Literature Collection

In-depth understanding of dementia carer experience can assist clinicians by providing insight into dementia onset, symptoms and management, and help conceptualize and understand the pattern of dementia progress over time and what help is needed. We undertook a qualitative study to understand dementia carers experiences of providing care and reasons for admission to a residential aged care facility (RACF). Three themes were identified: (1) Challenges in the path to diagnosis and care, leading to delays accessing support; (2) Carer role impacted by living circumstances; and (3) Variation in decision support prior to admission to a RACF. Identifying dementia carer experiences, reinforces the need for more timely diagnosis, referral for support and interventions to promote better quality of life for a people living with dementia and their carer and to delay premature RACF placement.

OBJECTIVES: To explore how primary care providers report discussing substance use with transgender and gender diverse (TGD) adult patients within the context of discussing gender-affirming interventions. METHODS: Between March and April 2022, in-depth, semi-structured qualitative interviews were conducted with 15 primary care providers who care for TGD patients in the Northeastern US. Thematic analysis was used to analyze interview data and identify themes. RESULTS: Two primary themes emerged among providers: 1) placing a focus on harm reduction, emphasizing reducing negative consequences of substance use, and 2) using access to gender-affirming interventions as an incentive for patients to change their substance use patterns. CONCLUSIONS: Focusing on harm reduction can emphasize reducing potential adverse outcomes while working with TGD patients towards their gender-affirmation goals. Future research should explore varying approaches to how substance use is discussed with TGD patients, as well as the interpretation of gender-affirming clinical guidelines. PRACTICE IMPLICATIONS: Findings from this study indicate a need for enhancing provider knowledge around the appropriate application of gender-affirming care guidelines. Investing in training efforts to improve gender-affirming care is critical for encouraging approaches that prioritize harm reduction and do not unnecessarily prevent access to gender-affirming interventions.

In this first of three papers, we seek to understand how the new "integrated care" global policy directive, pursuing greater alignment for health and social care systems, will be translated into preparation for practice concerning interprofessional education (IPE) from pre-to-post registration level and for continuing professional development. We ask questions about the implications for leaders and practitioners in the field of IPE and collaborative practice (CP). In seeking to understand this new global policy directive, we explore the plethora of definitions, concepts and perspectives, continuously evolving and at times counterproductive as they try to synthesize complexity, to describe how health and social care systems and practitioners work together. We trace research on how integrated care is understood drawing upon transnational current understandings of integrated working in North America, Europe and the UK. We ask questions of the ambitions of integrated care aligned to forging closer working relationships between health and social care practitioners to tackle modern complex healthcare challenges. In reading the literature we have sought to identify the themes which emerge to direct the field of IPE and CP so that the workforce is prepared to deliver care, as policy makers intended, within locally designed new innovative care systems. We conclude that it remains unclear as to whether these new policy aspirations will achieve the connectivity required, for a supported workforce, committed to working together to deliver care envisaged to help people experiencing complex long-term conditions, disadvantage and health inequalities. In our second paper, we review the developmental pathway for IPE, taking a closer look at preparation for integrated care pathways and collaborative practice, seeking evidence to guide us. Finally, in our third paper, we turn our attention to the implications for the workforce composition, dynamics, and relationships, exploring heightened progressive ever-changing roles and responsibilities, focusing on social work.

INTRODUCTION: Opioid use disorder (OUD) is a debilitating illness that remains a serious public health issue in the United States. Use of telemedicine to deliver medications for the treatment of OUD (MOUD) was limited until the confluence of the COVID-19 and opioid addiction epidemics in spring 2020. Starting in spring 2020, the Department of Veterans Health Affairs (VHA) transitioned from in-person to mostly telemedicine-delivered OUD care to reduce COVID-19 transmission among veterans and providers. To gain a nuanced understanding of provider perspectives on MOUD care delivery using telemedicine, we conducted semi-structured interviews with VHA providers who were using telehealth to deliver MOUD care. METHODS: We conducted semi-structed Zoom interviews with VA clinicians at nine VA Medical Centers (VAMCs) in eight states. Potential study participants were identified as providers who were involved in referrals and provision of buprenorphine treatment for chronic pain and opioid addiction. Audio-recordings of all interviews were transcribed and entered into Atlas. Ti qualitative analysis software. The study team analyzed the transcripts for major themes related to tele-prescribing practices for buprenorphine. RESULTS: Twenty-three VA providers participated in the study, representing 32% of all providers invited to participate in the study. The research team identified the following four themes: (1) COVID-19 spurred a seismic shift in OUD treatment; (2) Video calls provided a rare window into veterans' lives; (3) Providers experienced numerous challenges to virtual visits; and (4) Providers wrestled with paternalism and trust. CONCLUSIONS: The pandemic accelerated the movement toward harm reduction approaches. Prior to the pandemic, stringent requirements existed for patients receiving MOUD care. Providers in this study reflected on the need for these requirements (e.g., in-person visits, toxicology screens) and how reducing this monitoring implied more trust in patients' autonomous decisions. Providers' observation that videoconferencing offered them a window into patients' lives may offer some ways to improve rapport, and research should explore how best to incorporate the additional information conveyed in virtual visits.

The need for mental health care for pediatric patients outstrips the supply, especially in states, like Kansas, that experience shortages of mental health professionals. Pediatric mental health care access programs, like KSKidsMAP (Kansas Kids Mental health Access Program), increase access to care by building competence and confidence in primary care physicians and clinicians (PCPs) through a statewide integrated system that includes a consultation line. This study is a secondary analysis of KSKidsMAP consultation Line inquiries regarding patients aged 0 to 21 years with mental and behavioral health concerns. The study employs a mixed-method approach with descriptive statistics and thematic analysis of inquiries. Five themes were identified: (1) pharmacotherapy, (2) diagnostic evaluation, (3) community resources, (4) psychotherapy, and (5) other. This study sheds light on PCPs needs and illustrates the importance of Pediatric Mental Health Care Access programs offering interprofessional expertise to consulting PCPs, allowing for expansion of pediatric mental illness care into the primary care setting.