Literature Collection

Integrated Care (IC) models have increased, but the current mechanisms to analyze the efficacy and fidelity of behavioral interventions within IC models are limited. A mixed methods concurrent process evaluation was used within the context of a randomized clinical trial to assess intervention fidelity for a Solution-focused brief therapy (SFBT) intervention implemented within an IC model. A qualitative content analysis was conducted to develop a participant survey and charting template for the SFBT intervention. Quantitative data were collected through (1) participant surveys, (2) interventionist self-report surveys, and (3) data from participant charts. Descriptive statistics and repeated measures ANOVA were used to analyze quantitative data. Data triangulation was used to present findings. The average SFBT intervention was 24.6 min and 33/34 (97%) of participants in the intervention group completed all 3 SFBT sessions. Most visits were weekly follow-ups (53.9%), followed by biweekly (28.2%) and then 3-week follow-ups (5.1%). The interventionist used session templates and a self-report checklist to monitor intervention integrity. Those in the intervention group had increased growth regarding Solution-focused core constructs (a scale created by the authors) when compared to the treatment-as-usual group (F [1, 64] = 22.7, p < 0.001): mean difference, 15.1 [95% CI 11.2 to 18.9]. Our study examined fidelity comprehensively and provides a foundation for studies interested in fidelity monitoring of SFBT interventions as well as behavioral interventions within IC models. Trial Registration: The study was pre-registered at ClinicalTrials.gov Identifier: NCT05838222 on 01/05/2023.

BACKGROUND: Opioid use disorder (OUD) remains a significant public health issue as the number of opioid-related overdose deaths continues to reach new highs each year. Buprenorphine/Naloxone is a medication that has been shown to be highly effective for the treatment of OUD. However, the clinical management of patients on this medication is challenging as many patients discontinue treatment prematurely. We conducted a qualitative study focusing on experienced prescribers of buprenorphine to learn about what they believe are key challenges in prescribing this medication to patients with OUD and related strategies for improving treatment outcomes. METHODS: We conducted two rounds of interviews with 12 prescribers who were either trained as a primary care physician, nurse practitioner, or physician assistant. These prescribers were recruited from an academically-based treatment program, a community health center, and a commercial substance use disorder treatment facility. Interview data were coded and analyzed in accordance with a grounded theory approach. RESULTS: Key findings and related recommendations emerged for patient monitoring, integration of behavioral health with prescribing, patient volume requirements, and use of telehealth. CONCLUSION: The interviews generated a number of recommendations for improving patient outcomes from buprenorphine treatment. Some of these recommendations can be implemented quite readily whereas others entail more substantial resources and time commitments.

BACKGROUND: Veterans involved in the legal system have a high risk of overdose mortality but limited utilization of medications for opioid use disorder (MOUD). To increase the use of MOUD in Veterans Health Administration (VHA) facilities and reduce overdose mortality, the VHA should incorporate strategies identified by legal-involved veterans to improve quality of care and ensure that their patients' experiences are integrated into care delivery. This study aims to determine strategies to increase use of MOUD from the perspective of legal-involved veterans with a history of opioid use or opioid use disorder (OUD). METHODS: Between February 2018 and March 2019, we conducted semistructured interviews with 18 veterans with a history of opioid use or OUD and legal involvement (15 men and 3 women; mean age 41, standard deviation 13, range 28-61). Veterans were from 9 geographically dispersed United States VHA facilities. The study analyzed verbatim transcripts using the framework method. The primary focus was themes that represented legal-involved veteran-identified strategies to improve the use of MOUD. RESULTS: The 18 veterans interviewed had legal involvement directly related to their opioid use and most (n = 15; 83%) had previously used MOUD. Veteran-identified strategies to improve access to and use of MOUD included: (1) VHA should provide transportation or telehealth services; (2) legal agencies should increase access to MOUD during incarceration; (3) the VHA should reduce physician turnover; (4) the VHA should improve physician education to deliver compassionate, patient-centered treatment; (5) the VHA should improve veteran education about MOUD; and (6) the VHA should provide social support opportunities to veterans. CONCLUSIONS: Legal-involved veterans provided strategies that can inform and expand MOUD to better meet their needs and the treatment needs of all patients with OUD. The VHA should consider incorporating these strategies into care, and should evaluate their impact on patients' experience, initiation of and retention on medications, and overdose rates.

In a deinstitutionalised mental health care system, those with mental illness require complex, multidisciplinary and intersectoral care at the primary or community service setting. This paper describes an Evidence Map of different strategies to strengthen the provision of mental health care at the primary health care (PHC) setting, the quality of the evidence, and knowledge gaps. Electronic and reference searching yielded 2666 articles of which 306 qualified for data extraction. A systematic review methodology identified nine different strategies that strengthen the provision of mental healthcare and these strategies are mapped in line with the outcomes they affect. The top three strategies that were reported the most, included strategies to empower families, carers and patients; integration of care or collaborative interventions; and e-health interventions. The least reported strategy was task shifting. The Evidence Map further shows the amount and quality of evidence supporting each of the listed strategies, and this helps to inform policy design and research priorities around mental health. This is the first systematic Evidence Map to show the different strategies that strengthen the provision of mental healthcare at PHC setting and the impact these strategies have on patient, hospital and societal level indicators.

BACKGROUND: Older adults with multimorbidity experience fragmentation of care. Ensuring optimal use of healthcare services requires stratifying their need for integrated care. We aimed to map existing stratification tools for assessing older adults with multimorbidity in an integrated care context. METHODS: We searched MEDLINE, Embase, PsycINFO, Cochrane Library, and CINAHL, and extracted definitions of population, concept, and context following the JBI Framework for Scoping Reviews. RESULTS: We identified 17,689 articles of which 11 articles were included. Few stratification tools for this population exist and differ on scoring methods, domains and settings of use. Stratification is used for identifying older adults with multimorbidity to multidisciplinary teams or to case managers. Future research should develop stratification tools across sectors focused on the common risk factors of multimorbidity in older adults.

OBJECTIVE: Postpartum depression (PPD) is a major contributor to postpartum morbidity and mortality. Beyond efforts at routine screening, risk stratification models could enable more targeted interventions in settings with limited resources. The authors sought to develop and estimate the performance of a generalizable risk stratification model for PPD in patients without a history of depression, using information collected as part of routine clinical care. METHODS: The authors conducted a retrospective cohort study of all individuals who delivered between 2017 and 2022 in one of two large academic medical centers and six community hospitals. An elastic net model was constructed and externally validated to predict PPD, defined as having a mood disorder, an antidepressant prescription, or a positive screen on the postpartum Edinburgh Postnatal Depression Scale. Predictors used included sociodemographic factors, medical history, and prenatal depression screening information, all of which were known before discharge from the delivery hospitalization. RESULTS: The cohort included 29,168 individuals; 2,696 (9.2%) met at least one criterion for postpartum depression in the 6 months following delivery. In the external validation data, the model had good discrimination and remained well calibrated: the area under the receiver operating characteristic curve was 0.721 (95% CI=0.709, 0.736), and the Brier calibration score was 0.087 (95% CI=0.083, 0.091). At a specificity of 90%, the positive predictive value was 28.8% (95% CI=26.7, 30.8), and the negative predictive value was 92.2% (95% CI=91.8, 92.7). CONCLUSIONS: These findings demonstrate that a simple machine-learning model can be used to stratify the risk for PPD before delivery hospitalization discharge. This tool could help identify patients within a practice at the highest risk and facilitate individualized postpartum care planning for the prevention of, screening for, and management of PPD at the start of the postpartum period and potentially the onset of symptoms.