Literature Collection

Physician workload is known to impact provider well-being and individual patient encounters, but less is understood about how provider availability affects broader community health outcomes. Primary care physicians (PCPs) often serve as de facto mental health providers, particularly in underserved communities. This study evaluated whether PCP and mental health provider workload, measured by provider-to-resident ratios, predict population-level physical and mental health outcomes. County-level data from the 2024 Robert Wood Johnson Foundation County Health Rankings dataset (N = 3142 counties) were analyzed using two path analysis models; such models are used to estimate both direct and indirect relationships among multiple predictors and outcomes simultaneously. Predictor variables included provider ratios, percent uninsured (mediator), and self-reported physically and mentally unhealthy days (outcomes). Higher PCP workload was significantly associated with greater numbers of poor physical and mental health days. Mental health provider ratios were not directly associated with either outcome. Indirect effects through the percent uninsured were also significant, particularly for physical health outcomes. These findings suggest that PCPs play a disproportionate role in shaping both mental and physical health at the community level. The analysis supports the conclusion that addressing provider shortages and improving insurance coverage can enhance health outcomes, particularly when efforts are integrated into collaborative care models that distribute workload across providers and align treatment approaches with the diverse psychosocial and medical needs of the populations they serve.

PURPOSE: Cognitive functional therapy (CFT) is a person-centred biopsychosocial intervention for chronic low back pain, with large sustained clinical and economic benefits. This study explored the experiences of physiotherapists delivering CFT in their usual clinical practice after being trained to competency for the RESTORE clinical trial. MATERIALS AND METHODS: A qualitative study design was used. Fifteen primary care physiotherapists were interviewed (seven female, clinical experience 3-25 years). An inductive-deductive content analysis was used, including the Theoretical Domains Framework and socioecological model. RESULTS: Facilitators and barriers were identified within and between individual, micro (clinical interface), meso (health service), and macro (health system) levels. Physiotherapists reported feeling competent and skilled delivering CFT. At the microsystem, this was influenced by time and their evolving professional identity. At the mesosystem, social support within the clinical community and positive patient outcomes facilitated CFT, while disunity in pain management across the health system and inadequate remuneration were barriers. Societal beliefs about pain, shifts in professional identity, and funding models influenced delivery at the macrosystem. CONCLUSIONS: This study highlights multilevel facilitators and barriers that physiotherapists perceive when implementing CFT. Targeting these may help to optimise the implementation of this promising intervention, thereby contributing to better patient outcomes.; Ensuring that physiotherapists are trained to competency in cognitive functional therapy (CFT) empowers clinicians with the necessary skills and confidence to effectively treat a broad range of musculoskeletal pain patients in usual clinical practice.Building communities of practice that facilitate peer review and reflection builds skills and prevents drift from the competencies of delivering CFT.Creating clinical environments that support both privacy for sensitive patient disclosures alongside connectivity and opportunities for self-management is crucial for delivering person-centred care.Addressing challenges with current funding models is essential for improving access to biopsychosocial interventions like CFT.Patient triage and outcome-based funding models that incentivise high-value care could help ensure more equitable, timely, and cost-effective physiotherapy services.; eng

Background: Opioid treatment programs (OTPs) permit patients to ingest daily methadone doses unsupervised and away from the clinic, a strategy that enhances treatment access and convenience but has the potential for mismanagement.Objective: This retrospective review, conducted during the COVID-19 pandemic (5/2020-1/2022), evaluates the feasibility and acceptability of a commercially available electronic pillbox to safely administer methadone take-home tablets in a large community-based OTP (census >500 people).Methods: Study participants (n = 24; 54% male, 46% female; M age = 63 years) had recently received more take-homes per visit to support national social distancing directives, and were instructed that they could maintain these privileges by agreeing to use the pillbox.Results: Results demonstrate good demand feasibility as most participants (71%) agreed to use the pillbox. Good implementation feasibility was observed through safe and reliable delivery of most take-home tablets, with a staff support line to resolve technical issues. Acceptability was modest as six participants (25%) requested to return the pillbox despite losing some take-home privileges.Conclusion: Results support continued use and study of the electronic pillbox to safely deliver and increase access to methadone take-home doses.

This pilot randomized controlled trial examined the feasibility and acceptability of a Syndemics intervention targeting the intersection of stimulant use, trauma, and difficulties with HIV disease management in cocaine-using women. All participants received contingency management (CM) for 3 months with financial incentives for stimulant abstinence during thrice-weekly urine screening and refilling antiretroviral medications monthly. Sixteen participants were randomized to complete four expressive writing (n = 9) or four neutral writing (n = 7) sessions delivered during the CM intervention period. Completion rates for writing sessions were high (15 of 16 women completed all four sessions) and engagement in CM urine screening was moderate with women randomized to expressive writing providing a median of 11 non-reactive urine samples for stimulants. There were non-significant trends for those randomized to expressive writing to provide more CM urine samples that were non-reactive for stimulants, report greater decreases in severity of cocaine use, and display reductions in log(10) HIV viral load at 6 months. Although the Syndemics intervention was feasible and acceptable to many women, qualitative interviews with eligible participants who were not randomized identified structural and psychological barriers to engagement. Further clinical research is needed to test the efficacy of Syndemics interventions with HIV-positive, cocaine-using women.