Literature Collection

The field of neuropsychology is making inroads in primary care as the importance of cognition in physical health is increasingly acknowledged. With neuropsychology primary care integration, patients receive a range of cognitive assessments (e.g., screens, brief neuropsychological assessments, treatment recommendations through provider-to-neuropsychologist consultations) based on a stepped model of care which can more efficiently diagnose cognitive disorders/problems and assist with treatment. Two case studies are described to illuminate this process. Information is provided to illustrate how neuropsychology integration was introduced in two primary care clinics at a community-based hospital system.

BACKGROUND: Given the increasing recognition of the value of greater integration of physical and mental health services for children and young people, we aimed to evaluate preferences among parents for the characteristics associated with integrated health service provision for two conditions (eating disorders, functional symptom disorders). METHODS: Two discrete choice experiments (DCEs) were conducted, using electronic surveys. Participants were adult parents of children and young people. Choice scenarios were based on five attributes for the eating disorders study, and four attributes for the functional symptom disorders study. RESULTS: Two hundred parents participated in each DCE. For eating disorders, days missed from school in the last year was the attribute valued most highly, followed by days in hospital in the last year, costs to the NHS, functioning, and interaction with peers with eating disorders. Respondents were willing to trade £531 of costs to the NHS for one less day missed from school. For functional symptom disorders, time to diagnosis was valued most highly, followed by days missed from school while obtaining a diagnosis, reservations about seeing a mental health practitioner, and costs of diagnosis to the NHS. Respondents were willing to trade £4237 of costs to the NHS to wait one month less for a diagnosis. CONCLUSION: Respondents' preferences were largely consistent with the planned goals of integrating physical and mental health services. Our findings show the factors which ought to be considered when designing new integrated pathways and evaluating them.

BACKGROUND: Americans experiencing substance use disorder (SUD) carry a significant chronic disease burden, yet only half use primary care. Patients in treatment for SUD who are connected with primary care typically have better overall health outcomes. LOCAL PROBLEM: The identified intensive outpatient program (IOP) had no protocol in place to engage patients with primary care. METHODS: This project piloted the development and implementation of an original, evidence-based primary care integration program. It consisted of a psychoeducation group, a referral by case management, and establishment of an internal referral process to affiliated primary care providers (PCPs). INTERVENTIONS: Following the psychoeducation group, pre and posttests of patient-reported knowledge and attitudes regarding primary care were compared. Participants were contacted to collect further data after IOP discharge. An education and feedback session was held with affiliated PCPs, and an internal referral process was devised by leadership. RESULTS: Mean scores measuring patient knowledge and attitudes regarding primary care increased after participation in the structured psychoeducation group. By time of IOP discharge, 100% (n = 12) of participants had either a referral or scheduled appointment with a PCP in place. At time of follow-up, 90% (n = 9) reported that they had attended or planned to attend their scheduled PCP appointment. CONCLUSIONS: A comprehensive integration program in the IOP setting can improve patient engagement with primary care. Quality improvement implementation will require consideration of challenges faced during the pilot involving scheduling, staff buy-in, changes in patient acuity, the electronic medical record, and insurance.

Introduction: Psychological distress can have a significant impact on cardiovascular disease (CVD) and efforts to treat psychological distress may improve CVD risk factors. Therefore, we conducted a retrospective feasibility of implementation study to assess the utilization of short-term psychotherapy in patients engaged in a cardiovascular prevention program. Methods: Participants included patients engaged in the Women's Health or Preventive Cardiology programs from January 2019 to June 2022. Patients were referred for psychology services if deemed likely to benefit from improvements in their psychological well-being to control their CVD risk factors. Biomarkers were obtained within 6 months pre- and post-therapy. Results: More than half (52.8%) of the 36 patients referred to the program attended ≥6 psychotherapy sessions. In patients with HTN, 50% were above goal (130/80 mmHg) pre-therapy and 20.8% post-therapy. 55.5% of patients with an LDL-C ≥100 mg/dL pre-therapy achieved an LDL-C <100 mg/dL post-therapy. Among patients with a hemoglobin A1c ≥5.7% pre-therapy, 12.5% lowered their hemoglobin A1c to <5.7%. Conclusion: Our study shows the potential benefit of psychological services when delivered concurrently with preventive cardiology visits. These findings raise the possibility that expanding access to psychology services in clinical cardiology care may be a model to reduce excess cardiovascular risk factor burdens.

BACKGROUND: Evidence suggests that centralising specialist healthcare services can improve outcomes for patients but increase travel distances and times. Traditionally, people requiring specialist health care were cared for by a single specialist, with mental and physical health care delivered by separate services. Recent trends involve greater collaboration between specialists. Integrated care is the highest level of collaboration, including shared access to medical records and multidisciplinary care. OBJECTIVES: To investigate how centralisation of specialised healthcare services can be characterised. To examine the proposed integration between physical and mental health services in the care of children and young people with eating disorders and functional symptom disorders in one region of England. DESIGN: Mixed-methods study comprising: a scoping review (conducted in November 2020) of four databases to characterise centralisation of specialised healthcare services; a systematic literature review (conducted in August 2022, updated in July 2024) of three databases to evaluate integration of physical and mental health services for children and young people with eating disorders and functional symptom disorders; an interview study of parents (n = 10 participants), healthcare professionals (n = 14 participants) and a project lead (n = 1 participants) to understand perspectives on integration, which analysed data in themes organised within the Consolidated Framework for Implementation Research; and two discrete choice experiments of preferences using online surveys (n = 400 participants). RESULTS: The scoping review (n = 93 studies) found that definitions of centralisation commonly lacked detail but, where available, covered centralisation's form, objectives, mechanisms and drivers. Limited evidence suggests centralisation could be linked to better outcomes, but many important outcomes were rarely examined. The systematic review of integration found one low-quality (uncontrolled) pre-post study of eating disorders in Australia. Findings from the interviews suggest that service redesign should ensure the concept of 'integration' has shared meaning among professionals, and that agreement is reached over roles and responsibilities. From the discrete choice experiments, the main things that mattered to parents when thinking about integration were days missed from school in the case of eating disorders and time to diagnosis for functional symptom disorders. LIMITATIONS: Limited, poor-quality literature in the reviews; small numbers of interview participants; difficulties engaging parents, carers and healthcare professionals for the discrete choice experiment. CONCLUSIONS: There is a lack of evidence around integrated care for children and young people affected by eating disorders and functional symptom disorders. Implementation of integrated services needs to address concerns regarding roles, responsibilities and leadership. Future evaluations should measure impact in terms of the factors found to matter most to participants in this study. FUTURE WORK: Mixed-methods studies to evaluate integrated pathways. FUNDING: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR133613.; ‘Specialised healthcare services’ are teams who are expert in treating people with certain kinds of health problem. Sometimes, they are joined up into a smaller number of larger services, so that they can treat more patients with the same condition: this is called ‘centralisation’. Previous evidence suggests that centralising specialist healthcare services can improve outcomes for patients, but it can also increase travel distances and times for patients and families. We reviewed the evidence on centralisation of specialised services. The evidence was limited, but said that centralisation was linked with better care or outcomes. We also did a more focused study looking at integration between physical and mental health services for children and young people, to inform the development of a new children’s hospital. Traditionally, people requiring specialised health care were cared for by a single specialist, with mental and physical health care delivered by separate services. More recent trends involve greater collaboration between specialists. Integrated care is the highest level of collaboration, involving shared access to medical records and multidisciplinary care. We focused on two health conditions, eating disorders and functional symptom disorders (experiencing physical symptoms, for which there is no clear explanation). We looked for research to find out what is known about integrating services for these conditions and found little evidence. We also conducted interviews with healthcare professionals, and interviews and a survey of parents to find out their views. These found broad support for integrating services for children and young people affected by these conditions. There were several concerns about integration, mostly around clearly defining roles and responsibilities of staff. The main things that mattered to parents when thinking about integration were days missed from school in the case of eating disorders, and time to diagnosis in the case of functional symptom disorders.; eng

OBJECTIVES: Women experiencing homelessness (WEH) often face barriers to accessing substance use disorder (SUD) treatment. The Veterans Health Administration (VHA) has invested in primary care redesign efforts for women's health (women's primary care clinics, "PCCs") and for homelessness (homeless-tailored PCCs). There have been no comparative examinations of SUD integration in these PCCs. We aim to compare VHA SUD integration across homeless-tailored and women's PCCs, identifying areas to improve care for WEH. METHODS: A 40-question provider survey was administered online. PCC physicians, nurses, and mental health providers were randomly sampled from 57 VHAs across the United States. Likert-type items assessed active service arrangement, active communication, same-day reachability of SUD specialists, collaboration with SUD specialists, and preparedness to meet women's needs and SUD needs. Multiple-choice items assessed time to referral completion, location of routine and urgent treatment, medication, counseling, staffing, and resource needs. Ordinal logistic regressions assessed Likert-type measures. χ2 tests assessed multiple-choice items. RESULTS: Based on 114 respondents (response=23.6%), women's PCCs scored below homeless-tailored PCCs on several items: collaboration via shared patient discussions, service consults, and treatment plan coordination; women's health preparedness; SUD preparedness; urgent treatment location; and medication availability (all P values<0.05). Most providers (90% and 86%) reported access to staff with mental health or addiction expertise, but SUD treatment remained predominantly confined to specialty care rather than primary care. The most frequently endorsed resource need was on-demand access to addiction specialists. CONCLUSIONS: VHA PCCs that serve WEH report modest SUD integration; lessons from homeless-tailored PCCs could strengthen SUD practices in women's PCCs.