Literature Collection

INTRODUCTION: Integrated care systems (ICSs) are the latest major innovation aiming to develop localised, integrated health and social care services to improve population health in England. Nationally, alcohol has received limited attention in National Health Service (NHS) strategic decision-making relative to its burden of harm, which varies considerably in localities. We examined decision-making and progress on alcohol in two contrasting ICSs, identifying systemic barriers to dealing with alcohol harm and potential leverage points, particularly in primary care. METHODS: Qualitative case study in two ICSs differing in strategic prioritisation of alcohol in Northern England. In-depth semistructured interviews with 14 senior stakeholders followed by constructionist thematic analysis. RESULTS: ICS formation occurred when services had been under sustained pressures with lines of communication and accountability emergent and unclear. Stakeholders identified fundamental disconnects between prevention and treatment. ICS strategic prioritisation of alcohol engendered new perspectives and novel actions. Even where not prioritised, there was a demand for placing alcohol work within a population frame. Attention to alcohol was somewhat precarious in primary care and overlooked in NHS health inequalities discourse. Reframing alcohol clinically as a drug was seen as having unrealised potential to prevent or delay disease onset and complications and improve NHS effectiveness. While congruent with the vision of how the new system should be working, there were doubts about capacity in current circumstances. CONCLUSIONS: There is much to do to create a joined-up, system-wide approach to alcohol, and thus a strong case for a national NHS alcohol strategy to guide ICS decision-making, addressing links between NHS work and public health.

The adoption of digital therapeutics among older adults presents both opportunities and challenges in modern healthcare. While these technologies enhance disease management, autonomy, and quality of life, engagement remains hindered by cognitive, emotional, systemic, and sociocultural barriers. This narrative review synthesizes findings from 76 peer-reviewed studies identified through Scopus and Web of Science (2010-2024) to examine key factors influencing geriatric engagement with digital therapeutics. FINDINGS: indicate that technological illiteracy, privacy concerns, usability challenges, and mistrust in digital platforms significantly limit adoption. Additionally, cultural attitudes, generational skepticism, and infrastructural limitations exacerbate digital disparities. Conversely, personalized health benefits, caregiver and peer support, and intuitive design features serve as key motivators for adoption and sustained engagement. To enhance digital inclusion, this review highlights the need for user-centered design principles, tailored digital literacy programs, and systemic policy interventions, such as broadband expansion and privacy safeguards. Future research should explore longitudinal engagement patterns, culturally adaptive digital interventions, and the integration of behavioral and technological frameworks to optimize geriatric digital health solutions. Addressing these factors will be essential to ensuring equitable, inclusive, and effective digital therapeutics for aging populations worldwide.

Medication treatment for opioid use disorder (M-OUD) is underutilized, despite research demonstrating its effectiveness in treating opioid use disorder (OUD). The UNC Extension for Community Healthcare Outcomes for Rural Primary Care Medication Assisted Treatment (UNC ECHO for MAT) project was designed to evaluate interventions for reducing barriers to delivery of M-OUD by rural primary care providers in North Carolina. A key element was tele-conferenced sessions based on the University of New Mexico Project ECHO model, comprised of case discussions and didactic presentations using a "hub and spoke" model, with expert team members at the hub site and community-based providers participating from their offices (i.e., spoke sites). Although federal funders have promoted use of the model, barriers for providers to participate in ECHO sessions are not well documented. Methods: UNC ECHO for MAT included ECHO sessions, provider-to-provider consultations, and practice coaching. We conducted 20 semi-structured interviews to assess perceived usefulness of the UNC ECHO for MAT intervention, barriers to participation in the intervention, and persistent barriers to prescribing M-OUD. Results: Participants were generally satisfied with ECHO sessions and provider-to-provider consultations; however, perceived value of practice support was less clear. Primary barriers to participating in ECHO sessions were timing and length of sessions. Participants recommended recording ECHO sessions for viewing later, and some thought incentives for either the practice or provider could facilitate participation. Providers who had participated in ECHO sessions valued the expertise on the expert team; the team's ability to develop a supportive, collegial environment; and the value of a community of providers interested in learning from each other, particularly through case discussions. Conclusions: Despite the perceived value of ECHO, barriers may prevent consistent participation. Also, barriers to M-OUD delivery remain, including some that ECHO alone cannot address, such as Medicaid and private-insurer policies and availability of psychosocial resources.

INTRODUCTION: Researchers predict long-term increases in suicide deaths following the COVID-19 pandemic. Little is known about risk factors for suicidal ideation (SI) and suicidal attempts (SA) or treatment barriers and promoters during the pandemic. We examine these factors in a young adult sample. METHODS: Analyses used a 2022 cross-sectional survey dataset (N = 1,956). Logistic regression identified factors associated with pandemic suicidality (i.e., SI, SA). Non-treatment seekers reported barriers to seeking treatment. Logistic regression identified promotive factors associated with treatment-seeking. RESULTS: 28.6 % of our sample developed suicidality during the pandemic, of whom 49.6 % did not seek treatment. Asian race and sexual minority status were strongly associated with increased odds of pandemic suicidality. Among SI non-treatment-seekers, barriers were primarily attitudinal (e.g., "symptoms are not serious enough for treatment"); among non-treatment-seekers with SA, barriers were mostly structural (e.g., insufficient funds). Previous depression treatment was strongly associated with increased odds of treatment-seeking. CONCLUSION: Asian American individuals were at increased risk for pandemic suicidality, which may reflect interpersonal risks related to COVID-19-related anti-Asian racism. Our findings point to a "foot-in-the-door" effect: past treatment-seeking was positively associated with future treatment-seeking. To promote this effect and decrease barriers, we suggest integrated mental health screening and referrals in primary care.

The integrated behavioral health care model in primary care has the potential to reduce barriers to care experienced by children and families from ethnic minorities and low socioeconomic status. Limited access to pediatric behavioral health care is a significant problem, with up to 40% of children and adolescents with identified mental disorders and only 30% of them receiving care. Barriers include transportation, insurance, and shortage of specialists. Primary care provider bias, decreased knowledge and feelings of competence, and cultural beliefs and stigma also affect earlier diagnosis and treatment, particularly for Hispanic families with low English proficiency and African Americans.