Literature Collection

OBJECTIVE: This study aimed to assess the feasibility of the screening for early emerging mental experiences model, which is designed to screen for psychosis in settings with integrated primary and mental health care. METHODS: Psychosis screening, triage, and engagement processes (July 2021-June 2022) were implemented in four integrated care practices serving approximately 7,000 patients in the targeted age range (14-26 years). Practice and community stakeholders participated in the project's design and development. Psychosis care specialists provided training and case consultation to general medical providers and behavioral health clinicians (BHCs). The BHCs screened all patients referred for selective screening. One practice aimed to universally screen patients ages 14-26 attending well visits. RESULTS: Training sessions were attended by 100% (N=6) of the BHCs and by 79% (N=27 of 34) of the primary care providers. The BHCs selectively screened and triaged 266 patients (89% of their new patients). Providers conducted universal screening of 606 patients (67% of that site's well visits). The screening samples were >90% White and >55% rural, consistent with the clinics' populations. Rates of positive selective screens were consistent with published rates in similar populations. Of the recorded screening-related activities, 92% (146 of 159) were completed within the billable intake time, and 11% (N=17) of these patients were engaged in a psychosis-relevant discussion. The providers reported that the project was important and positive. CONCLUSIONS: Systematic assessment of psychosis symptoms, followed by triage and engagement, appeared to be feasible and acceptable to patients and providers in integrated care settings.

BACKGROUND: Intrinsic capacity (IC) co-exists with frailty and multimorbidity in primary care and guidelines recommend screening for IC and frailty to improve health outcomes. To inform effective implementation of such screening, this study aimed to understand the association between IC and frailty, and the discriminative ability of IC for frailty in older adults with multimorbidity. METHOD: A cross-sectional study was conducted across three primary care clinics from August to October 2022. The participants were multimorbid older adults who had the triad of diabetes mellitus, hypertension and hyperlipidemia and who could walk independently. Data collected included sociodemographic factors, Integrated Care Older People Screening Tool (ICOPE), social vulnerability, chronic conditions, functional impairment, modified Frailty Phenotype (mFP), and Clinical Frailty Scale (CFS). Multinomial logistic regression was used to assess the association between IC and frailty while area under the curve of the receiver operating characteristic (AUC-ROC), sensitivity, specificity, and false positive result were used to assess the discriminative ability of IC for frailty. RESULTS: 411 participants were included in the study and the mean age was 69.9 (± 6.2) years. 11.9% of the participants were mFP frail while 7.5% were CFS frail, and almost all the participants (98.0%) had reduced IC. Higher composite IC score was associated with reduced odds of frailty (OR 0.39 (mFP) and OR 0.45 (CFS), p ≤ 0.05). The IC domains associated with frailty depended on the frailty measure used and socio-cultural factors. An IC cut-off score of 2 had AUC-ROC, sensitivities, specificities, and false positive results of 0.72, 59.2%, 77.9% and 22.1% respectively for mFP; and 0.74, 61.3%, 76.3% and 23.7% respectively for CFS. CONCLUSIONS: In a primary care population with multimorbidity, IC screening inadequately discriminates for frailty and functional impairment with insufficient sensitivity and high false positive results. In view of the very high prevalence of IC losses, IC screening followed by frailty screening of selected patients with IC losses may not be feasible and other approaches should be considered to optimise screening.