUD and its effects on patients' ability to access services and staff/provider ability to provide services. The most frequent enablers of program success were trainee interest, organizational leadership support, and a dedicated MOUD care team. CONCLUSIONS: Organizations used clinical and systems improvement knowledge to enhance their existing programs or to take steps to create new programs. All participants identified the need for additional staff/clinician training, especially to overcome stigma around OUD. The outcomes demonstrated the crucial importance of long-term organizational support for program success.

Understanding the neural mechanisms that underlie behavior change is critical for improving lifestyle management in type 2 diabetes. Individuals with type 2 diabetes face unique challenges in adopting and maintaining healthy behaviors, which can be influenced by alterations in brain function and plasticity, potentially leading to cognitive impairment. Diabetes self-management education and support (DSMES) programs aim to enhance lifestyle changes and promote better health outcomes while reducing cognitive decline. However, complex neural disruptions in critical regions for cognitive processes like the prefrontal cortex and parietal lobe present significant challenges. Given the likely role of neural mechanisms in behavioral choices, understanding how type 2 diabetes affects these neural substrates is crucial for developing effective interventions. Despite considerable research efforts aimed at testing lifestyle interventions, a critical gap remains in understanding the cognitive and behavioral components of successful diabetes self-management, the neural substrates of those components, and the impact of diabetes on those neural substrates. Bridging this gap necessitates a comprehensive examination integrating neural processes, DSMES strategies, and behavior change models. Thus, this perspective review highlights the urgent need to address the knowledge gaps surrounding the neural correlates of diabetes self-management and the integration of behavioral models into intervention frameworks. We propose a hypothesis-generating question and present preliminary findings comparing neural plasticity, executive functions, and lifestyle behavior among individuals with type 2 diabetes, pre-diabetes, and healthy controls. By elucidating the neural substrates underpinning diabetes and exploring their implications for DSMES and readiness to change, we can pave the way for more effective, personalized approaches to diabetes care.

INTRODUCTION: Social prescribing (SP) involves person-centred integration of non-clinical supports into care, which is critical for addressing mental health and psychosocial needs and enhancing wellbeing. This systematic review evaluated the impact of SP referral pathways on mental health, wellbeing, and psychosocial outcomes. METHODS: Four databases (Medline, Embase, PsycINFO and Scopus) were searched for empirical studies of referral pathways to community-based SP interventions targeting mental health, psychosocial factors and/or wellbeing. Data from studies published from January 2010 to April 2024 were extracted; referral pathways, interventions, and their resultant outcomes were synthesised and tabulated. RESULTS: Across the 30 included studies, 27 SP interventions and two main referral pathways were identified, involving providers across health, community, social, and voluntary care sectors. Quantitative outcomes (n = 21, 70%) most frequently measured were wellbeing, anxiety, depression and quality of life. Findings were mixed, and widely varying methodological approaches limited study comparability. Qualitative outcomes (n = 16, 53%) were mostly associated with social interactions (e.g., increased sense of belonging) and self-concepts and feelings (e.g., increased sense of purpose). DISCUSSION AND CONCLUSION: Research on SP referral pathways supporting mental health, wellbeing and psychosocial outcomes is proliferating, but high heterogeneity in the evidence base limits conclusive inferences about effectiveness. Standardised quantitative measurement of core outcomes, supplemented by rigorous qualitative designs, will enhance capacity to demonstrate the value of an SP approach to integrated care for mental and psychosocial health and wellbeing.