Literature Collection

INTRODUCTION: Chronic constipation (CC) is a common gastrointestinal disorder with limited treatment options. Linaclotide is a potent peptide agonist of the guanylate cyclase-C receptor. This action activates intracellular conversion of guanosine 5-triphosphate to cyclic guanosine monophosphate resulting in the stimulation of intestinal fluid secretion. Linaclotide is a promising new agent for refractory constipation. Areas covered: All published articles regarding the development, clinical efficacy, and safety of linaclotide in treating CC were reviewed. Pharmacodynamics, pharmacokinetics, and metabolism of this secretagogue agent were examined. Clinical studies showed that linaclotide increases the number of spontaneous bowel movements and stool consistency scores. Overall, patients reported relief from abdominal discomfort and severity of constipation. Finally, linaclotide has a good safety profile, with diarrhea being the main side effect. Expert opinion: Linaclotide appears to be a well-tolerated and effective agent for patients with CC, and could be effectively combined with other drugs in patients with refractory constipation. However, data on the efficacy and safety of linaclotide in pediatric patients and in opioid-induced constipation are currently limited and more studies need to be undertaken.

INTRODUCTION: Sexual and reproductive health (SRH) is a critical component of overall well-being, yet individuals with substance use disorder (SUD) often face significant barriers to accessing SRH services-and vice versa. SRH settings offer important opportunities to identify and address SUD needs through screening and referral, whereas SUD treatment settings can serve as key access points for SRH care. The Link Study was developed as a cross-training intervention to strengthen collaboration and care coordination between SRH and SUD providers. METHODS: We designed a curriculum covering core elements of SRH and SUD care, emphasizing person-centered practices, trauma-informed approaches, and evidence-based screening and referral tools. Thirty-five providers from three SRH and SUD site pairs participated. Evaluation included pre- and post-training knowledge surveys, site-level screening and referral data, and provider focus groups. We used confidence intervals to assess changes in quantitative outcomes and conducted thematic analysis of qualitative data. RESULTS: Providers demonstrated consistent increases in self-reported knowledge across key domains. Two of the three SRH and SUD sites showed statistically significant improvements in screening practices. Although referral rates did not change significantly, sites reported meaningful updates to workflows, tools, and policies to support integration. All sites sustained cross-sector provider relationships for at least 6 months post-training. DISCUSSION: The Link Study showed promising gains in provider knowledge, improvements in screening practices, and lasting collaboration across SRH and SUD service sectors. Findings highlight the potential of cross-disciplinary training and technical assistance to build integrated care pathways and strengthen community-based health systems.

OBJECTIVE: To evaluate the impact of a digital platform that connects primary care providers and commercially insured adults to outpatient behavioral health services on behavioral health utilization and total medical costs. STUDY DESIGN: A matched difference-in-differences approach was used to assess the effects of the intervention. Data were obtained from administrative medical claims for commercially insured adults. METHODS: The intervention group consisted of members assigned to 735 practices that adopted the platform, and the comparison group included members from 516 practices that did not. Propensity score matching was employed to balance baseline characteristics, and doubly robust difference-in-differences analysis was applied to estimate the intervention's effects on outpatient behavioral health visits, emergency department (ED) visits, inpatient admissions, and total medical costs over 18 months. RESULTS: The intervention group had a 68% higher likelihood of receiving outpatient behavioral health services. They were 35% less likely to have a behavioral health-related ED visit and 43% less likely to be admitted for behavioral health-related inpatient care. Despite increased outpatient utilization, total medical costs were significantly lower in the intervention group (-$27.63 per member per month at 18 months post intervention). CONCLUSIONS: Connecting commercially insured adults to outpatient behavioral health services via a digital platform improves utilization of behavioral health care while reducing costly emergency and inpatient services. These findings suggest that enhancing access to outpatient behavioral health services can lead to better health outcomes and greater cost efficiency in managed care populations.