Literature Collection

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.

AIM: This research aimed to explore the perspectives of primary and community care providers on the challenges that hinder the delivery and uptake of personalized type 2 diabetes (T2D) care, with a focus on the integration of mental health support and care. BACKGROUND: The day-to-day burden and demand of self-managing T2D can negatively impact quality of life and take a toll on mental health and psychological well-being. As a result, there is a need for personalized T2D self-management education and support that integrates mental health care. Despite the need for this personalized care, existing systems remain siloed, hindering access and uptake. In response, innovative, comprehensive, and collaborative models of care have been developed to address fragmentations in care. As individuals living with T2D often receive their care in primary care settings, linking mental health care to existing teams and networks in primary care settings is required. However, there is a need to understand how best to support access, adoption, and engagement with these models in these unique contexts. METHODS: A cross-sectional survey was distributed to primary and community providers of an Ontario-based smoking cessation network. Survey data were analyzed descriptively with free text responses thematically reported. FINDINGS: Survey respondents (n = 85) represented a broad mix of health professions across primary and community care settings. Addressing challenges to the delivery and uptake of personalized T2D care requires comprehensive strategies to address patient-, practice-, and system-level challenges. Findings from this survey identify the need to tailor these models of care to individual needs, clearly addressing mental health needs, and building strong partnership as means of enhancing accessibility and sustainability of integrated care delivery in primary care settings.

Culture, tradition, structural violence, and mental health-related stigma play a major role in global mental health for refugees. Our aim was to understand what factors determine the success or failure of community-based psychotherapy for trauma-affected refugees and discuss implications for primary health care programs. Using a systematic realist-informed approach, we searched five databases from 2000 to 2018. Two reviewers independently selected RCTs for inclusion, and we contacted authors to obtain therapy training manuals. Fifteen articles and 11 training manuals met our inclusion criteria. Factors that improved symptoms of depression, anxiety, and PTSD included providing culturally adapted care in a migrant-sensitive setting, giving a role to other clinical staff (task-shifting), and intervention intensity. Precarious asylum status, constraining program monitoring requirements, and diverse socio-cultural and gender needs within a setting may reduce the effectiveness of the program. Primary care programs may enable community based mental health care and may reduce mental health-related stigma for refugees and other migrants. More research is needed on the cultural constructs of distress, programs delivered in primary care, and the role of cultural and language interpretation services in mental health care.

BACKGROUND: The postpartum period represents a critical period for both birthing and nonbirthing parents due to mental health concerns and new caregiving demands. Collaborative care models aim to address these needs, but postpartum care remains fragmented, lacking continuity and holistic support. Baby2Home (B2H) is a digital intervention rooted in the collaborative care model, specifically designed to support parents through their transition into parenthood by addressing their physical, emotional, and psychosocial needs. This intervention seeks to close the gaps left by traditional care models by providing continuous, organized, and accessible support throughout the postpartum period. In our qualitative study of the B2H intervention, we reference the parallel journeys framework and use it as a part of our analysis to evaluate whether mobile health (mHealth) technology addresses the holistic needs (postpartum and psychosocial) of new parents. OBJECTIVE: We aimed to assess how the B2H app supports the holistic needs of new parents and addresses care gaps identified in traditional postpartum services. METHODS: We conducted semistructured interviews with 20 birthing and nonbirthing parents selected through purposive sampling based on their app use. Data were analyzed using the postpartum parallel journeys framework and inductive coding. RESULTS: Our findings demonstrate the comprehensive impact of the B2H intervention in addressing both the physical and psychosocial needs of new parents. B2H supported postpartum care by helping parents navigate uncertainties, enhancing health care provider-parent communication, promoting self-care, and increasing parental self-efficacy. Psychosocial support included symptom identification, timely care manager assessments, coordinated treatment, and transition resources. The app also addressed care gaps by promoting inclusivity for nonbirthing parents, bridging screening and treatment, supporting real-time treatment navigation, and ensuring continuity of care. CONCLUSIONS: We demonstrate that the use of mHealth technology such as the B2H app can effectively support the multifaceted needs of new parents during their postpartum care period. By applying the parallel journeys framework, the research also identifies gaps in care that are addressed by the B2H app, presenting unique opportunities for future development and research.

BACKGROUND: The Sparkbrook Children's Zone is an example of a place-based integrated health and social care service developed to support children and young people living in marginalized populations in the United Kingdom. This model of care is expected to address both clinical need and the social determinants of health but evidence of the practical support needed is lacking. OBJECTIVE: To understand the infrastructural challenges of providing a service combining clinical and non-clinical staff from a range of organisations and settings. METHODS: A qualitative exploration of the experiences of staff delivering the service and used a directed content analysis to present the results within the Sustainable integrated chronic care model for multi-morbidity: delivery, financing, and performance (SELFIE) framework. RESULTS: A total of 14 staff were interviewed including clinicians, social care providers, local voluntary groups, and school-based family mentors. Participants described the gap between system-level integration and the lack of practical support for delivering a unified service on the ground; the training opportunities afforded by collocation; the complexity of securing staff from multiple employers using various funding sources; and the need for lengthier evaluations that extend beyond early instability. CONCLUSIONS: Despite decades of structural reform aimed at integrating the health and social care system in the UK, there was a surprising lack of practicable support for delivering a place-based integrated health and social care service. Their delivery is also hindered by short-term funding cycles limiting the reliability of evidence gathered from complex and evolving services.