Literature Collection

This study describes the frequency and comfort of pediatric primary care clinicians (PCCs) as it relates to initiating, continuing, and stopping medications for attention-deficit/hyperactivity disorder (ADHD), anxiety/depression, and sleep problems across age groups (≤5 years, 6-12, and 13+). Primary care clinicians (N = 148) within an integrated primary care national research consortium participated in an anonymous online survey including questions examining practice settings, provider characteristics, prescribing frequency, and prescribing comfort. Results indicate that comfort and prescribing practices vary by patient age, practice setting, provider experience, and presenting diagnoses. Primary care clinicians generally felt more comfortable prescribing for school-age children and older and prescribing for ADHD-related concerns. Primary care clinicians appeared similarly comfortable starting, maintaining, and stopping medications. Rural PCCs reported greater comfort initiating and managing medication. Results highlight the need for ongoing training and support for PCCs in managing common childhood mental health conditions. Implications for establishing collaborative infrastructure support and team-based care are discussed.

Substance use disorders (SUD) remain a significant source of morbidity and mortality in the United States, and access to treatment continues to be inadequate. Primary Care Clinicians (PCCs) are well-positioned to provide long-term SUD care for patients. However, multiple provider-level barriers exist. Collaborative Care Management (CoCM) has proven successful in supporting PCCs in treating psychiatric conditions, such as depression. Our group proposes an addiction-focused modified CoCM that leverages telemedicine and an electronic platform (Senyo) into primary care. This study assesses PCCs' attitudes toward this proposed model and their likelihood (with support) of prescribing medications for alcohol and opioid use disorder. To achieve this, an anonymized and confidential electronic survey was deployed to all 489 of our institutions' PCCs. Eighty-five completed the survey (17.4% response); the majority (94%) agreed that digital CoCM for SUD will be helpful for their practice, and 85% expressed agreement that such a model will increase their confidence and likelihood to prescribe anti-craving medications. Additionally, we found that PCCs' comfort level in addressing SUD with patients is not associated with years in practice, clinician type (attending physicians, resident/fellow physicians, nurse practitioner or physician assistant), or their perception of currently available SUD treatment resources. Future work to evaluate practice changes, including rates of anti-craving medication prescribing and SUD-treatment outcomes after implementation of our digital CoCM will prove useful in determining the effectiveness of this model.

OBJECTIVES: Bereaved older adults often experience health complications, yet receive limited support in primary care settings. This research explored general practice staff's exposure to older patients' grief and identified barriers/enablers to bereavement support. METHODS: We examined 15 in-depth interviews with general practitioners and practice nurses across Australia. Data were analyzed thematically and via poetic narrative analysis, an innovative arts-based method to meaningfully translate participant's lived experience and emotions. RESULTS: Exposure to older people's grief and bereavement informed primary care staff assumptions about older people's grief, their ability to identify signs of grief, their understanding of how culture, gender, and grief intersected, and how grief could be managed in general practice (e.g. mobilizing nurses to provide support). Barriers/enablers to bereavement support included: Communication, access to support, time to discuss concerns, and knowledge/awareness of grief complications. CONCLUSIONS: Older adults require access to tailored support that addresses their experiences of repeated exposure to grief and loss. Primary care is a key conduit to specialist services but to make such referrals more training is needed on ageism and stigmas surrounding mental health. Arts-based methods can open a dialogue about grief and destigmatize help-seeking among older adults. CLINICAL IMPLICATIONS: Clear documentation of grief in patients' medical records; Destigmatizing mental health support among older patients; and Training primary care staff on grief, age-, culture- and gender-specific needs, and available resources can overcome some of the identified barriers to bereavement support. Primary care providers can use consultations with older patients to enquire about potential recent bereavements and mental health support needs, going beyond the mere assessments of physical symptoms. Timely assessment and documentation of grief in older patients can facilitate appropriate referrals and access to support services; this is a key task for general practitioners, who are gatekeepers to the healthcare system.