Literature Collection

OBJECTIVES: To assess primary care contributions to behavioral health in addressing unmet mental healthcare needs due to the COVID-19 pandemic. METHODS: Secondary data analysis of 2016 to 2018 Medical Expenditure Panel Survey of non-institutionalized US adults. We performed bivariate analysis to estimate the number and percentage of office-based visits and prescription medications for depression and anxiety disorders, any mental illness (AMI), and severe mental illness (AMI) by physician specialty (primary care, psychiatry, and subspecialty) and medical complexity. We ran summary statistics to compare the differences in sociodemographic factors between patients with AMI by seeing a primary care physician versus those seeing a psychiatrist. Binary logistic regression models were estimated to examine the likelihood of having a primary care visit versus psychiatrist visit for a given mental illness. RESULTS: There were 394 023 office-based visits in the analysis sample. AMI patients seeing primary care physician were thrice as likely to report 1 or more chronic conditions compared to those seeing psychiatrist. Among patients with a diagnosis of depression or anxiety and AMI the proportion of primary care visits ([38% vs 32%, P < .001], [39% vs 34%, P < .001] respectively), and prescriptions ([50% vs 40%, P < .001], [47% vs 44%, P < .05] respectively) were higher compared to those for psychiatric care. Patients diagnosed with SMI had a more significant percentage of prescriptions and visits to a psychiatrist than primary care physicians. CONCLUSION: Primary care physicians provided most of the care for depression, anxiety, and AMI. Almost a third of the care for SMI and a quarter of the SMI prescriptions occurred in primary care settings. Our study underscores the importance of supporting access to primary care given primary care physicians' critical role in combating the COVID-19 related rise in mental health burden.

INTRODUCTION: Ontario, Canada, is shifting to a more integrated healthcare delivery system through the Ontario Health Team (OHT) initiative. The extent to which OHTs have the capabilities to engage in integrated care is unknown and important to designing implementation supports. This article describes the development and psychometric testing of the Ontario Integrated Care Leadership Survey (OICLS), in 30 OHTs. The OICLS was informed by the Context and Capabilities for Integrated Care framework (CCIC). METHODS: The 42-item survey was distributed electronically to 765 eligible leaders across 30 OHTs; 480 (63%) responded representing approximately 600 organizations. Item analyses and scale psychometric analyses were undertaken to reduce the number of items in the CCIC survey tool while maintaining validity and reliability. RESULTS: The OICLS survey is comprised of 10 domains covering 12 of 17 capabilities identified in the CCIC. In the total sample, Cronbach's alpha exceeded 0.7 for nine of the ten domains. Descriptive responses to each of the 39 OICLS closed-ended survey questions illustrate the areas of strength and weakness and where supports are warranted to advance the formation of integrated care delivery systems. CONCLUSION: The OICLS offers a brief and valid assessment of foundational aspects of multi-organizational integrated care initiatives.

OBJECTIVE: To assess the feasibility of a new intervention designed to support adolescents and parents in the transition from paediatric eating disorder (ED) treatment to adult mental health services. METHOD: Pre-transition adolescents with EDs, and their parents, were invited to complete up to five transition intervention components over 3 months. A mixed methods design was used to assess intervention feasibility, comprised of acceptability and preliminary effectiveness. A single-arm pre-post design was used to collect and analyse quantitative survey and feasibility data. Individual qualitative interviews and written reflections were collected and analysed using content analysis. RESULTS: This study yielded a 33% (10/31) recruitment rate and 68% (13/19) retention rate. On average, participants completed 75% of the expected components in under 3 months, with varied completion of each expected intervention component (40%-100%). Participants found the intervention convenient and helpful. Parents reported a significant decrease in guilt (Z = -2.02, p = 0.04, d = -0.83). By 1-month post-transition, three adolescents transitioned to interim supports and none started specialist adult treatment. CONCLUSIONS: Although this transition intervention did not demonstrate adequate feasibility, its acceptability and effectiveness should be evaluated after an update based on participant feedback. Other solutions to bridge the transition gap for adolescents with EDs should continue to be identified. CLINICAL TRIAL REGISTRATION NUMBER: NCT04888273.

BACKGROUND: This study aimed to evaluate the impact of the Community Care Program, which was the amalgamation of three outreach services-post-acute care, Residential In-Reach, and the Hospital Admission Risk Program-into a single integrated care model. Specifically, we assessed its effects on unplanned hospital readmissions and emergency department re-presentations at 30-, 60- and 90-days post-enrolment. METHODS: A pragmatic, real-world, population-based observational study was conducted using an interrupted time series analysis. The study included 4708 adult patients across two periods: pre-amalgamation (November 2014-October 2016), and post-amalgamation (May 2017-October 2018). Data were sourced from the National Centre for Healthy Ageing Data Platform, with statistical analyses conducted using Generalised Least Squares models to account for autocorrelation. RESULTS: The study observed a significant increase in quarterly program enrolments post-amalgamation, from 578 to 1011 per quarter. The 30-day readmission rate decreased from 11.8% to 8.52% post-amalgamation. However, interrupted time series analysis revealed no statistically significant changes in the slopes of readmission and emergency department re-presentation rates after the program's amalgamation. The program did not result in significant changes in 60- or 90-day outcomes. CONCLUSIONS: The amalgamation of post-acute care, Residential In-Reach, and the Hospital Admission Risk Program into the Community Care Program led to increased service utilisation without a significant impact on reducing unplanned hospital readmissions or emergency department re-presentations. Although the program amalgamation demonstrated improved accessibility, its longer-term impact remains inconclusive, highlighting the need for continuous refinement and further evaluation to optimise system efficiency. No patient or public contribution occurred in this study. REPORTING METHOD: This study adhered to the STROBE guidelines for observational research.