Literature Collection

Continuing professional development (CPD) and quality improvement (QI) are both dedicated to improving clinical practice and health outcomes. Although leaders in both disciplines have long recommended closer alignment, few case studies have demonstrated how such alignment can be developed and sustained within a health care system. Kaiser Permanente Colorado is an integrated health care delivery system in the United States that has worked toward coordination of CPD and QI for >20 years. Alignment of departmental reporting structures, interdisciplinary teams of educators, incorporation of quality concerns into continuing education (CE) activities, coordination of CE activities with implementation of decision support tools, and reliance on evidence-based educational practices have all contributed to a unique organizational culture of education. Published research has shown that their approach can lead to sustainable practice change. Many elements of this approach are potentially applicable to other systems, including consistent use of interprofessional teams, recognizing the organizational context, development of a theory of change to address education and quality gaps, coordination of CE and quality interventions, and using educational and clinical data to evaluate the effectiveness of these interventions. Because these changes have occurred within an evolving environment of real-world practice, the effectiveness of specific components or the interactions between them are difficult to establish. Nonetheless, the Kaiser Permanente Colorado model provides one example of coordination between CPD and QI experts to achieve their shared goal of improving clinician practice, patient care, and system performance.

INTRODUCTION: Purnell's Model for Cultural Competence outlines that cultural competence is essential for bridging the gap between health care providers and patients from diverse cultural backgrounds.' METHODOLOGY: This study followed PRISMA-ScR guidelines, focusing on studies involving nurses, nursing students, and educators using Purnell's Model. Literature was searched across six databases up to July 2024. RESULTS: From 834 records, 20 studies met the inclusion criteria. The primary themes identified were "Cultural competence in health care" and "Nursing interventions and patient relationships." Subtopics included Cultural health care practices, Patient-centric nursing, holistic and culturally sensitive care, and integrated care and education. These subtopics provide a nuanced understanding of cultural competence application across various settings. DISCUSSION: Findings highlight the importance of integrating cultural competence training to reduce health care disparities, improve patient-provider communication, and enhance the efficacy of nursing interventions in diverse populations. Incorporating these aspects into education and practice is crucial for achieving cultural competence in nursing.

Background: Interprofessional collaboration is vital for comprehensive, patient-centered care. Despite growing recognition of oral-systemic health links, the integration of dentists into healthcare teams remains limited. This scoping review mapped existing evidence on dental professionals' roles within interprofessional healthcare, identifying key benefits, barriers, and facilitators. Methods: A systematic search of PubMed, SCOPUS, and Web of Science identified English-language studies (2014 to 2024) focused on collaboration between dental and non-dental providers. Studies addressing oral-systemic health without team-based integration were excluded. Screening and data charting followed the PRISMA-ScR framework using JBI data extraction and critical appraisal tools. Data were synthesized thematically by collaboration model, outcomes, and influencing factors. Results: Nine studies met the inclusion criteria. Integrating dental professionals into healthcare teams improved patient outcomes, quality of life, and satisfaction. Effective models included nurse practitioner-dentist partnerships and medical-dental collaboration in pediatrics and chronic disease care. Barriers included poor communication, lack of interoperable electronic health records, role ambiguity, and limited interprofessional training. Key facilitators were supportive policies, integrated care structures, professional education, and strong team communication. Conclusions: Integrating dentists into interprofessional teams enhances healthcare delivery and patient outcomes. However, significant barriers remain. Addressing communication gaps, implementing shared health records, and expanding interprofessional education are essential steps toward more cohesive care. Future research should evaluate scalable integration frameworks and incorporate patient perspectives to inform team-based care.

Digital cognitive behavioural therapy for insomnia has been developed to increase capacity and scalability for patients with insomnia, but implementation in primary care remains limited. The aim of the trial was to evaluate the implementation of digital insomnia therapy into primary care practice for patients with insomnia. We conducted a single-arm feasibility trial of digital behavioural therapy for insomnia (SleepFix) providing sleep restriction therapy with insomnia patients in primary care. Healthcare professionals (comprising General Practitioners, community pharmacists and nurses) were enrolled into the trial and, when deemed clinically appropriate, prescribed SleepFix to patients with insomnia. The primary outcome was uptake assessed by the number of downloads of SleepFix. Interviews with primary care healthcare professionals explored their attitudes towards implementing/using insomnia digital therapeutics in clinical practice, and patients about their experiences with SleepFix. Insomnia symptoms, mood and sleep quality were measured before and after the trial. This trial was prospectively registered (ACTRN12620000055909). Thirty healthcare professionals and 105 patients were enrolled into the trial. Fourteen healthcare professionals administered at least one insomnia digital therapeutic prescription between November 2021 and March 2022. Fifty patients downloaded and used SleepFix (47.6% uptake). In post-trial interviews, healthcare professionals felt they could incorporate digital sleep health into clinical practice and patients found SleepFix acceptable. There were significant improvements in insomnia symptoms, mood and sleep quality at week 6 (all p < 0.05). This trial shows a real-world implementation of a digital insomnia therapy into primary care that could provide a framework for prescribing digital sleep interventions.

Health disparities in the United States are not produced by single risk factors but by interacting social and biological conditions that cluster within structurally marginalized communities. Poverty, violence, and poor physical and mental health form a reinforcing system of disadvantage that traditional healthcare models-organized around isolated diseases-are poorly equipped to address. This perspective examines these dynamics through a syndemic framework, which conceptualizes co-occurring conditions as mutually interacting epidemics intensified by social inequality. Drawing on interdisciplinary evidence from public health, medicine, and social science, we describe how poverty-related stressors such as housing instability, food insecurity, and barriers to healthcare intersect with exposure to interpersonal and structural violence to amplify risks for depression, posttraumatic stress disorder, chronic disease, and premature mortality. These interactions produce compounded health burdens that are disproportionately experienced by marginalized populations. Despite increasing attention to social determinants of health, current healthcare responses remain fragmented. Health systems frequently identify risks through screening for social needs or trauma exposure but lack the institutional infrastructure, reimbursement mechanisms, and cross-sector partnerships required to address them effectively. We argue that advancing health equity requires moving beyond additive models of care coordination toward syndemic-informed healthcare systems that intervene simultaneously on clustered conditions and their shared upstream drivers. We outline key priorities for practice, policy, and research, including linking screening to actionable care pathways, strengthening partnerships between healthcare and social service systems, and expanding workforce training to include structural and syndemic competency.

Integrating exercise prescriptions with medication management represents a novel approach for enhancing health and function, optimising medication effectiveness, and reducing adverse drug reactions and polypharmacy in older adults (ie, those aged ≥60 years). This Personal View highlights the need for a comprehensive assessment of lifestyle, diagnoses, geriatric syndromes, and medications with an emphasis on fully incorporating exercise treatment into geriatric care. Exercise is an alternative to less effective or unsafe medications for many conditions, including depression, anxiety, insomnia, osteoarthritis, and dementia. Exercise is an important adjunct to pharmacotherapy for many common chronic conditions such as coronary artery disease, heart failure, diabetes, osteoporosis, cancer, and chronic obstructive pulmonary disease. Adding exercise to drug management can mitigate adverse drug reactions, enhance medication compliance, and reduce the adverse effects of sedentary behaviour and ageing processes on chronic disease expression. Targeted exercise programmes have also been shown to ameliorate drug-induced side-effects, including anorexia, falls, sarcopenia, osteoporosis, and orthostatic hypotension, and to overcome constraints such as reduced aerobic fitness, balance impairment, and muscle atrophy due to some medications. Health-care professionals require additional training and support to ensure that exercise assumes a key, central role in older adults with multimorbidity and polypharmacy, as supported by the current literature. This Personal View describes practical approaches to incorporating exercise into clinical practice as a step towards an integrated geriatric care model, with the ultimate aim of increasing health span and minimising disability.