Literature Collection

This case study explores the role that pharmacists can have managing resistant hypertension (RH) in rural Appalachian veterans, where health care access is limited. RH, defined as blood pressure above target despite adherence to multiple antihypertensive medications, presents challenges in chronic disease management. The Department of Veterans Affairs (VA) has integrated CPPs to improve medication adherence, reduce hospitalizations, and enhance blood pressure control, particularly in underserved areas. The patient, a 65-year-old male veteran with hypertension, obstructive sleep apnea, depression, and PTSD, had struggled with poorly controlled hypertension for years, experiencing adverse reactions to multiple antihypertensive medications. Living more than 60 minutes from the nearest VA facility, he had not seen his primary care provider since early 2021, exacerbating his condition. Despite initial reluctance to restart medications, the CPP implemented a stepwise management approach, utilizing telehealth for remote blood pressure monitoring and regular follow-ups. Over several months, pharmacologic therapy combined with lifestyle modifications led to significant blood pressure improvement. This case highlights the crucial role of CPPs in rural health care, offering accessible, continuous care and personalized management of complex conditions. Telehealth and remote monitoring further facilitated care, overcoming geographic barriers and enhancing patient engagement. The collaboration between pharmacists and specialists ensured comprehensive care and optimized treatment. This case demonstrates the potential for expanding CPP roles in rural areas to improve chronic disease management, reduce health care disparities, and enhance patient outcomes through telehealth and team-based care.

Drawing upon a longitudinal survey of clinicians who treat patients with opioid use disorder (OUD), we report changes over time in telemedicine use, clinicians' attitudes, and digital equity strategies. Clinicians reported less use of telemedicine (both video and audio-only) in 2022 than in 2020. In March 2022, 77.0 percent of clinician respondents reported implementing digital equity strategies to help patients overcome barriers to video visits.

PURPOSE: Strengthening primary care's integration function is a systematic approach to promote integrated care. Understanding the factors influencing the process of integrating care for every patient is crucial for effective intervention planning. The objective of this study was to generate an analytic framework and evidence map of the barriers and facilitators perceived by family physicians (FPs) in clinical integration, a process to coordinate health care services across time, place, discipline, diseases, and patient demographics. METHODS: Using the Joanna Briggs Institute umbrella review methodology, we searched the MEDLINE, Embase, and CINAHL databases, identifying 90 reviews (2010-2022) on primary care FPs and clinical integration. We adopted a best-fit framework approach to group the factors into a customized clinical integration framework, reflecting how a health care system functions. Two evidence maps were created to visualize the reviews' distribution. We validated the framework with another 21 reviews (2022-2024). RESULTS: The analytic framework consisted of 9 themes and 21 subthemes based on 2,891 factors derived from external and internal sources within primary care practices. Several subthemes were common across themes related to individuals (FPs, physicians other than family physicians and allied health providers, patients) and operating units (systems, organizations, practices), highlighting shared elements. The professional theme was the most significant, appearing in 86% of the reviews and including subthemes related to diseases, clinical guidelines, and teamwork. In contrast, themes related to systems, organizations, and practices were reported less frequently (48%, 22%, and 23%). CONCLUSION: The complex interactions among factors, subthemes, and themes elucidate challenges in finding a universal strategy or implementing initiatives. The generated evidence maps indicated knowledge gaps to guide future research work.