Literature Collection

Social workers are increasingly working in primary care clinics that provide Integrated Behavioral Healthcare (IBH) in which a patient's physical, behavioral, and social determinants of health are addressed on a collaborative team. Co-location, where care is housed in the same physical space, is a key element of IBH. Yet, little is known about the rate of social workers co-located with primary care physicians (PCPs). To identify national rates of social worker co-location, data were drawn from the Centers for Medicare and Medicaid (CMS) National Plan and Provider Enumeration System (NPPES; n = 232,021 social workers, n = 380,690 PCPs). Practice addresses were geocoded and straight-line distances between practice locations of social workers and PCPs were calculated. More than 26% of social workers were co-located with a PCP. However, in rural settings only 21% were co-located (p < .001). Co-location also varied by PCP practice size, specialty, and state. This study serves as a benchmark of the growth of IBH and continued monitoring of co-location is needed to ensure social work workforce planning and training are aligned with changing models of care. Further, identifying mechanisms to support social work education, current providers, and health systems to increase IBH implementation is greatly needed.

BACKGROUND: Optimizing antibiotic use is a UK Government priority. This study aimed to identify which combinations of interventions are associated with meeting primary care antibiotic prescribing targets in England's National Health Service, going beyond typical evaluations of individual interventions. METHODS: Data on interventions implemented by Integrated Care Boards (ICBs) in England were collected via an online survey (October 2023 to January 2024). The survey gathered information about 61 interventions covering data monitoring, incentives, governance, staff training, guidance, diagnostics, decision support tools and public awareness-raising activities.The survey data were linked to ICB-level antibiotic prescribing data, analysed descriptively and through a set-theoretic approach (fuzzy-set Qualitative Comparative Analysis, fsQCA). Clusters of ICBs that used a common set of interventions and met prescribing targets were identified. The average prescribing rates were calculated for each cluster and compared with ICBs that did not implement those interventions. RESULTS: Fifty-four responses were received from staff at 29 out of 42 ICBs (69%). Locally adapted prescribing guidance was used by all ICBs meeting targets. ICBs that monitored data and used incentives, guidance and/or challenged prescribers on their behaviour had the lowest prescribing. Implementing diagnostics, staff training or public awareness-raising interventions was not associated with lower prescribing. CONCLUSIONS: In a country that has been reducing antibiotic prescribing and implementing numerous antimicrobial stewardship interventions over the last decade, commissioning organizations that met policy targets were using combinations of a limited number of interventions by 2024. National and local efforts could therefore start prioritizing fewer interventions to further reduce prescribing.