Literature Collection

PURPOSE: The purpose of this paper is to examine the current provision of opioid substitution therapy (OST) during and immediately following release from detention in prisons in England and Wales. DESIGN/METHODOLOGY/APPROACH: A group of experts was convened to comment on current practices and to make recommendations for improving OST management in prison. Current practices were previously assessed using an online survey and a focus group with experience of OST in prison (Webster, 2017). FINDINGS: Disruption to the management of addiction and reduced treatment choice for OST adversely influences adequate provision of OST in prison. A key concern was the routine diversion of opiate substitutes to other prisoners. The new controlled drug formulations were considered a positive development to ensure streamlined and efficient OST administration. The following patient populations were identified as having concerns beyond their opioid use, and therefore require additional considerations in prison: older people with comorbidities and complex treatment needs; women who have experienced trauma and have childcare issues; and those with existing mental health needs requiring effective understanding and treatment in prison. ORIGINALITY/VALUE: Integration of clinical and psychosocial services would enable a joint care plan to be tailored for each individual with opioid dependence and include options for detoxification or maintenance treatment. This would better enable those struggling with opioid use to make informed choices concerning their care during incarceration and for the period immediately following their release. Improvements in coordination of OST would facilitate inclusion of strategies to further streamline this process for the benefit of prisoners and prison staff.

Perinatal psychological health conditions (eg, perinatal depression, anxiety) are some of the leading causes of maternal mortality in the United States and are associated with adverse pregnancy outcomes, long-term cardiovascular outcomes, and intergenerational effects on offspring neurodevelopment. These risks underscore the importance of addressing maternal psychological health as a key determinant of perinatal cardiovascular health. Thus, it is vital to recognize the spectrum of perinatal psychological health and to provide guidance for both patients and clinicians on screening and management options across the perinatal period. In this scientific statement from the American Heart Association, we redefine maternal cardiovascular health to include psychological health, provide robust evidence on the association of psychological health with cardiovascular outcomes, highlight the social and environmental underpinnings, and finally, offer guidance about how to integrate psychological health into maternal cardiovascular health with a specific focus on the perinatal period (ie, pregnancy through 1 year postpartum). We also describe opportunities for creating care delivery models that recurrently address perinatal psychological health in cardio-obstetric care, using behavioral and pharmacological interventions, with an emphasis on better integration of psychological health care, longer postpartum follow-up, and opportunities for evaluating the comparative effectiveness of these models with stakeholder partners.

BACKGROUND: Social care integration in health systems is on the rise in the United States, particularly since the National Committee for Quality Assurance introduced screening and intervention as HEDIS metrics. These policy levers outpace empirical knowledge to guide how best to operationalize social care. This study reports results from a quality improvement initiative to implement social care in an integrated health system. METHODS: A quantitative effectiveness evaluation was conducted across 32 clinics in Kaiser Permanente Washington, which had recently embedded Community Resource Specialists (CRS) in their primary care teams and integrated a social health screener into their electronic health record. Using a pragmatic design with propensity score matched comparison group (PSC), we compared two intervention arms (both of whom completed a social health screener): (1) CRS-S who engaged in only a single CRS visit and (2) CRS-M who engaged in at least two CRS visits. Patients completed a survey shortly after their qualifying primary care encounter and approximately three months later that assessed the following domains: social health, patient experience with the care team, and health and functioning; healthcare utilization was obtained from the electronic health record. Patients from each arm were then purposefully sampled for qualitative interviews. RESULTS: Quantitative results suggest that CRS-M patients experienced exacerbated social risk severity and food insecurity over three months, but improved financial risk. For the majority of domains, no differences were observed between arms, though CRS-M demonstrated poorer coping over time whereas PSC patients showed higher use of instrumental and emotional support coping strategies. CRS-M reported worse health and need for more help with activities of daily living, but improvements in trust in their care team. Qualitative results showcased, by design, the positive potential impact of working with a CRS across all domains of interest, especially social and mental health. CONCLUSION: This quality improvement evaluation of social care integration using the CRS illustrates a potential pathway for activating social support and healthcare relationships in primary care, but more rigorous designs and longer-term follow up are needed to explore if this pathway leads to improvements in patient or population health and healthcare utilization.