Literature Collection

Background/Objectives: With the acceleration of population ageing the need for integrated support in healthcare and caregiving is increasing, and the societal demand for improved service quality is also increasing. This study aims to explore how multidisciplinary professionals perceive the implementation of home-visit oral care (HVOC) within the Integrated Community Care in Older Adults model, in order to inform the design of future integrated oral health programs. Methods: The study participants comprised 16 individuals: eight dental hygienists with experience in HVOC and eight multidisciplinary healthcare providers. Focus group interviews were conducted with these participants, and the data were analysed using Colaizzi's phenomenological method to derive key themes and categories. Results: The analysis revealed four main thematic categories: (1) cognitive aspects (understanding of geriatric diseases and families); (2) technical aspects (effective communication and competence in oral care); (3) value-based aspects (empathy, patient-centredness, professional pride); (4) multidisciplinary organisational efforts (establishing interprofessional collaboration systems and integrated platforms). Conclusions: HVOC services provided by dental hygienists were found to promote oral health among older adults. To ensure the sustainability and effectiveness of such services, a customised integrated care model based on multidisciplinary collaboration should be established.

OBJECTIVES: Sleep disorders are wide-ranging in their causes and impacts on other physical and mental health conditions. Thus, sleep disorders could benefit from a multidisciplinary approach to assessment and treatment. An integrated care model is often recommended but is costly to implement. We sought to understand how, in the absence of an established organizational structure for integrated sleep care, providers from different clinics work together to provide care for sleep disorders. METHODS: A qualitative case study at one U.S. Department of Veterans Affairs (VA) medical center. We used a purposeful nested sampling strategy, combining maximum variation sampling and snowball sampling to recruit key staff involved in sleep care. RESULTS: We interviewed providers (N = 10) from sleep medicine, primary care, and mental health services. Providers identified the ubiquity of sleep disorders and a concomitant need for multidisciplinary care. However, they described limited opportunities for multidisciplinary interactions and consequently a negative impact on clinical care. Providers described fragmentation in two areas: among sleep specialists and between sleep specialists and other referring and managing providers. CONCLUSIONS: A range of interventions, based on setting and resources, could improve care coordination both among sleep specialists and between sleep and nonsleep providers. While integrated sleep specialist clinics could reduce care fragmentation, they may not directly impact coordination with referring providers, like primary care and general mental health, who are essential in managing chronic conditions. Future work should continue to explore improving care coordination for sleep problems to ensure patients receive high-quality, timely, patient-centered care.

Background: Treatment of opioid use disorder (OUD) is highly effective, but access is limited and care is often fragmented. Treatment in primary care can improve access to treatment and address psychiatric and physical co-morbidities in a holistic, efficient, and non-stigmatizing way. The Collaborative Care Model (CCM) of behavioral health integration into primary care has been widely disseminated and shown to improve outcomes and lower costs when studied for depression, but its use in treating substance use disorders has not been well documented. Methods: We used a mixed-methods approach to examine the impact of implementing multidisciplinary treatment of OUD in our health system's five primary care clinics using the framework of the CCM, with care shared between the primary care clinician (PCP), behavioral health clinician, and medical assistant. The implementation included staff education, creation of electronic health record tools, and implementation support, and was evaluated using data from the electronic health record, the medical staff office, and a clinician survey. Results: Over the last 2 years of implementation, the number of waivered providers increased from 11 to 35, providers prescribing for 5 or more patients increased from 2 to 18, and patients initiated on buprenorphine increased from 4/month to 18/month. 180-day treatment retention was 53%, and 81% of patients had consistently negative urine drug testing. Psychiatric and medical comorbidities were common, 70 and 44%, respectively. Although PCPs who prescribed buprenorphine found working in this model enjoyable and effective, the majority of non-waivered PCPs remained reluctant to participate. Conclusions: In our experience, treatment of OUD in primary care utilizing the CCM effectively addresses OUD and commonly comorbid anxiety and depression, and leads to an expansion of treatment. Successful implementation of OUD treatment requires addressing negative attitudes and perceptions.

Agitation and aggression are among the most common and clinically challenging behavioral and psychological symptoms of dementia in older adults. These manifestations worsen patients' daily functioning and increase the likelihood of hospitalization and long-term care placement. In addition, it imposes a significant burden on caregivers and healthcare systems. Their presentation is heterogeneous and reflects the complex interactions among neurodegenerative changes, medical comorbid conditions, environmental stressors, and the quality of care and communication. This review summarizes current approaches to the management of aggression in dementia, with a particular focus on multimodal strategies integrating behavioral, systemic, and pharmacological interventions. Emphasis is placed on non-pharmacological measures, which are widely regarded as first-line treatment due to their favorable safety profile and their potential to achieve sustained clinical benefits. These interventions include individualized behavioral strategies, environmental adaptations, structured daily activities, and caregiver education programs. Pharmacological treatment is discussed as a complementary option, appropriate primarily in cases of severe or persistent aggression or when there is an imminent risk to the patient or others. The review highlights the importance of cautious prescribing and using medications, limiting treatment duration, and regularly reassessing therapeutic effectiveness in relation to adverse effects, particularly in geriatric patients with multimorbidity. We also emphasize the need for an individualized approach, adjusted to the dementia subtype, overall medical condition, and prior treatment response. Ethical considerations are also addressed, including respect for patient dignity, minimization of coercive measures, and the responsibility of care institutions to create environments supportive of persons living with dementia. The available evidence supports a patient-centered, multimodal approach as the most balanced and effective strategy for managing aggression in dementia. Further pragmatic research is obligatory to refine integrated care models and to evaluate their effectiveness across diverse clinical settings.

Background/Objectives: Pediatric chronic pain requires individualized care. The Pediatric Pain Screening Tool (PPST) allows for stratification of psychosocial and physical risk factors and may guide targeted interventions. However, its integration into multimodal physiotherapy programs remains unexplored. This exploratory feasibility case series study evaluated a PPST-guided, risk-stratified multimodal physiotherapy intervention in children aged 8-17 years with chronic pain. Methods: Participants were classified as low, medium, or high risk. Interventions were tailored accordingly. Outcomes were assessed pre- and post-intervention and included pain intensity, pain interference, psychological distress, and quality of life. Results: Ten participants (mean age = 13.5 years; 60% girls) were included. Six were classified as high, three as medium, and one as low risk based on the PPST. After an 8-week physiotherapist intervention program, pain interference significantly decreased (MD = -7.5; p = 0.040; d = 1.69), as did pain intensity at rest (MD = -3.1; p = 0.002; d = 2.60) and during movement (MD = -3.0; p = 0.004; d = 2.55), exceeding the MCID of 1.92. In the high-risk group, reductions were observed in anxiety (p = 0.006; d = 2.36), pain-related worries (p = 0.001; d = 3.79), fear of movement (p = 0.015; d = 1.62), and fear of pain (p = 0.002; d = 3.37). Eighty percent reported feeling "a great deal better" in the PGIC including all high-risk participants. Conclusions: These results supports the feasibility of integrating PPST risk stratification into multimodal management, providing a structured and effective framework for addressing pediatric chronic pain.