Literature Collection

BACKGROUND: Around 1 in 7 people in India are impacted by mental illness. The treatment gap for people with mental disorders is as high as 75-95%. Health care systems, especially in rural regions in India, face substantial challenges to address these gaps in care, and innovative strategies are needed. METHODS: We hypothesise that an intervention involving an anti-stigma campaign and a mobile-technology-based electronic decision support system will result in reduced stigma and improved mental health for adults at high risk of common mental disorders. It will be implemented as a parallel-group cluster randomised, controlled trial in 44 primary health centre clusters servicing 133 villages in rural Andhra Pradesh and Haryana. Adults aged ≥ 18 years will be screened for depression, anxiety and suicide based on Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorders (GAD-7) scores. Two evaluation cohorts will be derived-a high-risk cohort with elevated PHQ-9, GAD-7 or suicide risk and a non-high-risk cohort comprising an equal number of people not at elevated risk based on these scores. Outcome analyses will be conducted blinded to intervention allocation. EXPECTED OUTCOMES: The primary study outcome is the difference in mean behaviour scores at 12 months in the combined 'high-risk' and 'non-high-risk' cohort and the mean difference in PHQ-9 scores at 12 months in the 'high-risk' cohort. Secondary outcomes include depression and anxiety remission rates in the high-risk cohort at 6 and 12 months, the proportion of high-risk individuals who have visited a doctor at least once in the previous 12 months, and change from baseline in mean stigma, mental health knowledge and attitude scores in the combined non-high-risk and high-risk cohort. Trial outcomes will be accompanied by detailed economic and process evaluations. SIGNIFICANCE: The findings are likely to inform policy on a low-cost scalable solution to destigmatise common mental disorders and reduce the treatment gap for under-served populations in low-and middle-income country settings. TRIAL REGISTRATION: Clinical Trial Registry India CTRI/2018/08/015355 . Registered on 16 August 2018.

BACKGROUND: Human papillomavirus (HPV) vaccination rates lag behind other recommended adolescent vaccines. Practice- and clinician-based interventions to improve HPV vaccination rates are known to be effective in improving completion rates. PURPOSE: The aim is to determine whether implementing bundled interventions across an integrated health system would result in systemwide improvements in HPV vaccination rates. METHODS: We assessed the impact of multilevel interventions across an integrated health system to increase HPV vaccination rates between 2019 and 2024 in a large and predominantly rural state. We analyzed the effects of implementing sequential bundles of interventions over multiple years, including efforts focused on quality improvement, physician leadership, electronic medical record enhancements, clinical decision support tools, and communications. RESULTS: Human papillomavirus vaccination completion rates improved from 46.2% in December 2019 to 55.4% in December 2024 (+9.2 percentage points), comparing favorably with changes in national rates during the same interval. These findings demonstrate that the interventions had a statistically significant impact on HPV vaccination rates in 13 year olds. CONCLUSIONS: By applying multilevel interventions, a system-wide implementation strategy can be successful in increasing HPV vaccination rates across an integrated health system.

BACKGROUND: In January 2020, the WHO declared the SARS-CoV-2 outbreak a public health emergency; by March 11, a pandemic was declared. To date in Ireland, over 3300 patients have been admitted to acute hospitals as a result of infection with COVID-19. AIMS: This article aims to describe the establishment of a COVID Recovery Service, a multidisciplinary service for comprehensive follow-up of patients with a hospital diagnosis of COVID-19 pneumonia. METHODS: A hybrid model of virtual and in-person clinics was established, supported by a multidisciplinary team consisting of respiratory, critical care, infectious diseases, psychiatry, and psychology services. This model identifies patients who need enhanced follow-up following COVID-19 pneumonia and aims to support patients with complications of COVID-19 and those who require integrated community care. RESULTS: We describe a post-COVID-19 service structure together with detailed protocols for multidisciplinary follow-up. One hundred seventy-four patients were discharged from Beaumont Hospital after COVID-19 pneumonia. Sixty-seven percent were male with a median age (IQR) of 66.5 (51-97). Twenty-two percent were admitted to the ICU for mechanical ventilation, 11% had non-invasive ventilation or high flow oxygen, and 67% did not have specialist respiratory support. Early data suggests that 48% of these patients will require medium to long-term specialist follow-up. CONCLUSIONS: We demonstrate the implementation of an integrated multidisciplinary approach to patients with COVID-19, identifying those with increased physical and mental healthcare needs. Our initial experience suggests that significant physical, psychological, and cognitive impairments may persist despite clinical resolution of the infection.

Addressing the impact of chronic conditions on work participation requires an integrated care model that embeds work-related goals from diagnosis onward. The Work-oriented Care Model (WoCM) adopts a biopsychosocial, patient-centered approach and incorporates key elements of the Capability Approach (CA) and the International Classification of Functioning (ICF), aligning functional performance with individual goals and contextual factors. A case study illustrates the need for continuous work-oriented assessment involving healthcare and occupational professionals. Implementation challenges underscore the importance of structural integration and improved coordination across healthcare and occupational systems.

This report reflects significant input from hundreds of Maryland stakeholders, and the committed efforts of many individuals across the Department of Health and Mental Hygiene (Department). It builds upon work conducted by the Department in 2011 that culminated in a consultant report. The 2011 Consultant Report recommended that Maryland should better align and integrate behavioral health services.The recommendation of a model that improves the integration of Medicaid-financed behavioral health services, presented in this report, represents a major milestone. Significant work still lies ahead. The Department greatly appreciates the contributions of everyone who has participated thus far and we look forward to continuing to work with stakeholders in the coming months to improve health care in Maryland.

BACKGROUND: Management of idiopathic intracranial hypertension (IIH) is complex requiring contributions from multiple specialized disciplines. In practice, this creates considerable organizational and communicational challenges. To meet those challenges, we established an interdisciplinary integrated outpatient clinic for IIH with a central coordination and a one-stop- concept. Here, we aimed to evaluate effects of this concept on sick leave, presenteeism, and health care utilization. METHODS: In a retrospective cohort study, we compared the one-stop era with integrated care (IC, 1-JUL-2021 to 31-DEC-2022) to a reference group receiving standard care (SC, 1-JUL-2018 to 31-DEC-2019) regarding economic outcome parameters assessed over 6 months. Multivariate binary logistic regression models were used to adjust for confounders. RESULTS: Baseline characteristics of the IC group (n = 85) and SC group (n = 81) were comparable (female: 90.6% vs. 90.1%; mean age: 33.6 vs. 32.8 years, educational level: ≥9 years of education 60.0% vs. 59.3%; located in Vienna 75.3% vs. 76.5%). Compared to SC, the IC group showed significantly fewer days with sick leave or presenteeism (-5 days/month), fewer unscheduled contacts for IIH-specific problems (-2.3/month), and fewer physician or hospital contacts in general (-4.1 contacts/month). Subgroup analyses of patients with migration background and language barrier consistently indicated stronger effects of the IC concept in these groups. CONCLUSIONS: Interdisciplinary integrated management significantly improves the burden of IIH in terms of sick leave, presenteeism and healthcare consultations - particularly in socioeconomically underprivileged patient groups.

We describe the design of the North Carolina Integrated Care for Kids (NC InCK) model. NC InCK is one of seven nationwide CMMI-funded pediatric health care delivery models that integrate services to promote whole-child health. NC InCK was collaboratively designed by health care systems, the state Medicaid agency, Medicaid managed care organizations, child-serving organizations across multiple sectors, and families. The model uses three key approaches to integrate care: 1) a risk stratification algorithm using data across healthcare, education, and social systems to holistically understand needs and identify children who may benefit from additional supports; 2) a family-centered, longitudinal care management model to integrate cross-sector services for children and youth needing clinical and nonclinical support; and 3) an alternative payment model with innovative measures around social needs and school readiness to drive investment in child and family well-being. Early success designing NC InCK has been driven by cross-sector and multi-level governance from the start of model design, garnering deep trust and alignment around shared goals. NC InCK is a step toward supporting whole-child health via cross-sector service integration and timely identification of children and families experiencing medical and social complexity. Lessons learned from design of this demonstration model can be applied to pediatric health initiatives nationwide.