Literature Collection

Background: Substance use disorder (SUD) treatment centers serve a population of clients who have diverse needs, and may desire or require access to varied treatments while seeking care for their SUDs. While pharmacotherapies have increased in popularity for the treatment of SUDs, adoption rates do remain quite low. But a wider array of pharmacotherapies has become available in recent years which may shift the trend. This article helps shed light on how variations in SUD treatment centers develop and persist with regard to the adoption and delivery of off-label medications. Methods: We use a nationally representative and longitudinal sample of SUD treatment centers in the US (N = 196). We use a logistic regression to analyze the relationship between organizational characteristics and offering any medications, off-label. We also use a negative binomial regression to analyze the relationship between organizational characteristics and the number of medications that were used off-label. Results: Our findings reveal that older centers, accredited centers, and centers that offer mental health screenings are all positively associated with the provision of off-label medication in SUD treatment. We also find a positive relationship between private funding and offering a greater number of off-label medications. Conclusions: Our results suggest that SUD clients who seek treatment from centers that offer medications off-label, may have access to a greater number of medication-assisted treatment options.

BACKGROUND: The increasing number of older adults with complex care needs underscores the urgent need for improved coordination between health and social services, emphasizing the importance of integrated care models. The Social Return on Investment (SROI) framework is a valuable tool for evaluating the social, economic, and environmental impact of healthcare interventions, including integrated long-term care (LTC) solutions. However, a gap remains in reviews specifically analyzing its application to integrated LTC interventions. OBJECTIVE: To examine how SROI has been used to evaluate integrated LTC interventions, particularly for older adults. METHODS: A scoping review of peer-reviewed and grey literature was conducted, covering January 2012 to June 2024, through MEDLINE, CINAHL, Google Scholar, and citation searches. Three independent reviewers assessed study eligibility, following PRISMA guidelines. Data were extracted using PICOS terms and organized into summary tables detailing study characteristics and SROI findings. RESULTS: Out of 556 screened papers, only 11 studies met the inclusion criteria, with most conducted in the UK. SROI evaluations focused on Personal and Community Resources, such as improved physical and mental health and social connections, while Public Resource benefits, including reduced healthcare workloads, were noted in seven studies. Financial proxies came from sources like HACT Social Value Bank and Global Value Exchange. All studies reported positive SROI ratios, though methodological limitations affect interpretation. CONCLUSIONS: The application of SROI to integrated LTC remains limited, primarily UK-based and reliant on context-specific methodologies. Expanding its use requires standardized methods, broader geographic representation, and localized proxies for more accurate evaluations.

The Vermont Child Psychiatry Access Program (VTCPAP), launched in 2022 to address gaps in youth mental health care access in Vermont, offers same-day consultation to primary care providers (PCPs). Over 16 months, the VTCPAP facilitated 597 patient-specific consultations, including in rural and underserved areas. With VTCPAP's services, PCPs reported being better able to treat patients' mental health as well as enhancement to their own work life. Plans to maximize limited resources and to address the full spectrum of youth mental health care needs include providing asynchronous messaging for consultation initiation and integrating an existing perinatal mental health consultation program.

Objectives: Community-based multi-disciplinary teams (MDTs) were among the most widely reported health and care integration initiatives in the Integrated Care Pioneers in England. Such MDTs bring together staff from different sectors to co-ordinate and plan care for patients, who are often older, have multiple long-term conditions and risk hospital admission. As part of our evaluation of MDTs in two contrasting Pioneers, we explored MDT patients' and informal carers' perspectives on health and care services. As the COVID-19 pandemic started during data collection, we also wanted to understand its impact on patients' access to services. Methods: We conducted qualitative interviews with 44 patients aged 60 or over, with long-term conditions, and on the caseload of one of 11 participating MDTs. We also undertook qualitative interviews with 15 carers. Interviews took place between November 2019 and March 2021. Interview transcripts were coded in NVivo-12 and analysed thematically. Results: In addition to formal services, patients often relied on informal care. Valued aspects of care included equipment and home modifications that supported independence, timely access to and continuity in care, effective information-sharing, professionals who made them feel that their needs mattered, and having a named contact. Where challenges were experienced (e.g. with accessing professionals, communication, and care quality), patients and carers sometimes felt abandoned. While some patients mentioned being on an MDT caseload, few reported having a care plan. The impacts of caring on informal carers were sometimes considerable. COVID-19 affected patient and carer wellbeing, but the new ways of accessing care generated by the pandemic were valued by some participants. Conclusions: As long as challenges remain, patients and carers are unlikely to perceive care as joined-up and patient-centred. If truly integrated and holistic care is to be provided, barriers (such as the lack of shared patient records) must be addressed. Even where MDTs function primarily to co-ordinate rather than deliver care, they could better communicate their co-ordinating role, and MDT discussion outcomes, including care decisions, to patients. Informal carers' needs also require greater attention by MDTs.