Literature Collection

BACKGROUND: Adolescents and young adults (AYA) living with sickle cell disease (SCD) transitioning to adult hematology care are at risk of dropping out of care and relying on emergency departments (ED) for acute crisis management. This can result in decreased continuity of care, an increase in serious health complications, and a greater mortality risk. This study aimed to investigate how transitioning to adult care is associated with SCD treatment outcomes, and test whether this association is moderated by comorbid mental health concerns (i.e., symptoms of anxiety and depression). PROCEDURE: We tested differences by age group (16-20, 21-25, 26-33 years) in the number of opioid prescriptions, hydroxyurea prescriptions, and ED visits using unadjusted comparisons and multivariable regression models, hypothesizing increased acute care use and decreased preventive treatment among the older age groups due to the complications associated with transitioning to adult care. We also tested whether there was an exacerbating effect of depression and anxiety symptoms on transition by assessing interaction terms between age group and symptoms in regression models. RESULTS: After adjusting for sociodemographic and mental health symptoms, the 26-33-year-old group had a significantly higher number of opioid prescriptions, and the 21-25 and 26-33 year groups had fewer hydroxyurea prescriptions and a greater number of ED visits than their 16-20-year-old counterparts. The higher number of opioid prescriptions among the older age group was even more pronounced among those with moderate to severe anxiety symptoms. CONCLUSIONS: Transitioning from pediatric to adult hematology poses a significant risk for AYA with SCD, especially for those with anxiety symptoms.

INTRODUCTION: Day care services have a long history in the support of older people, both internationally and in England. However, despite their longevity there is no consensus about the aims of day care services and their contribution to integrated care is unrecognised. This paper defines day care as community building-based services that provide care and/or health related services and/or clubs and activities specifically for older people (65+) with care and support needs, which support wellbeing and health, and/or support people to remain living at home and/or enable informal carers to sustain care. METHODS: The paper draws on qualitative data collected in a national study to reimagine day care services for older people in England. Eight sites participated, all from the voluntary sector. RESULTS: Day care services act as both a site of, and facilitator to, integrated care and whilst settings experienced many of the challenges faced by voluntary sector organisations, including a reliance on limited and uncertain funding, they had developed a range of strategies to partially manage them. CONCLUSIONS: Collective forms of day care services have the potential to play a more significant role in the provision of local place based integrated care in England.

OBJECTIVES: This study examines the role of mental health in consumer healthcare choices, using a discrete choice experiment to analyze choices regarding routine primary care visits in Australia. It captures mental health through 3 variables: self-reported current mental health condition and clinically validated measures of depression and anxiety symptoms, the Patient Health Questionnaire-9 capturing depression, and the Generalized Anxiety Disorder 7-item scale capturing anxiety. METHODS: Data were collected during November and December 2021 from a sample (N = 568) representative of the Australian population in age, gender, and location. Participants made hypothetical choices between in-person and telehealth alternatives or a no-visit alternative. Alternatives were described in terms of general practitioner familiarity, out-of-pocket cost, wait time, waiting area size, mask requirements, and modality of telehealth. RESULTS: The results suggest that symptoms of depression and anxiety could affect healthcare choices with opposite direction of effect on uptake and distinct from the presence of a mental health condition. CONCLUSIONS: These findings support the need for more careful consideration of the role of mental health in the analysis of discrete choice experiments, particularly in healthcare, including a better understanding of the mechanisms and time-varying nature of any effect.

OBJECTIVES: Suicide remains a significant public health challenge in the United States and globally, with risk influenced not only by mental health conditions but also by social and structural factors. This analysis examines how social determinants of health contribute to suicide risk and identifies evidence-supported nurse practitioner (NP) interventions that may reduce vulnerability in primary care settings. METHODS: A theory-based analysis was conducted using the World Health Organization Social Determinants of Health framework, the Stress Process Model, and Joiner's Interpersonal Theory of Suicide to examine how social conditions influence suicide risk and to identify opportunities for NP intervention. RESULTS: Economic hardship contributes to chronic stress and perceived burdensomeness, social isolation weakens protective belongingness, and limited access to behavioral health services delays treatment of depression and suicidal ideation. Evidence supports NP-led strategies, including social determinants screening, collaborative care models, integrated behavioral health services, and structured suicide risk assessment protocols as practical approaches to addressing these risks. CONCLUSION: Effective suicide prevention requires expanding beyond symptom management to include upstream social risk factors. Nurse practitioners are well-positioned to lead these efforts through early identification, integrated care delivery, and whole-person primary care models addressing both clinical and social drivers of suicide risk.

This paper is a short report considering the role of occupational therapy in providing mental health services in primary care. Primary care is the first point of contact most people have with the healthcare system. Occupational therapists have a role working with people with mental illness but the role of an occupational therapist working in mental health in a primary care setting is not well understood. Common interventions discussed in the literature included lifestyle approaches, assessment and information gathering, and the teaching of skills for daily living. There was a clear divide in the literature regarding the use of generic or specialist (occupation-focused) roles. Physical health was often prioritized over mental health concerns. Limited research examined both the population group of people with mental health concerns and the practice setting of primary care, identifying the need for further research to articulate the role of occupational therapy in working with mental health in primary care settings.