Literature Collection

INTRODUCTION: The profession of pharmacy has been continuously evolving, redefining scope of practice in every practice settings to meet the ongoing needs of the health care system and to meet patient expectations and need. Pharmacists are increasingly becoming part of primary care teams in countries such as Canada, the United Kingdom and Australia. In British Columbia, Canada, the Pharmacists in Primary Care Network (PCN) Program integrated primary care clinical pharmacists (PCCPs) as core members of the interprofessional team (IPT). The IPT members' experiences of collaborating with a pharmacist in a team-based primary care setting have not been extensively studied. AIM: To describe the experiences of IPT members and PCCPs while working collaboratively for the shared care of mutual patients to identify the enablers, barriers, and development of interprofessional collaborations within the primary care setting in a province-wide program. METHOD: Based upon the evaluation of the Pharmacists in the PCN Program, this work was informed by Qualitative Description methodology. Interview and focus group data were performed during two time periods (T1 and T2) of program implementation. Study participants included PCCPs, prescribers (family physicians and nurse practitioners), and PCN IPT members (social workers, dieticians, physiotherapists, and clinical counsellors). Each participant was invited via e-mail to attend a Zoom interview or focus group session. RESULTS: In T1 we interviewed 15 PCCPs and in T2, we interviewed 39 PCCPs, 12 IPT members and 11 prescribers. Data analysis developed four themes: (i) awareness shaping early acceptance and role clarity; (ii) deepening interprofessional collaboration over time; (iii) communication strategies which facilitated relationship building with the PCN providers; and (iv) impact of the co-location model on teamwork and improved care coordination. CONCLUSION: The interprofessional collaboration between PCCPs, prescribers, and IPT members was strengthened through efforts of relationship building, improved role clarity, and easily accessible communication methods. The PCN teams addressed the initial integration challenges and provided the support for effective shared patient care.

OBJECTIVE: The Children's Depression Rating Scale-Revised (CDRS-R) is widely used in clinical research to assess depression in adolescents; however, limited research explores its measurement properties. This study aimed to test the interrater reliability of the CDRS-R and describe the corresponding measurement error. METHOD: A cross-sectional design was used in the context of a controlled clinical trial. The sample consisted of help-seeking adolescents (N = 55, ages 13-18 years, inclusive) experiencing depressive symptoms. A research analyst administered and coded the CDRS-R to adolescents through a virtual video-based platform with audio and video recordings. A second research analyst independently watched and coded recordings. The lower bound of the 95% CI of the intraclass correlation coefficient with respect to absolute agreement between 2 independent raters was hypothesized to be ≥0.70. RESULTS: The reliability of CDRS-R was calculated as an intraclass correlation coefficient of 0.84 (95% CI 0.71 to 0.91), indicating acceptable reliability. The associated standard error of measurement was 4.67, and the mean difference in scores between raters was 1.13. The limits of agreement were -11.59 to 13.84. CONCLUSION: The findings provide support for the CDRS-R as a tool with adequate interrater reliability to assess depressive symptoms in adolescents. The measurement error parameters can assist in clinical interpretation of differences in scores when adolescents are assessed by multiple raters. CLINICAL TRIAL REGISTRATION INFORMATION: Effectiveness of an Integrated Care Pathway for Depression: Cluster Randomized Controlled Trial (CARIBOU-2); https://clinicaltrials.gov/study/NCT05142683.; This study evaluated the reliability of the Childhood Depression Rating Scale-Revised (CDRS-R), a common interview tool used to assess depression among youth. Researchers found strong agreement among different raters, with a high statistical reliability score of 0.84. These results suggest that the CDRS-R is a consistently reliable assessment tool.; eng

INTRODUCTION: Medications for opioid use disorder (MOUD) are evidence-based treatments, yet can be controversial among some populations. This study provides a systematic review of prejudice and discrimination toward MOUD, a form of "intervention stigma," or stigma associated with a particular medical treatment. METHODS: A systematic search strategy was used in PsychInfo and PubMed to identify studies published between 1998 and 2018. Studies that empirically examined stigma toward MOUD were included if the manuscript was of moderate or high quality. Studies were analyzed using thematic synthesis. RESULTS: The search yielded 972 studies, of which 28 were included. Most studies utilized qualitative methods to examine intervention stigma toward methadone or buprenorphine, with one including naltrexone. Studies demonstrated that intervention stigma among healthcare providers was influenced by lack of training and abstinent treatment preferences. Providers equated MOUD with illicit substance use and at times refused to care for MOUD patients. Stigma among peer patients seeking treatment was also influenced by abstinent treatment preferences, and among the general public stigma was influenced by lack of MOUD knowledge. Intervention stigma was also driven at the policy level by high regulation of methadone, which fueled diversion and hindered social functioning among patients. Few studies indicated how to reduce intervention stigma toward MOUD. CONCLUSIONS: Intervention stigma affects both provision and perceptions of methadone and buprenorphine, decreasing access and utilization of MOUD. Future research should further develop and test MOUD stigma reduction interventions in a variety of social contexts to improve access to care and reduce patient barriers.

BACKGROUND: This proof-of-concept study tested the feasibility and acceptability of INTEGRATE-D, an implementation support intervention for primary care clinics to improve the psychosocial care of patients with type 2 diabetes. METHODS: Cluster randomized controlled pragmatic trial, with a parallel, convergent mixed methods design. Two Intervention Clinics (ICs) were offered tailored training on American Diabetes Association (ADA)-recommended psychosocial care and facilitation to identify and support clinical change. Two Control Clinics (CCs) received no intervention. PRIMARY OUTCOMES: intervention acceptability, appropriateness and feasibility. SECONDARY OUTCOMES: process-of-care metrics (eg, depression screening, diabetes management) and clinical outcomes measures (PHQ-9 and A1C). Qualitative data were collected to assess implementation and experience with the intervention. RESULTS: ICs were offered training and received 15-months of facilitation. To accommodate COVID-19-related safety restrictions, the intervention was changed to be delivered virtually (eg, remote facilitation and training sessions). Despite an adapted delivery and COVID-19 and staffing stressors, clinics exposed to INTEGRATE-D found it to be acceptable, well-aligned with clinics' needs, and feasible. Qualitative data suggest COVID-19 stressors tempered feasibility. The effect of INTEGRATE-D on process and clinical outcome measures were mixed. Several factors, including differences in ICs and CCs not addressed in randomization and delivery of a less intensive intervention due to the pandemic, may help explain these results. CONCLUSIONS: Given the growing number of people with type 2 diabetes and the importance of psychosocial care for these patients, INTEGRATE-D warrants further pilot-testing with a larger sample of clinics and patients, and under conditions where in-person facilitation and expanded training is possible.

Background: Concurrent with the opioid overdose crisis there has been an increase in hospitalizations among people with opioid use disorder (OUD), with one in ten hospitalized medical or surgical patients having comorbid opioid-related diagnoses. We sought to conduct a systematic review of hospital-based interventions, their staffing composition, and their impact on outcomes for patients with OUD hospitalized for medical or surgical conditions. Methods: Authors searched PubMed MEDLINE, PsychINFO, and CINAHL from January 2015 through October 2020. The authors screened 463 titles and abstracts for inclusion and reviewed 96 full-text studies. Seventeen articles met inclusion criteria. Extracted were study characteristics, outcomes, and intervention components. Methodological quality was evaluated using the Methodological Quality Rating Scale. Results: Ten of the 17 included studies were controlled retrospective cohort studies, five were uncontrolled retrospective studies, one was a prospective quasi-experimental evaluation, and one was a secondary analysis of a completed randomized clinical trial. Intervention components and outcomes varied across studies. Outcomes included in-hospital initiation and post-discharge connection to medication for OUD, healthcare utilization, and discharge against medical advice. Results were mixed regarding the impact of existing interventions on outcomes. Most studies focused on linkage to medication for OUD during hospitalization and connection to post-discharge OUD care. Conclusions: Given that many individuals with OUD require hospitalization, there is a need for OUD-related interventions for this patient population. Interventions with the best evidence of efficacy facilitated connection to post-discharge OUD care and employed an Addiction Medicine Consult model.

Mental health and substance use disorders can negatively affect physical health, illness management, care access, and quality of life. These behavioral health conditions are prevalent and undertreated among people with HIV and may worsen outcomes along the entire HIV Care Continuum. This narrative review of tested interventions for integrating care for HIV and behavioral health disorders summarizes and contextualizes findings from systematic reviews and meta-analyses conducted in the past decade. We sought to identify gaps in research that hinder implementing evidence-based integrated care approaches. Using terms from the Substance Abuse and Mental Health Services Administration-Health Resources & Services Administration standard framework for integrated health care, we searched PubMed and PsycInfo to identify peer-reviewed systematic reviews or meta-analyses of intervention studies to integrate behavioral health and HIV published between 2010 and 2020. Among 23 studies identified, only reviews and meta-analyses that described interventions from the United States designed to integrate BH services into HIV settings for adults were retained, leaving six studies for narrative review by the study team. Demonstrated benefits from the relatively small literature on integrated care interventions include improved patient- and service-level outcomes, particularly for in-person case management and outreach interventions. Needed are systems-level integration interventions with assessments of long-term outcomes on behavioral health symptoms, HIV viral suppression, HIV transmission rates, and mortality. HIV, primary care, and other providers must include behavioral health as a part of overall healthcare and must play a central role in behavioral health care delivery. Research is needed to guide their way.