Waters, Nicola

This integrative review examines the growing prevalence of depression, a leading cause of primary care visits in Canada, and the need for accessible treatment options such as telemedicine. Despite substantial evidence supporting the widespread adoption of telemedicine in primary care, including for treating depression, research on patient experiences with telemedicine for depression remains limited. This integrative review aims to explore patients' experiences of using telemedicine for the treatment of depression in primary care to identify areas for enhancing the quality of care. The key findings reveal several themes influencing patient experience: the therapeutic relationship, the environment of care delivery, individualization of treatment approaches, accessibility of telemedicine, and the level of knowledge patients possess regarding telemental health. The findings have implications for primary care providers, including nurse practitioners (NPs), in optimizing the delivery of telemedicine for depression. Limitations of this review include a restricted number of studies that specifically focused on depression. Further investigation is needed to gain a deeper understanding of patient experiences with telemedicine for depression treatment.

The opioid crisis remains a significant public health concern, with fentanyl contributing to 79% of accidental opioid-related deaths in Canada between January and June 2024, nearly a 40% increase since the national surveillance in 2016. Opioid agonist therapy (OAT), using medications such as methadone and buprenorphine, is an evidence-based treatment for opioid use disorder (OUD) that aims to reduce harm and mortality. While OAT is increasingly delivered in primary care to improve accessibility, patient retention in these programs remains a significant challenge. Retention is a commonly used outcome in OUD treatment studies; however, there is no universal definition. This integrative review explores the factors influencing OAT retention among individuals with opioid use disorder in primary care settings. A systematic search of peerreviewed literature published from 2016 to 2024 identified nine U.S.-based studies, including three qualitative and six cohort studies. Findings indicate that comorbid mental health and substance use disorders, along with limited access to psychosocial supports, negatively affect retention. Conversely, low-barrier, trauma-informed, and multidisciplinary care models are associated with improved outcomes. These findings highlight the need for OAT programs to adapt to the complex needs of patients with OUD by providing individualized, flexible, and accessible treatment options. Integrating mental health and addiction care within primary care settings may improve patient engagement and decrease opioid-related harm and mortality.