Literature Collection

IMPORTANCE: During the COVID-19 pandemic, a large fraction of mental health care was provided via telemedicine. The implications of this shift in care for use of mental health service and quality of care have not been characterized. OBJECTIVE: To compare changes in care patterns and quality during the first year of the pandemic among Medicare beneficiaries with serious mental illness (schizophrenia or bipolar I disorder) cared for at practices with higher vs lower telemedicine use. DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, Medicare fee-for-service beneficiaries with schizophrenia or bipolar I disorder were attributed to specialty mental health practices that delivered the majority of their mental health care in 2019. Practices were categorized into 3 groups based on the proportion of telemental health visits provided during the first year of the pandemic (March 2020-February 2021): lowest use (0%-49%), middle use (50%-89%), or highest use (90%-100%). Across the 3 groups of practices, differential changes in patient outcomes were calculated from the year before the pandemic started to the year after. These changes were also compared with differential changes from a 2-year prepandemic period. Analyses were conducted in November 2022. EXPOSURE: Practice-level use of telemedicine during the first year of the COVID-19 pandemic. MAIN OUTCOMES AND MEASURES: The primary outcome was the total number of mental health visits (telemedicine plus in-person) per person. Secondary outcomes included the number of acute hospital and emergency department encounters, all-cause mortality, and quality outcomes, including adherence to antipsychotic and mood-stabilizing medications (as measured by the number of months of medication fills) and 7- and 30-day outpatient follow-up rates after discharge for a mental health hospitalization. RESULTS: The pandemic cohort included 120 050 Medicare beneficiaries (mean [SD] age, 56.5 [14.5] years; 66 638 females [55.5%]) with serious mental illness. Compared with prepandemic changes and relative to patients receiving care at practices with the lowest telemedicine use: patients receiving care at practices in the middle and highest telemedicine use groups had 1.11 (95% CI, 0.45-1.76) and 1.94 (95% CI, 1.28-2.59) more mental health visits per patient per year (or 7.5% [95% CI, 3.0%-11.9%] and 13.0% [95% CI, 8.6%-17.4%] more mental health visits per year, respectively). Among patients of practices with middle and highest telemedicine use, changes in adherence to antipsychotic and mood-stabilizing medications were -0.4% (95% CI, -1.3% to 0.5%) and -0.1% (95% CI, -1.0% to 0.8%), and hospital and emergency department use for any reason changed by 2.4% (95% CI, -1.5% to 6.2%) and 2.8% (95% CI, -1.2% to 6.8%), respectively. There were no significant differential changes in postdischarge follow-up or mortality rates according to the level of telemedicine use. CONCLUSIONS AND RELEVANCE: In this cohort study of Medicare beneficiaries with serious mental illness, patients receiving care from practices that had a higher level of telemedicine use during the COVID-19 pandemic had more mental health visits per year compared with prepandemic levels, with no differential changes in other observed quality metrics over the same period.

BACKGROUND: Integrated care addresses system fragmentation, especially for people with disabilities who require support across multiple domains. Most models focus on healthcare, overlooking social and environmental factors that hinder health management for people with disabilities. The International Classification of Functioning, Disability and Health (ICF)'s biopsychosocial approach integrates these broader factors, but its application in integrated care remains underexplored. OBJECTIVE: This scoping review aimed to explore the application of the ICF in research on integrated care, informed by the SELFIE framework, within the context of disability. METHODS: Following Joanna Briggs Institute's guidance and the PRISMA extension for scoping reviews, seven databases were searched from January 2011 to September 2023. Independent screening, selection, and data extraction were performed, with key findings related to integrated care identified deductively using the SELFIE framework. RESULTS: Twenty-six studies were included. These focused on populations with visual impairments, hearing loss, intellectual or developmental disabilities, spinal cord injuries, brain injuries, physical and learning disabilities, psychological impairment, and wheelchair users. Most studies applied the ICF as a conceptual framework rather than a coding system. Key elements of integrated care, such as holistic assessment, service delivery, leadership, governance, and workforce, were emphasized, while components like financing, technology, and research received limited attention. CONCLUSIONS: Traditional integrated care models, focusing on disease management, fall short for people with disabilities, who have diverse, often cross-system needs and social barriers. This review highlights the importance of integrating the context of disability, with the ICF's biopsychosocial model playing a crucial role in addressing environmental factors impacting body functions, activities, and participation.

This study evaluates the user experience and usability of a web-based tool, AICP, that supports healthcare professionals in creating personalized care plans with the help of clinical decision support (CDS), using the System Usability Scale (SUS), User Experience Questionnaire (UEQ), and Single Ease Questions (SEQs). The results show high usability (SUS: 75.45) and positive user experience, particularly in stimulation and novelty. Following CDS recommendations in a structured way and displaying patients' care plan adherence in charts and tables were found effective. However, dynamic content changes and raw sensor data presentation were identified as areas for improvement. Combining data through reasoning or allowing users to make inferences could further improve usability, supporting better patient care coordination.

BACKGROUND: Primary care serves as an entry point for many patients to access health care services, especially those who reside in medically underserved areas. Because an initiative exists for family nurse practitioners (FNPs) to fill primary care gaps in medically underserved areas, they must be included in educational strategies to provide quality behavioral health care within their scope of practice. METHOD: An academic-practice partnership was used to provide FNP residents the opportunity to learn to work within their scope of practice in a behavioral health integration model. RESULTS: The residents noted satisfaction with the learning environment, supervisory relationship, and role of the faculty. CONCLUSION: Innovative continuing education activities are needed to prepare novice FNPs to safely practice and enter into a health care workforce pipeline focused on reducing disparities in medically underserved areas. [J Contin Educ Nurs. 2024; 55(4):203-208.].