Collaborative Care Model Research Articles

Patient Perspectives on Adapting Collaborative Care for Opioid Use Disorder With Depression and/or Post-traumatic Stress Disorder

Abstract: Background: Individuals with opioid use disorder and cooccurring mental health concerns experience heightened consequences and lower rates of treatment access. Engaging patients as research partners alongside health systems is critical for tailoring care for this population. Collaborative care is promising for the treatment of co-occurring disorders Objectives: We used a community-participatory partnered research1 approach to partner with patients, providers, and clinic administrators to adapt and implement a collaborative care intervention for co-occurring disorders in primary care. Methods: We conducted qualitative interviews with patients to assess their feedback on the proposed collaborative care model before intervention implementation. A first round of interviews was conducted to obtain patient feedback on our adaptation ideas ( n = 11). The team then incorporated these suggestions, beta-tested the intervention with participants ( n = 9), and assessed participant feedback. Data were analyzed using rapid content analysis and then implemented by health systems. Results: Patient feedback underscored the need for the care coordinator (CC) to be trained in patient engagement and stigma reduction and to provide assistance around socioeconomic barriers and relapse. Patients shared that it was helpful to have the CC address co-occurring disorders, emphasized the need for the CC to be flexible, and expressed that tele-health was acceptable. Patient feedback was integrated in subsequent CC training with health systems. Conclusions: The present research demonstrates the feasibility and usefulness of incorporating patient perspectives into treatment design and implementation in health systems using community-participatory partnered research .

Linking Post-Treatment Rehabilitation with Healthcare Roles: How Nurses and Technicians Influence Patient Satisfaction

Post-treatment rehabilitation is a critical component of healthcare that significantly influences patient recovery and long-term outcomes. This review explores the interconnected roles of nurses and technicians in delivering effective post-treatment rehabilitation and its impact on patient satisfaction. Nurses play a vital role in patient education, monitoring, and emotional support, while technicians ensure the proper functioning of medical equipment and therapies. Through a collaborative care model, both healthcare roles contribute to improving service delivery and patient experiences. However, challenges such as resource constraints, communication barriers, and the need for specialized training must be addressed to fully harness their potential. By enhancing the roles of nurses and technicians in rehabilitation services, healthcare systems can improve patient satisfaction and develop more efficient, patient-centered services.

Managing medications for patients with cancer and chronic conditions: It's time for collaboration between primary care and oncology pharmacists.

To provide a rationale for a collaborative care model involving oncology and primary care pharmacists to improve the coordination of care of medications for cancer patients with multiple chronic conditions. A review of selected literature and the authors' own research was used. Studies illustrating the gaps in care for medications and pharmacists' roles in oncology and primary care settings from PubMed were reviewed. There has been a substantial increase in the development and utilization of oral anticancer agents (OAAs). Although OAAs offer convenience and flexibility, they also introduce challenges related to medication adherence, monitoring, and managing side effects. Up to 17.5% of patients experience moderate to severe symptoms from OAAs and about 30% report less than excellent medication adherence. Further, studies showed that 30% to 53% of adult cancer patients have at least one chronic condition that complicates their treatment plan due to the need for medications, increasing the risk of drug interactions, side effects, and non-adherence. The Primary Care Oncology Model (PCOM) incorporates both primary care and oncology pharmacists with comprehensive medication review and patient-reported outcome measure, respectively, to enhance medication appropriateness and effectiveness, and improve overall patient experience. Implementing PCOM may improve the medication management of patients taking OAAs for active cancer treatment and chronic medications for their multiple chronic conditions. This collaborative approach can transform patient care by leveraging the expertise of both primary care and oncology pharmacists.

Chronic pain after traumatic brain injury: a collaborative care approach.

Chronic pain is common after traumatic brain injury (TBI), frequently limits daily activities, and is associated with negative outcomes such as decreased community participation. Despite the negative impact of chronic pain, few people with TBI receive effective treatment. This paper describes a collaborative care (CC) intervention, TBI Care, adapted specifically to treat chronic pain in people living with TBI, emphasizing expert clinician input, cognitive behavioral therapy (CBT) techniques, and other non-pharmacological approaches for decreasing pain interference. 79 participants engaged in the CC intervention from two academic medical rehabilitation clinics with weekly assessments of pain intensity, interference, and medication use. Participant feedback on the intervention was gathered by interview with the care manager (CM) at the last treatment session and/or booster session. Provider feedback was gathered by a confidential survey post intervention. Ninety percent of participants received at least 11 of the target 12 sessions with a care manager (CM), the majority occurring over the phone. Participants endorsed an average of 7 pain locations. All participants received pain education, skills in self-monitoring, goal setting/behavioral activation and relaxation training. Pain interference scores (impact on activity and enjoyment), tracked weekly by the CM, significantly decreased across sessions. 89% of participants received recommendations for CBT skills, 65% received referrals for additional treatments targeting pain interference, and 43% received care coordination. 75% of participants reported 6 or more medications/supplements at both the first and last session, with changes recommended primarily for headache treatment. Feedback from participants and providers was positive. TBI Care, a novel patient-centered CC approach, was flexibly delivered, tailored to the needs of those living with TBI and chronic pain, with a high level of participant engagement, and satisfaction among participants and providers. This approach, prioritizing pain self-management strategies and other non-pharmacological approaches, along with optimizing pharmacological treatment, led to significant reductions in self-reported pain interference and intensity during the intervention. Using a CC model in TBI is feasible and successfully improved access to evidence-based treatments for chronic pain as well as outcomes for pain interference and intensity. ClinicalTrials.gov, identifier NCT03523923.

Healing the Whole: An International Review of the Collaborative Care Model between Primary Care and Psychiatry.

The collaborative care model (CCM) was created to improve the delivery of mental health care and is reported to improve access, enhance treatment outcomes, and reduce healthcare costs. To understand the impacts of the CCM on symptom management, diverse populations, and sustainability in healthcare systems, a systematic review was conducted. Several databases were searched for articles assessing the CCM. The inclusion criteria limited the studies to those (1) published between January 2008 and January 2024; (2) written in the English language; (3) analyzing adult patients; (4) analyzing symptom improvement in major depressive disorder, generalized anxiety disorder, or post-traumatic stress disorder; and (5) fitting the given definition of a CCM. We identified 9743 articles. Due to missing information or duplication, 4702 were excluded. The remaining articles were screened, yielding 468 articles for full-text analysis, of which 16 articles met the inclusion criteria. Of these articles, five primarily focused on individual patient outcomes, five focused on specific populations, and six reviewed system impacts; eleven articles studied US populations and five studied international populations. An analysis revealed that in 12 of the final articles, the CCM led to a statistically significant improvement in anxiety and depression symptoms with viable implementation and sustainability strategies. The CCM is an effective method for improving patient symptoms and can be potentially affordable in healthcare systems.

Innovative Nursing Care for Patients with Psychological Disorders: A Comprehensive Review on Iranian Versus Global Nursing Interventions

Psychological disorders (PDs) are one of the most important global challenges that affect a large number of individuals regardless of geographical location. In Iran, similar to other parts of the world, the prevalence of PDs is increasing and requires innovative nursing care (NC) interventions. The present study aims to comprehensively assess the current NC practices for patients with PDs, as well as compare traditional and innovative approaches between Iran and global healthcare systems. Traditional NC practices in Iran emphasize a holistic and culturally sensitive approach, which integrates traditional NCs with evidence-based therapies; however, global practices often focus on evidence-based and cognitive-behavioral therapies. Innovative NC approaches, e.g., technology-assisted interventions and personal care programs, play a fundamental role in improving treatment outcomes and quality of life for patients with PDs. Also, Iranian nurses are integrating complementary therapies with evidence-based practices to provide comprehensive and personalized care for patients. On a global scale, there is an increasing emphasis on collaborative care models and cutting-edge technologies to enhance the availability and effectiveness of care. Previous evidence indicated the roles of technology-based interventions, concentration techniques, and personal care programs in improving Iranian patient outcomes. While there are challenges such as limited resources, cultural stigma, and lack of specialties both in Iran and around the world, preventive efforts to address these barriers can facilitate the widespread adoption of innovative national NCs. Future research directions include remote psychiatry, integration of complementary therapies with traditional NCs, and providing interdisciplinary collaboration to enhance patient-centered care for individuals with PDs. Hence, by promoting knowledge exchange and collaboration among healthcare professionals, organizations can create a supportive environment for implementing and maintaining innovative NCs that are ultimately able to provide comprehensive mental health care for individuals around the world.

Advancing Care Team Adoption of Electronic Health Record Systems for Cancer Symptom Management: Findings From a Hybrid Type II, Cluster-Randomized, Stepped-Wedge Trial.

The enhanced, electronic health record (EHR)-facilitated cancer symptom control (E2C2) trial is a cohort cluster-randomized, stepped-wedge, hybrid type II trial that leverages EHR systems to facilitate a collaborative care model (CCM) approach with the goal of improving cancer symptom management. Understanding factors that influence care team adoption of EHR systems remains a critical understudied area of research. This study examines how oncology care teams' perceptions regarding the feasibility, acceptability, and appropriateness of E2C2 EHR systems preimplementation were associated with adoption 3 months after implementation and characterizes differences in adoption by individual- and system-level factors. Care team members completed an electronic survey before and 3 months after implementation of E2C2 for their respective sequence. Adoption was defined as frequency of use to statements aligned with care team-directed EHR systems designed to facilitate CCM approaches. Chi-square tests assessed differences in adoption while logistic regression models estimated associations between baseline mean scores of acceptability, feasibility, and appropriateness on care team adoption at 3 months. Results from 94 care team members (37.2% oncologists, 72.6% female, 55.3% in their role for 6+ years) found that adoption rates ranged from 48.9% to 71.7%, with significant differences observed by location (community-based health care systems v tertiary medical center) and professional role. Adjusting for professional role, care team members reporting higher levels of perceived acceptability and appropriateness at baseline had greater odds of adopting EHR systems at 3 months. EHR systems perceived as acceptable and appropriate are more likely to be adopted by oncology care teams in our sample. Future implementation efforts should consider tailored strategies to facilitate adoption of EHR systems designed to promote CCM-based approaches to improve cancer symptom management.

Implications of the stigma of mental illness for professional knowledge development and practice: An Interprofessional Health Education framework from structural violence perspectives

AbstractPersons with mental illness (PWMI) continue to encounter stigma from the public with negative outcomes. Recent stigma discourse points to power differentials as key in shaping stigma related to mental illness within social settings. The perceived social injustice towards PWMI is known to exist both anecdotally and in documented discourses. Stigma constitutes the product of public attitudes and behaviors that characterize labeling, stereotyping, prejudice, cognitive separation, status loss, and discrimination that lead to responses that may include stress and esteem‐related appraisal of experienced, anticipated, perceived, or personal endorsement of societal actions that are anchored by existing power relational differentials. The potential consequence of such societal injustices (unfair treatments) towards PWMI may result in stigma and its sequels, including low socioeconomic status, stress, low self‐esteem, unemployment, homelessness, exclusion, and human rights abuse. This paper proposes an Interprofessional Health Education framework and discusses the implications of such unfair social treatments for Professional knowledge development and practice among healthcare professionals, with the view to improving collaboration and patient care outcomes. A more collaborative model of care, where service users and clinicians regard each other as knowledgeable with shared power to achieve healthy outcomes, empowers patients even more in areas where they fall short.

Bringing Care Close to Home: Remote Management of Heart Failure In Partnership with Indigenous Communities In Northern Ontario, Canada

BackgroundThe Weeneebayko Area Health Authority (WAHA) is a regional, community-based Indigenous health authority in Northern Ontario, Canada. From September 2022 to March 2023, the WAHA and University Health Network engaged in a partnership that designed a collaborative model of care to address inequities in cardiology specialist access in Northern Ontario. This model implemented a digital therapeutic for heart failure, (the Medly program) and in-person cardiology clinics in the region. MethodsA WAHA-based Medly program clinical coordinator worked closely with the University Health Network team to deliver care and support patient self-management of HF. The use and effectiveness of the Medly program were tracked through app usage and rules-based algorithm alerts, based on patient self-reported data. Distribution of relevant equipment (a scale, a blood pressure cuff, and a mobile device) for the Medly program was recorded. Surveys to assess patient and provider satisfaction with the Medly program also were administered. A retrospective chart audit of electronic medical records and administrative databases was conducted. ResultsA total of 33 patients in the WAHA were enrolled in the Medly program during a 7-month period, surpassing the enrollment goal of 25 patients. A total of 93% of eligible patients were on optimized guideline-directed medical therapy or were being titrated for it. Of 15 surveyed patients, 100% agreed or strongly agreed that the Medly program facilitated delivery of care close to home, and 86% of surveyed clinicians (n = 7) agreed or strongly agreed that the Medly program addresses a gap in available care in the region. ConclusionsThe implementation of the Medly program in partnership with the WAHA has demonstrated success in terms of the volume of referrals, the quality of care, adherence to evidence-based best-practice guidelines, and satisfaction with the program.

Multidisciplinary Approach to Patent Foramen Ovale Closure for Cryptogenic Stroke: Brain-Heart Board Experience.

Patent foramen ovale (PFO) is present in approximately 25% of adult population. The prevalence of PFO is high in patients with cryptogenic stroke suggesting paradoxical embolism. PFO closure in carefully selected patients is an effective secondary preventive strategy in these patients. We report predictors of management recommendations by the multidisciplinary Board and their impact on outcomes. Brain-Heart Board comprises vascular and interventional neurology and cardiology subspecialties (structural, electrophysiology, and cardiac imaging). Adult patients referred to the Board for consideration of PFO closure between October 2017 to March 2021 were included in this retrospective cohort analysis. Demographics, comorbid conditions, risk of paradoxical embolism (RoPE) score, event frequencies (transient ischemic attack [TIA] or stroke, intracranial hemorrhage [ICH], post-PFO closure cardiac arrhythmias), and modified Rankin Scale (mRS) at 1 year were compared between the groups (PFO closure vs medical management). Multivariable logistic regression was used to identify factors associated with management recommendation and chi-square tests to test differences in outcomes for patients according to management. Two hundred seventy patients (229 stroke; 41 TIA) were discussed by the Board for PFO closure. 119 (44.0%) patients were recommended for PFO closure of which 117 (98.3%) had evidence of ischemic infarct on imaging. In univariate analysis, age was similar (50 ± 11.9 vs 52 ± 12.8, p = 0.17), but RoPE score was higher in closure as compared with the medical management group (6 [IQR 5-7] vs 5 [IQR 4-7], p < 0.05). In multivariable analysis, TIA as the index event was an independent predictor of Board recommendation against PFO closure (OR 0.05, 95% CI 0.01-0.19, p < 0.05). Event frequency was low in both cohorts (5.9% vs 4.8%, p > 0.05) and comprised cardiac arrhythmias (6 cases of atrial fibrillation and 1 ICH in closure group; 1 TIA and 1 recurrent stroke in medical management group). Excellent functional outcome (mRS 0-1) was similar in both cohorts (66.3% vs 70.7%, p > 0.05) at 1 year. Multidisciplinary Brain-Heart Board provides a clinical practice model of collaborative care to ensure proper patient selection for PFO closure. TIA as the index event is associated with recommendation of medical management by the multidisciplinary Brain-Heart Board.

Primary care team perspectives on approaches to engaging patients in treatment for opioid use disorder

IntroductionEngagement is a critical component of successful treatment for opioid use disorder (OUD). However, rates of patient engagement in OUD treatment, especially in outpatient settings, are variable and often low. Little is known about the specific strategies members of primary care teams use to initiate and encourage ongoing participation in OUD treatment. In a national cohort of primary care clinics in the U.S., we explored the perspectives of primary care team members on the meaning of and approaches to OUD treatment engagement. MethodsWe conducted semi-structured interviews with 35 providers from multidisciplinary primary care teams in an existing national cohort of 13 clinics across seven states. Teams were delivering OUD treatment via the Collaborative Care Model, a model that combines primary care providers (PCP), behavioral health care managers (BHCM) and consulting psychiatric providers (CPP) in a structured way to provide patient-centered, team-based, and measurement-based care. Interview participants included 14 PCPs, 13 BHCMs, and 8 CPPs. Interviews asked open-ended questions about provider experiences and practices that aided or hindered patient engagement in OUD treatment. Interview transcripts were double-coded by trained qualitative researchers and analyzed using a combination of deductive and inductive approaches to identify themes. ResultsTwo themes emerged that describe provider perspectives on the meaning of engagement: 1) qualifying engagement by the volume of contact with patients, and 2) the need for more multidimensional measures of engagement. Six themes emerged that characterized provider engagement practices: 1) creating an environment of disclosure, 2) normalizing OUD treatment, 3) offering gentle but persistent outreach, 4) providing human connection and encouragement, 5) tailoring treatment to patient needs, and 6) avoiding stigmatizing responses. Analysis identified multiple replicable strategies that providers used to support these engagement practices. ConclusionsProviders consistently apply a range of strategies when trying to engage patients in OUD treatment. Specific engagement strategies used embodied compassion and pragmatism, hallmarks of patient-centered care. Further research is needed to understand the impact of scaling engagement approaches across all care settings.

Multilevel perspectives on the implementation of the collaborative care model for depression and anxiety in primary care

BackgroundThe Collaborative Care Model (CoCM) is an evidence-based mental health treatment in primary care. A greater understanding of the determinants of successful CoCM implementation, particularly the characteristics of multi-level implementers, is needed.MethodsThis study was a process evaluation of the Collaborative Behavioral Health Program (CBHP) study (NCT04321876) in which CoCM was implemented in 11 primary care practices. CBHP implementation included screening for depression and anxiety, referral to CBHP, and treatment with behavioral care managers (BCMs). Interviews were conducted 4- and 15-months post-implementation with BCMs, practice managers, and practice champions (primary care clinicians). We used framework-guided rapid qualitative analysis with the Consolidated Framework for Implementation Research, Version 2.0, focused on the Individuals domain, to analyze response data. These data represented the roles of Mid-Level Leaders (practice managers), Implementation Team Members (clinicians, support staff), Innovation Deliverers (BCMs), and Innovation Recipients (primary care/CBHP patients) and their characteristics (i.e., Need, Capability, Opportunity, Motivation).ResultsMid-level leaders (practice managers) were enthusiastic about CBHP (Motivation), appreciated integrating mental health services into primary care (Need), and had time to assist clinicians (Opportunity). Although CBHP lessened the burden for implementation team members (clinicians, staff; Need), some were hesitant to reallocate patient care (Motivation). Innovation deliverers (BCMs) were eager to deliver CBHP (Motivation) and confident in assisting patients (Capability); their opportunity to deliver CBHP could be limited by clinician referrals (Opportunity). Although CBHP alleviated barriers for innovation recipients (patients; Need), it was difficult to secure services for those with severe conditions (Capability) and certain insurance types (Opportunity).ConclusionsOverall, respondents favored sustaining CoCM and highlighted the positive impacts on the practice, health care team, and patients. Participants emphasized the benefits of integrating mental health services into primary care and how CBHP lessened the burden on clinicians while providing patients with comprehensive care. Barriers to CBHP implementation included ensuring appropriate patient referrals, providing treatment for patients with higher-level needs, and incentivizing clinician engagement. Future CoCM implementation should include strategies focused on education and training, encouraging clinician buy-in, and preparing referral paths for patients with more severe conditions or diverse needs.Trial registrationClinicalTrials.gov(NCT04321876). Registered: March 25,2020. Retrospectively registered.

Adolescent-Centered mHealth Applications in a Collaborative Care Model: A Virtual Focus Group Study With Audiologists.

Technology-enabled care, including the use of mobile health (mHealth), is emerging as a viable hearing health care delivery method. While the integration of mHealth with adult populations currently supports a wide array of hearing services, a better understanding of the implementation across the lifespan is needed. Literature surrounding the unique population of adolescent hearing aid users is currently lacking. Research is needed to highlight factors important to the use and clinical integration of mHealth hearing aid applications (apps) with adolescents. This study explored two primary objectives: (a) audiologists' perceptions around the use of mHealth apps to enable collaborative, child-inclusive hearing aid personalization, and (b) person-centered ideation around potential app design components to benefit users aged 12 to 17 years. Twelve audiologists participated in virtual synchronous focus groups, across three group sessions using Cisco Webex. Sessions were recorded, transcribed, and analyzed using an inductive, codebook thematic analysis approach. Six main themes resulted from group discussion analyses: (a) client candidacy: characteristics impacting suitability for mHealth use; (b) clinical implementation: organizational, professional, or patient-level strategies for mHealth adoption; (c) collaboration: the use of two or more individuals working together; (d) empowerment: process of acquiring and using knowledge, skills, and strategies; (e) remote technology: technologies enabling remote hearing aid personalization; and (f) application functionality and design: features and characteristics important to an adolescent-focused app. Findings identified the potential for clinical integration of hearing aid apps with adolescents in a collaborative care model, including consideration of child-specific use patterns, outcomes, and key design and technology components to support real-world implementation and use. Results may guide development and tailoring efforts around existing and future hearing aid apps for use with adolescent populations.

TABLET TOSCANA to Develop Innovative Organizational Models for Tele-Rehabilitation in Subjects with Congenital and Acquired Developmental Disabilities: A Wait-List Control Group Trial Protocol.

Background/Objectives: In recent years, the advent of new technologies has fostered their application in neuro-psychomotor and language rehabilitation, particularly since the COVID-19 pandemic. Tele-rehabilitation has emerged as an innovative and timely solution, enabling personalized interventions monitored by clinicians. TABLET TOSCANA project aims to develop innovative tele-rehabilitation organizational models in children, adolescents and young adults with congenital and acquired developmental disabilities, using the Virtual Reality Rehabilitation System (VRRS) Home Kit and the MedicoAmico APP. Methods: The trial is designed according to the CONSORT statement guidelines. The project encompasses three phases: adapting the technologies for pediatric use, validating them through a wait-list study, and analyzing feasibility and effectiveness data to define new organizational models. A randomized wait-list-control study with 100 subjects aged 6 to 30 years will compare tele-rehabilitation versus prosecution of standard care. Discussion: Although literature highlights tele-rehabilitation benefits such as improved access, cost savings, and enhanced treatment adherence, practical implementation remains limited (i.e., the definition of standardized procedures). TABLET TOSCANA project seeks to address these gaps by focusing on multi-domain treatments for neurodevelopmental disabilities and emphasizing the integration of tele-rehabilitation into local health services. Conclusion: The project aims to improve the continuity and intensity of care through innovative models that integrate tele-rehabilitation into local health services. The results could inform healthcare policies and promote the development of innovative and collaborative models of care, paving the way for more effective and widespread tele-rehabilitation solutions and fostering collaborative networks among professionals.

Change in suicidal ideation, depression, and anxiety following collaborative care in the community

BackgroundThe Collaborative Care Model (CoCM) increases access to mental health treatment and improves outcomes among patients with mild to moderate psychopathology; however, it is unclear how effective CoCM is for patients with elevated suicide risk.MethodsWe examined data from the Penn Integrated Care program, a CoCM program including an intake and referral management center plus traditional CoCM services implemented in primary care clinics within a large, diverse academic medical system. In this community setting, we examined: (1) characteristics of patients with and without suicidal ideation who initiated CoCM, (2) changes in suicidal ideation (Patient Health Questionnaire-9 [PHQ-9] item 9), depression (PHQ-9 total scores), and anxiety (Generalized Anxiety Disorder Scale-7 scores) from the first to last CoCM visit overall and across demographic subgroups, and (3) the relationship between amount of CoCM services provided and degree of symptom reduction.ResultsFrom 2018 to 2022, 3,487 patients were referred to CoCM, initiated treatment for at least 15 days, and had completed symptom measures at the first and last visit. Patients were 74% female, 45% Black/African American, and 45% White. The percentage of patients reporting suicidal ideation declined 11%-7% from the first to last visit. Suicidal ideation severity typically improved, and very rarely worsened, during CoCM. Depression and anxiety declined significantly among patients with and without suicidal ideation and across demographic subgroups; however, the magnitude of these declines differed across race, ethnicity, and age. Patients with suicidal ideation at the start of CoCM had higher depression scores than patients without suicidal ideation at the start and end of treatment. Longer CoCM episodes were associated with greater reductions in depression severity.ConclusionsSuicidal ideation, depression, and anxiety declined following CoCM among individuals with suicidal ideation in a community setting. Findings are consistent with emerging evidence from clinical trials suggesting CoCM’s potential for increasing access to mental healthcare and improving outcomes among patients at risk for suicide.

Constructing a needs-based collaborative care model for preterm infants and their families.

Constructing a needs-based collaborative care model for preterm infants and their families.

Clinical practice review: outpatient palliative care for the geriatric chronic kidney disease population.

With a growing geriatric population in the United States, there is an increased need for healthcare resources and collaborative care for serious illnesses. Patients with chronic illnesses including chronic kidney disease (CKD) often experience severe symptoms and face complex decisions, many of which develop or occur in the outpatient setting. Though many of these symptoms overlap between different chronic illnesses, the CKD population remains largely untapped in terms of access to said resources; until recently, the focus in palliative care has been largely in the oncologic population. Older patients with CKD may benefit from additional tools and resources provided from collaborative care models specifically involving palliative care, especially as this population is high risk for experiencing lack of support. In this review, we use case vignettes to discuss the key concepts and roles of outpatient palliative care and how they can be integrated into the nephrology care of older patients with advanced kidney disease. These highlighted concepts include shared decision-making, selective deprescribing and symptom management, psychosocial support, and advance care planning. We also review different outpatient models for integrative palliative care, and the roles and resources of the palliative multidisciplinary team within these models and how these models can potentially be implemented in the care of CKD patients.

Economic evaluation of Maternal Depression Treatment in HIV (M-DEPTH) for perinatal depression among women living with HIV in Uganda: a cost-effectiveness analysis

ObjectiveWe conducted a cost-effectiveness analysis of an evidence-based collaborative care model for treatment of perinatal depression among women living with HIV in Uganda.DesignMaternal Depression Treatment in HIV (M-DEPTH) is a...

Role of Community Health Nursing in Insulin Initiation for Type 2 Diabetes Patients: A Literature Review

Background: Insulin therapy is essential for managing type 2 diabetes in patients who do not achieve adequate glycemic control with oral medications. Despite its benefits, initiating insulin therapy presents numerous challenges due to psychological, physical, and systemic barriers. This study examines the critical role of community health nurses in facilitating the initiation and management of insulin therapy, addressing patient and healthcare provider barriers, and improving clinical outcomes. Methods: A comprehensive review of existing literature was conducted, focusing on the impact of community health nurses on diabetes management, particularly in insulin initiation and adherence. Results: : Community health nurses play a pivotal role in overcoming barriers to insulin therapy. They provide essential patient education, psychosocial support, and practical training in insulin administration. These efforts lead to improved glycemic control, higher rates of insulin adherence, and better patient satisfaction. Additionally, community health nurses facilitate collaborative care models, integrating with primary care teams to provide continuous and coordinated care. The involvement of community health nurses in diabetes management addresses both patient-related and systemic barriers. Their holistic approach includes personalized patient education, emotional support, and care coordination, significantly enhancing patient adherence and clinical outcomes. Conclusions: Community health nurses are integral to the successful initiation and management of insulin therapy in type 2 diabetes. Future research should focus on developing standardized training programs for community health nurses and exploring innovative care models that leverage their unique skills. Policy support is essential to recognize and expand the role of community health nurses in diabetes care.

A Systematic Review of Healthcare Providers Awareness of Medication Switching for Polypharmacy Patients in Saudi Arabia

Background: Polypharmacy, the concurrent use of multiple medications by an individual, presents challenges in medication management, patient safety, and healthcare outcomes, particularly among older adults. In Saudi Arabia, the prevalence of polypharmacy is increasing due to the aging population and the burden of chronic diseases. Understanding healthcare providers' awareness and practices regarding medication switching is crucial for optimizing medication use and improving patient outcomes. Study Aim: This systematic review aims to synthesize and analyze existing literature on healthcare providers' awareness of medication switching for polypharmacy patients in Saudi Arabia. The study focuses on pharmacists and physicians, exploring their knowledge, attitudes, and practices related to medication management, deprescribing, pharmacovigilance, and Medication Therapy Management (MTM) services. Methodology: A systematic search was conducted across major databases, including PubMed, Scopus, and Google Scholar, using predefined search terms related to polypharmacy, medication switching, healthcare providers' awareness, and Saudi Arabia. Eligible studies were selected based on inclusion criteria, including study design, setting, participants, and relevance to the study aim. Data extraction and synthesis were performed to analyze key findings and themes related to healthcare providers' awareness of medication switching. Results: Six eligible studies were included in the systematic review, encompassing survey-based investigations, cross-sectional studies, and qualitative studies conducted in various healthcare settings across Saudi Arabia. The findings revealed gaps in pharmacists' and physicians' knowledge regarding Potentially Inappropriate Medications (PIMs), Drug-Drug Interactions (DDIs), pharmacovigilance practices, and deprescribing strategies. Recommendations for improving pharmacists' education, enhancing pharmacovigilance practices, and promoting collaborative care models were highlighted. Conclusion: Healthcare providers in Saudi Arabia demonstrate varying levels of awareness and practices regarding medication switching for polypharmacy patients. There is a need for targeted educational interventions, standardized pharmacovigilance practices, and collaborative efforts among healthcare providers to optimize medication use, reduce polypharmacy-related risks, and improve patient outcomes.