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Tranberg K, Colnadar B, Nielsen MH, Hjorthøj C, Møller A. Interventions targeting patients with co-occuring severe mental illness and substance use (dual diagnosis) in general practice settings - a scoping review of the literature. BMC PRIMARY CARE 2024; 25:281. [PMID: 39097682 PMCID: PMC11297724 DOI: 10.1186/s12875-024-02504-3] [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: 07/17/2023] [Accepted: 07/01/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND People with dual diagnosis die prematurely compared to the general population, and general practice might serve as a setting in the healthcare system to mend this gap in health inequity. However, little is known about which interventions that have been tested in this setting. AIM To scope the literature on interventions targeting patients with dual diagnosis in a general practice setting, the outcomes used, and the findings. DESIGN AND SETTING A scoping review of patients with dual diagnosis in general practice. METHODS From a predeveloped search string, we used PubMed (Medline), PsychInfo, and Embase to identify scientific articles on interventions. Studies were excluded if they did not evaluate an intervention, if patients were under 18 years of age, and if not published in English. Duplicates were removed and all articles were initially screened by title and abstract and subsequent fulltext were read by two authors. Conflicts were discussed within the author group. A summative synthesis of the findings was performed to present the results. RESULTS Seven articles were included in the analysis. Most studies investigated integrated care models between behavioural treatment and primary care, and a single study investigated the delivery of Cognitive Behavioral treatment (CBT). Outcomes were changes in mental illness scores and substance or alcohol use, treatment utilization, and implementation of the intervention in question. No studies revealed significant outcomes for patients with dual diagnosis. CONCLUSION Few intervention studies targeting patients with dual diagnosis exist in general practice. This calls for further investigation of the possibilities of implementing interventions targeting this patient group in general practice.
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Affiliation(s)
- Katrine Tranberg
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Bawan Colnadar
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maria Haahr Nielsen
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Mental Health Center Copenhagen, Copenhagen Research Center for Mental Health - CORE, Copenhagen University Hospital, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Møller
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Nyaku AN, Zerbo EA, Chen C, Milano N, Johnston B, Chadwick R, Marcello S, Baston K, Haroz R, Crystal S. A survey of barriers and facilitators to the adoption of buprenorphine prescribing after implementation of a New Jersey-wide incentivized DATA-2000 waiver training program. BMC Health Serv Res 2024; 24:179. [PMID: 38331802 PMCID: PMC10851589 DOI: 10.1186/s12913-024-10648-2] [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: 11/03/2023] [Accepted: 01/28/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Opioid-involved overdose deaths continue to rise in the US, despite availability of highly effective treatments for opioid use disorder (OUD), in part due to the insufficient number of treatment providers. Barriers include the need for providers to gain expertise and confidence in providing MOUD to their patients who need these treatments. To mitigate this barrier, New Jersey sponsored a buprenorphine training program with financial incentives for participation, which met the then existing requirement for the DATA-2000 waiver. In a 2019 follow-up survey, participants reported on barriers and facilitators to subsequent buprenorphine prescribing. METHODS Participants in the training program completed a 10-min electronic survey distributed via email. The survey addressed demographics, practice characteristics, current buprenorphine prescribing, and barriers and facilitators to adoption and/or scale up of buprenorphine prescribing. RESULTS Of the 440 attendees with a valid email address, 91 individuals completed the survey for a response rate of 20.6%. Of the 91 respondents, 89 were eligible prescribers and included in the final analysis. Respondents were predominantly female (n = 55, 59.6%) and physicians (n = 55, 61.8%); representing a broad range of specialties and practice sites. 65 (73%) of respondents completed the training and DEA-registration, but only 31 (34.8%) were actively prescribing buprenorphine. The most frequently cited barriers to buprenorphine prescribing were lack of access to support services such as specialists in addiction, behavioral health services, and psychiatry. The most frequently reported potential facilitators were integrated systems with direct access to addiction specialists and psychosocial services, easier referral to behavioral health services, more institutional support, and improved guidance on clinical practice standards for OUD treatment. CONCLUSION More than half (52.3%) of those who completed incentivized training and DEA registration failed to actively prescribe buprenorphine. Results highlight provider perceptions of inadequate availability of support for the complex needs of patients with OUD and suggest that broader adoption of buprenorphine prescribing will require scaling up support to clinicians, including increased availability of specialized addiction and mental health services.
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Affiliation(s)
- Amesika N Nyaku
- Department of Medicine, Division of Infectious Diseases, Rutgers New Jersey Medical School, 185 South Orange Ave, MSB I689, Newark, NJ, 07103, USA.
| | - Erin A Zerbo
- Private Practice, Montclair, NJ, 07042, USA
- Department of Psychiatry, Rutgers New Jersey Medical School, 183 South Orange Ave, BHSB F-Level, Newark, NJ, 07103, USA
| | - Clement Chen
- Department of Psychiatry, Rutgers New Jersey Medical School, 183 South Orange Ave, BHSB F-Level, Newark, NJ, 07103, USA
| | - Nicole Milano
- Mental Health Association in New Jersey, 673 Morris Avenue, Suite 100, Springfield, NJ, 07781, USA
| | - Barbara Johnston
- Mental Health Association in New Jersey, 673 Morris Avenue, Suite 100, Springfield, NJ, 07781, USA
| | - Randall Chadwick
- Rutgers University Behavioral Health Care, 151 Centennial Avenue, Suite 1140, Piscataway, NJ, 08854, USA
| | - Stephanie Marcello
- Rutgers University Behavioral Health Care, 151 Centennial Avenue, Suite 1140, Piscataway, NJ, 08854, USA
| | - Kaitlan Baston
- Department of Internal Medicine, Cooper Medical School of Rowan University, Three Cooper Plaza, Camden, NJ, 08103, USA
| | - Rachel Haroz
- Department of Emergency Medicine, Cooper Medical School of Rowan University, One Cooper Plaza, Camden, NJ, 08103, USA
| | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St, 3rd Floor, New Brunswick, NJ, 08901, USA
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Strong SH, Oldfield BJ, van den Berg JJ, Cole CA, Biegacki E, Ogbuagu O, Virata M, Chan PA, Edelman EJ. Perspectives on unhealthy alcohol use among men who have sex with men prescribed HIV pre-exposure prophylaxis: A qualitative study. Prev Med Rep 2024; 37:102553. [PMID: 38282665 PMCID: PMC10810836 DOI: 10.1016/j.pmedr.2023.102553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 01/30/2024] Open
Abstract
Unhealthy alcohol use is a common, often unaddressed behavior associated with increased risk for acquisition of HIV and may also be associated with decreased adherence to oral pre-exposure prophylaxis (PrEP) among gay, bisexual, and other men who have sex with men (MSM) living in the United States. To inform future alcohol-reduction interventions among individuals engaging in PrEP care, we sought to explore perspectives on alcohol use, PrEP adherence, and the acceptability of alcohol use treatment options for MSM prescribed oral formulations of PrEP in the Northeastern United States. Between February 2019 and July 2020, we conducted semi-structured interviews with 15 MSM without HIV who were prescribed PrEP and screened positive for unhealthy alcohol use with AUDIT-C ≥ 4 and were receiving care in Providence, Rhode Island or New Haven, Connecticut. Interviews were coded and analyzed using thematic analysis. Three themes emerged: 1) Consequences of fluctuations in drinking 2) Alcohol use negatively impacts health and relationships; and 3) Desire for a multimodal approach to treatment of unhealthy alcohol use. Our findings support the need to raise awareness of potential alcohol-related harms, address the spectrum of unhealthy alcohol use among MSM prescribed PrEP, and the acceptability and preferences for alcohol reduction interventions within PrEP programs.
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Affiliation(s)
- Sabrina H. Strong
- Department of Medicine, Alpert Brown Medical School, Providence, RI, USA
| | - Benjamin J. Oldfield
- Fair Haven Community Health Care, New Haven, CT, USA
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jacob J. van den Berg
- Department of Medicine, Alpert Brown Medical School, Providence, RI, USA
- School of Public Health, Brown University, Providence, RI, USA
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | | | - Emma Biegacki
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Onyema Ogbuagu
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Michael Virata
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Philip A. Chan
- Department of Medicine, Alpert Brown Medical School, Providence, RI, USA
- School of Public Health, Brown University, Providence, RI, USA
| | - E. Jennifer Edelman
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA
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Okoli RCB, Shedul G, Hirschhorn LR, Orji IA, Ojo TM, Egenti N, Omitiran K, Akor B, Baldridge AS, Huffman MD, Ojji D, Kandula NR. Stakeholder perspectives to inform adaptation of a hypertension treatment program in primary healthcare centers in the Federal Capital Territory, Nigeria: a qualitative study. Implement Sci Commun 2021; 2:97. [PMID: 34462016 PMCID: PMC8404273 DOI: 10.1186/s43058-021-00197-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 08/05/2021] [Indexed: 12/01/2022] Open
Abstract
Background Implementing an evidence-based hypertension program in primary healthcare centers (PHCs) in the Federal Capital Territory, Nigeria is an opportunity to improve hypertension diagnosis, treatment, and control and reduce deaths from cardiovascular diseases. This qualitative research study was conducted in Nigerian PHCs with patients, non-physician health workers, administrators and primary care physicians to inform contextual adaptations of Kaiser Permanente Northern California's hypertension model and the World Health Organization’s HEARTS technical package for the system-level, Hypertension Treatment in Nigeria (HTN) Program. Methods Purposive sampling in 8 PHCs identified patients (n = 8), non-physician health workers (n = 12), administrators (n = 3), and primary care physicians (n = 6) for focus group discussions and interviews. The Primary Health Care Performance Initiative (PHCPI) conceptual framework and Consolidated Framework for Implementation Research (CFIR) domains were used to develop semi-structured interviews (Appendix 1, Supplemental Materials) and coding guides. Content analysis identified multilevel factors that would influence program implementation. Results Participants perceived the need to strengthen four major health system inputs across CFIR domains for successful adaptation of the HTN Program components: (1) reliable drug supply and blood pressure measurement equipment, (2) enable and empower community healthcare workers to participate in team-based care through training and education, (3) information systems to track patients and medication supply chain, and (4) a primary healthcare system that could offer a broader package of health services to meet patient needs. Specific features of the PHCPI framework considered important included: accessible and person-centered care, provider availability and competence, coordination of care, and proactive community outreach. Participants also identified patient-level factors, such as knowledge and beliefs about hypertension, and financial and transportation barriers that could be addressed with better communication, home visits, and drug financing. Participants recommended using existing community structures, such as village health committees and popular opinion leaders, to improve knowledge and demand for the HTN Program. Conclusions These results provide information on specific primary care and community contextual factors that can support or hinder implementation and sustainability of an evidence-based, system-level hypertension program in the Federal Capital Territory, Nigeria, with the ultimate aim of scaling it to other parts of the country. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00197-8.
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Affiliation(s)
| | - Gabriel Shedul
- University of Abuja Teaching Hospital Gwagwalada, Abuja, Nigeria
| | - Lisa R Hirschhorn
- Feinberg School of Medicine, Northwestern University, 420 E Superior, 6th Floor, Chicago, IL, 60611, USA
| | - Ikechukwu A Orji
- University of Abuja Teaching Hospital Gwagwalada, Abuja, Nigeria
| | - Tunde M Ojo
- University of Abuja Teaching Hospital Gwagwalada, Abuja, Nigeria
| | - Nonye Egenti
- University of Abuja Teaching Hospital Gwagwalada, Abuja, Nigeria
| | | | - Blessing Akor
- University of Abuja Teaching Hospital Gwagwalada, Abuja, Nigeria
| | - Abigail S Baldridge
- Feinberg School of Medicine, Northwestern University, 420 E Superior, 6th Floor, Chicago, IL, 60611, USA
| | - Mark D Huffman
- Feinberg School of Medicine, Northwestern University, 420 E Superior, 6th Floor, Chicago, IL, 60611, USA
| | - Dike Ojji
- University of Abuja Teaching Hospital Gwagwalada, Abuja, Nigeria
| | - Namratha R Kandula
- Feinberg School of Medicine, Northwestern University, 420 E Superior, 6th Floor, Chicago, IL, 60611, USA.
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Scott VC, Gold SB, Kenworthy T, Snapper L, Gilchrist EC, Kirchner S, Wong SL. Assessing cross-sector stakeholder readiness to advance and sustain statewide behavioral integration beyond a State Innovation Model (SIM) initiative. Transl Behav Med 2021; 11:1420-1429. [PMID: 33823044 DOI: 10.1093/tbm/ibab022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Integrated care is recognized as a promising approach to comprehensive health care and reductions in health care costs. However, the integration of behavioral health and primary care is complex and often difficult to implement. Successful and sustainable integration efforts require coordination and alignment both within health care organizations and across multiple sectors. Furthermore, implementation progress and outcomes are shaped by the readiness of stakeholders to work together toward integrated care. In the context of a Colorado State Innovation Model (SIM) effort, we examined stakeholder readiness to advance and sustain partnerships for behavioral health integration beyond the period of grant funding. Partnership readiness was assessed using the Readiness for Cross-sector Partnerships Questionnaire (RCP) in spring 2019. Participants from 67 organizations represented seven sectors: government, health care, academic, practice transformation, advocacy, payer, and other. RCP analyses indicated a moderate level of readiness among Colorado stakeholders for partnering to continue the work of behavioral health integration initiated by SIM. Stakeholders indicated their highest readiness levels for general capacity and lowest for innovation-specific capacity. Five thematic categories emerged from the open-ended questions pertaining to partnership experiences: (a) collaboration and relationships, (b) capacity and leadership, (c) measurement and outcomes, (d) financing integrated care, and (e) sustainability of the cross-sector partnership. Partnering across sectors to advance integrated behavioral health and create more equitable access to services is inherently complex and nonlinear in nature. The RCP usefully identifies opportunities to strengthen the sustainability of integrated care efforts.
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Affiliation(s)
- Victoria C Scott
- Department of Psychological Science, The University of North Carolina at Charlotte, Colvard 4035, 9201 University City Blvd., Charlotte, NC, USA
| | - Stephanie B Gold
- Eugene S. Farley, Jr. Health Policy Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tara Kenworthy
- Department of Psychology, The University of South Carolina, Columbia, SC, USA
| | - Leslie Snapper
- Department of Psychological Science, The University of North Carolina at Charlotte, Colvard 4035, 9201 University City Blvd., Charlotte, NC, USA
| | - Emma C Gilchrist
- Eugene S. Farley, Jr. Health Policy Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Stephanie Kirchner
- Eugene S. Farley, Jr. Health Policy Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Shale L Wong
- Eugene S. Farley, Jr. Health Policy Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Amin S, Gibson KM, Bines D. Integrated Behavioral Health Collaborative Practice Embedded Within the Pediatric Residency Continuity Clinic: Incorporating a Multicultural Lens. Pediatr Clin North Am 2021; 68:659-668. [PMID: 34044992 DOI: 10.1016/j.pcl.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pediatric patients often work with multiple health care providers for complex presenting concerns. This complexity has called for pediatric health care providers to strengthen interdisciplinary relationships with mental health providers to meet patient needs. Integrated behavioral health collaborative practice models, using the Interprofessional Education Collaborative competencies, provide the necessary scaffolding to train medical and mental health professionals. A multicultural framework can be integrated into the interprofessional education curricula to better equip health care professionals to provide culturally competent services that decenter hierarchy, power, privilege, and implicit bias, resulting in improved access and quality of comprehensive health care services.
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Affiliation(s)
- Sonia Amin
- University of California-Berkeley, Berkeley, CA, USA.
| | - Kristine M Gibson
- Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, USA
| | - Derrick Bines
- San Francisco State University, San Francisco, CA, USA
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Rogers L, De Brún A, McAuliffe E. Defining and assessing context in healthcare implementation studies: a systematic review. BMC Health Serv Res 2020; 20:591. [PMID: 32600396 PMCID: PMC7322847 DOI: 10.1186/s12913-020-05212-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 04/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The implementation of evidence-based healthcare interventions is challenging, with a 17-year gap identified between the generation of evidence and its implementation in routine practice. Although contextual factors such as culture and leadership are strong influences for successful implementation, context remains poorly understood, with a lack of consensus regarding how it should be defined and captured within research. This study addresses this issue by providing insight into how context is defined and assessed within healthcare implementation science literature and develops a definition to enable effective measurement of context. METHODS Medline, PsychInfo, CINAHL and EMBASE were searched. Articles were included if studies were empirical and evaluated context during the implementation of a healthcare initiative. These English language articles were published in the previous 10 years and included a definition and assessment of context. Results were synthesised using a narrative approach. RESULTS Three thousand and twenty-one search records were obtained of which 64 met the eligibility criteria and were included in the review. Studies used a variety of definitions in terms of the level of detail and explanation provided. Some listed contextual factors (n = 19) while others documented sub-elements of a framework that included context (n = 19). The remaining studies provide a rich definition of general context (n = 11) or aspects of context (n = 15). The Alberta Context Tool was the most frequently used quantitative measure (n = 4), while qualitative papers used a range of frameworks to evaluate context. Mixed methods studies used diverse approaches; some used frameworks to inform the methods chosen while others used quantitative measures to inform qualitative data collection. Most studies (n = 50) applied the chosen measure to all aspects of study design with a majority analysing context at an individual level (n = 29). CONCLUSIONS This review highlighted inconsistencies in defining and measuring context which emphasised the need to develop an operational definition. By providing this consensus, improvements in implementation processes may result, as a common understanding will help researchers to appropriately account for context in research.
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Affiliation(s)
- L. Rogers
- University College Dublin Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), Belfield, Dublin 4, Ireland
- University College Dublin School of Nursing, Midwifery and Health Systems, Belfield, Dublin 4, Ireland
| | - A. De Brún
- University College Dublin Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), Belfield, Dublin 4, Ireland
- University College Dublin School of Nursing, Midwifery and Health Systems, Belfield, Dublin 4, Ireland
| | - E. McAuliffe
- University College Dublin Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), Belfield, Dublin 4, Ireland
- University College Dublin School of Nursing, Midwifery and Health Systems, Belfield, Dublin 4, Ireland
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Alvidrez J, Nápoles AM, Bernal G, Lloyd J, Cargill V, Godette D, Cooper L, Horse Brave Heart MY, Das R, Farhat T. Building the Evidence Base to Inform Planned Intervention Adaptations by Practitioners Serving Health Disparity Populations. Am J Public Health 2020; 109:S94-S101. [PMID: 30699023 DOI: 10.2105/ajph.2018.304915] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Many evidence-based interventions (EBIs) have been developed to prevent or treat major health conditions. However, many EBIs have exhibited limited adoption, reach, and sustainability when implemented in diverse community settings. This limitation is especially pronounced in low-resource settings that serve health disparity populations. Often, practitioners identify problems with existing EBIs originally developed and tested with populations different from their target population and introduce needed adaptations to make the intervention more suitable. Although some EBIs have been extensively adapted for diverse populations and evaluated, most local adaptations to improve fit for health disparity populations are not well documented or evaluated. As a result, empirical evidence is often lacking regarding the potential effectiveness of specific adaptations practitioners may be considering. We advocate an expansion in the emphasis of adaptation research from researcher-led interventions to research that informs practitioner-led adaptations. By presenting a research vision and strategies needed to build this area of science, we aim to inform research that facilitates successful adaptation and equitable implementation and delivery of EBIs that reduce health disparities.
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Affiliation(s)
- Jennifer Alvidrez
- Jennifer Alvidrez, Anna María Nápoles, Rina Das, and Tilda Farhat are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Guillermo Bernal was with the Office of the President, Carlos Albizu University, San Juan, PR, during the time of essay preparation. Jacqueline Lloyd is with the National Institute on Drug Abuse, NIH. Victoria Cargill is with the Office of Research on Women's Health, NIH. Dionne Godette is with the Office of Disease Prevention, NIH. Lisa Cooper is with the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Maria Yellow Horse Brave Heart is with the Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Anna María Nápoles
- Jennifer Alvidrez, Anna María Nápoles, Rina Das, and Tilda Farhat are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Guillermo Bernal was with the Office of the President, Carlos Albizu University, San Juan, PR, during the time of essay preparation. Jacqueline Lloyd is with the National Institute on Drug Abuse, NIH. Victoria Cargill is with the Office of Research on Women's Health, NIH. Dionne Godette is with the Office of Disease Prevention, NIH. Lisa Cooper is with the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Maria Yellow Horse Brave Heart is with the Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Guillermo Bernal
- Jennifer Alvidrez, Anna María Nápoles, Rina Das, and Tilda Farhat are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Guillermo Bernal was with the Office of the President, Carlos Albizu University, San Juan, PR, during the time of essay preparation. Jacqueline Lloyd is with the National Institute on Drug Abuse, NIH. Victoria Cargill is with the Office of Research on Women's Health, NIH. Dionne Godette is with the Office of Disease Prevention, NIH. Lisa Cooper is with the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Maria Yellow Horse Brave Heart is with the Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Jacqueline Lloyd
- Jennifer Alvidrez, Anna María Nápoles, Rina Das, and Tilda Farhat are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Guillermo Bernal was with the Office of the President, Carlos Albizu University, San Juan, PR, during the time of essay preparation. Jacqueline Lloyd is with the National Institute on Drug Abuse, NIH. Victoria Cargill is with the Office of Research on Women's Health, NIH. Dionne Godette is with the Office of Disease Prevention, NIH. Lisa Cooper is with the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Maria Yellow Horse Brave Heart is with the Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Victoria Cargill
- Jennifer Alvidrez, Anna María Nápoles, Rina Das, and Tilda Farhat are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Guillermo Bernal was with the Office of the President, Carlos Albizu University, San Juan, PR, during the time of essay preparation. Jacqueline Lloyd is with the National Institute on Drug Abuse, NIH. Victoria Cargill is with the Office of Research on Women's Health, NIH. Dionne Godette is with the Office of Disease Prevention, NIH. Lisa Cooper is with the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Maria Yellow Horse Brave Heart is with the Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Dionne Godette
- Jennifer Alvidrez, Anna María Nápoles, Rina Das, and Tilda Farhat are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Guillermo Bernal was with the Office of the President, Carlos Albizu University, San Juan, PR, during the time of essay preparation. Jacqueline Lloyd is with the National Institute on Drug Abuse, NIH. Victoria Cargill is with the Office of Research on Women's Health, NIH. Dionne Godette is with the Office of Disease Prevention, NIH. Lisa Cooper is with the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Maria Yellow Horse Brave Heart is with the Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Lisa Cooper
- Jennifer Alvidrez, Anna María Nápoles, Rina Das, and Tilda Farhat are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Guillermo Bernal was with the Office of the President, Carlos Albizu University, San Juan, PR, during the time of essay preparation. Jacqueline Lloyd is with the National Institute on Drug Abuse, NIH. Victoria Cargill is with the Office of Research on Women's Health, NIH. Dionne Godette is with the Office of Disease Prevention, NIH. Lisa Cooper is with the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Maria Yellow Horse Brave Heart is with the Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Maria Yellow Horse Brave Heart
- Jennifer Alvidrez, Anna María Nápoles, Rina Das, and Tilda Farhat are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Guillermo Bernal was with the Office of the President, Carlos Albizu University, San Juan, PR, during the time of essay preparation. Jacqueline Lloyd is with the National Institute on Drug Abuse, NIH. Victoria Cargill is with the Office of Research on Women's Health, NIH. Dionne Godette is with the Office of Disease Prevention, NIH. Lisa Cooper is with the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Maria Yellow Horse Brave Heart is with the Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Rina Das
- Jennifer Alvidrez, Anna María Nápoles, Rina Das, and Tilda Farhat are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Guillermo Bernal was with the Office of the President, Carlos Albizu University, San Juan, PR, during the time of essay preparation. Jacqueline Lloyd is with the National Institute on Drug Abuse, NIH. Victoria Cargill is with the Office of Research on Women's Health, NIH. Dionne Godette is with the Office of Disease Prevention, NIH. Lisa Cooper is with the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Maria Yellow Horse Brave Heart is with the Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Tilda Farhat
- Jennifer Alvidrez, Anna María Nápoles, Rina Das, and Tilda Farhat are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Guillermo Bernal was with the Office of the President, Carlos Albizu University, San Juan, PR, during the time of essay preparation. Jacqueline Lloyd is with the National Institute on Drug Abuse, NIH. Victoria Cargill is with the Office of Research on Women's Health, NIH. Dionne Godette is with the Office of Disease Prevention, NIH. Lisa Cooper is with the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Maria Yellow Horse Brave Heart is with the Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
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Terry DL, Terry CP. Addressing Mental Health Concerns in Primary Care: Practices Among Medical Residents in a Rural Setting. J Clin Psychol Med Settings 2019; 26:395-401. [PMID: 30758698 DOI: 10.1007/s10880-019-09609-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Behavioral health issues like anxiety and depression negatively impact numerous aspects of primary care, including medical regimen adherence, communication, physical well-being, and engagement in beneficial health behaviors. This study aimed to examine internal and family medicine residents': (1) patterns of addressing mental health concerns (e.g., frequency of referral for psychotherapy and/or medication), (2) self-perceptions of competency in assessment and treatment of specific mental health disorders, and (3) frequency of utilization of efficacious therapeutic strategies during clinical encounters. Self-report surveys were administered to Family Medicine and Internal Medicine residents (N = 39). Descriptive analyses indicated that 81% of the time, residents discussed mental health concerns when it was the presenting concern, and routinely offered medication and psychotherapy (71% and 68% of the time, respectively). Residents felt most competent in addressing major depressive disorder and generalized anxiety disorder, and least competent in addressing somatization disorder and bipolar disorder. Residents reported that they most often used motivational interviewing (MI), followed by Cognitive Behavioral Therapy, psychoeducation, and solution-focused strategies during medical encounters. These findings highlight a need to identify barriers to addressing mental health conditions in primary care and potential gaps in training that might address low levels of perceived competency among medical residents.
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Affiliation(s)
- Danielle L Terry
- Robert Packer Hospital, Guthrie Medical Center, One Guthrie Square, Sayre, PA, 18840, USA.
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Oldfield BJ, Muñoz N, Boshnack N, Leavitt R, McGovern MP, Villanueva M, Tetrault JM, Edelman EJ. "No more falling through the cracks": A qualitative study to inform measurement of integration of care of HIV and opioid use disorder. J Subst Abuse Treat 2019; 97:28-40. [PMID: 30577897 DOI: 10.1016/j.jsat.2018.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/06/2018] [Accepted: 11/19/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Integration of HIV- and opioid use disorder (OUD)-related care is associated with improved patient outcomes. Our goal was to develop a novel instrument for measuring quality of integration of HIV and OUD-related care that would be applicable across diverse care settings. METHODS Grounded in community-based participatory research principles, we conducted a qualitative study from August through November 2017 to inform modification of the Behavioral Health Integration in Medical Care (BHIMC) instrument, a validated measure of quality of integration of behavioral health in primary care. We conducted semi-structured interviews of patients (n = 22), focus groups with clinical staff (n = 24), and semi-structured interviews of clinic leadership (n = 5) in two urban centers in Connecticut. RESULTS We identified three themes that characterize optimal integration of HIV- and OUD-related care: (1) importance of mitigating mismatches in resources and knowledge, particularly resources to address social risks and knowledge gaps about evidence-based treatments for OUD; (2) need for patient-centered policies and inter-organization communication, and (3) importance of meeting people where they are, geographically and at their stage of change. These themes highlighted aspects of integrated care for HIV and OUD not captured in the original BHIMC. CONCLUSIONS Patients, clinical staff, and organization leadership perceive that addressing social risks, communication across agencies, and meeting patients in their psychosocial and structural context are important for optimizing integration of HIV and OUD-related care. Our proposed, novel instrument is a step towards measuring and improving service delivery locally and nationally for this vulnerable population.
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Affiliation(s)
- Benjamin J Oldfield
- National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, United States of America; Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America; Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States of America.
| | - Nicolas Muñoz
- Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | | | - Robert Leavitt
- AIDS Project New Haven, New Haven, CT, United States of America
| | - Mark P McGovern
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Merceditas Villanueva
- Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, United States of America
| | - Jeanette M Tetrault
- Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - E Jennifer Edelman
- Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, United States of America
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McVicar KL, Ivanitskaya LV, Bradley DW, Montero JT. Primary Care and Public Health Collaboration Reports: A Qualitative Review of Integration Aims, Participants, and Success Determinants. Popul Health Manag 2018; 22:422-432. [PMID: 30562144 DOI: 10.1089/pop.2018.0160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This qualitative review of 57 published case reports aimed to analyze primary care and public health integration efforts in 45 states to summarize collaboration aims, participants, and systemic, organizational, and interactional success determinants. Chronic disease management, maternal and child health, and wellness and health promotion were the most commonly reported aims of collaboration between primary care and public health entities in the United States. Typical participants were government public health structures, health delivery systems, communities, academia, state professional medical associations, and employers and businesses. Systemic, organizational, and interactional determinants included adequate funding, multiple stakeholder engagement, leadership, data and information sharing, capitalization on collaborator resources, community engagement, steering committees, effective communication, regular meetings, shared mission, vision, and goals, previous positive relationships, collaborations, and partnerships. The present study contributes to the body of knowledge of when, where, and under what contextual circumstances collaboration and integration have been perceived as effective. Future research could extrapolate which determinants are more essential than others and focus on how systemic, organizational, and interactional factors are interrelated. To advance the practice of successful integration between primary care and public health entities, longitudinal research is needed to examine the degree of integration and sustainability.
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Affiliation(s)
- Kimberly L McVicar
- College of Health Professions, Ferris State University, Big Rapids, Michigan
| | - Lana V Ivanitskaya
- School of Health Sciences, Central Michigan University, Mount Pleasant, Michigan
| | - Don W Bradley
- Duke University School of Medicine, Durham, North Carolina
| | - Jose T Montero
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Castro FG, Yasui M. Advances in EBI Development for Diverse Populations: Towards a Science of Intervention Adaptation. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018. [PMID: 28620723 DOI: 10.1007/s11121-017-0809-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This introduction examines major issues and challenges as presented in this special issue of Prevention Science, "Challenges to the Dissemination and Implementation of Evidence Based Prevention Interventions for Diverse Populations." We describe the Fidelity-Adaptation Dilemma that became the origin of dynamic tensions in prevention science. It generated controversies and debates and new perspectives on the dissemination and implementation of evidence-based interventions (EBIs) within diverse populations. The five articles in this special issue address many of these challenges. These dynamic tensions have culminated in a reframing of this dilemma that now argues that fidelity and adaptation are both equally important imperatives. These five articles also examine the abiding challenges of engagement and sustainability. Also, two commentaries from expert research investigators reflect on these five articles and their contributions to prevention science. The current introduction describes this "second generation" of EBIs as they may contribute towards a reduction of the health disparities and inequities that disproportionately affect sectors of the major ethnocultural populations in the USA. We also present a systems analysis of approaches and challenges in the dissemination and implementation of EBIs within the contemporary integrative care environment. Finally, we mention an initiative for, "building a science of intervention adaptation," that proposes systematic research and the creation of an archive of scientific data on the benefits and problems of intervention adaptation. Collectively, these new directions can integrate scientific rigor and sensitivity to cultural factors, for enhancing the effectiveness and reach of this second generation of evidence-based interventions with diverse ethnocultural populations.
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