Literature Collection

This article focuses on reporting the methodology and results of the EU funded project PROCare4Life, whose main goal has been to develop an integrated, personalised, IT system, to empower and improve the Quality of Life of elderly people living with Parkinsons', Alzheimer's or another dementia. Research has been implemented to evaluate the results against the PROCare4Life integrated care strategy. Multimethod, quantitative, and qualitative research has been performed, benefiting from the Pilot 3 results gathered by consortium members. The article has been organised according to the research questions, which were based on the expected results by PROCare4Life that might support the future integration of care when the system is further developed and implemented into healthcare provision organisations. The PROCare4Life system is a digital tool that includes features that might support the advance of the integration of care, such as data sharing among multidisciplinary healthcare professionals and with patients and caregivers, the enhancement of direct communication among them or the constant sharing of the data monitored by the PROCare4Life system. Technology readiness levels (TRLs) 7 was achieved by the final prototype of the PROCare4Life system. Pilot representatives consider the PROCare4Life idea and underlying model of care very innovative and promising and believe it can certainly improve care practice through more enhanced integrated care. It is usable for people of different ages, conditions, and socioeconomic levels. It has been assessed to be more effective for elderly people living with Parkinson's than with dementia. Patients and caregivers indicated that the system helped them reduce their anxiety and increase their quality of life. Although overall assessment of the system by healthcare professionals was positive, divided opinions were shared on its capability to save time. Requirements for future scalability have been included in the last section.

OBJECTIVE/BACKGROUND: In response to the unprecedented rates of illicit drug use, including opioid addiction and overdose in Rhode Island, local healthcare institutions, led by the Warren Alpert Medical School (AMS) of Brown University, collaborated to present "Bridging Health Disparities to Address the Opioid Epidemic." This symposium sought to educate a wide array of healthcare providers and professionals around opioid use disorder, including the state of the opioid crisis in Rhode Island, national efforts around opioid misuse and how providers can work together to stem the opioid crisis in the state. DESIGN AND METHODS: The symposium included a keynote session which aimed to increase knowledge and decrease stigma. This was followed by two rounds of breakout sessions which focused on various components of opioid disorder treatment. We elicited feedback from participants in order to plan further interventions to educate providers in Rhode Island around the opioid epidemic. Primary Results: Initial feedback was positive. More importantly, this workshop allowed us to identify gaps in knowledge amongst healthcare providers in Rhode Island in order to plan further interventions for healthcare providers, including physicians, around opioid misuse, in Rhode Island. PRINCIPAL CONCLUSIONS: This symposium is one of the first steps that a consortium of healthcare institutions, including AMS, will take to address the opioid crisis in Rhode Island. Feedback from the event was elicited to identify gaps in healthcare provider knowledge and will be used to design and implement further interventions.

The growing demand for mental health services in the United States has intensified pressure to expand the psychiatric workforce, prompting some systems to consider deploying nonpsychiatric nurse practitioners (NPs), such as family, adult-gerontology, and pediatric NPs, to independently staff psychiatry-only practices. This essay argues that such a strategy is unsafe, unethical, and inconsistent with advanced practice nursing standards. Psychiatric-mental health NPs receive specialized training in psychopathology, advanced assessment, psychopharmacology, and psychotherapy that generalist NPs do not. The diagnostic and pharmacologic complexity of specialty psychiatric care, particularly for severe and treatment-resistant conditions, amplifies the risks of misdiagnosis, inappropriate prescribing, and inadequate risk management when care is provided by nonspecialists. Case-based evidence and regulatory guidance highlight patient safety concerns and liability exposure when NPs practice beyond their certified scope. The essay differentiates appropriate mental health management in primary care from specialist psychiatric practice and rebuts arguments grounded in workforce shortages and "experience-based" competence. It concludes by outlining safer evidence-informed solutions, postmaster's psychiatric-mental health NP certification, telepsychiatry, and collaborative care models, that expand access while maintaining high standards of psychiatric care.

OBJECTIVES: This study identified profiles of outpatient physician follow-up care and other practice features, mostly after detection of incident mental disorders (MD), and associated these profiles with patient characteristics and subsequent adverse outcomes. METHODS: A cohort of 170,957 patients age 12 + with a new or recurrent MD detected in 2019-20 was investigated based on data from the Quebec Integrated Chronic Disease Surveillance System. Latent class analysis was performed to identify follow-up care profiles, mostly within one year of MD detection. Bivariate analyses tested associations between profiles and patient characteristics; logistic regressions examined relationships between profiles and adverse outcomes after one year. RESULTS: Five profiles were identified: Profiles 2 and 5 (64%) offered low mental health (MH) outpatient follow-up care, while the others dispensed higher MH follow-up care. Profiles differed in patient characteristics and related outcomes. Labelled "Follow-up care by usual psychiatrist", Profile 1 (1% of sample) included younger patients with the most health and social issues. Profile 2 (50%), "Low MH follow-up care but high prior consultations for physical reasons", mostly integrated older patients with chronic physical illnesses. Profile 3 (11%), "Follow-up care by general practitioners (GP) and psychiatrists", referred to physicians other than the usual ones (e.g., walk-in practice) and encompassed patients with severe MD conditions. Profile 4 (23%), "High follow-up care by usual GP and prior consultations for physical reasons", showed the typical characteristics of patients treated in primary care (more common MD, women, less materially and socially deprived). Profile 5 (15%), "Low MH follow-up care and prior consultations for physical reasons", integrated more younger men, materially deprived patients, and with substance-related disorders (SRD) or co-occurring MD-SRD. More Profile 1 and 3 patients lived in university regions - those of Profile 4 were the least numerous in such regions. More Profile 5 patients lived in metropolitan and rural areas. Risk of death was higher in Profiles 5, 2, 3, and risk of frequent ED use and hospitalization higher in Profiles 1, 3, and 5 - patients with severe health and social issues. CONCLUSION: The study confirmed the need to improve prompt, adequate and continuous follow-up care for patients with incident MD.

People with serious mental illness (SMI) are more likely to smoke and less likely to quit than the general population. More effective and accessible cessation treatments are needed to promote health and prevent disease in this disparity population. To this end, we optimized a multicomponent health promotion intervention tailored for people with SMI, Breathe Well, Live Well, and conducted a quasi-experimental program evaluation to assess program feasibility and effectiveness compared with a usual care comparison condition consisting of "The 3 As." Community mental health center staff trained as health coaches delivered eight telehealth Breathe Well, Live Well sessions over 4 months to individuals. Breathe Well, Live Well content included cognitive behavioral therapy (CBT)-based counseling, pharmacotherapy support, incentivized app use (National Cancer Institute's quitSTART), and social support person coaching. Participants were 170 integrated mental health and primary care service recipients with SMI who smoked daily; 53 Breathe Well, Live Well and 117 comparison participants were enrolled during February 2020 through July 2022. Effectiveness was measured via biologically verified abstinence; feasibility was measured via Breathe Well, Live Well intervention engagement. Participants of Breathe Well, Live Well were about three times more likely to be abstinent at follow-up compared with comparison participants. Among those still smoking, Breathe Well, Live Well participants were about five times more likely to have decreased their daily cigarette consumption by at least half. Intervention engagement was strong for pharmacotherapy, counseling, and incentivized quitSTART app use, indicating that these components were feasible to deliver by community mental health center staff.

Many women receive their regular check-ups and preventive care through a women's health clinic, including their behavioral health needs. Most of these clinics have not yet developed the capacity to adequately manage behavioral health concerns. We describe our clinical experience integrating behavioral health services into a women's health clinic. In one year, 108 women (54% White, Mage= 35) were referred for behavioral health treatment 47% were identified using a screening questionnaire, 51% were referred by their women's health provider and 2% were self-referred. The most common presenting concerns were anxiety (52%) and depressive symptoms (48%). Sixty-one (56%) patients completed an intake assessment, of whom 33 (54%) engaged in follow-up treatment (M = 3.7 treatment sessions, SD = 3.0). Behavioral health screening and treatment appears to be feasible and effective within a women's health setting. Further research is needed to overcome barriers to referrals and treatment engagement in this population.