Demand For Health Services Research Articles

Advancing Mental Health Care: A Comprehensive Review of Digital Tools and Technologies for Enhancing Diagnosis, Treatment, and Wellness

ABSTRACTAn individual's mental health influences their capacity to think effectively, feel emotionally stable, and perform daily activities. As mental health concerns become more prevalent worldwide, new awareness and diagnostic and treatment tactics are needed. Digital tools and technology are helping solve these problems by providing scalable, tailored solutions for large populations. This detailed review examines mental health‐promoting internet tools. Smartphone applications, web‐based therapy systems, wearable tech, artificial intelligence‐powered resources, and virtual reality (VR) technologies were evaluated for efficacy and side effects. PubMed, PsycINFO, Scopus, IEEE Xplore, and Google Scholar were carefully searched. Search terms included “digital mental health tools,” “online therapy,” and “AI in mental health.” Randomized controlled trials, cohort studies, cross‐sectional studies, systematic reviews, and meta‐analyses of digital technology and mental health were included from among the literature published after 2010. Cognitive behavioral therapy methods, mood monitoring, and mindfulness exercises are among the numerous features of smartphone applications that have been demonstrated to mitigate symptoms of anxiety, depression, and tension. Online therapy platforms let marginalized individuals obtain therapy remotely. Wearable technology may detect heart rate, blood pressure, and sleep length, which may reveal mental health difficulties. Chatbots employ machine learning algorithms and natural language processing to deliver customized support and show promise for quick intervention. Exposure therapy for anxiety and trauma is increasingly using virtual reality environments. Although digital mental health therapies face challenges in relation to data privacy, limited long‐term efficacy, and technological inequality, digital technologies are modernizing mental healthcare. By offering inexpensive and effective alternatives to traditional therapies, digital technologies may help healthcare systems meet the growing demand for mental health services and overall well‐being.

Morbidities and perceived health status among elderly in Eastern India: some observations from NSSO data

BackgroundSince the number of elderly people in Odisha, Eastern India, is predicted to rise faster than the national average and surpass that of developed states like Karnataka, wherein the majority of them live in rural areas with low per capita income, study on their illness prevalence and morbidity patterns and health status is crucial for developing welfare programs and improving healthcare facilities to meet the demands of curative and preventative health services. Therefore, this paper examines the prevalence rate and pattern of morbidities among elderly people in Odisha and subsequently finds the determinants of the prevalence of chronic morbidity and self-reported health status (SRHS). Data source and methodologyA unit-level nationally representative sample survey data (75th round of the NSS data) has been used for our analysis. The survey was conducted across all states and UTs, consisting of 1,13,823 households and 555,114 people. From which Odisha’s sample (19,083 individuals) has been selected, of which 1914 individuals were 60 years and above. The outcome variables used in the analysis were chronic illness and self-reported health status. Bivariate and multivariate logit regressions have been used to study the prevalence of morbidity and health status of the elderly. FindingsThe result shows that hypertension/ heart diseases (57 per thousand), diabetes (38 per thousand), and musculoskeletal (61 per thousand) are the major diseases the elderly mainly suffer from, irrespective of their residence and gender. There is little difference in the prevalence of diseases between males and females in rural areas. However, a gender divide in the prevalence of diseases is noticed in urban areas where females mainly suffer from musculoskeletal health issues, but hypertension/ heart diseases and diabetes are two major diseases affecting male elderly. From logit regression results, it is found that factors like age, caste, place of residence, and MPCE quintile significantly affect the likelihood of prevalence of chronic diseases. It also finds that marital status, education, caste, gender, chronic illness, living arrangements, and economic independence are the major factors influencing their perceived health status (SRHS). Conclusion and policy implicationIn order to achieve health equity, the study’s findings can be used to support the implementation of various health initiatives, guide intervention efforts, and provide fresh ideas for government policymaking on the health of the elderly.

Boosting Digital Health Engagement Among Older Adults in Hong Kong: Pilot Pre-Post Study of the Generations Connect Project.

Older adults' utilization of digital health care remains low despite a high demand for regular health services. Easily accessible eHealth interventions designed for older adults are needed. This study aimed to examine the feasibility and effectiveness of an intergenerational, home-based eHealth literacy intervention package on older adults in Hong Kong. In this study, 101 older adults (n=64, 63.4% female) with a median age of 80 (IQR 77-85) years received an intergenerational, home-based eHealth literacy intervention package, delivered by trained university student interventionists. The intervention (median 60, IQR 40.8-70 minutes) included personalized guidance on using mobile health apps, QR code scanners and instant messaging, and access to online health information, along with recommendations for physical and mental well-being. Following the intervention, a daily health-coaching message was sent to older adults via WhatsApp for 14 days. eHealth literacy, health, and lifestyle were assessed at baseline and at a 2-week follow-up using paired t tests. Retention rate for the 2-week follow-up was 70.3% (71/101). Compared to baseline, eHealth literacy scores increased by 2.39 points (P=.11; Cohen d=0.20), and daily smartphone use rose by 0.45 hours (P=.07; Cohen d=0.05). Participants self-reported increased physical activity (50/71, 70%), more frequent viewing of health videos (43/70, 61%), and improved handwashing practices (39/71, 55%). The intervention achieved a high satisfaction rating of 4.32 out of 5. The intergenerational, home-based eHealth literacy intervention package was feasible and acceptable, showing promise for increasing older adults' engagement with digital health care resources and promoting healthy behaviors. Future studies should explore longer-term effects and ways to further improve the intervention.

Back-to-Back Climate shocks and the mental health crisis: A Texas-sized surge in depression and anxiety ER visits.

Climate change is intensifying the frequency and severity of climate-related disasters, posing significant challenges to public mental health. This study explores the relationship between successive climate events and emergency department (ED) visits for depression and anxiety in the Greater Houston area from 2019 to 2023. Combining monthly data from the Texas Syndromic Surveillance System, the National Weather Service, and the Agency for Healthcare Research and Quality, we conducted a time-series analysis to assess the impact of successive weather events on ED visits for anxiety and depression. Our random forest models reveal significant associations between weather variables and mental health-related ED visits. Specifically, time series decomposition uncovered distinct seasonal patterns, with specific periods consistently showing higher demand for mental health services. Additionally, the analysis indicates that severe weather events that restrict mobility, such as hurricanes and tropical storms, initially lead to a decrease in ED visits, followed by a surge in the following months, whereas events that do not impede travel, such as heatwaves and droughts, correlate with immediate increases in visits. Feature importance analysis indicated social factors, such as the number of households and children ≤17, along with weather variables like average temperature and total precipitation, were significant predictors of ED visits for both anxiety and depression. Access to healthcare services, including proximity to healthcare clinics and treatment centers, also played a crucial role. These observed patterns underscore the significant influence of seasonal and weather-related factors on mental health and underscore the need for targeted public health interventions that consider the timing and nature of climate events, as well as strategies to enhance community resilience and strengthen mental health support systems.

Does bundling reminders with messages debunking misconceptions improve the demand for preventive health services? A randomized controlled trial among adults with hypertension in Punjab, India.

Does bundling reminders with messages debunking misconceptions improve the demand for preventive health services? A randomized controlled trial among adults with hypertension in Punjab, India.

Sustainable Mental Health: Development and Changes

Sustainable mental health promotes long-term well-being through prevention, early intervention, and treatments addressing the root causes of mental illness. This approach has emerged as a critical global public health priority, as mental illness imposes significant burdens on individuals and communities. The COVID-19 pandemic has highlighted the urgency of implementing effective strategies to manage anxiety, social isolation, and increased demand for mental health services (Reger et al., 2020). The concept of sustainable mental health is rooted in proactive and reactive measures that foster supportive environments, enhance access to care, and prevent mental illness. A growing body of research emphasizes the importance of addressing systemic factors such as poverty, inequality, and social isolation, which are closely linked to mental health outcomes (Vigo et al., 2016). Advances in medical and psychological treatments have further bolstered mental health care, underscoring the potential of holistic and integrative approaches (Herman et al., 2011). Future strategies must prioritize prevention, early intervention, and community-centered practices while addressing social and environmental determinants. Integrating these elements into global public health frameworks can promote resilience and sustainable outcomes. As the field evolves, sustainable mental health offers transformative potential to address the underlying causes of mental illness and foster long-term well-being. This holistic approach aligns with the growing recognition of mental health as a cornerstone of global health initiatives.

Bolstering agreement with scarce resource allocation policy using education: a post hoc analysis of a randomized controlled trial

BackgroundThe COVID- 19 pandemic prompted rapid development of scarce resource allocation policies (SRAP) in case demand for critical health services eclipsed capacity. We sought to test whether a brief, educational video could improve alignment of participant values and preferences with the tenets of the University of California Health’s SRAP in a post hoc analysis of a randomized controlled trial (RCT) conducted during the pandemic.MethodsAn RCT of an educational video intervention embedded in a longitudinal web-based survey conducted from May to December 2020, analyzed in August 2024. The “explainer” video intervention was approximately 6 min long and provided an overview of the mechanics and ethical principles underpinning the UC Health SRAP, subtitled in six languages. California residents were randomized to view the intervention or not, stratified by age, sex, education, racial identity, and self-reported health care worker status. Non-California residents were assigned to the control group. 1,971 adult participants were enrolled at baseline, and 939 completed follow-up. 770 participants with matched baseline and follow-up responses were analyzed. Self-reported survey assessments of values regarding components of SRAP were scored as the percentage of agreement with the UC Health SRAP as written. Participants responded to items at baseline and follow-up (approximately 10 weeks after baseline), with randomization occurring between administrations.ResultsAfter the intervention, overall agreement improved by a substantial margin of 5.2% (from 3.8% to 6.6%, P <.001) for the intervention group compared to the control group. Significant changes in agreement with SRAP logistics and health factors were also observed in the intervention group relative to the control, while no significant changes were noted for social factors. Differential intervention effects were observed for certain demographic subgroups.ConclusionsA brief educational video effectively explains the complex ethical principles and mechanisms of the SRAP, as well as how to improve the alignment of participant values with the foundational principles of UC Health SRAP. This directly informs practice by providing a framework for educating individuals about the use of these policies during future situations that require crisis standards of care, which can, in turn, enhance agreement and buy-in from affected parties.Trial registrationClinicalTrials.gov registration NCT04373135 (registered 4 May 2020).

Increasing access to school-based mental health services for youth subsequent to the COVID-19 pandemic.

There is a lack of mental health services in schools across the United States. According to recent data, 52% of public schools struggled to effectively provide mental health services to students. We explored the surge in demand for mental health services in schools for students, an ongoing need that continues beyond the COVID-19 pandemic. It is clear that schools struggle with their effort to provide mental health services for students, primarily stemming from insufficient funding, shortage of licensed mental health professionals, and a lack of mental health training among school staff. School administrators must remain dedicated to identifying strategies to increase access to mental health services in schools for students.

Beyond depression and anxiety in pediatric primary care: Current insights from the collaborative care model.

Beyond depression and anxiety in pediatric primary care: Current insights from the collaborative care model.

Sociodemographic and Clinical Profiles of Participants in Nova Scotia's Rapid Access Stabilization Program and Community Mental Health Program: A Comparative Analysis.

Background/Objective: To address the growing demand for mental health services, Nova Scotia Health introduced the Rapid Access Stabilization Program (RASP) through its Mental Health and Addictions Program (MHAP) in April 2023. RASP is designed to help reduce long wait times, frequent emergency department visits, and admissions to provide early intervention for individuals experiencing mental health problems. The RASP focuses on rapid access and early mental health intervention, aiming to prevent the worsening of patients' symptoms, improve access to psychiatric care, and reduce service pressures on programs like the Community Mental Health Program (CMHP), which provide more extended, ongoing mental health support. This study compared participants' sociodemographic and clinical profiles in the RASP and the CMHP. Methods: Data were collected from 1392 participants accessing mental health support either through the RASP or CMHP. A comparative analysis of sociodemographic factors (e.g., age, education, and income) and clinical characteristics (e.g., depression, anxiety, resilience, and substance use) was conducted. Chi-square tests and independent sample t-tests were used to evaluate the mean differences between the groups. Results: Significant sociodemographic and clinical differences emerged between the RASP and CMHP participants. The RASP group was older (M = 40.10 vs. 34.52 years) and more socioeconomically stable, with higher rates of employment (55.3% vs. 47.9%) and homeownership (36.5% vs. 17.7%). In contrast, the CMHP group had higher unemployment (25.7% vs. 16.5%) and lower income levels, with 47.5% earning <CAD 29,590 compared to 30.3% in the RASP group. Clinical profiles differed markedly: depression was more prevalent in the RASP (48.2% vs. 19.3%), whereas the CMHP had higher rates of psychosis (10.6% vs. 2.5%) and substance use disorder (7.8% vs. 1.9%). The RASP participants exhibited higher anxiety (GAD-7: M = 14.17 vs. 11.81) and depression symptoms (PHQ-9: M = 16.62 vs. 14.20) but lower resilience (BRS: M = 2.47 vs. 2.77). The CMHP participants had more adverse childhood experiences (ACE: M = 3.92 vs. 3.16) and lower suicidal intent (81.4% vs. 99.4% had no intention to act). Conclusions: The findings highlighted the unique profiles between the RASP and CMHP participants, suggesting the need for program-specific interventions. While the CMHP participants may benefit from integrated social support and trauma-informed care, the RASP participants may require cognitive behavioral therapy and resilience-building interventions. Tailoring mental health services to meet these unique needs could enhance program effectiveness and patient outcomes across both groups.

A hospital-based special care unit for dementia decreased hospital readmission rates for behaviour while reducing rates of falls and occupational violence across medical wards.

Hospital-based Special Care Units (SCU) for dementia show promise as effective models of care. However, limited research describes hospital-wide benefits. To describe patient-level outcomes and hospital service-level outcomes of a SCU. Pre-post analyses of SCU-patient data and hospital service-unit incident report data. 2-years of SCU-patient admissions and 4-years of hospital incident-reports from four medical wards (2-years pre-post SCU). Admission and discharge severity of SCU-patients' behaviour was prospectively measured by specialist SCU nurses. One-year hospitalisation rates, length-of-stay, diagnosis and patient demographics were retrospectively obtained from medical records. Hospital service-unit data included 4 years of monthly incident report rates for falls, pressure injury and occupational violence (OV) across four medical wards. Analysis of count data used Poisson and Negative Binomial Regression models. 121 SCU admissions involved 107 unique patients. Median SCU LoS was 23days (interquartile range [IQR], 13-50), and stabilisation of behaviour severity took 11days (IQR 6-12). Barriers to discharge related to substitute decision-making and care facility availability. After SCU discharge, yearly hospitalisation rates for 'all-reasons' decreased by 68% (Incident Rate Ratio [IRR], 0.32, 95% CI, 0.23-0.43), and 83% for behaviour-related admissions (IRR 0.17, 95% CI, 0.11-0.28). For hospital service-unit outcomes, falls-per-month decreased by 21% (IRR 0.79, 95% CI 0.64-0.99) after SCU implementation and OV by 26% (IRR, 0.74, 95% CI 0.59-0.94). A hospital-based SCU reduced hospital health service demand through decreased SCU-patient readmissions and was associated with decreased falls and OV rates across hospital medical wards.

Use of e-Mental Health Tools for Suicide Prevention in Clinical Practice by Mental Health Professionals in NSW, Australia: Cross-Sectional Survey.

Suicide is a significant global health concern. In the context of increased demand for mental health services and workforce shortages, exacerbated by the COVID-19 pandemic, electronic mental health (eMH) tools represent a promising means of augmenting mental health care generally and for suicide prevention specifically. A significant research gap exists however with respect to the use and uptake of eMH tools, especially electronic mental health tools for suicide prevention (eMH-SP). This study aimed to investigate the use of eMH tools by Australian mental health professionals, both in general and with respect to suicide prevention specifically, examining changes in use since COVID-19. Further, it explored factors associated with frequent use of eMH-SP, including sociodemographic and professional characteristics. A web-based cross-sectional survey was conducted across 15 local health districts (LHDs) in New South Wales, Australia, from May 2022 to July 2023. The sample was drawn from over 10,000 mental health professionals working in government services statewide. The survey explored the use of electronic mental health tools for general mental health issues (eMH-gen) and eMH-SP, explored the changes in the use of both since COVID-19, and used multivariable logistic regression to identify factors associated with the current use of eMH-SP. Among 469 participants, increased use since COVID-19 was reported by over half (247/469, 52.7%) for eMH-gen, and by approximately one-third (141/386, 36.6%) for eMH-SP. The proportion reporting frequent use increased significantly from before to after COVID-19 for both eMH-gen (243/469, 51.8% to 283/469, 60.3%; P<.001) and eMH-SP (152/386, 39.4% to 170/385, 44.2%; P=.01). Since COVID-19, the most frequently used types of eMH tools for eMH-gen and eMH-SP, respectively, were information sites (231/469, 49.3% and 130/385, 33.8%), phone/online counseling (173/469, 36.9% and 130/385, 33.8%), and apps (145/469, 30.9% and 107/385, 27.8%). Professionals more likely to use eMH-SP frequently were females (odds ratio [OR] 3.32, 95% CI 1.88-5.87; P<.001) compared with males; peer workers (OR 2.17, 95% CI 1.0-4.71; P<.001) compared with nurses; those located in regional/rural LHDs (OR 1.65, 95% CI 1.04-2.61; P=.03) compared with metropolitan LHDs; and those practicing in emergency health care settings (OR 8.31, 95% CI 2.17-31.75; P=.03) compared with inpatient settings. The study's findings highlight the increasing adoption of eMH tools and delivery of remote care by mental health professionals and provide valuable new insights into sociodemographic factors associated with the use of eMH for suicide prevention specifically. Continued research on the role eMH is playing is essential for guiding policy, optimizing resources, and enhancing mental health care and suicide prevention efforts.

Hidden behind a cloak of silence and exclusion: a qualitative study of healthcare professionals and mandated COVID-19 vaccinations

ABSTRACT Aotearoa New Zealand (Aotearoa), like many countries, experienced widespread demand for health services, threatening to collapse the health system. In addition to stringent border control, isolation policies for those with COVID-19, and instituting lockdowns, the government imposed a COVID-19 vaccine mandate for groups of essential workers, including healthcare professionals. Some literature argues that the COVID-19 vaccine mandates restrict individuals’ freedoms through the loss of employment, income, and status as a healthcare professional. This qualitative research explored how COVID-19 vaccine mandates impacted healthcare professionals. Data from eight in-depth interviews with former healthcare professionals who experienced termination of their employment, and four managers or business owners were thematically analysed. The theme, Mandate-Induced Traumatic Decision-Making and Loss and two sub-themes, A Change in Attitudes and Ongoing Impacts on Lives, were identified. We found the COVID-19 vaccine mandates had detrimental impacts on those healthcare professionals affected by their decision not to have or complete COVID-19 vaccinations. Despite what participants believed were legitimate reasons for not being vaccinated, they experienced ongoing trauma and psychological, unemployment, and financial harm. The findings question the public good benefits of the vaccine mandate when it restricts the freedom, autonomy, and agency of much-needed healthcare professionals, which provide useful insights.

New York City Faith-Based Leaders' Views on COVID-19's Impact on the Mental Health Needs of Black/African American Communities.

This investigation sought to understand the mental health needs of Black/African Americans during the COVID-19 pandemic and explore the church leaders' perspectives and experiences in supporting the mental health of their communities during this time. This exploratory qualitative study uses semi-structured interviews with 21 church leaders from predominantly Black neighborhoods in Brooklyn and Harlem, New York City (NYC), which were most adversely impacted by COVID-19. Neighborhoods were selected based on COVID-19 infection and mortality data from the NYC Department of Health. Transcripts were coded and thematically analyzed using Dedoose software. Four overarching themes and one subtheme emerged: (1) The COVID-19 pandemic amplified underlying community quality of life challenges, creating a "downward cascade" of mental health, (1a) COVID-19 is a source of collective grief and trauma; (2) Faith-based leaders play a key role in providing mental health support to their community; (3) Faith-based leaders seek strategies to reduce mental health stigma, normalize conversations around mental health; and (4) Faith-based leaders often operate in isolation from citywide mental health services, disconnected from existing programs and resources. Leaders anticipate a higher demand for mental health services. On the road to emotional wellness post-pandemic, public awareness of symptoms of mental health issues must be emphasized and available resources utilized to reduce stigma and encourage help-seeking behavior. Addressing these implications requires comprehensive multi-sector community driven efforts that include collaboration with faith-based communities to support community resilience and improve mental healthcare access.

Six teaching methods on the effectiveness of community nursing education for nursing students in China: A systematic review and network meta-analysis.

Six teaching methods on the effectiveness of community nursing education for nursing students in China: A systematic review and network meta-analysis.

Design and Application Research of Multidimensional Intelligent Psychological Assessment System

The rapid development of society has increasingly highlighted people's mental health issues, and efficient and accurate psychological assessment tools have become an important demand for mental health education and services. This article explores a multidimensional intelligent psychological assessment system that integrates intelligent algorithms, multidimensional data analysis, and user-friendly interaction design to achieve automation, precision, and personalization of psychological assessment. This article elaborates on the technical implementation path of the system, including the collaborative mechanism of functional modules, security control scheme, and user experience optimization strategy. Through case analysis, its advantages in improving evaluation efficiency and decision-making scientificity are verified. The research results indicate that the multidimensional intelligent psychological assessment system provides innovative technological solutions for the field of psychology and has broad application prospects.

Measurement of the operational efficiency of tertiary public hospitals in Western China: evidence from Guangxi from 2019 to 2022.

The continuous increase in health care costs and the growing demand for health services among residents make it an urgent priority to improve the operational efficiency of the health system in Chinese society. In this study, data on the operational efficiency of tertiary public hospitals in Guangxi were analyzed to identify issues in hospital management within the context of performance assessment, which thereby enhanced the social service capacity of hospitals. A comprehensive evaluation index system was constructed based on the "national monitoring indicators" of operational efficiency. The indicators were analyzed using data envelopment analysis with Banker, Charnes and Cooper (DEA-BCC) and Malmquist index models. The Tobit regression model was used to analyze the major factors affecting the efficiency of public hospitals. Between 2019 and 2022, the pure technical efficiency (PTE) of 61 tertiary public hospitals in Guangxi remained at a relatively high level. The results of the Malmquist index showed a downward trend. The technical progress (TC) indicator became the main factor affecting the decline in the operational efficiency of hospitals. Tobit regression analysis revealed that plenty of factors exerted a significant impact on the operating efficiency of hospitals. These factors included the number of beds, the ratio of outpatient and inpatient patients relative to total patient numbers, the proportion of discharged patients undergoing surgery among total patients, business expenditures and total annual revenue. The scale of tertiary public hospitals in Guangxi is prominently unreasonable. It is necessary to raise the efficiency of resource utilization. The operation and management situation is not optimistic. Hospitals should accelerate the transformation of their development model, rationally allocate medical resources and shift from scale expansion to the improvement of quality and efficiency. Meanwhile, they should actively participate in establishing the hierarchical medical treatment system, controlling operating costs and reasonably increasing the proportion of personnel expenses to improve operational and management efficiency.

Factors influencing access to primary health care in Luanda, Angola

IntroductionThe primary health care system is the first of the three hierarchical levels of care, and it is the first point of contact of the population with the health system. In Luanda, Angola, the primary care network presents challenges in its management, as well as in the perception of its purposes, which constitutes a serious problem for the demand for health services, being the reason for this study. The present research aimed to evaluate the level of adherence and satisfaction related to the health care system and their influence on usage of the public primary health care facilities in Luanda, from the perspective of health professionals and users.MethodsA cross-sectional and descriptive study was carried out on 120 health professionals and 423 users.ResultsWe found a statistically significant association between the level of education and the professionals' disbelief in health services (P = 0.001), as well as the users' family income (P = 0.0002).DiscussionThe users' perception is that there is a switch in test results (P = 0.01). Furthermore, they also believe that when attending health units, the user leaves sicker than he entered (P = 0.01).ConclusionThus, it was found that the level of user adherence to the services of the primary health care units in Luanda ranged between "good" and "acceptable". We identified elements capable of compromising the quality of services and, consequently, interfering with adherence to them, which suggests the need for the development of management strategies for health facilities, in order to overcome the challenges presented in the study.

A199 MODELS OF OUTPATIENT INFLAMMATORY BOWEL DISEASE CARE DELIVERY: A SCOPING REVIEW

Abstract Background The rapidly increasing prevalence of inflammatory bowel disease (IBD) in Canada, combined with an aging population at higher risk of age-related comorbidities, will place a significant strain on gastroenterology clinics and the broader healthcare system. Changes in care delivery are necessary to meet the growing demand for health services among people living with IBD. Aims To understand the extent and type of evidence focused on models of outpatient care delivery for disease management in individuals with IBD. Methods A scoping review was conducted by searching MEDLINE, EMBASE, CINAHL, and PsycINFO (from inception to March 4, 2024) to identify studies describing or evaluating models of care for managing people with IBD in outpatient settings. We included English language published studies of any type (primary studies, reviews, and opinion pieces) focusing on any age group, specific aspects of care (e.g., preconception, transition from pediatric to adult care), or setting (e.g., remote care or monitoring). Studies were screened for eligibility in duplicate, and conflicts were resolved by consensus. Heat maps were created to synthesize the evidence and summarize the literature recommendations. Results Our search yielded 13,146 records, of which 209 met our inclusion criteria. These included 88 quantitative studies, 11 qualitative studies, 18 mixed methods studies, and 21 systematic or scoping reviews; the remaining studies consisted of clinical practice guidelines, narrative reviews, or perspectives. The models of care evaluated, along with their outcomes, are summarized in Figure A. Many interventions resulted in high levels of patient and clinician satisfaction, as well as reduced healthcare utilization and costs (direct, indirect, and out-of-pocket). However, data on other outcomes were mixed, with many studies being underpowered to detect significant improvements in patient outcomes. Gastroenterologists, nurses, mental health professionals (e.g., social workers, psychologists, psychiatrists), and dietitians were consistently identified as key members of multidisciplinary teams (Figure B). Conclusions Several innovative outpatient models of IBD care have been proposed. The recommendations from these studies can guide adaptations in the Canadian healthcare system, addressing the growing healthcare needs of the increasing number of people living with IBD. Heat maps describing (A) the evaluated models of outpatient inflammatory bowel disease care and their outcomes and (B) the recommended core and auxiliary members of multidisciplinary teams included in the described and evaluated models of care Funding Agencies None

Assessing Mental Illness Referral Request Acceptance: A Nationwide E-Referral Data From Saudi Arabia.

Mental disorders significantly impact quality of life and life expectancy, representing a leading cause of global disease burden. Healthcare systems worldwide face challenges in meeting mental health service demands, particularly due to specialist shortages and geographical barriers. Saudi Arabia has implemented an innovative nationwide electronic referral system (SMARC) as part of its digital health transformation strategy to enhance mental healthcare accessibility. This study examined SMARC's effectiveness in facilitating mental health service access by analyzing patient transfer acceptance rates between healthcare facilities and identifying factors influencing these rates. This retrospective cross-sectional study analyzed 9722 mental health electronic referrals within SMARC from January 2020 to December 2021. Descriptive statistics characterized referral patterns, while bivariate and multivariable logistic regression analyses identified factors associated with referral acceptance, calculating adjusted odds ratios (aORs) and 95% confidence intervals. The system achieved an overall acceptance rate of 82.5%, with different patterns across age groups and regions. Lower acceptance rates were observed for ages 15-25 years (aOR = 0.84; 95% CI = 0.70-0.99) and 46-65 years (aOR = 0.83; 95% CI = 0.70-0.99) compared to ages 26-35 years. Life-saving referrals showed the highest acceptance (aOR = 2.60; 95% CI = 1.51-4.48), while psychiatrist availability significantly influenced acceptance rates (aOR = 1.36; 95% CI = 1.17-1.58). External referrals were half as likely to be accepted as internal ones (aOR = 0.51; 95% CI = 0.42-0.64). SMARC demonstrates effectiveness in optimizing mental healthcare access through strategic matching of patient needs with available resources. The system's selective acceptance patterns reflect its capability to prioritize care based on clinical urgency and resource availability. These findings provide valuable insights for policymakers to keep enhancing digital health infrastructure and mental healthcare delivery. The SMARC model offers a promising framework for implementing similar digital referral systems globally to improve mental healthcare coordination and accessibility.