Literature Collection

Alzheimer's Disease is a complex, chronic illness of increasing prevalence in the US and worldwide. The complexity of this illness, and its impact on caregivers make it an ideal candidate for navigation services. The development of billable navigation codes now make it possible to create a financially sustainable navigation program. We describe our initial experience with a brain health navigator program, partnering between primary and specialty memory care, in a large integrated healthcare system. While a number of challenges exist, and careful planning was required, we have successfully implemented a navigation program, enrolling greater than 100 patients in the initial 6 months. Patient and caregiver feedback has been highly positive. We have experienced no significant barriers to reimbursement and when accounting for incremental downstream revenue generation (e.g. MRI, labs), we are forecasting long-term financial sustainability and the opportunity for continued scaling over time.

BACKGROUND: Poor oral health is associated with cardiovascular diseases (CVDs), largely due to shared risk factors such as smoking, diabetes and socioeconomic disadvantage. Integrating oral health into primary and specialist care, particularly cardiac services, presents a promising strategy to improve early detection of oral diseases and related health outcomes. This systematic review examines oral health strategies implemented in primary and cardiovascular care settings, focusing on their impact on oral and CVD indicators, service delivery and medical-dental collaboration. METHODS: A systematic review was conducted in accordance with the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and reported following PRISMA 2020 guidelines, with the protocol registered in PROSPERO. Peer-reviewed studies were systematically searched across major databases. Guided by the PICO framework, data were extracted on populations, interventions, settings and outcomes. Study quality was assessed using JBI and Mixed Methods Appraisal Tool criteria, and findings were synthesised using narrative and thematic analysis. RESULTS: Evidence from 17 studies highlight key integration strategies: (1) medical-dental collaboration through interdisciplinary care and co-location; (2) implementing oral health screening in non-dental settings; (3) non-dental teams providing oral health education and preventive care and (4) upskilling non-dental providers. Reported outcomes included improved oral health access, earlier detection of oral disease, enhanced provider confidence, increased chronic disease screening in dental settings and improved CVD markers. CONCLUSION: Integrated care models can bridge the oral-CVD care divide, improving equity and outcomes. However, sustainable implementation will require policy support, workforce training and evaluation of long-term cost-effectiveness and impact. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251113478, PROSPERO CRD420251113478.

INTRODUCTION: This study explored how youth with mental health issues, peer support workers, and primary care professionals perceive youth's needs while receiving support, key elements of peer support, and its integration into primary healthcare. METHOD: Twenty-eight semi-structured interviews were conducted and analyzed thematically to identify youth's needs, core components of peer support, and collaboration challenges between peer support services and primary care. RESULTS: All stakeholder groups recognized peer support as a valuable, low-threshold complement to traditional care, particularly for those awaiting treatment or lacking social support. Youth emphasized needs for knowledge, destigmatization, validation and connection - needs specifically addressed by the informal, empathetic, and non-hierarchical nature of peer support. Peer support workers and professionals emphasized the need to balance authenticity with safety and professional boundaries. Effective integration requires structured referral pathways, clear communication channels, confidentiality safeguards, and role clarity. Divergent expectations around responsibility for information sharing and formal requirements on lived experience highlight areas for improvement. Flexible peer support options that match youth's changing needs were seen as essential. DISCUSSION: While peer support services offer a valuable addition to youth mental healthcare, its integration with primary care remains complex and requires improved communication, role clarification, and adaptable support options.

Many people face problems about physical, mental, and social dimensions of health, and may have complex needs. They often experience a mismatch between their needs and the ability of the healthcare system to meet them, resulting in under- or overutilization of the healthcare system. On one hand, improving access to community-based primary healthcare for hard-to-reach populations should bring all healthcare and social services to one point of contact, near the community. On the other hand, better addressing the unmet needs of people who overuse healthcare services calls for integrated care among providers across all settings and sectors. In either case, intersectoral action between healthcare and social professionals and resources remains central to bringing care closer to the people and the community, enhancing equitable access, and improving health status. However, efforts to implement integrated care are unevenly weighted toward clinical and professional strategies (micro level), which could jeopardize our ability to implement and sustain integrated care. The development of appropriate policies and governance mechanisms (macro level) is essential to break down silos, promote a coherent intersectoral action, and improve health equity.