Abstract Background medication-related problems occur frequently when older patients are discharged from hospital. Interventions to support medication use have been developed; however, their effectiveness in older populations are unknown. This review evaluates interventions that support successful transitions of care through enhanced medication continuity. Methods a database search for randomised controlled trials was conducted. Selection criteria included mean participant age of 65 years and older, intervention delivered during hospital stay or following recent discharge and including activities that support medication continuity. Primary outcome of interest was hospital readmission. Secondary outcomes related to the safe use of medication and quality of life. Outcomes were pooled by random-effects meta-analysis where possible. Results twenty-four studies (total participants = 17,664) describing activities delivered at multiple time points were included. Interventions that bridged the transition for up to 90 days were more likely to support successful transitions. The meta-analysis, stratified by intervention component, demonstrated that self-management activities (RR 0.81 [0.74, 0.89]), telephone follow-up (RR 0.84 [0.73, 0.97]) and medication reconciliation (RR 0.88 [0.81, 0.96]) were statistically associated with reduced hospital readmissions. Conclusion our results suggest that interventions that best support older patients’ medication continuity are those that bridge transitions; these also have the greatest impact on reducing hospital readmission. Interventions that included self-management, telephone follow-up and medication reconciliation activities were most likely to be effective; however, further research needs to identify how to meaningfully engage with patients and caregivers to best support post-discharge medication continuity. Limitations included high subjectivity of intervention coding, study heterogeneity and resource restrictions.

As parto fa ne valuation of serviceu sers'a nd carers'e xperienceo fi nvolvement in mental healthe ducation, training and research,a ne xtended literaturer evieww as undertaken. The purposeo ft hisw as to reviewp olicy underpinning serviceu sera nd careri nvolvement in thosea reas,i dentifyt he extent and range of involvement, the processesi nvolved, andt he extent to which the effectivenessa nd impacto fi nvolvement had been evaluated. The reviewf ound that therew as ar angeo fd ifferent ways in which peoplew erei nvolved. It identified different types and levels of involvement and different motivationsf or takingp art in involvement activities. Government policy and guidanceo np ublic and patient involvement (PPI)i nh ealth services has clearly been ad rivera nd has resulted in widespread involvement activityb ut thish as developed on an ad hoca nd inconsistent basis.Therea re benefits for serviceu sers and carers,t he NHS, and educational establishments arisingout of involvement activity. Theseinclude improvementsinthe health and well-being of serviceu sers,e nhancingt he student experience, and improvements to serviced elivery. However,t herea re stillb arrierst oi nvolvement including organisational factorsa nd unintentional discrimination. Payment for involvement activityremains an under researched area. Service usersv alue payments but welfareb enefits rules, and inconsistent interpretation of good practice guidance,m ean thisc an be af urther barrier to involvement. Currently, the evidenceb asee valuatingt he effectiveness of serviceu seri nvolvement in a range of activities including serviceplanning, delivery, education and research is limited.

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Despite increasing evidence of the impact of health inequalities on mental health (Pickett and Wilkinson, 2015) there is only limited recognition of the potential role for mental health social work in addressing 'upstream' as well as 'downstream' challenges of poverty, disadvantage and oppression affecting many people experiencing mental health difficulties. This paper presents some of the current evidence concerning mental health inequalities and the opportunities for mental health social workers to promote wellbeing. A theme throughout the paper is the need to avoid the many examples of dichotomous thinking that frequently characterise thinking about mental health and mental health practice. Additionally the limitations of an individualised recovery discourse are acknowledged. Drawing on Krieger's (2011) ecosocial model, the social determinants of mental health are considered and the concept of embodiment is examined for its contribution to a more nuanced understanding of the relationship between inequality and health. Finally, the paper offers a version of mental health social work that 'faces both ways', involving issues at both the individual and the wider societal level. This includes developing and extending partnerships with service users and carers and with other professional and agencies.

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