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Fodstad EC, Erga AH, Pallesen S, Ushakova A, Erevik EK. Personality traits as predictors of recovery among patients with substance use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 162:209360. [PMID: 38631658 DOI: 10.1016/j.josat.2024.209360] [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: 03/06/2023] [Revised: 02/22/2024] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Substance use disorder (SUD) is often considered a chronic illness in which prolonged recovery, in terms of abstinence, is uncommon. Personality has been found to predict recovery, but not much is known about its long-term predictive ability as the majority of previous studies have had short follow-up periods (≥ one year). The current longitudinal cohort study therefore investigated whether personality traits predict short- (STR) as well as long-term recovery (LTR) in SUD patients. METHODS Treatment-seeking patients with SUD (n = 123) completed the NEO Personality Inventory - Revised. STR and LTR categories were defined as scoring <8 on the Alcohol Use Disorders Identification Test - C and <2 on the Drug Use Disorder Identification Test - C at the one-year and 6-8-year follow-up, respectively. Whether personality traits predicted outcome was investigated by two-tailed independent samples t-tests, α < 0.05. Additional analysis was conducted with latent growth curve model. RESULTS Neuroticism (inversely, p = .004, d = 0.55) and Extraversion (p = .04, d = 0.38) predicted STR (n = 114). Although not significant the effect size for Conscientiousness was above the cut-off for a practical significant effect (d = 0.31). No traits predicted LTR category. Still, the effect sizes for LTR regarding Neuroticism (d = 0.36), Extraversion (d = 0.21) and Conscientiousness (d = 0.27) indicated that these traits have relevance for LTR. The latent growth curve model indicated that these traits predicted the short-term use of drugs and long-term use of alcohol in this cohort dominated by patients suffering from severe poly-SUD. CONCLUSION Personality traits predict recovery. The effect sizes indicate that more studies with larger samples on personality traits and LTR are required to understand their possible influences on the recovery process.
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Affiliation(s)
- Elise Constance Fodstad
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway; Centre for Alcohol and Drug Research (KORFOR), Stavanger University Hospital, Stavanger, Norway.
| | - Aleksander Hagen Erga
- Centre for Alcohol and Drug Research (KORFOR), Stavanger University Hospital, Stavanger, Norway; Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Anastasia Ushakova
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway
| | - Eilin Kristine Erevik
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
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Chiu K, Pandya S, Sharma M, Hooimeyer A, de Souza A, Sud A. An international comparative policy analysis of opioid use disorder treatment in primary care across nine high-income jurisdictions. Health Policy 2024; 141:104993. [PMID: 38237202 DOI: 10.1016/j.healthpol.2024.104993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/09/2023] [Accepted: 01/09/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Opioid use disorder (OUD) and opioid-related harms are current health priorities in many high-income countries such as Canada. Opioid agonist therapy (OAT) is an effective evidence-based treatment for OUD, but access is often limited. AIMS To describe and compare OUD treatment policies across nine international jurisdictions, and to understand how they are situated within their primary care and health systems. METHODS Using policy documents, we collected data on health systems, drug use epidemiology, drug policies, and OUD treatment from Australia, Canada, France, Germany, Ireland, Portugal, Sweden, Switzerland, and Taiwan. We used the health system dynamics framework and adapted definitions of low- and high-threshold treatment to describe and compare OUD treatment policies, and to understand how they may be shaped by their health systems context. RESULTS Broad similarities across jurisdictions included the OAT pharmacological agents used and the need for supervised dosing; however, preferred OAT, treatment settings, primary care and specialist physicians' roles, and funding varied. Most jurisdictions had elements of lower-threshold treatment access, such as the availability of treatment through primary care and multiple OAT options, but the higher-threshold criteria of supervised dosing. CONCLUSIONS From the Canadian perspective, there are opportunities to improve accessibility of OUD care by drawing on how different jurisdictions incorporate multidisciplinary care, regulate OAT medications, remunerate healthcare professionals, and provide funding for services.
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Affiliation(s)
- Kellia Chiu
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Saloni Pandya
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Manu Sharma
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Alexandra de Souza
- Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, NSW, Australia
| | - Abhimanyu Sud
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Humber River Hospital, Toronto, ON, Canada.
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Oster C, Hunter S, Schultz T, Harvey G, Lawless M, Battersby M. Barriers and facilitators to the implementation of the Flinders Chronic Condition Management Program in outpatient drug and alcohol settings in Australia. Drug Alcohol Rev 2024; 43:705-717. [PMID: 38098184 DOI: 10.1111/dar.13799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/20/2023] [Accepted: 11/29/2023] [Indexed: 03/02/2024]
Abstract
INTRODUCTION There has been a growing call for drug and/or alcohol dependence to be managed as a chronic condition. The Flinders Chronic Condition Management Program (Flinders Program) was implemented in a drug and alcohol service in Australia in 2019-2022 to explore the feasibility of chronic condition management in outpatient clinics. Implementation involved: adaptation of the Flinders Program; adaptation of clinical procedures; training clinicians and managers; training Flinders Program Accredited Trainers; and system integration. This study aims to explore barriers and enablers to implementation. METHODS A qualitative formative evaluation was undertaken. Data included implementation documents (n = 7), responses to open-ended questions in post-training surveys (n = 27), and focus groups and interviews with implementation staff, clinicians, managers and a trainer (n = 16). Data were analysed using the Consolidated Framework for Implementation Research in a 'coding reliability' approach to thematic analysis. RESULTS Participants responded positively to the Flinders Program's philosophy, processes, tools and training. However, barriers were identified across three Consolidated Framework for Implementation Research domains: (i) outer setting (client suitability and incompatibility with external policies and incentives); (ii) characteristics of individuals (low self-efficacy); and (iii) inner setting (lack of system and workflow integration). DISCUSSION AND CONCLUSIONS Executive support and systems integration are important for the implementation of the Flinders Program in drug and alcohol services. This needs to be achieved within externally mandated key performance indicators for outpatient services. Further research is needed to fully evaluate the potential of a chronic condition management framework in Australian outpatient drug and alcohol services.
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Affiliation(s)
- Candice Oster
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Timothy Schultz
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Gillian Harvey
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Michael Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Turi E, McMenamin AL, Martsolf G, Hasin D, Han BH, Liu J, Poghosyan L. Primary care nurse practitioner work environments and emergency department utilization among older adults with substance use disorders in rural areas. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209285. [PMID: 38159910 PMCID: PMC10922346 DOI: 10.1016/j.josat.2023.209285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/01/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION The prevalence of substance use disorders (SUDs) is growing among older adults, and older adults in rural areas face disparities in access to SUD care. Rural older adults with SUDs commonly have comorbid chronic conditions that puts them at risk for frequent acute healthcare utilization. In rural areas, primary care for patients with SUDs are increasingly provided by nurse practitioners (NPs), and quality primary care services may decrease ED visits in this population. Yet, NP-delivered primary care for rural older adults with SUDs may be limited by work environment barriers, which include lack of support, autonomy, and visibility. This study assessed the relationship between the NP work environment and ED utilization among rural older adults with SUDs. METHODS This was a secondary analysis of cross-sectional data from a large survey of NPs in six U.S. states merged with Medicare claims. The study measured the NP work environment by the four subscales of the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ), which measure 1) independent practice and support, 2) NP-physician relations, 3) NP-administration, and 4) professional visibility. Multilevel logistic regression models, adjusted for practice and patient covariates, assess the relationship between the NP work environment and all-cause ED use. RESULTS The sample included 1152 older adults with SUDs who received care at 126 rural NP primary care practices. NP independent practice and support at the practice was associated with 49 % lower odds of all-cause ED visits among older adults with SUDs. There were no relationships between the other NP-PCOCQ subscales and all-cause ED visits. CONCLUSIONS Organizational support for NP independent practice is associated with lower odds of all-cause ED utilization among rural older adults with SUDs. Practice administrators should ensure that NPs have access to support and resources to enhance their ability to care for rural older adults with SUDs. Ultimately, these practice changes could reduce ED utilization and health disparities in this population.
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Affiliation(s)
- Eleanor Turi
- University of Pennsylvania Perelman School of Medicine, 423 Guardian Drive, Philadelphia, PA 19104, United States of America.
| | - Amy L McMenamin
- Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, United States of America
| | - Grant Martsolf
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15213, United States of America
| | - Deborah Hasin
- Columbia University Department of Psychiatry, 1051 Riverside Drive, New York, NY 10032, United States of America; Columbia University Mailman School of Public Health; 722 West 168th Street, New York, NY 10032, United States of America
| | - Benjamin H Han
- University of California San Diego Department of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, United States of America
| | - Jianfang Liu
- Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, United States of America
| | - Lusine Poghosyan
- Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, United States of America; Columbia University Mailman School of Public Health; 722 West 168th Street, New York, NY 10032, United States of America
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Ornell F, Scherer JN, Schuch JB, Sordi AO, Halpern SC, Rebelatto FP, Bristot G, Kapczinski F, Roglio VS, Pechansky F, Kessler FHP, von Diemen L. Serum BDNF levels increase during early drug withdrawal in alcohol and crack cocaine addiction. Alcohol 2023; 111:1-7. [PMID: 37037287 DOI: 10.1016/j.alcohol.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/02/2023] [Accepted: 04/05/2023] [Indexed: 04/12/2023]
Abstract
Brain-derived neurotrophic factor (BDNF) is involved in several drug-induced brain neuroadaptations. The impact of withdrawal from substances that have different neurological mechanisms on BDNF levels is unclear. Our goal was to compare serum BDNF levels in inpatients with alcohol or crack cocaine use disorders during the early withdrawal period, and to evaluate the association with substance-related outcomes. We performed a follow-up study with 101 men under detoxification treatment (drug preference: alcohol [n = 37] and crack cocaine [n = 64]). Blood samples were collected on the 1st and 15th days of hospitalization to measure serum BDNF levels. Serum BDNF levels increased during the early stage of withdrawal (28.2 ± 10.0 vs. 32.6 ± 13.3, p < 0.001), similarly in individuals with alcohol and crack cocaine use. In the alcohol group, BDNF levels on the 15th day of hospitalization were negatively correlated with age (r = -0.394, p = 0.023). Delta BDNF levels were also negatively correlated with BDNF on the 1st day of hospitalization (p = 0.011). No significant correlation was found regarding substance-related outcomes. This is the first study to compare BDNF levels in alcohol and crack cocaine users undergoing similar treatment conditions. These findings could be related to clinical improvement after abstinence or even to drug withdrawal itself, decreasing neuronal injury. Furthermore, age may be a crucial factor, hindering the recovery of neuroplasticity in alcohol users.
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Affiliation(s)
- Felipe Ornell
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Juliana N Scherer
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jaqueline B Schuch
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Anne O Sordi
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Silvia C Halpern
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernando P Rebelatto
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Giovana Bristot
- Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Graduate Program in Biological Sciences: Biochemistry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Flavio Kapczinski
- Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Department of Psychiatry and Behavioural Neurosciences, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Vinicius S Roglio
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Flavio Pechansky
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Felix H P Kessler
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Lisia von Diemen
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Brandt L, Hu MC, Nunes EV, Campbell ANC. Exploring the performance of during-treatment substance use outcome measures in predicting longer-term psychosocial functioning and post-treatment abstinence. Drug Alcohol Depend 2023; 248:109918. [PMID: 37224673 PMCID: PMC10680067 DOI: 10.1016/j.drugalcdep.2023.109918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/19/2023] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The selection of appropriate efficacy endpoints in clinical trials has been a long-standing challenge for the substance use disorder field. Using data from a large, multi-site National Drug Abuse Treatment Clinical Trials Network trial (CTN-0044; n=474), this secondary data analysis aimed to explore whether specific proximal (during-treatment) substance use outcome measures predict longer-term improvements in psychosocial functioning and post-treatment abstinence, and whether predictions vary depending on the specific substance (cannabis, cocaine/stimulants, opioids, and alcohol). METHODS Generalized linear mixed models examined associations between six during-treatment substance use outcome measures and social functioning impairment (Social Adjustment Scale Self-Report) and severity of psychiatric symptoms (Brief Symptom Inventory-18) at end-of-treatment, and 3- and 6-months after treatment as well as post-treatment abstinence. RESULTS Maximum days of consecutive abstinence, proportion of days abstinent, ≥3 weeks of continuous abstinence, and the proportion of urine specimens negative for the primary substance were associated with post-treatment psychiatric and social functioning improvement and abstinence. However, only the effects of abstinence during the last 4 weeks of the treatment period on all three post-treatment outcomes was stable over time and did not differ between primary substance groups. In contrast, complete abstinence during the 12-week treatment period was not consistently associated with functioning improvements. CONCLUSIONS Substance use outcome measures capturing the duration of primary substance abstinence during treatment are suitable predictors of post-treatment abstinence and longer-term psychosocial functioning improvement. Binary outcomes, such as end-of-treatment abstinence, may be particularly stable predictors and attractive given their ease of computation and straightforward clinical interpretability.
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Affiliation(s)
- Laura Brandt
- Department for Psychology, The City College of New York, New York, NY, USA.
| | - Mei-Chen Hu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
| | - Edward V Nunes
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
| | - Aimee N C Campbell
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; Division on Substance Use Disorders, New York State Psychiatric Institute, New York, NY, USA
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Nakaishi L, Sugden SG, Merlo G. Primary Care at the Intersection of Lifestyle Interventions and Unhealthy Substance Use. Am J Lifestyle Med 2023; 17:494-501. [PMID: 37426739 PMCID: PMC10328212 DOI: 10.1177/15598276221111047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Primary care physicians are well-positioned to integrate lifestyle interventions into the management of patients with unhealthy substance use, who may also have mental and physical chronic health comorbidities. However, the COVID-19 pandemic exacerbated the U.S.'s poor state of health, revealing that its current approach to chronic disease management is neither effective nor sustainable. Today's full spectrum comprehensive care model requires an expanded toolkit. Lifestyle interventions broaden current treatment approaches and may enhance Addiction Medicine care. Primary care providers have the potential to have the greatest impact on unhealthy substance use care because they are experts in chronic disease management and their frontline accessibility minimizes healthcare barriers. Individuals with unhealthy substance use are at an increased risk of chronic physical conditions. Incorporating lifestyle interventions with unhealthy substance use care at every level of medicine, from medical school through practice, normalizes both as part of the standard care of medicine and will drive evidence-based best practices to support patients through prevention, treatment, and reversal of chronic diseases.
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Affiliation(s)
- Lindsay Nakaishi
- Family Medicine, University of Pittsburgh Medical Center St. Margaret, Pittsburgh, PA, USA (LN); Huntsman Mental Health Institute, Spencer Fox Eccles University of Utah School of Medicine, Salt Lake City, UT, USA (SS); and Psychiatry, NYU Grossman School of Medicine, Rory Meyers College of Nursing, New York University, New York, NY, USA (GM)
| | - Steven G Sugden
- Family Medicine, University of Pittsburgh Medical Center St. Margaret, Pittsburgh, PA, USA (LN); Huntsman Mental Health Institute, Spencer Fox Eccles University of Utah School of Medicine, Salt Lake City, UT, USA (SS); and Psychiatry, NYU Grossman School of Medicine, Rory Meyers College of Nursing, New York University, New York, NY, USA (GM)
| | - Gia Merlo
- Family Medicine, University of Pittsburgh Medical Center St. Margaret, Pittsburgh, PA, USA (LN); Huntsman Mental Health Institute, Spencer Fox Eccles University of Utah School of Medicine, Salt Lake City, UT, USA (SS); and Psychiatry, NYU Grossman School of Medicine, Rory Meyers College of Nursing, New York University, New York, NY, USA (GM)
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Beeler S, Renn T, Pettus C. "…he's going to be facing the same things that he faced prior to being locked up": perceptions of service needs for substance use disorders. HEALTH & JUSTICE 2023; 11:13. [PMID: 36862229 PMCID: PMC9979411 DOI: 10.1186/s40352-023-00213-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 02/05/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND High rates of substance use disorders (SUDs) exist among justice-involved populations (i.e., persons incarcerated or recently released). SUD treatment is crucial for justice-involved populations as unmet treatment need increases reincarceration risk and impacts other behavioral health sequalae. A limited understanding of health needs (i.e. health literacy) can be one reason for unmet treatment needs. Social support is critical to seeking SUD treatment and post-incarceration outcomes. However, little is known about how social support partners understand and influence SUD service utilization among formerly incarcerated persons. METHODS This mixed method, exploratory study utilized data from a larger study comprised of formerly incarcerated men (n = 57) and their selected social support partners (n = 57) to identify how social support partners understand the service needs of their loved ones recently released from prison who returned to the community with a diagnosis of a SUD. Qualitative data included 87 semi-structured interviews with the social support partners covering post-release experiences with their formerly incarcerated loved one. Univariates were conducted on the quantitative service utilization data and demographics to complement the qualitative data. RESULTS Majority of the formerly incarcerated men identified as African American (91%) averaging 29 years of age (SD = 9.58). Most social support partners were a parent (49%). Qualitative analyses revealed that most social support partners avoided using or did not know the language to use regarding the formerly incarcerated person's SUD. Treatment needs were often attributed to focus on peer influences and spending more time at their residence/housing. Analyses did reveal that when treatment needs were recommended in the interviews, social support partners reported employment and education services to be most needed for the formerly incarcerated person. These findings align with the univariate analysis with their loved ones reporting employment (52%) and education (26%) as their most reported service utilized post-release, compared to only 4% using substance abuse treatment. CONCLUSION Results provide preliminary evidence suggesting social support partners do influence the types of services accessed by formerly incarcerated persons with SUD. The findings of this study emphasize the need for psychoeducation during and after incarceration for individuals with SUDs and their social support partners.
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Affiliation(s)
- Sara Beeler
- Jane Addams College of Social Work, University of Illinois Chicago, 1040 W Harrison St., 4420 ETMSW MC 309, Chicago, IL 60607 USA
| | - Tanya Renn
- College of Social Work, Institute for Justice Research and Development, Florida State University, 296 Champions Way, University Center, Building C - Suite 2500, Tallahassee, FL 32306-2570 USA
| | - Carrie Pettus
- Justice System Partners, South Easton, MA, United States
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Cloutier RM, Cole ES, McDonough BL, Lomauro DA, Miller JP, Talbert AL, Bear TM, Bridges NC, Foulds AL, Taber R, Gordon AJ, Cochran GT, Kmiec J, Donohue JM, Kelley D, DiDomenico E, Adair D, Pringle JL. Strategies to recruit rural primary care providers to implement a medication for opioid use disorder (MOUD) focused integrated care model. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231152808. [PMID: 37091535 PMCID: PMC9978659 DOI: 10.1177/26334895231152808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Background Access to providers and programs that provide medications for opioid use disorder (MOUD) remains a systemic barrier for patients with opioid use disorder (OUD), particularly if they live in rural areas. The Rural Access to Medication Assisted Treatment (MAT) in Pennsylvania Project (Project RAMP) addressed this problem with a multisystem partnership that recruited, trained, and supported rural primary care providers to provide MOUD and implement an integrated care model (ICM) for patients with OUD. Given the demonstrated efficacy of Project RAMP, this article summarizes our recruitment strategies, including feasibility concerns for further expansion into other regions. Methods The approach for recruiting implementation sites included two phases: partner outreach and site identification. Once recruited, the Systems Transformation Framework guided planning and implementation activities. Recruitment and implementation activities were assessed with implementation trackers and evaluated by providers via key informant interviews (KIIs). Results Project RAMP recruited 26 primary care practices from 13 counties, including nine health systems and two private practice groups-exceeding the original target of 24 sites. There was a median of 49 days from first contact to project onboarding. A total of 108 primary care practices spanning 22 health systems declined participation. Findings from the KIIs highlighted the value of engaging PCPs by connecting to a shared vision (i.e., improving the quality of patient care) as well as addressing perceived participation barriers (e.g., offering concierge technical assistance to address lack of training or resources). Conclusion Findings highlight how successful recruitment activities should leverage the support of health system leadership. Findings also emphasize that aiding recruitment and engagement efforts successfully addressed prescribers' perceived barriers to providing MOUD as well as facilitating better communication among administrators, PCPs, behavioral health professionals, care managers, and patients.Plain Language Summary: Opioid use disorder (OUD) is one of the leading causes of preventable illness and death. The standard of care for OUD is the provision of medications for opioid use disorder (MOUD) and the application of an integrative integrated care model (ICM) where behavioral health is blended with specialized medical services. Unfortunately, access to providers and healthcare facilities that provide MOUD or apply an ICM remains a systemic barrier for patients with OUD, particularly if they live in rural areas. Although there is no one-size-fits-all approach to implementing MOUD in primary care, findings from Project The Rural Access to Medication Assisted Treatment (MAT) in Pennsylvania Project (Project RAMP) highlight strategies that may improve future MOUD and ICM implementation efforts in similar rural contexts. Specifically, future efforts to increase MOUD capacity by recruiting new providers should be prepared to leverage health system leadership, address provider barriers via training and expert consultation, and facilitate connections to local behavioral health providers. This approach may be helpful to others recruiting health systems and primary care practices to implement new care models to use MOUD in treating patients with OUD.
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Affiliation(s)
- Renee M. Cloutier
- Program Evaluation and Research Unit, University of Pittsburgh School of
Pharmacy, Pittsburgh, PA, USA
| | - Evan S. Cole
- Department of Health Policy and Management, University of Pittsburgh Graduate School
of Public Health, Pittsburgh, PA, USA
| | - Brianna L. McDonough
- Program Evaluation and Research Unit, University of Pittsburgh School of
Pharmacy, Pittsburgh, PA, USA
| | - Daniel A. Lomauro
- Program Evaluation and Research Unit, University of Pittsburgh School of
Pharmacy, Pittsburgh, PA, USA
| | - John P. Miller
- Program Evaluation and Research Unit, University of Pittsburgh School of
Pharmacy, Pittsburgh, PA, USA
| | - Abigail L. Talbert
- Program Evaluation and Research Unit, University of Pittsburgh School of
Pharmacy, Pittsburgh, PA, USA
| | - Todd M. Bear
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School
of Public Health, Pittsburgh, PA, USA
| | - Nora C. Bridges
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Abigail L. Foulds
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School
of Public Health, Pittsburgh, PA, USA
| | - Rachel Taber
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School
of Public Health, Pittsburgh, PA, USA
| | - Adam J. Gordon
- Program for Addiction Research, Clinical Care, Education, and
Advocacy, University of Utah School of
Medicine, Salt Lake City, UT, USA
| | - Gerald T. Cochran
- Program for Addiction Research, Clinical Care, Education, and
Advocacy, University of Utah School of
Medicine, Salt Lake City, UT, USA
| | - Julie Kmiec
- Department of Psychiatry, University of Pittsburgh School of
Medicine, Pittsburgh, PA, USA
| | - Julie M. Donohue
- Department of Health Policy and Management, University of Pittsburgh Graduate School
of Public Health, Pittsburgh, PA, USA
| | - David Kelley
- Office of Medical Assistance Programs, Pennsylvania Department of Human
Services, Harrisburg, PA, USA
| | - Ellen DiDomenico
- Pennsylvania Department of Drug and Alcohol Programs, Harrisburg,
PA, USA
| | - Dale Adair
- Office of Medical Assistance Programs, Pennsylvania Department of Human
Services, Harrisburg, PA, USA
| | - Janice L. Pringle
- Program Evaluation and Research Unit, University of Pittsburgh School of
Pharmacy, Pittsburgh, PA, USA
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10
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Iturralde E, Weisner CM, Adams SR, Chi FW, Ross TB, Cunningham SF, Ghadiali M, Asyyed AH, Satre DD, Campbell CI, Sterling SA. Patterns of Health Care Use 5 Years After an Intervention Linking Patients in Addiction Treatment With a Primary Care Practitioner. JAMA Netw Open 2022; 5:e2241338. [PMID: 36355373 PMCID: PMC9650610 DOI: 10.1001/jamanetworkopen.2022.41338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/24/2022] [Indexed: 11/11/2022] Open
Abstract
Importance Substance use disorders are associated with high rates of emergency department (ED) use and challenges engaging with primary care services. Objective To examine 5-year health care engagement and utilization outcomes for participants in the LINKAGE trial, given previously reported associations of LINKAGE with improved care engagement in the short term. Design, Setting, and Participants In this post hoc analysis of a nonrandomized controlled trial, participants were assigned to the LINKAGE or usual care (UC) groups using a nonrandomized 3-month alternating off and on strategy over 30 months. Baseline through 5-year follow-up data were collected from April 2011 to October 2018. The trial was conducted at an urban outpatient addiction treatment clinic within a large health system among patients newly enrolled in addiction treatment. Data analysis was conducted from April 2021 to February 2022. Intervention The LINKAGE intervention included 6 group-based sessions emphasizing patient agency, skill, and motivation in navigating health care services as well as a facilitated telephone or email connection with a primary care practitioner. The UC group received medical education. Main Outcomes and Measures Substance use problem discussions with primary care practitioners (by patient self-report at 1-, 2-, and 5-year follow-up interview) and annual use of the electronic patient portal, primary care, and ED based on electronic health records. Results A total of 503 participants, with a mean (SD) age of 42 (12) years, 346 (69%) male participants and 37 (7%) African American, 34 (7%) Asian, and 101 (20%) Hispanic participants, were assigned to LINKAGE (252 participants) or UC (251 participants). Compared with UC participants, LINKAGE participants were significantly more likely to discuss substance use problems with a primary care practitioner at 1-year follow-up (risk ratio [RR], 1.30; 95% CI, 1.03-1.65; P = .03) and use the electronic patient portal at 1- and 2-year follow-up (eg, messaging clinicians at 2 years: RR, 1.24; 95% CI, 1.04-1.47; P = .02). The LINKAGE group had small, statistically significant 5-year annual increases in primary care use (RR, 1.03; 95% CI, 1.003-1.07; P = .03) and significant annual decreases in substance-related ED use (RR, 0.79; 95% CI, 0.64-0.97; P = .03), relative to UC. The LINKAGE group did not significantly differ from the UC group on other types of ED utilization. Conclusions and Relevance In this study, a patient activation intervention embedded in outpatient addiction treatment was associated with sustained improvements in health care engagement beyond previously reported 6-month outcomes and with long-term improvements in health care use patterns. Trial Registration ClinicalTrials.gov Identifier: NCT01621711.
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Affiliation(s)
- Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Constance M. Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Behavioral Sciences, University of California, San Francisco
| | - Sara R. Adams
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Felicia W. Chi
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Thekla B. Ross
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Sarah F. Cunningham
- Division of Research, Kaiser Permanente Northern California, Oakland
- The Permanente Medical Group, Oakland, California
| | | | | | - Derek D. Satre
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Behavioral Sciences, University of California, San Francisco
| | - Cynthia I. Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Behavioral Sciences, University of California, San Francisco
| | - Stacy A. Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Behavioral Sciences, University of California, San Francisco
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11
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Rautiainen E, Ryynänen OP, Rautiainen P, Laatikainena T. How do individuals with alcohol problems use social and healthcare services in Finland? Comparison of service use patterns between two high-need patient groups. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 38:450-465. [PMID: 35308819 PMCID: PMC8900183 DOI: 10.1177/14550725211018593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/30/2021] [Indexed: 11/16/2022] Open
Abstract
Aims: Alcohol use disorders (AUDs) are associated with high risk of comorbidities and excess use of social and healthcare services. We examined health service use (HSU) frequencies of patients with AUD in comparison to those with type 2 diabetes mellitus (T2DM). Design: A random sample of individuals with AUD (n = 396) were identified based on ICD-10 codes and HSU patterns, morbidity and mortality were compared with age- and gender-matched T2DM controls (n = 792) using logistic regression analysis. Six years (2011–2016) of electronic health record (EHR) data from the North Karelia district in Finland were used. Results: Similarities in comorbidity patterns existed, although mental health comorbidity (odds ratio [OR] 1.86) was more prevalent in the AUD group. The average annual HSU varied according to the groups: T2DM patients had more continuous contact with public health nurses in primary care, whereas AUD patients were more likely to experience somatic specialised care hospitalisations (OR 11.30) and have frequent somatic primary healthcare doctor visits (OR 3.30) and frequent emergency room doctor visits in specialised care (OR 8.89). Furthermore, patients with AUD had a 7.5 times higher risk of death compared with T2DM patients. Conclusions: This study identified rather similar comorbidity status for the AUD and T2DM patients, but their HSU patterns differed noticeably. AUD patients had higher frequencies of hospitalisation periods and emergency service use and were at a higher risk of death compared with T2DM patients, indicating greater challenges in the organisation of care for AUD patients compared with those having T2DM.
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Affiliation(s)
- Elina Rautiainen
- University of Eastern Finland, Kuopio, Finland; and National Institute for Health and Welfare, Helsinki, Finland
| | - Olli-Pekka Ryynänen
- University of Eastern Finland, Kuopio, Finland; and Kuopio University Hospital, Finland
| | - Päivi Rautiainen
- Joint Municipal Authority for North Karelia Social and Health Services (Siun sote), Tikkamäentie, Joensuu, Finland
| | - Tiina Laatikainena
- Joint Municipal Authority for North Karelia Social and Health Services (Siun sote), Tikkamäentie, Joensuu, Finland; and National Institute for Health and Welfare, Helsinki, Finland
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12
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Abstract
Unhealthy alcohol and drug use are among the top 10 causes of preventable death in the United States, but they are infrequently identified and addressed in medical settings. Guidelines recommend screening adult primary care patients for alcohol and drug use, and routine screening should be a component of high-quality clinical care. Brief, validated screening tools accurately detect unhealthy alcohol and drug use, and their thoughtful implementation can facilitate adoption and optimize the quality of screening results. Recommendations for implementation include patient self-administered screening tools, integration with electronic health records, and screening during routine primary care visits.
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Affiliation(s)
- Jennifer McNeely
- Section on Alcohol, Tobacco, and Drug Use, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 17th Floor, New York, NY 10016, USA; Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU Grossman School of Medicine, New York, NY 10016, USA.
| | - Leah Hamilton
- Section on Alcohol, Tobacco, and Drug Use, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 17th Floor, New York, NY 10016, USA; Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA 98101, USA
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13
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Zhen-Duan J, Fukuda M, DeJonckheere M, Falgas-Bagué I, Miyawaki S, Khazi P, Alegría M. Ensuring access to high-quality substance use disorder treatment for Medicaid enrollees: A qualitative study of diverse stakeholders' perspectives. J Subst Abuse Treat 2021; 129:108511. [PMID: 34176694 PMCID: PMC8380648 DOI: 10.1016/j.jsat.2021.108511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/01/2021] [Accepted: 05/26/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Medicaid programs are vital to ensure low-income individuals have access to substance use disorder (SUD) treatment. However, shifts in Medicaid policies may alter coverage and SUD care for this population, who already face difficulties receiving high-quality SUD treatment. Using a policy implementation research approach, we sought to identify barriers and facilitators when transitioning from Medicaid fee-for-service to managed care plan structures and opportunities for improving SUD care in New York State (NYS). METHOD Study staff conducted semistructured, in-depth qualitative interviews (N = 40 total) with diverse stakeholders involved with different aspects of SUD treatment in NYS, including policy leaders (n = 13), clinicians (n = 12), Medicaid managed care plan administrators (n = 5), and patients (n = 10). RESULTS Findings from thematic analysis centered on three themes: 1) while transitions to managed care have benefited clinicians, certain policies affect patients' Medicaid enrollment and quality of care; 2) stakeholders perceived individuals with dual diagnoses, older adults, and linguistic minorities to be at higher risk for inadequate care; and 3) current quality metrics may not adequately capture treatment quality. CONCLUSION Policy changes should focus on promoting increased collaboration among stakeholders, expanding Medicaid coverage, and reducing stigma. Resources should be diverted to facilitate psychiatric care for patients with dual diagnoses and to build workforce capacity to adequately meet the needs of older adults and linguistic minorities. Opportunities for NYS Medicaid include adapting performance metrics to capture meaningful patient outcomes and link reimbursements to improvements in patients' quality of life.
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Affiliation(s)
- Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Marie Fukuda
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Irene Falgas-Bagué
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Steven Miyawaki
- Department of Sociology, Bowdoin College, Brunswick, ME, USA
| | - Parwana Khazi
- Department of Public Health, Santa Clara University, Santa Clara, CA, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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14
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Crable EL, Drainoni ML, Jones DK, Walley AY, Milton Hicks J. Predicting longitudinal service use for individuals with substance use disorders: A latent profile analysis. J Subst Abuse Treat 2021; 132:108632. [PMID: 34607732 DOI: 10.1016/j.jsat.2021.108632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/05/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Substance use disorders (SUD) are chronic conditions that often warrant coordinated medical care throughout a relapsing and remitting course. However, SUD treatment is frequently measured as a binary outcome, where individuals either receive or do not receive care following the immediate treatment seeking event. This study aimed to describe longitudinal treatment seeking behaviors by assessing service use patterns among individuals with diagnosed SUDs in a safety net hospital that offers a "no wrong door" care model. This study also examined whether certain patient subgroups were more likely to transition to service use patterns that support recovery or treatment disengagement over time. METHODS The team conducted a retrospective cohort study using electronic health record data from adult patients diagnosed with SUDs (n = 1157) who regularly accessed services at a safety net hospital over a five-year period. The study used latent class analysis (LCA) and latent profile analysis to empirically identify distinct treatment utilization profiles of individuals with SUDs. We used multinomial logistic regression to evaluate predictors of class membership and transitions over a five-year period. RESULTS The research team identified five distinct service use classes, including patients who disengaged from services (42.4%), or those who predominantly used outpatient substance use services (7.0%), mental health services (13.0%), primary care services (24.7%), or other specialty care services (13.1%). Being female and an older adult were statistically significant predictors for membership in any service use-driven status. Black patients had increased odds for "substance use service" and "primary care" service statuses over time. CONCLUSION LCA and latent transition analysis (LTA) methods are novel approaches for identifying profiles of patients with higher risk for health services disengagement. SUD treatment engagement strategies are needed to reach males, young adults, and individuals with non-opioid SUDs.
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Affiliation(s)
- Erika L Crable
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA; Child and Adolescent Services Research Center, Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; ACTRI UC San Diego Dissemination and Implementation Science Center, La Jolla, CA, USA.
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - David K Jones
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Alexander Y Walley
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
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15
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Gordon AJ, Drexler K, Hawkins EJ, Burden J, Codell NK, Mhatre-Owens A, Dungan MT, Hagedorn H. Stepped Care for Opioid Use Disorder Train the Trainer (SCOUTT) initiative: Expanding access to medication treatment for opioid use disorder within Veterans Health Administration facilities. Subst Abus 2021; 41:275-282. [PMID: 32697170 DOI: 10.1080/08897077.2020.1787299] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The US is confronted with a rise in opioid use disorder (OUD), opioid misuse, and opioid-associated harms. Medication treatment for opioid use disorder (MOUD)-including methadone, buprenorphine and naltrexone-is the gold standard treatment for OUD. MOUD reduces illicit opioid use, mortality, criminal activity, healthcare costs, and high-risk behaviors. The Veterans Health Administration (VHA) has invested in several national initiatives to encourage access to MOUD treatment. Despite these efforts, by 2017, just over a third of all Veterans diagnosed with OUD received MOUD. VHA OUD specialty care is often concentrated in major hospitals throughout the nation and access to this care can be difficult due to geography or patient choice. Recognizing the urgent need to improve access to MOUD care, in the Spring of 2018, the VHA initiated the Stepped Care for Opioid Use Disorder, Train the Trainer (SCOUTT) Initiative to facilitate access to MOUD in VHA non-SUD care settings. The SCOUTT Initiative's primary goal is to increase MOUD prescribing in VHA primary care, mental health, and pain clinics by training providers working in those settings on how to provide MOUD and to facilitate implementation by providing an ongoing learning collaborative. Thirteen healthcare providers from each of the 18 VHA regional networks across the VHA were invited to implement the SCOUTT Initiative within one facility in each network. We describe the goals and initial activities of the SCOUTT Initiative leading up to a two-day national SCOUTT Initiative conference attended by 246 participants from all 18 regional networks in the VHA. We also discuss subsequent implementation facilitation and evaluation plans for the SCOUTT Initiative. The VHA SCOUTT Initiative could be a model strategy to implement MOUD within large, diverse health care systems.
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Affiliation(s)
- Adam J Gordon
- Vulnerable Veteran Innovative PACT (VIP) Initiative, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Karen Drexler
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC, USA
| | - Eric J Hawkins
- Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington, USA.,VA Puget Sound Health Care System, Center of Excellence in Substance Addiction Treatment and Education, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jennifer Burden
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC, USA
| | - Nodira K Codell
- Vulnerable Veteran Innovative PACT (VIP) Initiative, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Amy Mhatre-Owens
- Vulnerable Veteran Innovative PACT (VIP) Initiative, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Matthew T Dungan
- Vulnerable Veteran Innovative PACT (VIP) Initiative, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Hildi Hagedorn
- Center for Care Delivery and Outcomes Research Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
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16
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Magel J, Kietrys D, Kruger ES, Fritz JM, Gordon AJ. Physical therapists should play a greater role in managing patients with opioid use and opioid misuse. Subst Abus 2021; 42:255-260. [PMID: 34524070 DOI: 10.1080/08897077.2021.1971818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The U.S. opioid crisis necessitates that health care providers of all types work collaboratively to manage patients taking prescription opioid medications and manage those who may be misusing prescription opioids. Musculoskeletal conditions are the most common diagnoses associated with an opioid prescription. Physical therapists commonly manage patients with musculoskeletal conditions and chronic pain. Some patients who attend physical therapy for pain management take prescription opioid medications for pain and some of these patients may be misusing prescription opioids. Physical therapists who manage patients with musculoskeletal conditions are well-positioned to help address the opioid crisis. Historically, physical therapists have not been adequately engaged in efforts to manage persons with co-occurring musculoskeletal pain and opioid misuse or OUD. The American Physical Therapy Association (APTA) has emphasized physical therapy over the use of prescription opioids for the management of painful conditions. The APTA, however, does not highlight the important role that physical therapists could play in monitoring opioid use among patients receiving treatment for pain, nor the role that physical therapists should play in screening for opioid misuse. Such screening could facilitate referral of patients suspected misuse to an appropriate provider for formal assessment and treatment. This commentary presents simulated musculoskeletal patient presentations depicting 2 common opioid use states; chronic opioid use and opioid misuse. The cases highlight and interactions that physical therapists could have with these patients and actions that the physical therapist could take when working inter-disciplinarily. Recommendations are provided that aim to increase physical therapists' knowledge and skills related to managing patients taking prescription opioid medications for pain.
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Affiliation(s)
- John Magel
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - David Kietrys
- Department of Rehabilitation and Movement Sciences, Rutgers School of Health Professions, Newark, NJ, USA
| | - Eric S Kruger
- School of Medicine, Department of Orthopaedics and Rehabiliation, Division of Physical Therapy, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
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17
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Thoele K, Yu M, Dhillon M, Comer RS, Maxey HL, Newhouse R, Oruche UM. Development and assessment of the usability of a web-based referral to treatment tool for persons with substance use disorders. BMC Med Inform Decis Mak 2021; 21:260. [PMID: 34496855 PMCID: PMC8425151 DOI: 10.1186/s12911-021-01620-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 08/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background Hospitalized people with unhealthy substance use should be referred to treatment. Although inpatient referral resources are often available, clinicians report that outpatient referral networks are not well-established. The purpose of this manuscript is to describe the development and usability testing of a web-based Referral to Treatment Tool (RTT © 2020 Trustees of Indiana University, all rights reserved) designed to identify treatment centers for people with unhealthy substance use. Results The RTT was conceptualized, developed, and then populated with public use and local survey data of treatment centers from 14 market ZIP codes of hospitals participating in an SBIRT implementation study. The tool underwent initial heuristic testing, followed by usability testing at three hospitals within a large healthcare system in the Midwest region of the United States. Administrative (n = 6) and provider (n = 12) users of the RTT completed a list of tasks and provided feedback through Think-Aloud Tests, the System Usability Scale, and in-person interviews. Patients (n = 4) assessed multiple versions of a take-home printout of referral sites that met their specifications and completed in-person interviews to provide feedback. Each administrative task was completed in less than 3 min, and providers took an average of 4 min and 3 s to identify appropriate referral sites for a patient and print a referral list for the patient. The mean System Usability Scale score (M = 77.22, SD = 15.57, p = 0.03) was significantly higher than the passable score of 70, indicating favorable perceptions of the usability of the RTT. Administrative and provider users felt that the RTT was useful and easy to use, but the settings and search features could be refined. Patients indicated that the printouts contained useful information and that it was helpful to include multiple referral sites on the printout. Conclusion The web-based referral tool has the potential to facilitate voluntary outpatient referral to treatment for patients with unhealthy substance use. The RTT can be customized for a variety of health care settings and patient needs. Additional revisions based on usability testing results are needed to prepare for a broader multi-site clinical evaluation. Trial Registration Not applicable.
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Affiliation(s)
- Kelli Thoele
- Robert Wood Johnson Future of Nursing Scholar, Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN, 46202, USA.
| | - Mengmeng Yu
- School of Informatics and Computing, 535 W Michigan Street, Indianapolis, IN, 46202, USA
| | - Mandeep Dhillon
- School of Informatics and Computing, 535 W Michigan Street, Indianapolis, IN, 46202, USA
| | - Robert Skipworth Comer
- School of Informatics and Computing, 535 W Michigan Street, Indianapolis, IN, 46202, USA
| | - Hannah L Maxey
- Indiana University School of Medicine, 1110 West Michigan St., Suite 200, Indianapolis, IN, 46202, USA
| | - Robin Newhouse
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Ukamaka M Oruche
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN, 46202, USA
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18
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Schuler MS, Dick AW, Stein BD. Growing racial/ethnic disparities in buprenorphine distribution in the United States, 2007-2017. Drug Alcohol Depend 2021; 223:108710. [PMID: 33873027 PMCID: PMC8204632 DOI: 10.1016/j.drugalcdep.2021.108710] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess whether per capita buprenorphine distribution varies by regional racial/ethnic composition, Medicaid expansion status, and time period. METHODS Our unit of analysis -- three-digit ZIP codes ("ZIP3s") -- was classified into quintiles based on percentage of White residents. A weighted linear regression model of buprenorphine distribution -- including White resident quintile, waivered prescriber rate, overdose rate, sociodemographic factors, and year fixed effects -- was estimated using national buprenorphine distribution data from 2007 to 2017. We report predictive margins of the buprenorphine distribution rate by quintile, as well as average marginal effects of waivered prescriber rate on buprenorphine distribution rate for each quintile. Analyses were stratified by Medicaid expansion status and time period (2007-2010, 2011-2014, 2015-2017). RESULTS Buprenorphine distribution increased nationally during 2007-2017, yet growth was disproportionately greater for ZIP3s with higher percentages of White residents. Medicaid expansion states exhibited significant differences in buprenorphine distribution across ZIP3 quintiles during 2007-2010, the magnitude of which increased across time periods. Non-expansion states exhibited significant quintile differences during 2011-2014 and 2015-2017. The average marginal effect of increasing the waivered prescriber rate on the distribution rate was consistently smaller in ZIP3s with lower percentages of White residents, particularly in expansion states. CONCLUSIONS We find ecological evidence consistent with racial/ethnic disparities in buprenorphine distribution. Our finding that increasing the waivered prescriber rate had differential effects by ZIP3 racial/ethnic composition suggest that broad initiatives to increase the number of waivered prescribers are likely insufficient to achieve equitable buprenorphine access. Rather, targeted and tailored policy efforts are warranted.
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Affiliation(s)
- Megan S Schuler
- RAND Corporation, 20 Park Plaza #920, Boston, MA, 02216, USA.
| | - Andrew W Dick
- RAND Corporation, 20 Park Plaza #920, Boston, MA, 02216, USA
| | - Bradley D Stein
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA, 15213, USA
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19
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Tai B, Dobbins R, Blackeney Q, Liu D, Moran L. The NIDA clinical trials network: evolving, expanding, and addressing the opioid epidemic. Addict Sci Clin Pract 2021; 16:28. [PMID: 33964973 PMCID: PMC8105960 DOI: 10.1186/s13722-021-00238-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/24/2021] [Indexed: 11/12/2022] Open
Abstract
Over the past two decades, the National Drug Abuse Treatment Clinical Trials Network (CTN), a program of the National Institute on Drug Abuse (NIDA), has expanded from the initial six Nodes to 16 Nodes, as a nationwide consortium of research scientists and treatment providers working together to improve care for substance use in the nation’s communities. Encompassing both specialty care programs and general medical settings, the Network has become a unique resource for expertise on clinically focused research, bridging the gap between research and treatment delivery. Over 22 years, the CTN has completed 101 studies, resulting in 650 publications. In response to the opioid epidemic, a CTN task force generated a comprehensive list of research priorities in the areas of prevention, treatment, knowledge dissemination, and workforce training, to form the basis of the Network’s opioid portfolio. The Network’s opioid portfolio currently includes five main categories of studies: (1) large multi-site studies; (2) studies aimed at closing the treatment gap; (3) expansion of ongoing studies to improve service delivery and implementation; (4) studies to explore the use of substance use data in electronic health record systems; (5) training and dissemination projects to expand the research/health care provider workforce. With funding from the Helping to End Addiction Long-Term InitiativeSM (HEAL), the CTN established five new Nodes, which, along with the pre-existing Nodes, are distributed in every region of the nation and engage researchers and clinicians in areas that have been among the hardest hit by the opioid epidemic. Through this expanded network and its commitment to developing personalized, evidence-based treatments, the CTN is poised to address and provide solutions for the ongoing epidemic of opioid use and addiction.
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Affiliation(s)
- Betty Tai
- Center for the Clinical Trials Network, National Institute On Drug Abuse, National Institutes of Health, 3WFN Room 09A48 MSC 6022, 301 North Stonestreet Avenue, Bethesda, MD, 20892, USA.
| | - Ronald Dobbins
- Center for the Clinical Trials Network, National Institute On Drug Abuse, National Institutes of Health, 3WFN Room 09A48 MSC 6022, 301 North Stonestreet Avenue, Bethesda, MD, 20892, USA
| | - Quandra Blackeney
- Center for the Clinical Trials Network, National Institute On Drug Abuse, National Institutes of Health, 3WFN Room 09A48 MSC 6022, 301 North Stonestreet Avenue, Bethesda, MD, 20892, USA
| | - David Liu
- Center for the Clinical Trials Network, National Institute On Drug Abuse, National Institutes of Health, 3WFN Room 09A48 MSC 6022, 301 North Stonestreet Avenue, Bethesda, MD, 20892, USA
| | - Landhing Moran
- Center for the Clinical Trials Network, National Institute On Drug Abuse, National Institutes of Health, 3WFN Room 09A48 MSC 6022, 301 North Stonestreet Avenue, Bethesda, MD, 20892, USA
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20
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Codell N, Kelley AT, Jones AL, Dungan MT, Valentino N, Holtey AI, Knight TJ, Butz A, Gallop C, Erickson S, Patton J, Hyte-Richins LJ, Rollins BZ, Gordon AJ. Aims, development, and early results of an interdisciplinary primary care initiative to address patient vulnerabilities. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:160-169. [PMID: 33301347 DOI: 10.1080/00952990.2020.1832507] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Addressing substance use disorders and social determinants of poor health at a population level is a major national healthcare priority. One promising model to improve healthcare outcomes for patients with these conditions is the Vulnerable Veteran Innovative Patient-Aligned Care Team (PACT) Initiative, or VIP - an interdisciplinary, team-based primary care delivery model designed to address the needs of vulnerable patients in the Veterans Health Administration. VIP establishes a single, integrated primary care environment for the management of substance use disorders, mental illness, social determinants of poor health, and complexities in care resulting from the co-occurrence of these conditions. We describe the origination, goals, and evolution of VIP to provide an example of how clinics and health systems can address vulnerable patient populations within a primary care clinic framework. While ongoing evaluation will be essential to understand its impact on patient outcomes and its sustainability and scalability in the future, VIP holds promise as a novel model to improve care for patients with addiction and other vulnerabilities.
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Affiliation(s)
- Nodira Codell
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - A Taylor Kelley
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA.,Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Audrey L Jones
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Matthew T Dungan
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Natalie Valentino
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Ana I Holtey
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Tania J Knight
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Amy Butz
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Christina Gallop
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sean Erickson
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Jeremy Patton
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Laura Jane Hyte-Richins
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Benjamin Z Rollins
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Adam J Gordon
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA.,Greater Intermountain Node (GIN) of the NIDA Clinical Trials Network, University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
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21
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Rombouts SA, Conigrave JH, Saitz R, Louie E, Haber P, Morley KC. Evidence based models of care for the treatment of alcohol use disorder in primary health care settings: a systematic review. BMC FAMILY PRACTICE 2020; 21:260. [PMID: 33278891 PMCID: PMC7719241 DOI: 10.1186/s12875-020-01288-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/15/2020] [Indexed: 11/14/2022]
Abstract
Background Pharmacological and behavioural treatments for alcohol use disorders (AUDs) are effective but the uptake is limited. Primary care could be a key setting for identification and continuous care for AUD due to accessibility, low cost and acceptability to patients. We aimed to synthesise the literature regarding differential models of care for the management of AUD in primary health care settings. Methods We conducted a systematic review of articles published worldwide (1998-present) using the following databases; Medline, PsycINFO, Cochrane database of systematic reviews, Cochrane Central Register of Controlled Trials and Embase. The Grey Matters Tool guided the grey literature search. We selected randomised controlled trials evaluating the effectiveness of a primary care model in the management of AUD. Two researchers independently assessed and then reached agreement on the included studies. We used the Cochrane risk of bias tool 2.0 for the critical appraisal. Results Eleven studies (4186 participants) were included. We categorised the studies into ‘lower’ versus ‘higher’ intensity given the varying intensity of clinical care evaluated across the studies. Significant differences in treatment uptake were reported by most studies. The uptake of AUD medication was reported in 5 out of 6 studies that offered AUD medication. Three studies reported a significantly higher uptake of AUD medication in the intervention group. A significant reduction in alcohol use was reported in two out of the five studies with lower intensity of care, and three out of six studies with higher intensity of care. Conclusion Our results suggest that models of care in primary care settings can increase treatment uptake (e.g. psychosocial and/or pharmacotherapy) although results for alcohol-related outcomes were mixed. More research is required to determine which specific patient groups are suitable for AUD treatment in primary health care settings and to identify which models and components are most effective. Trial Registration PROSPERO: CRD42019120293.
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Affiliation(s)
- Susan A Rombouts
- Discipline of Addiction Medicine, Central Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - James H Conigrave
- Centre of Research Excellence in Indigenous Health and Alcohol, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Richard Saitz
- Community Health Sciences, School of Public Health, Boston University, Boston, MA, USA
| | - Eva Louie
- Discipline of Addiction Medicine, Central Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Paul Haber
- Discipline of Addiction Medicine, Central Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Kirsten C Morley
- Discipline of Addiction Medicine, Central Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
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22
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Afuseh E, Pike CA, Oruche UM. Individualized approach to primary prevention of substance use disorder: age-related risks. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:58. [PMID: 32795372 PMCID: PMC7427884 DOI: 10.1186/s13011-020-00300-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 07/28/2020] [Indexed: 11/13/2022]
Abstract
Background The misuse of legal and illegal substances has led to an increase in substance use disorder (SUD) in the United States. Although primary prevention strategies have been successfully used to target chronic physical diseases, these strategies have been less effective with SUD, given misconceptions of SUD, shortages in behavioral health professionals, and the population-based focus on specific substances. A developmental approach to the identification and primary prevention of SUD that does not fully rely upon behavioral health workers is needed. The purpose of this paper was to examine age related risk factors for developing SUD and present a novel individualized approach to SUD prevention. Methods A literature search was conducted to identify risk factors for SUD among children, young adults, adults, and older adults. We searched CINAHL, PsycINFO, and PubMed between the years 1989–2019, and extracted data, analyzing similarities and differences in risk factors across life stages. Broader categories emerged that were used to group the risk factors. Results More than 370 articles were found. Across all age groups, risk factors included adverse childhood experiences, trauma, chronic health diseases, environmental factors, family history, social determinants, and grief and loss. Despite the similarities, the contextual factors and life challenges associated with these risks varied according to the various life stages. We proposed an approach to primary prevention of SUD based on risk factors for developing the disease according to different age groups. This approach emphasizes screening, education, and empowerment (SEE), wherein individuals are screened for risk factors according to their age group, and screening results are used to customize interventions in the form of education and empowerment. Given that trained persons, including non-healthcare providers, close to the at-risk individual could conduct the screening and then educate and mentor the individual according to the risk level, the number of people who develop SUD could decrease. Conclusions The risk factors for developing SUD vary across the various life stages, which suggests that individualized approaches that do not overtax behavioral healthcare workers are needed. Using SEE may foster early identification and individualized prevention of SUD.
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Affiliation(s)
- Eric Afuseh
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Caitlin A Pike
- Indiana University Purdue University Indianapolis, Indianapolis, IN, USA.
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23
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Jones AL, Kertesz SG, Hausmann LRM, Mor MK, Suo Y, Pettey WBP, Schaefer JH, Gundlapalli AV, Gordon AJ. Primary care experiences of veterans with opioid use disorder in the Veterans Health Administration. J Subst Abuse Treat 2020; 113:107996. [PMID: 32359670 DOI: 10.1016/j.jsat.2020.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 01/16/2020] [Accepted: 02/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND While patients with substance use disorders (SUDs) are thought to encounter poor primary care experiences, the perspectives of patients with opioid use disorder (OUD), specifically, are unknown. This study compares the primary care experiences of patients with OUD, other SUDs and no SUD in the Veterans Health Administration. METHODS The sample included Veterans who responded to the national Patient-Centered Medical Home Survey of Healthcare Experiences of Patients, 2013-2015. Respondents included 3554 patients with OUD, 36,175 with other SUDs, and 756,386 with no SUD; 742 OUD-diagnosed patients received buprenorphine. Multivariable multinomial logistic regressions estimated differences in the probability of reporting positive and negative experiences (0-100 scale) for patients with OUD, compared to patients with other SUDs and no SUD, and for OUD-diagnosed patients treated versus not treated with buprenorphine. RESULTS Of all domains, patients with OUD reported the least positive experiences with access (31%) and medication decision-making (35%), and the most negative experiences with self-management support (35%) and provider communication (23%). Compared to the other groups, patients diagnosed with OUD reported fewer positive and/or more negative experiences with access, communication, office staff, provider ratings, comprehensiveness, care coordination, and self-management support (adjusted risk differences[aRDs] range from |2.9| to |7.0|). Among OUD-diagnosed patients, buprenorphine was associated with more positive experiences with comprehensiveness (aRD = 8.3) and self-management support (aRD = 7.1), and less negative experiences with care coordination (aRD = -4.9) and medication shared decision-making (aRD = -5.4). CONCLUSIONS In a national sample, patients diagnosed with OUD encounter less positive and more negative experiences than other primary care patients, including those with other SUDs. Buprenorphine treatment relates positively to experiences with care comprehensiveness, medication decisions, and care coordination. As stakeholders encourage more primary care providers to manage OUD, it will be important for healthcare systems to attend to patient access and experiences with care in these settings.
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Affiliation(s)
- Audrey L Jones
- Informatics, Decision Enhancement and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Division of Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Stefan G Kertesz
- Birmingham VA Medical Center, Birmingham, AL, USA; University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
| | - Leslie R M Hausmann
- Center for Health Equity and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Maria K Mor
- Center for Health Equity and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
| | - Ying Suo
- Informatics, Decision Enhancement and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Division of Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Warren B P Pettey
- Informatics, Decision Enhancement and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Division of Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - James H Schaefer
- Department of Veterans Affairs Office of Reporting, Analytics, Performance, Improvement and Deployment, Durham, NC, USA.
| | - Adi V Gundlapalli
- Informatics, Decision Enhancement and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Division of Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Adam J Gordon
- Informatics, Decision Enhancement and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Division of Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA.
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24
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Chronic non-cancer pain among adults with substance use disorders: Prevalence, characteristics, and association with opioid overdose and healthcare utilization. Drug Alcohol Depend 2020; 209:107902. [PMID: 32088587 PMCID: PMC7127943 DOI: 10.1016/j.drugalcdep.2020.107902] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic non-cancer pain (CNCP) among patients with substance use disorder (SUD) poses a risk for worse treatment outcomes. Understanding the association of CNCP with SUD is important for informing the need and potential benefits of pain assessment/management among those with SUDs. METHODS We analyzed electronic health record data from 2013 to 2018 among adults aged ≥18 years (N = 951,533; mean age: 48.4 years; 57.4 % female) in a large academic healthcare system. Adjusted logistic regression models were conducted to estimate the association of CNCP conditions with opioid overdose, emergency department utilization, and inpatient hospitalization stratified by different SUD diagnoses and by gender. RESULTS Among the total sample, the prevalence of CNCP was 46.6 % and any SUD was 11.2 %. The majority of patients with a SUD had CNCP (opioid: 74.7 %; sedative: 72.3 %; cannabis: 64.3 %; alcohol: 58.7 %; tobacco: 59.5 %). The prevalence of CNCP was greater in females vs. males for most SUD diagnoses. The presence of CNCP was associated with more mental health disorders and chronic medical conditions among each SUD group. CNCP was associated with significantly decreased odds of overdose among those with opioid use disorder but increased odds of overdose and healthcare utilization among other SUDs. CNCP was positively associated with overdose in females, but not males, with alcohol or non-opioid drug use disorders. CONCLUSIONS The direction and magnitude of the association between CNCP and negative health indicators differed as a function of SUD type and gender, respectively. Greater awareness of potential unmet pain treatment need may have implications for improving SUD outcomes.
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Hallgren KA, Witwer E, West I, Baldwin LM, Donovan D, Stuvek B, Keppel GA, Mollis B, Stephens KA. Prevalence of documented alcohol and opioid use disorder diagnoses and treatments in a regional primary care practice-based research network. J Subst Abuse Treat 2020; 110:18-27. [PMID: 31952624 PMCID: PMC7255441 DOI: 10.1016/j.jsat.2019.11.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 11/09/2019] [Accepted: 11/14/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Most people with alcohol or opioid use disorders (AUD or OUD) are not diagnosed or treated for these conditions in primary care. This study takes a critical step toward quantifying service gaps and directing improvement efforts for AUD and OUD by using electronic health record (EHR) data from diverse primary care organizations to quantify the extent to which AUD and OUD are underdiagnosed and undertreated in primary care practices. METHODS We extracted and integrated diagnosis, medication, and behavioral health visit data from the EHRs of 21 primary care clinics within four independent healthcare organizations representing community health centers and rural hospital-associated clinics in the Pacific Northwest United States. Rates of documented AUD and OUD diagnoses, pharmacological treatments, and behavioral health visits were evaluated over a two-year period (2015-2016). RESULTS Out of 47,502 adult primary care patients, 1476 (3.1%) had documented AUD; of these, 115 (7.8%) had orders for AUD medications and 271 (18.4%) had at least one documented visit with a non-physician behavioral health specialist. Only 402 (0.8%) patients had documented OUD, and of these, 107 (26.6%) received OUD medications and 119 (29.6%) had at least one documented visit with a non-physician behavioral health specialist. Rates of AUD diagnosis and AUD and OUD medications were higher in clinics that had co-located non-physician behavioral health specialists. CONCLUSIONS AUD and OUD are underdiagnosed and undertreated within a sample of independent primary care organizations serving mostly rural patients. Primary care organizations likely need service models, technologies, and workforces, including non-physician behavioral health specialists, to improve capacities to diagnose and treat AUD and OUD.
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Affiliation(s)
- Kevin A Hallgren
- University of Washington, Department of Psychiatry and Behavioral Sciences, United States.
| | - Elizabeth Witwer
- University of Washington, Department of Family Medicine, United States
| | - Imara West
- University of Washington, Department of Psychiatry and Behavioral Sciences, United States
| | - Laura-Mae Baldwin
- University of Washington, Department of Family Medicine, United States
| | - Dennis Donovan
- University of Washington, Department of Psychiatry and Behavioral Sciences, United States; University of Washington, Alcohol and Drug Abuse Institute, United States
| | - Brenda Stuvek
- University of Washington, Alcohol and Drug Abuse Institute, United States
| | - Gina A Keppel
- University of Washington, Department of Family Medicine, United States
| | - Brenda Mollis
- University of Washington, Department of Family Medicine, United States
| | - Kari A Stephens
- University of Washington, Department of Psychiatry and Behavioral Sciences, United States; University of Washington, Department of Biomedical Informatics and Medical Education, United States
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Wiercigroch D, Sheikh H, Hulme J. A rapid access to addiction medicine clinic facilitates treatment of substance use disorder and reduces substance use. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:4. [PMID: 31931831 PMCID: PMC6958640 DOI: 10.1186/s13011-019-0250-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 12/30/2019] [Indexed: 01/14/2023]
Abstract
Background Substance use is prevalent in Canada, yet treatment is inaccessible. The Rapid Access to Addiction Medicine (RAAM) clinic opened at the University Health Network (UHN) in January 2018 as part of a larger network of addictions clinics in Toronto, Ontario, to enable timely, low barrier access to medical treatment for substance use disorder (SUD). Patients attend on a walk-in basis without requiring an appointment or referral. We describe the RAAM clinic model, including referral patterns, patient demographics and substance use patterns. Secondary outcomes include retention in treatment and changes in both self-reported and objective substance use. Methods The Electronic Medical Record at the clinic was reviewed for the first 26 weeks of the clinic’s operation. We identified SUD diagnoses, referral source, medications prescribed, retention in care and self-reported substance use. Results The clinic saw 64 unique patients: 66% had alcohol use disorder (AUD), 39% had opiate use disorder (OUD) and 20% had stimulant use disorder. Fifty-five percent of patients were referred from primary care providers, 30% from the emergency department and 11% from withdrawal management services. Forty-two percent remained on-going patients, 23% were discharged to other care and 34% were lost to follow-up. Gabapentin (39%), naltrexone (39%), and acamprosate (15%) were most frequently prescribed for AUD. Patients with AUD reported a significant decrease in alcohol consumption at their most recent visit. Most patients (65%) with OUD were prescribed buprenorphine, and most patients with OUD (65%) had a negative urine screen at their most recent visit. Conclusion The RAAM model provides low-barrier, accessible outpatient care for patients with substance use disorder and facilitates the prescription of evidence-based pharmacotherapy for AUD and OUD. Patients referred by their primary care physician and the emergency department demonstrated a reduction in median alcohol consumption and high rates of opioid abstinence.
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Affiliation(s)
- David Wiercigroch
- Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, Ontario, M5S 1A8, Canada. .,Global Health Emergency Medicine, Toronto General Hospital, 200 Elizabeth Street, 12NU-1320, Toronto, ON, M5G 2C4, Canada.
| | - Hasan Sheikh
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario, M5G 1V7, Canada.,Emergency Department, University Health Network, 200 Elizabeth Street, R. Fraser Elliott Building, Ground Floor, Room 480, Toronto, ON, M5G 2C4, Canada
| | - Jennifer Hulme
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario, M5G 1V7, Canada.,Emergency Department, University Health Network, 200 Elizabeth Street, R. Fraser Elliott Building, Ground Floor, Room 480, Toronto, ON, M5G 2C4, Canada
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27
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Rombouts SA, Conigrave J, Louie E, Haber P, Morley KC. Evidence-based models of care for the treatment of alcohol use disorder in primary health care settings: protocol for systematic review. Syst Rev 2019; 8:275. [PMID: 31722739 PMCID: PMC6852723 DOI: 10.1186/s13643-019-1157-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) is highly prevalent and accounts globally for 1.6% of disability-adjusted life years (DALYs) among females and 6.0% of DALYs among males. Effective treatments for AUDs are available but are not commonly practiced in primary health care. Furthermore, referral to specialized care is often not successful and patients that do seek treatment are likely to have developed more severe dependence. A more cost-efficient health care model is to treat less severe AUD in a primary care setting before the onset of greater dependence severity. Few models of care for the management of AUD in primary health care have been developed and with limited implementation. This proposed systematic review will synthesize and evaluate differential models of care for the management of AUD in primary health care settings. METHODS We will conduct a systematic review to synthesize studies that evaluate the effectiveness of models of care in the treatment of AUD in primary health care. A comprehensive search approach will be conducted using the following databases; MEDLINE (1946 to present), PsycINFO (1806 to present), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL) (1991 to present), and Embase (1947 to present). Reference searches of relevant reviews and articles will be conducted. Similarly, a gray literature search will be done with the help of Google and the gray matter tool which is a checklist of health-related sites organized by topic. Two researchers will independently review all titles and abstracts followed by full-text review for inclusion. The planned method of extracting data from articles and the critical appraisal will also be done in duplicate. For the critical appraisal, the Cochrane risk of bias tool 2.0 will be used. DISCUSSION This systematic review and meta-analysis aims to guide improvement of design and implementation of evidence-based models of care for the treatment of alcohol use disorder in primary health care settings. The evidence will define which models are most promising and will guide further research. PROTOCOL REGISTRATION NUMBER PROSPERO CRD42019120293.
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Affiliation(s)
- Susan A Rombouts
- Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - James Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Eva Louie
- Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Paul Haber
- Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Kirsten C Morley
- Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
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28
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McGinnis KA, Fiellin DA, Skanderson M, Hser YI, Lucas GM, Justice AC, Tate JP. Opioid use trajectory groups and changes in a physical health biomarker among HIV-positive and uninfected patients receiving opioid agonist treatment. Drug Alcohol Depend 2019; 204:107511. [PMID: 31546119 PMCID: PMC6993986 DOI: 10.1016/j.drugalcdep.2019.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Objective outcomes for measuring the physical health effects of substance use disorder treatment are needed. We compared the responsiveness of CD4, HIV-1 RNA and a biomarker index (VACS Index 2.0) to changes in opioid use among people with HIV (PWH) and uninfected individuals receiving opioid agonist treatment (OAT). METHODS Electronic health record data were used to identify patients who received ≥90 days of OAT and had ≥1 urine toxicology test in the Veterans Aging Cohort Study. Trajectory models identified patterns of opioid urine toxicology results. We used linear regression adjusted for age and race/ethnicity to determine associations between opioid toxicology groups and biomarker changes from up to one-year pre OAT to 3-15 months after OAT initiation. RESULTS Among 266 with detectable HIV-1 RNA, 366 with suppressed HIV-1 RNA, and 1183 uninfected patients, we identified five opioid toxicology groups ranging from consistently negative (54%) to consistently positive (9%). Among PWH with detectable HIV-1 RNA, all three biomarkers improved more for those consistently negative compared to those consistently positive (all p < .05). Among PWH with suppressed HIV-1 RNA, CD4 improved for those consistently negative; and worsened for those in the slow decrease toward negative group (p = .04). Among those uninfected, VACS Index 2.0 did not differ by opioid toxicology groups. CONCLUSIONS Among patients on OAT, changes in biomarkers are associated with opioid toxicology groups among PWH, but vary by HIV-1 RNA. These findings may be useful for measuring the health effects of OAT.
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Affiliation(s)
| | - David A Fiellin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | | | - Yih-Ing Hser
- Integrated Substance Abuse Programs, Univeristy of California Los Angeles, Los Angeles, CA, USA
| | - Gregory M Lucas
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Amy C Justice
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Janet P Tate
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Cochran G, Cole ES, Warwick J, Donohue JM, Gordon AJ, Gellad WF, Bear T, Kelley D, DiDomenico E, Pringle J. Rural access to MAT in Pennsylvania (RAMP): a hybrid implementation study protocol for medication assisted treatment adoption among rural primary care providers. Addict Sci Clin Pract 2019; 14:25. [PMID: 31366408 PMCID: PMC6670171 DOI: 10.1186/s13722-019-0154-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 07/04/2019] [Indexed: 01/03/2023] Open
Abstract
Background The continued escalation of opioid use disorder (OUD) calls for heightened vigilance to implement evidence-based care across the US. Rural care providers and patients have limited resources, and a number of barriers exist that can impede necessary OUD treatment services. This paper reports the design and protocol of an implementation study seeking to advance availability of medication assisted treatment (MAT) for OUD in rural Pennsylvania counties for patients insured by Medicaid in primary care settings. Methods This project was a hybrid implementation study. Within a chronic care model paradigm, we employed the Framework for Systems Transformation to implement the American Society for Addiction Medicine care model for the use of medications in the treatment of OUD. In partnership with state leadership, Medicaid managed care organizations, local care management professionals, the Universities of Pittsburgh and Utah, primary care providers (PCP), and patients; the project team worked within 23 rural Pennsylvania counties to engage, recruit, train, and collaborate to implement the OUD service model in PCP practices from 2016 to 2019. Formative measures included practice-level metrics to monitor project implementation, and outcome measures involved employing Medicaid claims and encounter data to assess changes in provider/patient-level OUD-related metrics, such as MAT provider supply, prevalence of OUD, and MAT utilization. Descriptive statistics and repeated measures regression analyses were used to assess changes across the study period. Discussion There is an urgent need in the US to expand access to high quality, evidence-based OUD treatment—particularly in rural areas where capacity is limited for service delivery in order to improve patient health and protect lives. Importantly, this project leverages multiple partners to implement a theory- and practice-driven model of care for OUD. Results of this study will provide needed evidence in the field for appropriate methods for implementing MAT among a large number of rural primary care providers.
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Affiliation(s)
- Gerald Cochran
- Program for Addiction Research, Clinical Care, Education, and Advocacy, University of Utah School of Medicine, 30 N. 1900 E, Salt Lake City, UT, 84132, USA.
| | - Evan S Cole
- University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA, 15261, USA
| | - Jack Warwick
- University of Pittsburgh Program Evaluation Research Unit, 5631 Baum Blvd, Pittsburgh, PA, 15206, USA
| | - Julie M Donohue
- University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA, 15261, USA
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Education, and Advocacy, University of Utah School of Medicine, 30 N. 1900 E, Salt Lake City, UT, 84132, USA
| | - Walid F Gellad
- University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA
| | - Todd Bear
- University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA, 15261, USA
| | - David Kelley
- Pennsylvania Department of Human Services, 625 Forster St, Harrisburg, PA, 17120, USA
| | - Ellen DiDomenico
- Pennsylvania Department of Human Services, 625 Forster St, Harrisburg, PA, 17120, USA
| | - Jan Pringle
- University of Pittsburgh Program Evaluation Research Unit, 5631 Baum Blvd, Pittsburgh, PA, 15206, USA.,University of Pittsburgh School of Pharmacy, 3501 Terrace St, Pittsburgh, PA, 15213, USA
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McCarty D. A Changing Landscape for Treatment of Alcohol and Drug Use Disorders. Am J Public Health 2019; 109:838-839. [PMID: 31067113 DOI: 10.2105/ajph.2019.305080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Dennis McCarty
- Dennis McCarty is with the School of Public Health, Oregon Health & Science University-Portland State University, Portland
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Cronin CE, Franz B, Skinner D, Haile ZT. Hospitals and substance use disorder services in the time of the opioid epidemic. Health Serv Res 2019; 54:399-406. [PMID: 30723891 DOI: 10.1111/1475-6773.13116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To test whether the opioid epidemic increased hospitals' offerings of substance use services. DATA SOURCES/STUDY SETTING This study employs data from the 2010 and 2015 American Hospital Association Annual Survey. STUDY DESIGN A multilevel, cross-sectional design was utilized to examine associations between county-level overdose rates and hospital substance use services. DATA COLLECTION/EXTRACTION METHODS The analytic sample consisted of 3365 acute care hospitals that answered pertinent survey questions. PRINCIPAL FINDINGS In 2010, 334 hospitals offered inpatient opioid services and 588 hospitals offered outpatient services, compared to 327 and 577, respectively, in 2015, indicating that more hospitals dropped services than added them as overdose rates increased. Factors other than growing need weigh more heavily in hospitals' determination to offer substance use services, including resources, mission, and the presence of psychiatric facilities within their communities. Importantly, hospitals that employ medical home models had greater odds of offering outpatient substance abuse services in 2015 OR, 95 percent CI (1.54; 1.23-1.93; P < 0.0001). CONCLUSIONS Hospitals are either not willing or equipped to increase substance use services in response to growing need.
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Affiliation(s)
- Cory E Cronin
- Department of Social and Public Health, Ohio University College of Health Sciences and Professions, Athens, Ohio
| | - Berkeley Franz
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio
| | - Daniel Skinner
- Department of Social Medicine, Ohio University College of Osteopathic Medicine, Dublin, Ohio
| | - Zelalem T Haile
- Department of Social Medicine, Ohio University College of Osteopathic Medicine, Dublin, Ohio
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Wu LT, Zhu H, Ghitza UE. Multicomorbidity of chronic diseases and substance use disorders and their association with hospitalization: Results from electronic health records data. Drug Alcohol Depend 2018; 192:316-323. [PMID: 30312893 PMCID: PMC6358206 DOI: 10.1016/j.drugalcdep.2018.08.013] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Chronic diseases are prevalent and the leading causes of mortality. Comorbidity of substance use disorders (SUDs) and chronic diseases is understudied to inform behavioral healthcare integration. OBJECTIVES This study leveraged electronic health record (EHR) data of 211,880 adults from a large health system to examine prevalence and correlates of comorbidity of SUDs and nine chronic disease groups and to determine their association with hospitalization. METHODS Logistic regression analyses were conducted to estimate associations between chronic diseases and SUDs. To control for severity of diagnosis, analyses of associations between SUD and hospitalization were stratified by the number of chronic conditions. RESULTS In the sample, 48.3% had ≥1 chronic condition (hypertension 33.7%, arthritis 16.2%, diabetes 13.7%, chronic kidney disease 9.9%, asthma 9.1%, chronic obstructive pulmonary disease 8.9%, ischemic heart disease 8.3%, cancer 4.6%, and hepatitis 1.3%). Prevalence of SUD (overall 13.3%) among patients increased with multiple chronic conditions (14.3% having SUD among patients with one condition; 21.2% having SUD among patients with two to three conditions; and 32.5% having SUD among patients with 4-9 conditions). Chronic conditions were associated with increased odds of SUDs. For all SUD groups, hospitalization was more prevalent among patients with SUD than those without it; prevalence of hospitalization increased with the number of comorbid chronic conditions. CONCLUSIONS Findings reveal a striking pattern of multicomorbidity of SUD and chronic diseases and its positive association with hospitalization. Behavioral healthcare integration should consider efforts to assess and treat comorbid SUD and chronic diseases, especially among adults with multiple chronic conditions.
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Affiliation(s)
- Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA.
| | - He Zhu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Udi E Ghitza
- National Institute on Drug Abuse, Bethesda, MD, USA
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Mau M, Muller AE, Roessler KK. Alcohol relapse and near-relapse experiences show that relapse models need to be updated. ALCOHOLISM TREATMENT QUARTERLY 2018. [DOI: 10.1080/07347324.2018.1532775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Martin Mau
- Health Sciences Research Centre, UCL University College, Odense, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Ashley Elizabeth Muller
- Norwegian Centre for Addiction Research, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
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Hanley K, Bereket S, Tuchman E, More FG, Naegle MA, Kalet A, Goldfeld K, Gourevitch MN. Evaluation of the Substance Abuse Research and Education Training (SARET) program: Stimulating health professional students to pursue careers in substance use research. Subst Abus 2018; 39:476-483. [PMID: 29565782 DOI: 10.1080/08897077.2018.1449167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND We developed and implemented the Substance Abuse Research Education and Training (SARET) program for medical, dental, nursing, and social work students to address the dearth of health professionals pursuing research and careers in substance use disorders (SUD). SARET has 2 main components: (1) a novel online curriculum addressing core SUD research topics, to reach a large number of students; (2) a mentored summer research experience for in-depth exposure. METHODS Modules were integrated into the curricula of the lead institution, and of 5 external schools. We assessed the number of Web modules completed and their effect on students' interest in SUD research. We also assessed the impact of the mentorship experience on participants' attitudes and early career trajectories, including current involvement in SUD research. RESULTS Since 2008, over 24,000 modules have been completed by approximately 9700 individuals. In addition to integration of the modules into curricula at the lead institution, all 5 health-professional partner schools integrated at least 1 module and approximately 5500 modules were completed by individuals outside the lead institution. We found an increase in interest in SUD research after completion of the modules for students in all 4 disciplines. From 2008 to 2015, 76 students completed summer mentorships; 8 students completed year-long mentorships; 13 published in SUD-related journals, 18 presented at national conferences, and 3 are actively engaged in SUD-related research. Mentorship participants reported a positive influence on their attitudes towards SUD-related clinical care, research, and interprofessional collaboration, leading in some cases to changes in career plans. CONCLUSIONS A modular curriculum that stimulates clinical and research interest in SUD can be successfully integrated into medical, dental, nursing, and social work curricula. The SARET program of mentored research participation fostered early research successes and influenced career choice of some participants. Longer-term follow-up will enable us to assess more distal careers of the program.
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Affiliation(s)
- Kathleen Hanley
- a Department of Medicine, New York University School of Medicine , New York , New York , USA
| | - Sewit Bereket
- b Department of Population Health, New York University School of Medicine , New York , New York , USA
| | - Ellen Tuchman
- c New York University Silver School of Social Work , New York , New York , USA
| | - Frederick G More
- d Department of Epidemiology & Health Promotion , New York University College of Dentistry , New York , New York , USA
| | | | - Adina Kalet
- f Department of Medicine , New York University School of Medicine , New York , New York , USA
| | - Keith Goldfeld
- b Department of Population Health, New York University School of Medicine , New York , New York , USA
| | - Marc N Gourevitch
- b Department of Population Health, New York University School of Medicine , New York , New York , USA
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Abstract
Unhealthy substance use is common in primary care populations and is a major contributor to morbidity and mortality. Two key strategies to address unhealthy substance use in primary care are the process of screening, brief intervention, and referral to treatment (SBIRT), and integration of treatment for substance use disorders into primary care. Implementation of SBIRT requires buy-in from practice leaders, careful planning, and staff and primary care provider training. Primary care-based treatment of opioid and alcohol use disorders can be effective; more data are needed to better understand the benefits of these models and identify means of treating other substance use disorders in primary care.
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Affiliation(s)
- Christine A Pace
- Section of General Internal Medicine, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA.
| | - Lisa A Uebelacker
- Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Box G-BH, 700 Butler Drive, Providence, RI 02906, USA; Department of Family Medicine, Brown University, Memorial Hospital of RI, 111 Brewster Street, Pawtucket, RI 02860, USA; Psychosocial Research, Butler Hospital, 345 Blackstone Boulevard Providence, RI 02906, USA
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36
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Day E. Commentary on Jones et al. (2018): An inconvenient truth-complex problems require complex solutions. Addiction 2018; 113:287-288. [PMID: 29314403 DOI: 10.1111/add.14070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 10/17/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Ed Day
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Solihull Integrated Addiction Service, Solihull, UK
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Day E, Copello A, Seddon JL, Christie M, Bamber D, Powell C, Bennett C, Akhtar S, George S, Ball A, Frew E, Goranitis I, Freemantle N. A pilot feasibility randomised controlled trial of an adjunct brief social network intervention in opiate substitution treatment services. BMC Psychiatry 2018; 18:8. [PMID: 29334921 PMCID: PMC5769270 DOI: 10.1186/s12888-018-1600-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 01/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 3% of people receiving opioid substitution therapy (OST) in the UK manage to achieve abstinence from prescribed and illicit drugs within three years of commencing treatment. Involvement of families and wider social networks in supporting psychological treatment may be an effective strategy in facilitating recovery, and this pilot study aimed to evaluate the impact of a social network-focused intervention for patients receiving OST. METHODS A two-site, open feasibility trial randomised patients receiving OST for at least 12 months but still reporting illicit opiate use in the past 28 days to one of three treatments: 1) treatment as usual (TAU), 2) Brief Social Behaviour and Network Therapy (B-SBNT) + TAU, or 3) Personal Goal Setting (PGS) + TAU. The two active interventions consisted of 4 sessions. There were 3 aims: 1) test the feasibility of recruiting OST patients to a trial of B-SBNT, and following them up over 12 months; 2) test the feasibility of training clinicians to deliver B-SBNT; 3) test whether B-SBNT reduces heroin use 3 and 12 months after treatment, and to explore potential mediating factors. The primary outcome for aim 3 was number of days of heroin use in the past month, and a range of secondary outcome measures were specified in advance (level of drug dependence, mental health, social satisfaction, therapist rapport, treatment satisfaction, social network size and support). RESULTS A total of 83 participants were randomised, and 70 (84%) were followed-up at 12 months. Fidelity analysis of showed that B-SBNT sessions were clearly distinguishable from PGS and TAU sessions, suggesting it was possible to train clinical staff to an adequate level of competence. No significant differences were found between the 3 intervention arms in the primary or secondary outcome measures. Attendance at psychosocial treatment intervention sessions was low across all three arms (44% overall). CONCLUSIONS Patients receiving OST can be recruited into a trial of a social network-based intervention, but poor attendance at treatment sessions makes it uncertain whether an adequate dose of treatment was delivered. In order to achieve the benefits of psychosocial interventions, further work is needed to overcome poor engagement. TRIAL REGISTRATION ISRCTN Trial Registration Number: ISRCTN22608399 . Date of registration: 27/04/2012. Date of first randomisation: 14/08/2012.
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Affiliation(s)
- Ed Day
- Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Dept of Psychiatry, The Barberry 25 Vincent Drive, Edgbaston, Birmingham, B152FG, UK. .,Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Alex Copello
- grid.450453.3Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Dept of Psychiatry, The Barberry 25 Vincent Drive, Edgbaston, Birmingham, B152FG UK ,0000 0004 1936 7486grid.6572.6School of Psychology, The University of Birmingham, Birmingham, UK
| | - Jennifer L. Seddon
- grid.450453.3Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Dept of Psychiatry, The Barberry 25 Vincent Drive, Edgbaston, Birmingham, B152FG UK ,0000 0004 1936 7486grid.6572.6School of Psychology, The University of Birmingham, Birmingham, UK
| | | | | | | | - Carmel Bennett
- grid.450453.3Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Dept of Psychiatry, The Barberry 25 Vincent Drive, Edgbaston, Birmingham, B152FG UK
| | - Shabana Akhtar
- grid.450453.3Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Dept of Psychiatry, The Barberry 25 Vincent Drive, Edgbaston, Birmingham, B152FG UK
| | - Sanju George
- grid.450453.3Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Dept of Psychiatry, The Barberry 25 Vincent Drive, Edgbaston, Birmingham, B152FG UK
| | - Andrew Ball
- Leicester City Drug and Alcohol Service, Leicester, UK
| | - Emma Frew
- 0000 0004 1936 7486grid.6572.6Health Economics Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ilias Goranitis
- 0000 0004 1936 7486grid.6572.6Health Economics Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Nick Freemantle
- 0000000121901201grid.83440.3bInstitute of Clinical Trials and Methodology, University College London, London, UK
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Gordon A, Jaffe A, McLellan AT, Richardson G, Skipper G, Sucher M, Tirado CF, Urschel HC. How Should Remote Clinical Monitoring Be Used to Treat Alcohol Use Disorders?: Initial Findings From an Expert Round Table Discussion. J Addict Med 2017; 11:145-153. [PMID: 28157829 PMCID: PMC5367507 DOI: 10.1097/adm.0000000000000288] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 11/12/2016] [Indexed: 01/12/2023]
Abstract
Scientific evidence combined with new health insurance coverage now enable a chronic illness management approach to the treatment of alcohol use disorders (AUDs), including regular monitoring of blood alcohol content (BAC), as a useful indicator of disease control. Recent technical advances now permit many different types of remote, real-time monitoring of BAC. However, there is no body of research to empirically guide clinicians in how to maximize the clinical potential of remote BAC monitoring.As an initial step in guiding and supporting such research, the manufacturer of one remote BAC monitoring system sponsored a group of experienced clinicians and clinical researchers to discuss 8 issues that generally affect remote, clinical BAC monitoring of "adults in outpatient AUD treatment."The expert panel unanimously agreed that remote BAC monitoring for at least 12 months during and after the outpatient treatment of AUD was a clinically viable deterrent to relapse. There was also consensus that positive test results (ie, recent alcohol use) should lead to intensified care and monitoring. However, there was no agreement on specific types of clinical intensification after a positive test. The panel agreed that sharing positive and negative test results with members of the patient support group was helpful in reinforcing abstinence, yet they noted many practical issues regarding information sharing that remain concerning. Significant differences within the panel on several important clinical issues underline the need for more clinical and implementation research to produce empirically-supported guidelines for the use of remote BAC monitoring in AUD treatment.
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Affiliation(s)
- Alan Gordon
- Treatment Research Institute (ATM), Philadelphia, PA; Butler Hospital (AG), Providence, RI; Alternatives Behavioral Health (AJ), LLC, Los Angeles, CA; Edgewood Health Network (GR), British Columbia, Canada; Promises Professionals Treatment Program (GS), Santa Monica, CA; Greenberg & Sucher PC (MS), Scottsdale, AZ; ABRI Integrated Health, LLC (CT), Austin; Enterhealth LLC (HCU), Dallas, TX
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Kiluk BD, Babuscio TA, Nich C, Carroll KM. Initial validation of a proxy indicator of functioning as a potential tool for establishing a clinically meaningful cocaine use outcome. Drug Alcohol Depend 2017; 179:400-407. [PMID: 28858744 PMCID: PMC5611843 DOI: 10.1016/j.drugalcdep.2017.07.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/14/2017] [Accepted: 07/20/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Establishing a non-abstinence cocaine use outcome as clinically meaningful has been elusive, in part due to the lack of association between cocaine use outcomes and meaningful indicators of long-term functioning. METHODS Using data pooled across 7 clinical trials evaluating treatments for cocaine (N=718), a dichotomous indicator of functioning was created to represent a meaningful outcome ('problem-free functioning' - PFF), defined as the absence of problems across non-substance-related domains on the Addiction Severity Index. Its validity was evaluated at multiple time points (baseline, end-of-treatment, terminal follow-up) and used to explore associations with cocaine use. RESULTS The percentage of participants meeting PFF criteria increased over time (baseline=18%; end-of-treatment=32%; terminal follow-up=37%). At each time point, ANOVAs indicated those who met PFF criteria reported significantly less distress on the Brief Symptom Inventory and less perceived stress on the Perceived Stress Scale. Generalized linear models indicated categorical indices of self-reported cocaine use at the end of treatment were predictive of the probability of meeting PFF criteria during follow-up (β=-0.01, p<0.01; 95% CI: -0.008 to -0.003), with those reporting 0days or 1-4days ('occasional' use) in the final month of treatment showing an increased likelihood of achieving PFF. CONCLUSIONS Initial validation of a proxy indicator of problem-free functioning demonstrated criterion validity and sensitivity to change over time. Frequency of cocaine use in the final month of treatment was associated with PFF during follow-up, with strongest associations between PFF and abstinence or 'occasional' use.
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Affiliation(s)
- Brian D. Kiluk
- Correspondence author at: Yale University School of Medicine, Temple Medical Building, Suite 6C, 40 Temple Street, New Haven, CT 06510, USA. (B.D. Kiluk)
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Quinn AE, Rubinsky AD, Fernandez AC, Hahm HC, Samet JH. A Research Agenda to Advance the Coordination of Care for General Medical and Substance Use Disorders. Psychiatr Serv 2017; 68:400-404. [PMID: 27629798 PMCID: PMC5437979 DOI: 10.1176/appi.ps.201600070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The separation of addiction care from the general medical care system has a negative impact on patients' receipt of high-quality medical care. Clinical and policy-level strategies to improve the coordination of addiction care and general medical care include identifying and engaging patients with unhealthy substance use in general medical settings, providing effective chronic disease management of substance use disorders in primary care, including patient and family perspectives in care coordination, and implementing pragmatic models to pay for the coordination of addiction and general medical care. This Open Forum discusses practice and research recommendations to advance the coordination of general medical and addiction care. The discussion is based on the proceedings of a national meeting of experts in 2014.
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Affiliation(s)
- Amity E Quinn
- Dr. Quinn is with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (e-mail: ). When this work was conducted, Dr. Rubinsky was with the Health Services Research and Development Center of Innovation, Veterans Affairs (VA) Puget Sound Health Care System, Seattle. Dr. Rubinsky is currently with the Kidney Health Research Collaborative, University of California, San Francisco, and with San Francisco VA Medical Center, San Francisco. Dr. Fernandez is with the Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island. Dr. Hahm is with the School of Social Work, Boston University, Boston. Dr. Samet is with the School of Medicine and the School of Public Health, Boston University, and with Boston Medical Center, Boston
| | - Anna D Rubinsky
- Dr. Quinn is with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (e-mail: ). When this work was conducted, Dr. Rubinsky was with the Health Services Research and Development Center of Innovation, Veterans Affairs (VA) Puget Sound Health Care System, Seattle. Dr. Rubinsky is currently with the Kidney Health Research Collaborative, University of California, San Francisco, and with San Francisco VA Medical Center, San Francisco. Dr. Fernandez is with the Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island. Dr. Hahm is with the School of Social Work, Boston University, Boston. Dr. Samet is with the School of Medicine and the School of Public Health, Boston University, and with Boston Medical Center, Boston
| | - Anne C Fernandez
- Dr. Quinn is with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (e-mail: ). When this work was conducted, Dr. Rubinsky was with the Health Services Research and Development Center of Innovation, Veterans Affairs (VA) Puget Sound Health Care System, Seattle. Dr. Rubinsky is currently with the Kidney Health Research Collaborative, University of California, San Francisco, and with San Francisco VA Medical Center, San Francisco. Dr. Fernandez is with the Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island. Dr. Hahm is with the School of Social Work, Boston University, Boston. Dr. Samet is with the School of Medicine and the School of Public Health, Boston University, and with Boston Medical Center, Boston
| | - Hyeouk Chris Hahm
- Dr. Quinn is with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (e-mail: ). When this work was conducted, Dr. Rubinsky was with the Health Services Research and Development Center of Innovation, Veterans Affairs (VA) Puget Sound Health Care System, Seattle. Dr. Rubinsky is currently with the Kidney Health Research Collaborative, University of California, San Francisco, and with San Francisco VA Medical Center, San Francisco. Dr. Fernandez is with the Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island. Dr. Hahm is with the School of Social Work, Boston University, Boston. Dr. Samet is with the School of Medicine and the School of Public Health, Boston University, and with Boston Medical Center, Boston
| | - Jeffrey H Samet
- Dr. Quinn is with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (e-mail: ). When this work was conducted, Dr. Rubinsky was with the Health Services Research and Development Center of Innovation, Veterans Affairs (VA) Puget Sound Health Care System, Seattle. Dr. Rubinsky is currently with the Kidney Health Research Collaborative, University of California, San Francisco, and with San Francisco VA Medical Center, San Francisco. Dr. Fernandez is with the Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island. Dr. Hahm is with the School of Social Work, Boston University, Boston. Dr. Samet is with the School of Medicine and the School of Public Health, Boston University, and with Boston Medical Center, Boston
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Bhatraju EP, Grossman E, Tofighi B, McNeely J, DiRocco D, Flannery M, Garment A, Goldfeld K, Gourevitch MN, Lee JD. Public sector low threshold office-based buprenorphine treatment: outcomes at year 7. Addict Sci Clin Pract 2017; 12:7. [PMID: 28245872 PMCID: PMC5331716 DOI: 10.1186/s13722-017-0072-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 02/02/2017] [Indexed: 11/28/2022] Open
Abstract
Background Buprenorphine maintenance for opioid dependence remains of limited availability among underserved populations, despite increases in US opioid misuse and overdose deaths. Low threshold primary care treatment models including the use of unobserved, “home,” buprenorphine induction may simplify initiation of care and improve access. Unobserved induction and long-term treatment outcomes have not been reported recently among large, naturalistic cohorts treated in low threshold safety net primary care settings. Methods This prospective clinical registry cohort design estimated rates of induction-related adverse events, treatment retention, and urine opioid results for opioid dependent adults offered buprenorphine maintenance in a New York City public hospital primary care office-based practice from 2006 to 2013. This clinic relied on typical ambulatory care individual provider-patient visits, prescribed unobserved induction exclusively, saw patients no more than weekly, and did not require additional psychosocial treatment. Unobserved induction consisted of an in-person screening and diagnostic visit followed by a 1-week buprenorphine written prescription, with pamphlet, and telephone support. Primary outcomes analyzed were rates of induction-related adverse events (AE), week 1 drop-out, and long-term treatment retention. Factors associated with treatment retention were examined using a Cox proportional hazard model among inductions and all patients. Secondary outcomes included overall clinic retention, buprenorphine dosages, and urine sample results. Results Of the 485 total patients in our registry, 306 were inducted, and 179 were transfers already on buprenorphine. Post-induction (n = 306), week 1 drop-out was 17%. Rates of any induction-related AE were 12%; serious adverse events, 0%; precipitated withdrawal, 3%; prolonged withdrawal, 4%. Treatment retention was a median 38 weeks (range 0–320) for inductions, compared to 110 (0–354) weeks for transfers and 57 for the entire clinic population. Older age, later years of first clinic visit (vs. 2006–2007), and baseline heroin abstinence were associated with increased treatment retention overall. Conclusions Unobserved “home” buprenorphine induction in a public sector primary care setting appeared a feasible and safe clinical practice. Post-induction treatment retention of a median 38 weeks was in line with previous naturalistic studies of real-world office-based opioid treatment. Low threshold treatment protocols, as compared to national guidelines, may compliment recently increased prescriber patient limits and expand access to buprenorphine among public sector opioid use disorder patients.
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Affiliation(s)
- Elenore Patterson Bhatraju
- Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA.,Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA
| | - Ellie Grossman
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA
| | - Babak Tofighi
- Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA.,Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA
| | - Jennifer McNeely
- Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA.,Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA
| | - Danae DiRocco
- Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA
| | - Mara Flannery
- Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA
| | - Ann Garment
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA
| | - Keith Goldfeld
- Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA
| | - Marc N Gourevitch
- Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA
| | - Joshua D Lee
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA. .,Department of Population Health, NYU School of Medicine, 227 East 30th St #712, New York, NY, 10016, USA.
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Lévesque A, Campbell ANC, Pavlicova M, Hu MC, Walker R, McClure EA, Ghitza UE, Bailey G, Stitzer M, Nunes EV. Coping strategies as a mediator of internet-delivered psychosocial treatment: Secondary analysis from a NIDA CTN multisite effectiveness trial. Addict Behav 2017; 65:74-80. [PMID: 27776269 DOI: 10.1016/j.addbeh.2016.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 09/28/2016] [Accepted: 09/29/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Coping strategies are a predictor of abstinence among patients with substance use disorders. However, little is known regarding the role of coping strategies in the effectiveness of the Community Reinforcement Approach (CRA). Using data from a 12week randomized control trial assessing the effectiveness of the Therapeutic Education System (TES), an internet-delivered version of the CRA combined with contingency management, we tested the role of coping strategies as a mediator of treatment effectiveness. METHODS 507 participants entering 10 outpatient addiction treatment programs received either treatment-as-usual (TAU), a counselor-delivered treatment (Arm 1), or reduced TAU plus TES wherein 2h of TAU per week were replaced by TES (Arm 2). Abstinence from drugs and alcohol was evaluated using urine toxicology and self-report. Coping strategies were measured using the Coping Strategies Scale-Brief Version. Mediation analyses were done following Baron and Kenny's and path analysis approaches. RESULTS The average baseline coping strategies scores were not significantly different between the two treatment arms. Overall, TES intervention was significantly associated with higher coping strategies scores when accounting for baseline scores (F1,1342=8.3, p=0.004). Additionally, higher coping strategies scores at week 12 were associated with an increased likelihood of abstinence during the last 4weeks of the treatment, while accounting for treatment assignment and baseline abstinence. The effect of TES intervention on abstinence was no longer significant after controlling for coping strategies scores at week 12. CONCLUSION Our results support the importance of coping skills as a partial mediator of the effectiveness of an internet-version of the CRA combined with contingency management.
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Affiliation(s)
- Annie Lévesque
- Department of Psychiatry, Mount Sinai West Hospital, New York, NY, United States.
| | - Aimee N C Campbell
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York, NY, United States
| | - Martina Pavlicova
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Mei-Chen Hu
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York, NY, United States
| | - Robrina Walker
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Erin A McClure
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Charleston, SC, United States
| | - Udi E Ghitza
- National Institute on Drug Abuse (NIDA) Center for the Clinical Trials Network (CCTN), Bethesda, MD, United States
| | - Genie Bailey
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Stanley Street Treatment and Resources, Inc, Fall River, MA, United States
| | - Maxine Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, United States
| | - Edward V Nunes
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Medical Center, New York, NY, United States
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Watkins KE, Ober AJ, Lamp K, Lind M, Diamant A, Osilla KC, Heinzerling K, Hunter SB, Pincus HA. Implementing the Chronic Care Model for Opioid and Alcohol Use Disorders in Primary Care. Prog Community Health Partnersh 2017; 11:397-407. [PMID: 29332853 PMCID: PMC6124482 DOI: 10.1353/cpr.2017.0047] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Effective treatments for opioid and alcohol use disorders (OAUD) are available, yet only a small percentage of those needing treatment receive it. OBJECTIVES This paper describes a collaborative planning and development process used by researchers and community providers to apply the chronic care model to the delivery of treatment for OAUD in primary care. The goal was to develop and implement an intervention that would support the delivery of brief psychotherapy and medication-assisted treatment (MAT). METHODS We used focus groups and interviews to identify barriers and facilitators, and organized the results using the chronic care model. We then identified implementation strategies, the intended organizational changes, and the materials necessary to carry out each strategy, and pilot-tested the process. RESULTS AND CONCLUSIONS We describe the methods and outcomes of the collaborative planning and development process, and discuss implications of the work for the integration of substance use treatment with primary care.
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Weisner CM, Chi FW, Lu Y, Ross TB, Wood SB, Hinman A, Pating D, Satre D, Sterling SA. Examination of the Effects of an Intervention Aiming to Link Patients Receiving Addiction Treatment With Health Care: The LINKAGE Clinical Trial. JAMA Psychiatry 2016; 73:804-14. [PMID: 27332703 PMCID: PMC4972645 DOI: 10.1001/jamapsychiatry.2016.0970] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Research has shown that higher activation and engagement with health care is associated with better self-management. To our knowledge, the linkage intervention (LINKAGE) is the first to engage patients receiving addiction treatment with health care using the electronic health record and a patient activation approach. OBJECTIVE To examine the effects of an intervention aiming to link patients receiving addiction treatment with health care. DESIGN, SETTING, AND PARTICIPANTS A nonrandomized clinical trial evaluating the LINKAGE intervention vs usual care by applying an alternating 3-month off-and-on design over 30 months. Participants were recruited from an outpatient addiction treatment clinic in a large health system between April 7, 2011, and October 2, 2013. INTERVENTIONS Six group-based, manual-guided sessions on patient engagement in health care and the use of health information technology resources in the electronic health record, as well as facilitated communication with physicians, vs usual care. MAIN OUTCOMES AND MEASURES Primary outcomes, measured at 6 months after enrollment, were patient activation (by interview using the Patient Activation Measure), patient engagement in health care (by interview and electronic health record), and alcohol, drug, and depression outcomes (by interview using the Addiction Severity Index for alcohol and drug outcomes and Patient Health Questionnaire (PHQ) for depression). RESULTS A total of 503 patients were recruited and assigned to the LINKAGE (n = 252) or usual care (n = 251) conditions, with no differences in baseline characteristics between conditions. The mean (SD) age of the patients was 42.5 (11.8) years, 31.0% (n = 156) were female, and 455 (90.5%) completed the 6-month interview. Compared with usual care participants, LINKAGE participants showed an increase in the mean number of log-in days (incidence rate ratio, 1.53; 95% CI, 1.19-1.97; P = .001). Similar results were found across types of patient portal use (communicating by email, viewing laboratory test results and information, and obtaining medical advice). LINKAGE participants were more likely to talk with their physicians about addiction problems (odds ratio, 2.30; 95% CI, 1.52-3.49; P < .001). Although 6-month abstinence rates were high for both conditions (≥70.0% for both) and depression symptoms improved (the proportion with scores ≥15 on the 9-item PHQ dropped from 15.1% [38 of 252] to 8.0% [18 of 225] among LINKAGE participants), there were no differences between conditions. Those who received all intervention components had significantly better alcohol and other drug outcomes than those who received fewer intervention components. CONCLUSIONS AND RELEVANCE Findings support the feasibility and effectiveness of the LINKAGE intervention in helping patients receiving addiction treatment engage in health care and increase communication with their physicians. The intervention did not affect short-term abstinence or depression outcomes. Understanding if the LINKAGE intervention helps prevent relapse and manage long-term recovery will be important. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01621711.
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Affiliation(s)
- Constance M. Weisner
- Department of Psychiatry, University of California, San Francisco2Division of Research, Kaiser Permanente Northern California, Oakland
| | - Felicia W. Chi
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Yun Lu
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Thekla B. Ross
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Sabrina B. Wood
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Agatha Hinman
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - David Pating
- Chemical Dependency Recovery Program, Kaiser Permanente Medical Center, San Francisco, California4The Permanente Medical Group, Kaiser Permanente Northern California, Oakland
| | - Derek Satre
- Department of Psychiatry, University of California, San Francisco2Division of Research, Kaiser Permanente Northern California, Oakland
| | - Stacy A. Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland
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Dineen KK, DuBois JM. BETWEEN A ROCK AND A HARD PLACE: CAN PHYSICIANS PRESCRIBE OPIOIDS TO TREAT PAIN ADEQUATELY WHILE AVOIDING LEGAL SANCTION? AMERICAN JOURNAL OF LAW & MEDICINE 2016; 42:7-52. [PMID: 27263262 PMCID: PMC5494184 DOI: 10.1177/0098858816644712] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Prescription opioids are an important tool for physicians in treating pain but also carry significant risks of harm when prescribed inappropriately or misused by patients or others. Recent increases in opioid-related morbidity and mortality has reignited scrutiny of prescribing practices by law enforcement, regulatory agencies, and state medical boards. At the same time, the predominant 4D model of misprescribers is outdated and insufficient; it groups physician misprescribers as dated, duped, disabled, or dishonest. The weaknesses and inaccuracies of the 4D model are explored, along with the serious consequences of its application. This Article calls for development of an evidence base in this area and suggests an alternate model of misprescribers, the 3C model, which more accurately characterizes misprescribers as careless, corrupt, or compromised by impairment.
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Stoner SA, Mikko AT, Carpenter KM. Web-based training for primary care providers on screening, brief intervention, and referral to treatment (SBIRT) for alcohol, tobacco, and other drugs. J Subst Abuse Treat 2014; 47:362-70. [PMID: 25115136 PMCID: PMC4196703 DOI: 10.1016/j.jsat.2014.06.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 05/20/2014] [Accepted: 06/30/2014] [Indexed: 11/18/2022]
Abstract
This project evaluated a Web-based multimedia training for primary care providers in screening, brief intervention, and referral to treatment (SBIRT) for unhealthy use of alcohol, tobacco, and other drugs. Physicians (n = 37), physician assistants (n = 35), and nurse practitioners (n = 20) were recruited nationally by email and randomly assigned to online access to either the multimedia training or comparable reading materials. At baseline, compared to non-physicians, physicians reported lower self-efficacy for counseling patients regarding substance use and doing so less frequently. All provider types in both conditions showed significant increases in SBIRT-related knowledge, self-efficacy, and clinical practices. Although the multimedia training was not superior to the reading materials with regard to these outcomes, the multimedia training was more likely to be completed and rated more favorably. Findings indicate that SBIRT training does not have to be elaborate to be effective. However, multimedia training may be more appealing to the target audiences.
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Affiliation(s)
- Susan A Stoner
- Talaria, Inc., Seattle, Washington; The Alcohol and Drug Abuse Institute, University of Washington, Seattle, Washington.
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47
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Tai B, Sparenborg S, Ghitza UE, Liu D. Expanding the National Drug Abuse Treatment Clinical Trials Network to address the management of substance use disorders in general medical settings. Subst Abuse Rehabil 2014; 5:75-80. [PMID: 25114611 PMCID: PMC4114899 DOI: 10.2147/sar.s66538] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The Patient Protection and Affordable Care Act (2010) and the Mental Health Parity and Addiction Equity Act (2008) expand substance use disorder (SUD) care services in the USA into general medical settings. Care offered in these settings will engage substance-using patients in an integrated and patient-centered environment that addresses physical and mental health comorbidities and follows a chronic care model. This expansion of SUD services presents a great need for evidence-based practices useful in general medical settings, and reveals several research gaps to be addressed. The National Drug Abuse Treatment Clinical Trials Network of the National Institute on Drug Abuse can serve an important role in this endeavor. High-priority research gaps are highlighted in this commentary. A discussion follows on how the National Drug Abuse Treatment Clinical Trials Network can transform to address changing patterns in SUD care to efficiently generate evidence to guide SUD treatment practice within the context of recent US health care legislation.
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Affiliation(s)
- Betty Tai
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA
| | - Steven Sparenborg
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA
| | - Udi E Ghitza
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA
| | - David Liu
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA
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Abstract
The "Medication-Assisted Therapy for Opioid Addiction" session was chaired by Dr. Betty Tai and had three presenters. The presenters (and their topics) were: Dr. Andrew J. Saxon (Methadone and Buprenorphine for Treatment of Opioid Addiction and HIV Risk Reduction), Dr. Walter Ling (Opioid Antagonist Treatment for Opioid Addiction), and Dr. Betty Tai (Chronic Care Model for Substance Use Disorder).
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49
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Editorial: A New Public Understanding About Addiction. Public Health Rev 2013. [DOI: 10.1007/bf03391700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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