Literature Collection

BACKGROUND: General practitioners (GPs) play a pivotal role in a patient's health care journey. However, demands on general practice, including complex patient management, workforce shortages, and health system fragmentation, have been shown to adversely impact the delivery of high-quality care and health outcomes. Integrated care models, particularly those that offer virtual care options, can support improved access to quality care and efficiency of health care delivery across metropolitan and rural areas. The SUSTAIN model of care was created to provide an accessible option for integrated care. It consists of centralized pediatricians supporting GPs in their practice through virtual coconsultations, virtual "lunch and learn" case discussions, and phone or email support. There is limited evaluation literature on integrated models of care being implemented in a primary care setting where the GP and family are face to face and the non-GP specialist is virtual. To address this gap, a comprehensive implementation evaluation of the SUSTAIN model of care was conducted. OBJECTIVE: This study aimed to examine what, why, and how different factors impact the uptake of the SUSTAIN model of care from the perspectives of the SUSTAIN pediatricians and metropolitan and rural GPs in New South Wales, Australia. METHODS: A qualitative study was conducted as part of a mixed methods implementation evaluation of the SUSTAIN model of care. Data were collected via recorded online focus groups and interviews with GPs, practice managers, and pediatricians at 6 and 12 months after the commencement of SUSTAIN. Data were analyzed thematically using iterative thematic analysis informed by the Consolidated Framework of Implementation Research. RESULTS: Eighteen focus groups and 13 interviews were conducted. GPs, practice managers, and pediatricians found the SUSTAIN model acceptable, with the flexibility and practicality of the model highlighted. GPs valued the learning opportunities, collaboration, and support they gained from working alongside the pediatricians. Virtual delivery through telehealth was viewed as a positive means of receiving specialist support that would otherwise be inaccessible to many practices. Increased efficiency in workflow and working at the top of scope in pediatric care as well as opportunities for meaningful professional relationships and increased family trust in GP-delivered care were recognized as key benefits that enhanced uptake. The current landscape of Australian general practice, with fee-for-service billing and workflow pressures, was recognized as a barrier to engagement with SUSTAIN. GPs and pediatricians highlighted that more appropriate remuneration to support co-consultation is vital to the sustainability and scalability of the SUSTAIN model. CONCLUSIONS: The SUSTAIN model of care expands on our understanding of the benefits of integrated GP-pediatrician models of care in general practice by demonstrating the utility of a pediatrician supporting a GP in their practice via telehealth across metropolitan and rural environments in New South Wales, Australia.

OBJECTIVE: Patients who die by suicide are often seen in primary care settings in the weeks leading to their death. There has been little study of brief interventions to prevent suicide in these settings. METHOD: We conducted a virtual, pilot, randomized controlled trial of a brief suicide prevention strategy called Veterans Affairs Brief Intervention and Contact Program (VA BIC) in patients who presented to a primary care mental health walk-in clinic for a new mental health intake appointment and were at risk for suicide. Our primary aim was to assess feasibility. We measured our ability to recruit 20 patients. We measured the proportion of enrolled patients who completed all study assessments. We assessed adherence among patients assigned to VA BIC. RESULTS: Twenty patients were enrolled and 95% (N = 19) completed all study assessments. Among the 10 patients assigned to VA BIC, 90% (N = 9) of patients completed all required intervention visits, and 100% (N = 10) completed ≥70% of the required interventions visits. CONCLUSION: It is feasible to conduct a virtual trial of VA BIC in an integrated care setting. Future research should clarify the role of VA BIC as a suicide prevention strategy in integrated care settings using an adequately powered design. CLINICAL TRIAL REGISTRATION: NCT04054947.