Literature Collection

OBJECTIVE: The primary objective was to evaluate the impact of clinical decision support (CDS) tool integration into primary care visits on depression screening and follow-up rates and to assess whether CDS use improves adherence to Health Resources and Services Administration (HRSA) guidelines for depression screening and follow-up. DESIGN: This quality improvement evaluation study employed quantitative and qualitative components conducted in parallel to provide complementary insights. Modified Poisson regression with generalised estimating equation (GEE) was used to assess the association between CDS tool use and meeting HRSA criteria for depression screening and follow-up. In addition, semi-structured interviews explored perspectives on the implementation and utility of CDS tools. SETTING: This study was conducted at a federally qualified health centre in Minnesota. PARTICIPANT: The dataset included 12 338 patient encounters attributed to 8647 unique patients, covering 2 years of data. Five care providers were recruited through purposive sampling for the semi-structured interviews. RESULT: CDS use was significantly associated with an increased likelihood of meeting HRSA depression screening and follow-up criteria (relative risk 1.44, 95% CI 1.34 to 1.55; p<0.001). Qualitative findings suggested that while providers found CDS tools useful, workflow challenges and human-centred practices shaped their effectiveness. CONCLUSION: Integrating CDS tools into primary care workflows can enhance adherence to depression screening and follow-up guidelines. However, their effectiveness relies on supportive person-centred approaches, including collaboration and previsit preparation. These findings highlight the need for a balanced approach that integrates technological interventions with human interaction to enhance clinical practices. Future research should investigate how CDS tools are used in practice, address barriers to their adoption and develop strategies to promote their broader use while fostering continued learning among providers.

BACKGROUND: The Veterans Health Administration (VA) integrated mental and physical health services to better detect and treat depression. Primary care nurses conduct screening annually. Clinicians, including Primary Care Mental Health Integration (PCMHI) specialists, follow-up as needed for treatment. Depression detection and management processes are complex, involve multilevel stakeholders, and are subject to significant disruption from COVID-19 and from the resulting expansion of telehealth, aiming to preserve care access. This study aimed to examine whether the COVID-19 pandemic worsened depression-related care quality and/or patient outcomes (eg, suicide). METHODS: Given hypothesised care disruption (lowered care quality) during COVID-19, we will first assess the VA population's trajectory from a new positive depression (and suicide risk) screen to appropriate treatment (ie, medication, therapy) in the Fiscal Year 2019-2323. We will also examine the changing mix of virtual and in-person depression care delivered. Second, we will use interrupted time series analyses to explore the extent to which psychiatric emergency visits and hospitalisations may be mitigated by clinician detection of depression. As well as compare mental health-related mortality rates between patients detected and not detected to have depression. Subanalyses will reveal where (eg, clinics with low PCMHI access) and for whom (eg, minorities) detection does not systematically occur, and downstream negative sequelae, to guide future intervention. Finally, we will interview 40 veterans, half of whom were detected and half not detected to have depression and 40 VA primary care and PCMHI providers about changes brought on by the pandemic and the expansion of virtual care across three VA facilities. In addition to contextualising disrupted care findings, qualitative data will help identify best practices on patient-to-provider and provider-to-provider interactions in hybrid in-person/telehealth depression care models. ETHICS AND DISSEMINATION: Ethics approval was granted by the VA Greater Los Angeles Healthcare System Institutional Review Board. Alongside journal publications, dissemination activities include briefings to our policy and operational partners, and presentations to clinical, research and policy-oriented audiences.

INTRODUCTION: Integrated youth services (IYS) presents a unique opportunity to adopt social prescribing (SP) strategies within the IYS service model by developing and leveraging a highly connected multidisciplinary network of clinical and community-based service providers to tackle health inequities and enhance service access and outcomes for youth. This paper outlines a case study of Youth Wellness Hubs Ontario (YWHO), Canada, a collective of youth-serving organizations integrated and networked, and operating as a learning health system implementing SP services. The main study objective was to document how YWHO hubs engage in social prescribing through service provision. METHODS: We adopted an embedded case study approach. Data were collected from youth (n = 6361) aged between 12 and 25 years who were seeking services at a YWHO hub. Descriptive analyses, including frequencies across categories, were generated from service data, including reason for visit, needs addressed and service provided. RESULTS: A comparative analysis of services requested and provided found that youth across visits to YWHO hubs were engaging with multiple services and service providers, with a wide range of health, mental health and social support needs being addressed. CONCLUSION: YWHO implements SP services that aim to improve mental health resilience by supporting the vocational, educational and socialization needs of young people accessing IYS through YWHO hubs.; IYS exemplifies an innovative approach to SP through the development of a closely connected network of interdisciplinary service providers. Youth engaged in IYS are likely to connect with multiple services concurrently as biopsychosocial needs are identified and addressed. The most common services provided by YWHO address mental health, educational and relationships needs, and are provided by mental health workers, care navigators and education or training support workers.; eng

: Health care teams are constructive and efficient ways to approach, assess, coordinate, plan, and facilitate the client-centric and population-based care. Some iteration of team is in place across most practice settings, comprising different professionals and specialists, from multidisciplinary, interdisciplinary, and transdisciplinary to the most recent interprofessional model. This 2-part article series sets the tone for how interprofessional team-based care (IPTBC) empowers the care process. Part 1 focused on the history and fundamental concepts of interprofessional models, with outcomes to promote the value proposition for IPTBC implementation.This Part 2 article focuses on the identification of seminal group development and team processes. An original model, the Interprofessional Team Activation Cycle (ITAC), is presented, as well as defined tactics for professional case managers to promote successful implementation of IPTBC in their organizations. PURPOSE/OBJECTIVES: This article: PRIMARY PRACTICE SETTING(S):: Applicable to all health and behavioral health settings where case management is practiced. FINDINGS/CONCLUSIONS: Shifts in reimbursement models, organizational cultures, and client populations have yielded emphasis on the swift IPTBC implementation. In addition, the recognition of team development as a fluid process endemic to achieve client-centric outcomes and organizational return on investment mandates a keen eye to the phases of a team implementation, especially those that are interprofessional in scope. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: With case management so closely linked to the fiscal imperatives of organizations, engagement in IPTBC is a necessity for every practice setting yet not always implemented properly or successfully. Poor team collaboration contributes to unsuccessful outcomes for clients, increased costs, and concerning quality and risk management issues for the organization. Models focused on group development serve to support how health and behavioral health organizations consider and implement interprofessional teams.

Background: Screening for unhealthy drug use is now recommended for adult primary care patients, but primary care providers (PCPs) generally lack the time and knowledge required to screen and deliver an intervention during the medical visit. To address these barriers, we developed a tablet computer-based 'Substance Use Screening and Intervention Tool (SUSIT)'. Using the SUSIT, patients self-administer screening questionnaires prior to the medical visit, and results are presented to the PCP at the point of care, paired with clinical decision support (CDS) that guides them in providing a brief intervention (BI) for unhealthy drug use. Methods: PCPs and their patients with moderate-risk drug use were recruited from primary care and HIV clinics. A pre-post design compared a control 'screening only' (SO) period to an intervention 'SUSIT' period. Unique patients were enrolled in each period. In both conditions, patients completed screening and identified their drug of most concern (DOMC) before the visit, and completed a questionnaire about BI delivery by the PCP after the visit. In the SUSIT condition only, PCPs received the tablet with the patient's screening results and CDS. Multilevel models with random intercepts and patients nested within PCPs examined the effect of the SUSIT intervention on PCP delivery of BI. Results: 20 PCPs and 79 patients (42 SO, 37 SUSIT) participated. Most patients had moderate-risk marijuana use (92.4%), and selected marijuana as the DOMC (68.4%). Moderate-risk use of drugs other than marijuana included cocaine (15.2%), hallucinogens (12.7%), and sedatives (12.7%). Compared to the SO condition, patients in SUSIT had higher odds of receiving any BI for drug use, with an adjusted odds ratio of 11.59 (95% confidence interval: 3.39, 39.25), and received more elements of BI for drug use. Conclusions: The SUSIT significantly increased delivery of BI for drug use by PCPs during routine primary care encounters.