Collaborative Care Research Articles

Implementing primary care concepts in higher education: a mixed method study in Flanders (Belgium)

BackgroundThe policy shift towards person-centred integrated primary care systems drives interest in primary care across higher education programs. In Flanders, the Primary Care Academy (PCA) is established to support this policy shift. The PCA focusses on the concepts of goal-oriented care, self-management, and interprofessional collaboration to support the shift towards integrated care and to integrate them in curricula in order to strengthen and develop a futureproof health system. Therefore, the aim of this study is if and how lecturers implement these concepts in the curriculum and what they need for a successful implementation.MethodsA sequential explanatory mixed method study design was used combining quantitative and qualitative data. A cross-sectional survey was sent to 276 Flemish health care education programs. Qualitative data was collected through focus groups in which lecturers participated.ResultsThe results showed that 89% of the higher education programs address goal-oriented care, self-management, and interprofessional collaboration with regard to primary care. Further analysis of courses within the programs reveals that the concept of self-management is covered in only 58%, while goal-oriented care (73%) and interprofessional collaboration (80%) appear more frequently. The level at which the themes are addressed in the courses are often limited to an introduction.The focus groups revealed that primary care is present in education programs, however lecturers are limited aware where primary care is integrated in their own and other programs. Lectures expressed a need for more collaboration between research, education and practice in developing educational content. When new concepts are introduced, lecturers want them to be translated into educational content, learning objectives and competencies.ConclusionsThe study shows that the concepts of goal-oriented care, self-management, and interprofessional collaboration are present in higher education programs to a varying degree. Lecturers are eager to implement these new primary concepts but they lack collaboration between education, research and practice. Lecturers indicate the need for a competence profile for primary care professionals as common framework to guide curriculum development.

The Analysis Study of Management of Rehabilitation in Patient with Bladder Dysfunction : A Comprehensive Systematic Review

Background: Management of bladder dysfunction, a condition causing bladder problems, requires effective treatment strategies. PMR specialists, urologists, and gynecologists are primarily involved in this process. However, there is a lack of consensus on optimal treatment protocols, necessitating interdisciplinary collaboration and comprehensive care frameworks. Methods: This systematic review complied with the PRISMA 2020 requirements, concentrating solely on full-text papers published in English from 2014 to 2024. Editorials and review articles lacking a DOI were omitted to guarantee the use of high-quality sources. A comprehensive literature review was performed using esteemed databases such as ScienceDirect, PubMed, and SagePub to locate pertinent studies. Result: The initial database search yielded more than 3,000 publications related to the topic. Through a rigorous three-stage screening process, eight studies were identified that met the predefined inclusion criteria for detailed analysis. These selected studies underwent thorough critical evaluation, enabling an in-depth examination of the management of rehabilitation in patients with bladder dysfunction. This meticulous approach ensured that only the most relevant and high-quality studies were included in the review, providing a robust foundation for the subsequent analysis. Conclusion: Rehabilitation therapy has shown promising results in managing bladder dysfunction in neurological conditions like multiple sclerosis, stroke, and spinal cord injury. Non-invasive interventions like pelvic floor muscle training and electrostimulation improve urinary function and quality of life. Advanced therapeutic approaches like high-intensity-focused electromagnetic therapy and virtual reality offer personalized treatment options.

Prospects of Using AI Technologies in Open Journal Systems (OJS)

Open Journal Systems (OJS) is a widely used open-source platform for managing and publishing academic journals (Ndungu, 2020), (Hunter, 2010), (Tabatadze B. , 2024). Its modular design and open framework provide opportunities for integrating artificial intelligence (AI) technologies, which hold transformative potential for academic publishing. AI can enhance OJS by automating editorial workflows, improving user experience, and fostering global accessibility. Key areas for AI integration include automated peer review, where natural language processing (NLP) can identify relevant reviewers, detect plagiarism, and ensure structural compliance. AI-powered recommendation systems can personalize content delivery, offering tailored article suggestions based on user preferences and behaviors. Additionally, linguistic diversity can be bolstered through real-time translation tools and speech-to-text features, facilitating broader engagement with a global audience. AI also enables automation in editorial processes such as grammar checks, citation management, and abstract generation. Advanced analytics powered by AI can provide actionable insights into readership trends, engagement metrics, and impact factor predictions, supporting strategic decision-making for journal administrators. Despite its potential, AI integration poses challenges, including technical expertise requirements, financial constraints, and ethical concerns such as data privacy and bias. Overcoming these barriers will require careful planning and community collaboration. The future of AI in OJS looks promising, with opportunities to incorporate blockchain, adaptive learning systems, and AI-driven collaboration tools. By addressing these challenges, OJS can lead the evolution of open-access publishing, enhancing efficiency, accessibility, and inclusivity in scholarly communication.

The current state of the Multidisciplinary Heart Team Approach: a systematic review.

The heart team (HT) approach, recommended for managing cardiovascular diseases (CVDs), emphasizes multidisciplinary collaboration. Despite its potential benefits, evidence on its effectiveness and implementation is varied and sparse. This review assesses the HT approach's impact on patient outcomes and care delivery in cardiovascular care. A systematic review was conducted across MEDLINE, EMBASE, PubMed, Cochrane, and Google Scholar up to July 2023, focusing on studies that implemented an HT approach in coronary and heart valve disease management. Exclusion criteria included non-human studies, case reports, and studies not focusing on HT outcomes. From 6270 identified articles, 20 met the inclusion criteria. These studies demonstrated significant variability in HT composition and organisation, coupled with a lack of standardized metrics for evaluating clinical outcomes and the impact of the HT. Significant variability was observed in HT composition, with 13 of the 20 studies did not utilize structured templates, those that did demonstrated more consistent decision-making. In mitral valve interventions, HTs were linked to reduced in-hospital mortality and improved long-term survival (5-year survival probability of 0.74 vs 0.70, p = 0.04). In aortic valve interventions, 80% of patients underwent tailored valve procedures following HT evaluation. The HT approach in cardiovascular care demonstrates improved patient outcomes, particularly in specialized interventions for mitral and aortic valve diseases and CAD management. Despite these positive findings, the variability in HT implementation and the need for standardized outcome metrics call for further advances to optimize this collaborative care model.

The Nutrient–Skin Connection: Diagnosing Eating Disorders Through Dermatologic Signs

The interplay between nutrition and skin health provides a crucial lens for understanding, diagnosing, and managing eating disorders (EDs) such as anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED). This review explores the dermatological manifestations resulting from the nutritional deficiencies commonly associated with EDs, including conditions like hair loss, xerosis, and brittle nails. These changes in the skin and its appendages often reflect deeper systemic dysfunctions, such as deficiencies in essential micronutrients (zinc, iron, and vitamins A and C), hormonal imbalances, and electrolyte disturbances. Recognizing these dermatological signs as diagnostic tools is vital for the early identification and intervention of EDs. By integrating dermatological observations with psychiatric and nutritional care, a holistic, multidisciplinary approach can be developed to address both the physical and psychological complexities of EDs. This review highlights the critical role of these skin-related markers in promoting timely diagnosis and effective treatment. To examine the relationship between specific nutrients and dermatological manifestations in EDs, a systematic review of three electronic databases—PubMed, Google Scholar, and ResearchGate—was conducted. The findings underline the importance of early recognition of these skin symptoms for effective management. Collaborative care involving dermatologists, psychiatrists, and nutritionists is essential for diagnosing and treating EDs. Such integrated efforts ensure a comprehensive approach to these multifaceted conditions, ultimately improving patient outcomes and enhancing overall care.

Mental Illness is as Catastrophic as Physical Illness, If Not More!

As per the data released by the Mental Health Survey (NMHS) 2015-16, 10.6% (1) of the adults in India have something or other clinical mental illness, and many more suffer silently with subclinical symptoms. In India, the contribution of mental illness to disability-adjusted life-years (DALYs) in the year 2017 was 4.7% with an uprise of 88% from 2.5% in the year 1990. Social stress, highly competitive ecosystems, peer pressure, and erratic working schedules are some of the predisposing factors for the high prevalence of mental illness in urban areas. Mental illness has a larger economic burden on patients and it impacts even the purchasing power of the entire family. World over, mental neurological and substance use disorders collectively known as MNSUDs are recognized as a sizable factor contributing to the non-communicable diseases (NCDs) category with substantial impact on morbidity and disability. Unfortunately, in India, only 5% (one out of twenty) patients seek treatment for mental illness, and only 0.06% of the total health budget is for mental health programs. More non-medical community-based research is needed to fathom the gigantic mental illness across socioeconomic sects of society. Key Words: Mental Illness, DALYs, Mental Health Survey (NMHS) 2015-16, Post-Traumatic Stress Disorder (PTSD), Disease Burden, Bipolar Disorders, Social Stress, Suicidal Tendencies, Depression among women, Collaborative Care Models (CCMs), National Mental Health Program (NMHP), socio-ecological community intervention.

Perspectives of healthcare professionals on cross-sectoral collaboration between mental health centers and municipalities: A qualitative study.

This paper aims to explore the intricacies of cross-sectoral collaboration in mental health care, focusing on the perspectives of health professionals across various disciplines. It seeks to understand how collaboration can enhance service delivery and patient outcomes while identifying existing challenges. The evolving healthcare landscape emphasizes the importance of integrating services across sectors, particularly in mental health care, to improve continuity and efficiency of care. The study utilizes qualitative methods to investigate health professionals' experiences with cross-sectoral collaboration in mental health services. Purposive sampling was used to select 21 health professionals for focus group discussions held at a mental health center in Region Zealand, Denmark. Data was collected through these discussions, and content analysis was performed to extract key themes. The data collection took place in 2022. Health professionals recognized the potential benefits of cross-sectoral collaboration, such as enhanced service delivery and improved patient outcomes. However, significant barriers were identified, including bureaucratic obstacles, communication gaps, and insufficient organizational support. Cross-sectoral collaboration in mental health care offers significant advantages, but challenges must be addressed to fully realize its potential. Efforts should focus on policy reforms, organizational support, and fostering interdisciplinary communication to improve care delivery.

A Pre-Adoption Assessment of a Collaborative Care Approach to Dental-Fear Treatment

Background: With an estimated global prevalence rate of over 30%, dental fear is a ubiquitous public health phenomenon. Dental fear’s adverse effects on patient oral health and quality of life are well established; the stresses and financial repercussions it can pose to providers are increasingly recognized. Although dental fear is highly treatable, a disseminable intervention that satisfies the needs of patients and dental care providers has yet to be realized. Objectives: We sought to understand allied dental professionals’ experiences treating patients with dental fear and their impressions of, and receptivity to, a stepped-care approach, including perceived barriers and facilitators to its adoption. Methods: Thirteen semi-structured focus groups comprising students in (a) current dental hygiene programs and (b) other dental programs, who had prior experience working as licensed dental hygienists or allied professionals (i.e., dental assistants, dental therapists, dental treatment coordinators; N = 49) were conducted. Focus group discussions were recorded, transcribed, and thematically analyzed. Results: Participant responses supported the need for innovation in managing dental fear in practices, and supported hygienists as likely facilitators of any new behavioral approach. Overall, participants were receptive to the idea of a stepped-care treatment approach but identified several factors (e.g., accessibility, costs, treatment credibility) that would need to be addressed for its adoption by patients and dental professionals. Conclusion: A stepped-care approach to dental fear treatment has promise to meet the needs of patients and dental professionals. Potential barriers and facilitators to adoption provide a roadmap for future intervention refinement and efficacy testing.

The Tango to Modern Collaboration and Patient-Centric Value Generation in Health Care – a real-world guide from practitioners for practitioners

Background Value-Based Health Care (VBHC) represents a pivotal shift from volume-based to outcome-driven quality metrics centered on patient-valued outcomes. This approach requires collaboration across all participants in the health care value chain; providers, payers, pharma, policymakers and patients (collectively known as the 5Ps). Despite substantial theoretical endorsement of VBHC’s potential for improving health outcomes and system efficiency, empirical evidence detailing its practical implementation remains limited. This field study evaluates the real-word implementation of VBHC within a health care organization. Methods In 2022, a health care collaboration Think Tank initiated this investigation during a breakout session, gathering insights from 12 leading international organizations to construct an empirical VBHC transformation reference guide. Real-world data was collected through structured interviews over a 1-year period, covering the 5 P value chain in various healthcare settings. The VBHC initiatives were analyzed through four stages: initiation, data acquisition, collaborative frameworks, and results evaluation. Results The 12 interviews identified five key enablers for successful VBHC implementation: 1. Organizational Purpose: defining core motivators for change; 2. People: identifying pivotal roles and leadership to endorse change; 3. Resources: securing personnel and financial support; 4. Data Infrastructure: developing interoperable IT systems for effective data sharing and collection; 5. Execution: prioritizing sustained implementation processes. Conclusion The findings highlight that VBHC implementation and adoption is complex and requires incremental advancements, dedicated leadership, and resilient strategic framework spanning over multiple years. A comprehensive understanding of patient populations, risk stratification, and appropriate outcome metrics are essential to measure and deliver the VBHC transformation. Executive endorsement and transition funding during the transformation process are paramount to support this systemic shift. Collaboration among all 5 P stakeholders is essential for success. This field study underscores the importance of continuous learning and adaptation, providing a practical guide to enhance health care quality and efficiency that serves all stakeholders.

The Wound Reporting in Animal and Human Preclinical Studies Guidelines.

Preclinical studies for wound healing disorders are an essential step in translating discoveries into therapies. Also, they are an integral component of initial safety screening and gaining mechanistic insights using an in vivo approach. Given the complexity of the wound healing process, existing guidelines for animal testing do not capture key information due to the inevitable variability in experimental design. Variations in study interpretation are increased by complexities associated with wound aetiology, wounding procedure, multiple treatment conditions, wound assessment, and analysis, as well as lack of acknowledgement of limitation of the model used. Yet, no standards exist to guide reporting crucial experimental information required to interpret results in translational studies of wound healing. Consistency in reporting allows transparency, comparative, and meta-analysis studies and avoids repetition and redundancy. Therefore, there is a critical and unmet need to standardise reporting for preclinical wound studies. To aid in reporting experimental conditions, The Wound Reporting in Animal and Human Preclinical Studies (WRAHPS) Guidelines have now been created by the authors working with the Wound Care Collaborative Community (WCCC) GAPS group to provide a checklist and reporting template for the most frequently used preclinical models in support of development for human clinical trials for wound healing disorders. It is anticipated that the WRAHPS Guidelines will standardise comprehensive methods for reporting in scientific manuscripts and the wound healing field overall. This article is not intended to address regulatory requirements but is intended to provide general guidelines on important scientific considerations for such studies.

An in-depth Analysis of the Degree of Implementation of Integrated Care for Diabetes in Primary Health Care in Cambodia.

With the rising prevalence of type 2 diabetes (T2D), three care initiatives for T2D are being scaled-up in Cambodia to improve availability and accessibility of integrated care for T2D: (1) hospital-based care, (2) health centre-based care, and (3) community-based care. This case study aims to share learnings from an in-depth analysis of the level of integrated care implementation in these care initiatives for T2D in Cambodia. Twenty public health facilities in five operational districts were assessed on six integrated care components: (1) early detection and diagnosis, (2) treatment in primary care services, (3) health education, (4) self-management support, (5) structured collaboration, and (6) organisation of care. Two raters independently scored each facility on a 0-5 scale based on multiple sources of data and reached a consensus. The in-depth analysis showed that the three care initiatives were not implemented in an integrated manner, with low implementation scores (1 or 2 out of 5) in all selected settings. The presence of health centre-based care was associated with higher scores for early detection and diagnosis and treatment in primary care services, while the presence of community-based care was related to structured collaboration and organisation of care. The evidence suggests that while each care initiative has its potential contributions towards integrated care for T2D, the three care initiatives should be effectively implemented in an integrated manner in order to potentially produce the desired outcomes.

Lived Experience of Postpartum Women in Recovery for Opioid Use Disorder on Medication-Assisted Therapy.

The purpose of this study was to understand the lived experiences of postpartum women on medication-assisted therapy for opioid use disorder. van Manen's interpretive hermeneutic phenomenological design was used. Recruitment and data collection from seven participants occurred at an outpatient office offering care for perinatal patients on medication-assisted therapy for opioid use disorder. Data collection occurred between September 2021 and March 2022 via in-person interviews using a demographic data sheet, interview guide, speech recognition software, and digital recordings. Demographic data were analyzed using descriptive statistics. Qualitative data were analyzed using precoding, coding, and thematic analysis via van Manen's interpretive hermeneutic phenomenological method. Seven themes were identified: troubled origins, used opioids to deal with life issues, needed to be self-reliant, opioid use disorder overtook their life, the baby was a motivator to seek treatment, the need for combined medication-assisted therapy and collaborative care, and hope for a better life. Nurses can provide trauma-informed care, support the importance of medication-assisted therapy in recovery, incorporate a collaborative care team with expertise in postpartum opioid use disorder, continue the collaborative care team for a minimum of 1 year, and advocate for the patient's role as parent.

Critical Analysis of The Intersections Between Nursing and Midwifery

Nursing and midwifery are two health professions related to the scope of practice. However, they differ, especially in women's and children's health services. It recently became important to address overlaps between these fields, particularly about collaborative care models. To this end, this paper aims to investigate the complex role, shared tasks and dynamics, and issues relating to nurses and midwives in today's society. It explores the role of the professions in patient care, defines the areas of convergence and drawbacks of these professions, and analyzes the effect of these professions on patient care. Some issues include role confusion, variation in professional training, and constraints of the overall health system, which are outlined in addition to the suggested approaches to enhance relations between nursing and midwifery.

Pharmacist-led Care in Collaboration with a Cardiovascular Team to Improve the Management of Atherosclerotic Cardiovascular Disease Risk in Hospitalized Patients

Pharmacist-led Care in Collaboration with a Cardiovascular Team to Improve the Management of Atherosclerotic Cardiovascular Disease Risk in Hospitalized Patients

Nurses' and physicians’ experience of a new algorithm for tapering analgosedation in the paediatric intensive care unit: A focus-group investigation

Aim/objectiveIatrogenic withdrawal syndrome occurs frequently during the tapering phase of opioids and benzodiazepines in paediatric intensive care units. The aim of this study was to explore physicians' and nurses' experiences in patient care and staff collaboration during the tapering phase using a new “algorithm for tapering analgosedation” MethodsWe used a qualitative explorative design with focus groups. The framework method was followed including transcription, familiarisation, coding, developing a framework, applying the framework, charting data into the framework matrix, and interpreting the data. The study was conducted at two paediatric intensive care units at Oslo University Hospital in Norway. Nurses and physicians who had used the new algorithm participated in the study. FindingsThree focus-group interviews were conducted with a total of 15 informants. Three main themes were identified with relevant subthemes: “Caring for a child in withdrawal”, “Advantages of the algorithm”, and “Challenges of the algorithm”. The algorithm positively affected patient care and staff collaboration during tapering. The use of the Withdrawal Assessment Tool-1 integrated in the algorithm required experienced nurses due to the risk of false-positive patient assessments. ConclusionNurses and physicians in our study experienced that the new algorithm promoted staff collaboration and positively affected patient care. The use of the Withdrawal Assessment Tool-1 integrated in the algorithm required experienced staff and resources for continuous staff education.

S87 Addressing Medical Trauma in Young Adults With Inflammatory Bowel Disease: A Roadmap for Patient-Centered Resources and Collaborative Care

S87 Addressing Medical Trauma in Young Adults With Inflammatory Bowel Disease: A Roadmap for Patient-Centered Resources and Collaborative Care

Explaining how a psychosocial intervention (PROACTIVE) based on behavioural activation improved outcomes of depression in older adults living in deprived regions of Brazil: The mediating roles of reduced loneliness and stepped care

BackgroundThe PROACTIVE trial was a task-shared, stepped and collaborative care, psychosocial intervention based on psychoeducation and behavioural activation in 715 older adults (60–94 years; mean (SD) 68·6 (6.9) years; 74·1 % female), that was highly effective at improving recovery from depression among older adults in Brazil. Here we investigate mediators of the intervention's effectiveness. MethodsCausal mediation analysis using interventional indirect effects, simultaneously decomposed the total effect of PROACTIVE on recovery from depression (PHQ-9 < 10) into multiple indirect effects including: dose of intervention (numbers of sessions and activities completed); social support (Luben Social Network Scale); perceived loneliness (UCLA questionnaire); and additional sessions offered to participants who did not respond during the initial phase of the stepped care intervention. ResultsOf the intervention's total effect (difference in probability of recovery from depression between the intervention and control arms 0·216 [bias-corrected 95 % CI: 0·149, 0·291]): 13 % was mediated through reduced loneliness (0·028 [0·013, 0·046]); and 25 % through attending additional sessions for participants who did not initially respond to the intervention (0·055 [0·007, 0·102]). LimitationsDue to limitations in our sample size our study may lack power to detect some nuances such as interactions between different mediators. ConclusionsOur findings emphasise the importance of a home-based intervention to improve depression outcomes where participants are encouraged to self-select activities to mitigate against loneliness. Importantly, our findings suggest that the intervention's stepped-care component offering additional sessions to participants who did not experience an early response shows promise in ensuring a sustained recovery from depression.

Incorporating value-informed advanced nursing practice into APRN education

Value-informed advanced practice nursing capitalizes on the high-value nursing model of care to meet population health needs and address rising healthcare costs. However, nurse practitioners (NPs) often lack knowledge about value-based care, which limits their ability to lead systems-based changes to improve outcomes and lower costs. Identifying the key domains for value-informed advanced nursing practice can support curricular alignment with competency-based education. A review of the peer-reviewed and gray literature identified an initial list of domains that impact the success of value-based NP care. These domains were then confirmed and validated through interviews with eight NP practice owners. The final seven key domains of value-informed advanced nursing practice – Leadership/High Value Culture, Quality and Analytics, Care Coordination, Collaboration and Community Connections, Financial Management, Care Redesign, and IT Infrastructure and Interoperability – align with the sub-competencies established by the American Association of Colleges of Nursing and the National Organization of Nurse Practitioner Faculty. Learning activities are offered to facilitate NP understanding of value-informed nursing practice and meet selected sub-competencies. Incorporating the key domains for value-informed advanced nursing practice into NP and Doctor of Nursing Practice education prepares emerging and seasoned NPs to lead systems-level change and improve care delivery.

Implementing a Collaborative Care Model for Child and Adolescent Mental Health in Qatar: Addressing Workforce and Access Challenges

Implementing a Collaborative Care Model for Child and Adolescent Mental Health in Qatar: Addressing Workforce and Access Challenges

Immune-related adverse event detection in liver cancer patients treated with immune checkpoint inhibitors: Nationwide exploratory survey in Japan.

This study aimed to comprehensively assess the incidence of immune-related adverse events (irAEs) and the detection systems in place for patients with liver cancer undergoing treatment with immune checkpoint inhibitors (ICIs), using a self-administered anonymous questionnaire. The questionnaire was designed to gather crucial insights into the management of irAEs in these patients. A self-administered anonymous questionnaire was sent to 456 liver disease collaborative base hospitals and cancer care coordination base hospitals in Japan. Responses were received from 112 facilities, indicating a response rate of 25%. The region with the highest response rate was Kanto (22%, 24 sites), followed by Kyushu (19%, 21 sites), Chubu (14%, 15 sites), and Kinki (14%, 15 sites). The number of patients with hepatocellular carcinoma (HCC) who received ICI treatment varied, with a mean±SD of 20.4±19.4 cases per year per facility. The number of full-time physicians who provided ICI treatment for HCC was 4.2±3.3 (mean±SD), ranging from 0 to 24 per facility. Of these, the majority included hepatologists and oncologists, whose numbers were 3.3±2.4 (mean±SD) (range, 0-11) and 0.8±1.0 (0-3), respectively. Gastroenterologists and internal medicine specialists participated in the treatment at some facilities. The survey results revealed that physicians administered ICI therapy for an average of 20 HCC cases per institution, with more than 17 types of irAEs reported. The most common irAEs were hepatic dysfunction, followed by thyroid dysfunction, skin disorders, interstitial pneumonia, and renal dysfunction.