Literature Collection

The Military Health System (MHS) is a global, integrated health delivery system tasked with ensuring the medical readiness of the U.S. Armed Forces while fulfilling the individual health care needs of eligible military personnel and their dependents. The MHS network comprises military hospitals and clinics that ensure the medical readiness of the force, which are complemented by programs that enable beneficiary care in the private sector through the TRICARE insurance program. Mental health disorders accounted for the largest proportions of the morbidity and health care burdens that affected the pediatric and younger adult beneficiary age groups of nonservice member beneficiaries of the Military Health System in 2023. Among adults aged 45-64 years and adults aged 65 years and older, musculoskeletal diseases accounted for the most morbidity and health care burdens. With almost all health care for Medicare-eligible beneficiaries aged 65 years and older at private sector medical facilities, over 91% of health care encounters among non-service member beneficiaries (TRICARE-eligible and Medicare-eligible) occurred at non-military medical facilities.

BACKGROUND AND OBJECTIVES: Adolescent strengths and risks are not routinely captured in systematized and actionable ways in pediatric primary care. To address this problem, we developed a comprehensive adolescent health questionnaire (AHQ) integrated within the electronic health record and evaluated the AHQ's impact on collection of information on prioritized health-related domains. METHODS: We developed and pilot tested the AHQ. We then scaled and assessed the AHQ's impact on data collection. AHQ development used innovation methods and measured feasibility and acceptability outcomes. Scaling and postscaling outcomes included Reach, Effectiveness, Adoption, Implementation, Maintenance and Sustainability measures: Reach (total questionnaires completed), Effectiveness (capture of key information across health domains pre- vs post-AHQ scaling), Adoption (proportion of practices that adopted the AHQ), Implementation (proportion of eligible adolescents who completed the AHQ), and Maintenance (monthly completion rates). RESULTS: AHQ development led to a tool that was feasible and acceptable for use. During scaling (October 2020-December 2021), 22 147 questionnaires were completed by 20 749 unique adolescents aged 13 to 21 years at their preventive visit. Comparing pre- versus post-AHQ scaling data, use of the AHQ increased collection of information across domains, especially for strengths, gun safety, substance use, sexual activity, sexual orientation, and gender identity, from ranges of 0%-25% to 92%-95%. All 31 practices adopted the AHQ with completion at 88.7% of visits (n = 24 968). Two years postscaling, completion rates were >91% per month. CONCLUSIONS: We successfully developed, scaled, and maintained an AHQ in a widely-used electronic health record system, a model for improving adolescent care and foundation for developing future interventions.

BACKGROUND: People with common mental disorders (CMD) are prone to experience work disabilities, which can lead to sick leave. To support their recovery and return to work, evidence recommends providing a combination of primary care services including psychological and work rehabilitation interventions. Furthermore, interventions to coordinate return to work are required to ensure timely access to services and concerted action among stakeholders. Occupational therapists are qualified to provide these interventions and to facilitate sick leave management. However, current medical practices, lack of collaboration among stakeholders, and lack of occupational therapists working within family medicine groups create highly variable care pathways and delays in access to appropriate services. AIM: This study aims to evaluate the acceptability and explore the effects of an occupational therapist-led program integrated within family medicine groups designed to improve the management of CMD-related sick leave and promote patients' recovery and sustainable return to work in the Canadian province of Québec. METHODS: This study will consist of a mixed methods multiple case study design. It will also use a participatory research approach, actively engaging family medicine group team members and patient partners throughout the study. The occupational therapy program will include three components: 1) consultation for prevention of sick leave and support for return-to-work decisions, 2) coordination of recovery and return-to-work services, and 3) provision of recovery and work rehabilitation services adapted to each patient's needs. Questionnaires, interviews, and focus groups will be used to collect data on the eight dimensions of the acceptability model described by Sekhon et al. and to measure pre- and post-outcomes to assess the effects of the occupational therapy program. Data will be analyzed using the Framework Method and repeated measures statistical analysis. DISCUSSION: We expect that the provision of this innovative occupational therapy program will improve patients' outcomes and the service trajectory of people with CMD. This study will document how to enhance interprofessional collaboration within family medicine groups and to ensure equitable access to work rehabilitation services for all patients, thereby improving recovery and healthy sustainable return-to-work.

INTRODUCTION/BACKGROUND: Video directly observed therapy (video-DOT) through a mobile health platform may improve buprenorphine adherence and decrease diversion. This pilot study tested the acceptability and feasibility of using this technology among patients receiving buprenorphine in an office-based setting. METHODS: Participants were instructed to record videos of themselves taking buprenorphine. Data were collected from weekly in-person visits over a 4-week period; assessments included self-report of medication adherence, substance use, satisfaction with treatment and use of the application, and also urine drug testing. Open-ended questions at the final visit solicited feedback on patients' experiences using the mobile health application. RESULTS: The sample consisted of 14 patients; a majority were male (86%) and White (79%). All participants except 1 (93%) were able to use the application successfully to upload videos. Among those who successfully used the application, the percentage of daily videos uploaded per participant ranged from 18% to 96%; on average, daily videos were submitted by participants 72% of the time. Most participants (10/14; 71%) reported being "very satisfied" with the application; of the remaining 4 participants, 2 were "satisfied" and 2 were "neutral." Participants reported liking the accountability and structure of the application provided and its ease of use. Negative feedback included minor discomfort at viewing one's self during recording and the time required. CONCLUSIONS: Based on these results, use of a mobile health application for video-DOT of buprenorphine appears feasible and acceptable for patients who are treated in an office-based setting. Further research is needed to test whether use of such an application can improve treatment delivery and health outcomes.