Literature Collection

Integrated systems of care are increasingly seen as the means to bridge gaps between organisations, services and professions, increase quality, and decrease costly duplication across the health and care landscape. Integration and integrated health and care teams, composed of locality-oriented health and social care practitioners, have become central to global health policies. Integrated teams are expected to share distinct bodies of knowledge, evidence and expertise and use this to create holistic care plans. However, little research has examined how they achieve these knowledge-related goals. This research uses organisational knowledge creation theory to examine the discursive practices within integrated teams. Observational data from case management meetings across five integrated teams highlight four key themes: (1) Instrumental questioning dominated discussions, often making participants feel criticised and leading to the imposition of questioners' opinions. (2) Interactions were typically unstructured and unreflective, hindering clear objectives and limiting knowledge sharing and creation. (3) Teams often failed to retain and apply prior learning, struggling to identify cross-case insights. (4) Teams relied heavily on internal knowledge sources, rarely seeking evidence from patients, families or other professionals. These discursive practices undermine the policy goals of integrated care, particularly with regard to knowledge and evidence. To address this, teams need support to expand the forms of knowledge and evidence they draw upon, discuss contradictions and uncertainties, and value reflective, curiosity-driven dialogue.

BACKGROUND: Clinicians are the interface between artificial intelligence (AI) applications and patient care. To maximize benefits and minimize risks of AI, clinicians must be "AI-ready"-that is, willing and able to understand, evaluate, and appropriately use AI tools in practice. Prior literature suggests that clinicians lack fundamental competencies in the use of AI. These gaps could be especially problematic in primary care, given its broad reach into patient care. We surveyed primary care providers (PCPs) in the United States' largest integrated health care system, relatively early in its widespread implementation of clinical AI for frontline use, in order to identify readiness gaps that may warrant particular attention as part of a comprehensive AI implementation strategy. OBJECTIVE: The aim of this study was to characterize PCPs' use, knowledge, attitudes, and training priorities related to AI in order to inform health system AI implementation efforts. METHODS: We conducted a national cross-sectional survey of United States Veterans Health Administration (VA) PCPs in October 2025, assessing AI use, self-reported knowledge, attitudes, and training experience. Descriptive analyses summarized responses with exploratory bivariate comparisons across clinician subgroups. Conventional content analysis with inductive coding was used to characterize open-ended responses providing a definition of AI. RESULTS: Among 170 respondents (170/989, 17.2% response rate), 66.5% (113/170) reported current AI use, most commonly generative AI and decision support tools. Overall attitudes toward AI were positive, with 70.6% (120/170) mostly enthusiastic or more enthusiastic than apprehensive. Confidence in understanding sources of AI bias (62/170, 36.5%) and ethical issues (81/170, 47.6%) was limited. When asked to define AI, very few respondents provided an accurate technical definition. Key concerns about use of AI included accountability, accuracy, and transparency. Though 88.2% (150/170) identified AI training as a priority, only 26.5% (45/170) had any training. Training experiences ranged widely in source, focus, and structure. CONCLUSIONS: PCPs are eager to harness AI's practical advantages but lack foundational competencies to do so in ways that maximize benefit and minimize risk. Our findings highlight a need for targeted education that prioritizes critical appraisal, workflow integration, and risk mitigation, supported by governance that addresses clinicians' concerns and validated measures to evaluate progress toward an AI-ready workforce. These steps can empower PCPs to leverage AI safely and effectively and strengthen the quality and safety of primary care delivery at scale.

BACKGROUND: Opioid overdoses have continued to increase at higher rates among Black Americans compared to people from other racial groups. Despite demonstrated effectiveness of MOUD in reducing risk of opioid overdose, Black Americans face decreased access to and uptake of MOUD. The current study aimed to examine the knowledge, perceptions, and experiences with MOUD among a sample of Black adults who use prescription opioids nonmedically in order to inform tailored efforts to improve MOUD uptake. METHODS: Data were derived from a larger study assessing cultural and structural influences on drug use and drug treatment among people who use prescription opioids nonmedically. Semi-structured qualitative interviews were conducted with 34 Black men and women across four generational cohorts: born 1955-1969; 1970-1979; 1980-1994; and 1995-2001. Participant responses were analyzed using thematic analysis. RESULTS: Nearly half of participants (44.1%) reported no knowledge or experience with MOUD. Among participants who had any knowledge about MOUD, four major themes regarding their perceptions emerged: MOUD Helps with Recovery; Not Needed for Level of Drug Use; Side Effects and Withdrawal; Equivalence with Illicit Drug Use. The majority reported negative perceptions of MOUD (52.6%), and the youngest cohort (born 1995-2001) had a higher proportion of negative perceptions (80%) relative to other age cohorts (born 1980-1994: 50%; 1970-1979: 75%; 1955-1969: 16.6%). DISCUSSION: Findings indicate a significant knowledge gap and clear points of intervention for improving MOUD uptake. Interventions to improve communication of health information in ways that are culturally relevant and tailored by age group can be used in conjunction with efforts to improve MOUD access among Black individuals who use opioids nonmedically.; Half of our sample of Black Americans who use opioids nonmedically had no knowledge of medications for opioid use disorder (MOUD).For those who knew about MOUD, most reported negative perceptions, including concerns about side effects of using MOUD and believing MOUD is equivalent to illicit drug use.The youngest age group endorsed the highest rates of negative perceptions relative to older age cohorts, indicating a need for intervention approaches tailored by age group.; eng

OBJECTIVE: Implementation facilitation is an effective strategy that increases uptake of behavioral health interventions. Facilitation is grounded in partnerships with leadership and clinical stakeholders. Researchers have documented some negative consequences of facilitation-time, financial, and opportunity costs. Clinical leaders often agree to facilitation with the promise of increased implementation of an intervention. This study examined whether unintended positive consequences of facilitation might offset known costs. METHODS: This study was part of a stepped-wedge, hybrid type 2, pragmatic trial that used implementation facilitation to implement primary care mental health integration (PCMHI) via telehealth technology in six satellite Veterans Health Administration (VHA) clinics. Two facilitators provided facilitation for at least 6 months. This study included a focused analysis of an emerging phenomenon captured through weekly debriefing interviews with facilitators: unintended positive consequences of implementation facilitation, termed "lagniappes" here. A rapid content analysis was conducted to identify and categorize these consequences. RESULTS: The authors documented unintended positive consequences of the facilitation across the six VHA sites and categorized them into three clinically relevant domains: supporting PCMHI outreach at other clinics not in the original catchment area (e.g., providing tools to other sites), strengthening patient access (e.g., resolving unnecessary patient travel), and improving or modifying work processes (e.g., clarifying suicide assessment protocols). The positive consequences benefited sites and strengthened ongoing partnerships. CONCLUSIONS: Documenting unintended positive consequences of implementation facilitation may increase leadership engagement. Facilitators should consider leveraging unintended positive consequences as advantages for the site that may add efficiency to facility processes and workflows.

BACKGROUND: Language access is a system-level component of behavioral health service delivery for individuals with limited English proficiency. In behavioral health settings, where care depends on accurate communication, trust, confidentiality, and continuity, gaps in interpreter access, language-concordant communication, translated materials, and referral support may affect how Spanish-speaking adults enter, navigate, and remain connected to care. Limited evidence describes how these barriers recur across multiple behavioral health service settings. METHODS: This systems-level, multi-setting qualitative health services study examined language access barriers related to behavioral health service access and continuity among Spanish-speaking adults in San Bernardino County, California. Eighteen behavioral health stakeholders from six organizations completed semi-structured interviews across hospital-based behavioral health, crisis stabilization, outpatient behavioral health, and long-term care/community-based settings. Interviews focused on interpreter availability, documentation of preferred language, referral and follow-up processes, scheduling, discharge communication, telehealth, and cross-setting coordination. Data were documented through structured contemporaneous notes and analyzed using qualitative descriptive content analysis. RESULTS: Seven recurrent categories of language access barriers were identified: interpreter availability and modality; navigation and follow-through; staffing and training capacity; capacity, scheduling, and wait times; technology and telehealth; community partnerships and coordination; and stigma, trust, and privacy. Participants described delayed or inconsistent interpreter access, reliance on ad hoc communication strategies, limited Spanish-language materials, fragmented referral and follow-up processes, lack of bilingual navigation support, and telehealth workflows that did not consistently account for language needs. Barriers differed more by service setting and workflow point than by professional role. Hospital-based and crisis settings emphasized time-sensitive interpreter access and discharge communication, while outpatient and community-based settings emphasized scheduling, follow-up, telehealth support, and sustained navigation. CONCLUSIONS: Language access barriers in behavioral health care extend beyond individual clinical encounters and appear across referral, scheduling, discharge, follow-up, telehealth, and cross-setting coordination processes. Findings suggest that language access should be treated as a system-level component of behavioral health service design. Improving access and continuity for Spanish-speaking adults requires coordinated approaches integrating qualified interpreter access, bilingual navigation, workforce training, Spanish-language materials, telehealth support, and standardized referral workflows. TRIAL REGISTRATION: Not applicable.