Literature Collection

BACKGROUND: Depression in older adults is mainly treated in general practice but is often constrained by limited resources in primary healthcare services and suboptimal access to assistance from specialized care. This study aimed to evaluate the effectiveness of a structured collaborative model between GPs and geriatric psychiatrists compared to standard follow-up for individuals aged ≥ 65 with depression. METHODS: Patients with moderate depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] scores of 10-19) were invited to participate in a cluster-randomized controlled trial evaluating a structured collaborative intervention model involving GPs and geriatric psychiatrists. The core component of the intervention consisted of two consecutive joint consultations with the GP, patient, and geriatric psychiatrist, supplemented by individual GP-patient consultations. PHQ-9 assessments were conducted at baseline and at 6, 12, and 18 months. The primary outcome was a ≥ 50% reduction in PHQ-9 scores. RESULTS: 35 general practitioners initially agreed to participate, yet only 19 managed to recruit one or more depressed patients. Consequently, a total of 34 patients were enrolled in the study, with 30 providing survey responses during the follow-up period for subsequent analysis. Binary analysis (≥ 50% symptom reduction) showed a greater likelihood of improvement in the intervention group compared to the control, though this difference did not reach statistical significance. Notably, both groups showed significant mean PHQ-9 score reductions (3.4 and 4.0, respectively) at 18 months, but differences in mean PHQ-9 scores between the groups across all time points were not statistically significant. CONCLUSION: This study did not yield significant results for the collaborative model implemented. Major challenges in the recruitment process likely contributed to the low participation rate, which may explain the absence of positive findings. TRIAL REGISTRATION: The study was registered the 15.09.2019 in ClinicalTrials.gov with ID: NCT04078282.

In December 2024, Santé Québec (SQ), a province-wide agency overseeing health and social services delivery, was launched. Denis's essay offers an insightful and valuable lens to analyze the reform's underlying assumptions and to reflect on the opportunities and challenges ahead. SQ aims to separate policy making and planning from service delivery, a distinction that may prove difficult in practice. Moreover, the infrastructure for meaningful decentralization might be lacking, given Quebec's health system legacy of extensive structural integration. Nonetheless, existing assets - such as health regions, population-based responsibility and local health and social services networks - could prove to be valuable tools for stakeholder engagement and innovation.

Recognizing the current opioid crisis among justice-involved individuals and the need to intervene at the intersection of justice and community health, the JCOIN TCU hub study explores outcomes associated with a multi-level hybrid implementation approach. The study capitalizes on facilitated collaboration, training, and cross-system data sharing to leverage improvements in criminal justice (CJ) and community behavioral health (CBH) interagency collaboration. The goal is to improve local community public health and safety outcomes for reentering justice-involved individuals who have a history of (or are at risk for) using opioids. The study compares two implementation strategies: one (vertical) in which all units in a community are trained and begin the program simultaneously and another (horizontal) in which one lead-off unit in the community is trained as a prototype of the program, the prototype is tested and refined, and then the lead-off unit helps to train other units within the community. Specific aims are to 1) increase access to and retention in CBH and medications for opioid use disorder services; 2) improve outcomes associated with public health and safety; 3) compare two implementation strategies on systems-level outcomes designed to increase service initiation and receipt of implementation and services; and 4) examine the impact of these strategies on justice-involved individuals' outcomes. The study examines both implementation and implementation-effectiveness, seeking to answer the questions of which implementation strategy is most effective for rapid and sustainable uptake of evidence-based practices and for increasing service linkage and initiation, services retention, and improved opioid-related public health safety outcomes. The study uses a hybrid type 3 study design. The study's primary aim is to compare two implementation strategies and two interventions at two levels (client and system), with a secondary aim to assess client-level outcomes associated with the trial. The study design integrates 2 robust methodologies (stepped wedge and cluster randomized trial), and plans to include 18 research performance sites (communities) located in Texas, New Mexico, and Illinois. The study will contribute to the JCOIN network's effort to establish a national consortium of investigators examining promising strategies to enhance the capabilities and capacity of the justice system to more effectively address the opioid epidemic.