Literature Collection

IMPORTANCE: Emerging evidence suggests that integrated care models are associated with improved mental health care access and outcomes for youths (children ≤12 years and adolescents 12-21 years) served in pediatric primary care settings. However, the key components of these complex models remain unexamined. OBJECTIVE: To identify and describe the key components of effective pediatric integrated mental health care models. EVIDENCE REVIEW: The PubMed, Embase, PsycINFO, and Cochrane Controlled Register of Trials electronic databases were searched for relevant peer-reviewed articles published between January 1, 1985, and April 30, 2019. Articles were restricted to those published in the English language. Eligible articles reported original data on youths 17 years or younger, implemented an integrated mental health care model in a pediatric primary care setting, and assessed the model's association with primary outcomes (eg, mental health symptom severity) and secondary outcomes (eg, functional impairment and patient satisfaction). Articles that specified some degree of systematic coordination or collaboration between primary care and mental health professionals were included in the final review. Two independent reviewers extracted data on study design, model type, model components, level of integration, and outcomes. Study quality was assessed using the Jadad scale. Data were analyzed between January 1, 2018, and May 31, 2019. FINDINGS: Eleven randomized clinical trials involving 2190 participants were included. Three studies focused on youths with depression, 3 on youths with attention-deficit/hyperactivity disorder, and 5 on youths with behavioral disorders. Most studies (9 of 11) implemented either the collaborative care model (n = 3), a slightly modified version of the collaborative care model (n = 2), or colocated care (n = 4). The most commonly reported components of effective pediatric integrated mental health care models were population-based care, measurement-based care, and delivery of evidence-based mental health services; all 3 components were present in studies reporting clinical improvement of mental health symptoms. Other model components, such as treatment-to-target or team-based care, were common in studies reporting specific outcomes, such as functional impairment. CONCLUSIONS AND RELEVANCE: This review is the first to date to systematically search and qualitatively synthesize information on the key components of effective pediatric integrated mental health care models. This knowledge may be especially useful for pediatric primary care administrators in the selection of an integrated care model for their setting.

OBJECTIVES: The demand for home care services has increased with the growth of the older population. Currently, home care workers (HCWs) are experiencing challenges such as poor working conditions, high turnover, fragmented services and dissatisfied clients, which are indicative of limitations on HCWs' ability to provide quality integrated home care to older people. Therefore, we conducted a scoping review to identify the key elements that affect the capabilities of the HCWs in providing quality integrated care to older people in their homes. DESIGN: Scoping review. DATA SOURCES: PubMed, PsycINFO, Scopus, CINAHL, Cochrane, Analysis & Policy Observatory, Australian Association of Gerontology (Australia), WHO, Trove (Australia), Social Care Online (UK) and Google between January 2014 and August 2025. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies were included if they focused on the analysis of HCWs' experience in providing care to older people within home settings and were published in the English language between January 2014 and August 2025. RESULTS: 19 studies met the inclusion criteria out of 2844 retrieved articles. Most studies were conducted in North America (n=8). Qualitative studies were the most commonly reported (n=16). The findings of the studies were combined and categorised into four themes using a narrative synthesis approach. The four themes identified were HCWs' capability through (1) collaborative practice, (2) education and training, (3) structural conditions at work and (4) personal attributes. CONCLUSION: This scoping review on home care for older people highlights four interconnected pillars that shape HCWs' capabilities. This review provides valuable insights to inform the standards and policies to strengthen HCWs' capabilities across these domains. Future study is needed to explore the measures taken by agencies to understand and address key elements of HCWs' capability.

OBJECTIVES: Many patients with major depressive disorder must try multiple antidepressants before they identify a drug that is both effective and tolerable. Pharmacogenomic (PGx) testing may provide clinicians with guidance around medication choice based on a patient's drug response-related genetic variants. However, this technology is not routinely used in clinical care in Canada, and the views of key actors in the implementation process are largely unknown. The objective of this study was to qualitatively elicit the perspectives and attitudes of clinicians, scientists, policy actors and members of industry about PGx testing to guide antidepressant prescribing in primary care via interviews to help inform implementation policies for this technology. DESIGN: We conducted a qualitative description study. Data analysis proceeded in parallel with data collection and consisted of an inductive qualitative content analysis. SETTING: The focus of this study was implementation of PGx testing in primary care in Ontario, Canada. PARTICIPANTS: We conducted semistructured interviews with 28 individuals who had professional experience relevant to the implementation of PGx testing for depression care ('key informants'). Geographical limits for recruitment were applied based on the transferability of key informants' expertise to the Ontario setting; included participants worked in Canada, the USA and Europe. RESULTS: Participants described views about PGx testing relating to benefits and harms of this technology; their interpretation of the evidence base; implementation-oriented considerations and industry involvement. Overall, participants spoke enthusiastically about PGx testing, but emphasised genetic information is only one component of decision-making about medication prescription. Most endorsed implementation in primary care and felt a pre-emptive approach to testing would be ideal. CONCLUSIONS: Key informants consider the use of PGx testing to guide antidepressant prescribing in primary care as having both patient-level and system-level benefits. Concerns raised centred primarily around clinician education and barriers to access. Future research should focus on questions relating to feasibility of system-wide implementation.

INTRODUCTION: Standardized screening, objective evaluation, and management of behavioral health conditions are major challenges in primary care. The Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire (PHQ-9), and Mood Disorder Questionnaire (MDQ) provide standardized screening and symptom management tools for generalized anxiety disorder (GAD), major depressive disorder (MDD), and Mood Disorders (MD), respectively. This study explores family physicians' knowledge, attitudes, and practices regarding the utilization of GAD-7, PHQ-9, and MDQ in outpatient primary care offices. METHODS: The study method was a cross-sectional electronic and paper survey utilizing a self-administered questionnaire that assessed primary care physicians' demographics, knowledge, attitudes, and practices in rural and urban outpatient clinical settings regarding GAD-7, PHQ-9, and MDQ. Statistical software SAS 9.4 was used for descriptive and Chi-Square statistics. RESULTS: Out of 320 total participants,145 responded (45.3%). Responding family physicians demonstrated a high level of familiarity with the GAD-7 (97.9%), PHQ-9 (97.9%), and MDQ (81.3%) assessment tools. However, the reported utilization rates were relatively lower than knowledge, with 62.7%, 73.1%, and 31.9% extremely likely or likely to utilize the GAD-7, PHQ-9, and MDQ as screening and monitoring tools, respectively. Less than a quarter of the total respondents use the objective score for the future management of GAD, with significantly more residents utilizing the score for GAD-7 compared to attendings (P < .05). There was no statistical significance difference between residents and attendings for the objective evaluation of Major Depressive Disorder (P = .26) and Mood Disorders (P = .05). CONCLUSIONS: Despite being knowledgeable of the utility of GAD-7, PHQ-9, and MDQ, the primary care physicians in a large integrated health system in Central Pennsylvania and Northern Maryland report inconsistent utilization in their practice. Further studies are needed to determine the underlying factors contributing to the suboptimal usage of these screening tools and ways to increase it.