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Louie E, Giannopoulos V, Uribe G, Wood K, Teesson M, Childs S, Baillie A, Haber PS, Morley KC. Geographical variation in implementation of the Pathways to Comorbidity Care program in Australian drug and alcohol services. JBI Evid Implement 2023; 21:186-193. [PMID: 36378096 DOI: 10.1097/xeb.0000000000000344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Comorbid drug and alcohol and mental health disorders are highly prevalent. Significant gaps in service provision make this problem particularly difficult to address in regional Australia. The Pathways to Comorbidity Care (PCC) program was designed to improve management of comorbidity by outpatient drug and alcohol clinicians in New South Wales, Australia. This paper uses the Consolidated Framework for Implementation Research (CFIR) to evaluate variations in implementation outcomes across geographically diverse services. METHODS Twenty clinicians across three drug and alcohol services from metropolitan, outer metropolitan and regional geographic locations were engaged at multiple levels of influence (directors, managers, clinicians) during the implementation of the multimodal PCC training package. The CFIR guided the development of self-report measures and semi-structured interviews evaluating implementation of the PCC training, and disparities in implementation barriers and facilitators were determined. RESULTS Metropolitan clinicians identified less barriers than regional clinicians on several intervention characteristics (adaptability, complexity, design quality and packaging), as well as outer setting (peer pressure), inner setting (implementation climate, staff incentives, leadership engagement, available resources) and process (planning, opinion leaders, executing) domains. Regional clinicians evaluated the networks and communications construct more favourably. CONCLUSIONS Specific barriers identified more strongly by regional clinicians included the importance of communication with local clinicians and leadership about the practicalities of incorporating the approach into routine practice (allocation of time, increased accessibility of implementation team). Metropolitan clinicians provided more favourable evaluations of the package design, implementation climate and specific implementation processes such as a clear and informative implementation plan.
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Affiliation(s)
- Eva Louie
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney
- Edith Collins Centre (Translational Centre in Alcohol, Drugs & Toxicology), Sydney Local Health District & Royal Prince Alfred Hospital, Camperdown
| | - Vicki Giannopoulos
- Edith Collins Centre (Translational Centre in Alcohol, Drugs & Toxicology), Sydney Local Health District & Royal Prince Alfred Hospital, Camperdown
| | - Gabriela Uribe
- Menzies Centre for Health Policy, Faculty of Medicine and Health
| | - Katie Wood
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney
| | - Maree Teesson
- School of Medical Sciences, Faculty of Medicine and Health Sciences, The University of Sydney
| | - Steven Childs
- Central Coast Local Health District Drug and Alcohol Clinical Services, Gosford
| | - Andrew Baillie
- School of Health Sciences, Faculty of Medicine and Health Sciences, The University of Sydney, NSW, Australia
| | - Paul S Haber
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney
- Edith Collins Centre (Translational Centre in Alcohol, Drugs & Toxicology), Sydney Local Health District & Royal Prince Alfred Hospital, Camperdown
| | - Kirsten C Morley
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney
- Edith Collins Centre (Translational Centre in Alcohol, Drugs & Toxicology), Sydney Local Health District & Royal Prince Alfred Hospital, Camperdown
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Cheetham A, Arunogiri S, Lubman D. Integrated care – panacea or white elephant? A review of integrated care approaches in Australia over the past two decades. ADVANCES IN DUAL DIAGNOSIS 2023. [DOI: 10.1108/add-10-2022-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Purpose
Integrated care is widely supported as a means of improving treatment outcomes for people with co-occurring mental health and substance use disorders. Over the past two decades, Australian state and federal governments have identified integrated care as a policy priority and invested in a number of research and capacity building initiatives. This study aims to examine Australian research evaluating the effectiveness of integrated treatment approaches to provide insight into implications for future research and practice in integrated treatment.
Design/methodology/approach
This narrative review examines Australian research evaluating empirical evidence of the effectiveness of integrated treatment approaches within specific populations and evidence from initiatives aimed at integrating care at the service or system level.
Findings
Research conducted within the Australian context provides considerable evidence to support the effectiveness of integrated approaches to treatment, particularly for people with high prevalence co-occurring disorders or symptoms of these (i.e. anxiety and depression). These have been delivered through various modalities (including online and telephone-based services) to improve health outcomes in a range of populations. However, there is less evidence regarding the effectiveness of specific models or systems of integrated care, including for more severe mental disorders. Despite ongoing efforts on behalf of the Australian government, attempts to sustain system-level initiatives have remained hampered by structural barriers.
Originality/value
Effective integrated interventions can be delivered by trained clinicians without requiring integration at an organisational or structural level. While there is still considerable work to be done in terms of building sustainable models at a system level, this evidence provides a potential foundation for the development of integrated care models that can be delivered as part of routine practice.
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Merrick TT, Louie E, Cleary M, Molloy L, Baillie A, Haber P, Morley KC. A systematic review of the perceptions and attitudes of mental health nurses towards alcohol and other drug use in mental health clients. Int J Ment Health Nurs 2022; 31:1373-1389. [PMID: 35909095 PMCID: PMC9796325 DOI: 10.1111/inm.13043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 01/01/2023]
Abstract
Mental and substance use disorders are leading contributing factors for the Australian non-fatal burden of disease. These disorders frequently co-occur in the mental health population, and mental health nurses are the largest group of professionals treating dual diagnosis. A comprehensive understanding of mental health nurses' attitudes and perceptions is required to inform future implementation of dual diagnosis training programs. A systematic literature review of sources derived from electronic databases including Medline, CINAHL, SCOPUS review, and PsychINFO, along with Connected Papers. Selection criteria included a focus on mental health nurses' attitudes towards dual diagnosis of mental illness and substance use. Extracted data was qualitatively synthesized. Of the 5232 articles retrieved initially, 12 were included in the review. Four themes emerged from the synthesis: drug and alcohol use among mental health consumers (seven studies), caring for dual diagnosis consumers (eight studies), role perception (six studies), and treatment optimism (five studies). Salient beliefs included substance use as a self-inflicted choice (71%) or a form of 'self-medication' (29%); a lack of willingness to provide care (75%), or a strong commitment to care (25%); greater comfort with screening and acute medical management rather than ongoing management (83%); and pessimism about treatment effectiveness (100%). Mental health nurses' beliefs and attitudes towards dual diagnosis were often negative, which is likely to result in poor quality care and treatment outcomes. However, the lack of recent studies in this research area indicates the need for up-to-date knowledge that can inform the development of training programs.
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Affiliation(s)
- Tammy Tran Merrick
- Sydney Medical School, Faculty of Medicine and Health SciencesThe University of SydneySydneyNew South WalesAustralia
| | - Eva Louie
- Sydney Medical School, Faculty of Medicine and Health SciencesThe University of SydneySydneyNew South WalesAustralia
- Edith Collins Centre for Translational ResearchRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
| | - Michelle Cleary
- School of Nursing, Midwifery & Social ScienceCentral Queensland UniversityQueenslandRockhamptonAustralia
| | - Luke Molloy
- School of NursingUniversity of WollongongWollongongNew South WalesAustralia
| | - Andrew Baillie
- School of Health Sciences, Faculty of Medicine and Health SciencesThe University of SydneySydneyNew South WalesAustralia
| | - Paul Haber
- Sydney Medical School, Faculty of Medicine and Health SciencesThe University of SydneySydneyNew South WalesAustralia
- Edith Collins Centre for Translational ResearchRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
| | - Kirsten C. Morley
- Sydney Medical School, Faculty of Medicine and Health SciencesThe University of SydneySydneyNew South WalesAustralia
- Edith Collins Centre for Translational ResearchRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
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Louie E, Giannopoulos V, Baillie A, Uribe G, Wood K, Teesson M, Haber PS, Morley KC. Relationship between clinician-level attributes and implementation outcomes from the Pathways to Comorbidity Care training program. BMC MEDICAL EDUCATION 2022; 22:605. [PMID: 35931994 PMCID: PMC9354347 DOI: 10.1186/s12909-022-03671-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The process of determining the best strategy for increasing the uptake of evidence-based practice might be improved through an understanding of relevant clinician-level factors. The Pathways to Comorbidity Care (PCC) training program (Louie E, et al., J Dual Diagnosis 17:304-12, 2021) aimed to facilitate integrated management of comorbid drug and alcohol and mental disorders amongst drug and alcohol clinicians. We hypothesised that uptake of integrated management of comorbidity following the implementation of the PCC program would be associated with clinician-level: (i) demographics (gender, education, experience), (ii) attitudes (evidence-based practice, therapist manuals, counselling self-efficacy), and (iii) organisational readiness to change. METHODS Twenty clinicians participated in the 9-month PCC training program. Attitudes towards evidence-based practices and psychotherapist manuals, self-efficacy, and organisational readiness to change, along with demographics, were measured at baseline. At follow-up, change in Comorbidity Practice (CoP) scores related to integrated comorbidity management were obtained using a file audit checklist and categorised into high (at least 60% increase in CoP), medium or low (a decrease of - 20% or less in CoP). Clinician-level characteristics were examined across the implementation categories. RESULTS There were no significant differences found between implementation groups on sociodemographic variables (p's > 0.30), attitudes to evidence-based practices, attitudes to therapist manuals, and self-efficacy (p's > 0.52). The high implementation group demonstrated significantly higher scores on leadership practices aspect of organisational readiness to change relative to the low and medium implementation group ((F(2, 16) = 3.63, p = 0.05; Cohen's d = .31) but not on the other subscales (p's > 0.07). CONCLUSIONS Confidence that leadership will play a positive role in the implementation process may improve effectiveness of comorbidity training programs for drug and alcohol clinicians. On the other hand, contrary to our hypothesis, counselling self-efficacy, evidence-based practice attitudes, attitudes towards therapist manuals, gender, education and experience were not distinguishing factors.
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Affiliation(s)
- Eva Louie
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Edith Collins Centre (Translational Centre in Alcohol, Drugs & Toxicology), Sydney Local Health District & Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Vicki Giannopoulos
- Edith Collins Centre (Translational Centre in Alcohol, Drugs & Toxicology), Sydney Local Health District & Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Andrew Baillie
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Gabriela Uribe
- Menzies Centre for Health Policy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Katie Wood
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown, NSW, Australia
| | - Paul S Haber
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Edith Collins Centre (Translational Centre in Alcohol, Drugs & Toxicology), Sydney Local Health District & Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Kirsten C Morley
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
- Edith Collins Centre (Translational Centre in Alcohol, Drugs & Toxicology), Sydney Local Health District & Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
- Addiction Medicine, Central Clinical School, Sydney Medical School, University of Sydney, Camperdown, NSW, 2006, Australia.
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Louie E, Giannopoulos V, Baillie A, Uribe G, Wood K, Teesson M, Childs S, Rogers D, Haber PS, Morley KC. Barriers and Facilitators to the Implementation of the Pathways to Comorbidity Care (PCC) Training Package for the Management of Comorbid Mental Disorders in Drug and Alcohol Settings. FRONTIERS IN HEALTH SERVICES 2021; 1:785391. [PMID: 36926478 PMCID: PMC10012778 DOI: 10.3389/frhs.2021.785391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/05/2021] [Indexed: 11/13/2022]
Abstract
Background: We have previously reported that the Pathways to Comorbidity Care (PCC) training program for alcohol and other drug (AOD) clinicians improved identification of comorbidity, self-efficacy, and attitudes toward screening and monitoring of comorbidity. We aimed to identify barriers and facilitators of implementation of the PCC training program in drug and alcohol settings. Methods: The PCC training program was implemented across 6 matched sites in Australia as per (1), and 20 clinicians received training. PCC training included seminar presentations, workshops conducted by local "clinical champions," individual clinical supervision, and access to an online information portal. We examined barriers and facilitators of implementation according to the Consolidated Framework for Implementation Research. Results: Barriers included inner setting (e.g., allocated time for learning) and characteristics of individuals (e.g., resistance). Facilitators included intervention characteristics (e.g., credible sources), inner setting (e.g., leadership), and outer setting domains (e.g., patient needs). Clinical champions were identified as an important component of the implementation process. Conclusions: Barriers included limited specific allocated time for learning. A credible clinical supervisor, strong leadership engagement and an active clinical champion were found to be facilitators of the PCC training program.
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Affiliation(s)
- Eva Louie
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Vicki Giannopoulos
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Andrew Baillie
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gabriela Uribe
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, NSW, Australia
| | - Katie Wood
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, NSW, Australia
| | - Steven Childs
- Central Coast Local Health District, Drug and Alcohol Clinical Services, Gosford, NSW, Australia
| | - David Rogers
- Drug and Alcohol Services, Mid North Coast Local Health District, Port Macquarie, NSW, Australia
| | - Paul S. Haber
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Kirsten C. Morley
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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