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Frohlich JR, Rapinda KK, Schaub MP, Wenger A, Baumgartner C, Johnson EA, Blankers M, Ebert DD, Hadjistavropoulos HD, Mackenzie CS, Wardell JD, Edgerton JD, Keough MT. Examining differential responses to the Take Care of Me trial: A latent class and moderation analysis. Addict Behav Rep 2022; 16:100437. [PMID: 35694108 PMCID: PMC9184289 DOI: 10.1016/j.abrep.2022.100437] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/01/2022] [Accepted: 05/29/2022] [Indexed: 11/30/2022] Open
Abstract
Take Care of Me participants fell into three classes varying in risk. The low-risk class had the lowest pre-treatment symptom severity. The high-risk group had the highest symptom severity and executive dysfunction. Moderate risk individuals experienced the greatest benefits of the program. Future interventions may be tailored based on risk to maximize efficacy.
Given prevalent alcohol misuse-emotional comorbidities among young adults, we developed an internet-based integrated treatment called Take Care of Me. Although the treatment had an impact on several secondary outcomes, effects were not observed for the primary outcome. Therefore, the goal of the current study was to examine heterogeneity in treatment responses. The initial RCT randomized participants to either a treatment or psychoeducational control condition. We conducted an exploratory latent class analysis to distinguish individuals based on pre-treatment risk and then used moderated regressions to examine differential treatment responses based on class membership. We found evidence for three distinct groups. Most participants fell in the “low severity” group (n = 123), followed by the “moderate severity” group (n = 57) who had a higher likelihood of endorsing a previous mental health diagnosis and treatment and higher symptom severity than the low group. The “high severity” group (n = 42) endorsed a family history of alcoholism, and the highest symptom severity and executive dysfunction. Moderated regressions revealed significant class differences in treatment responses. In the treatment condition, high severity (relative to low) participants reported higher alcohol consumption and hazardous drinking and lower quality of life at follow-up, whereas moderate severity (relative to low) individuals had lower alcohol consumption at follow-up, and lower hazardous drinking at end-of-treatment. No class differences were found for participants in the control group. Higher risk individuals in the treatment condition had poorer responses to the program. Tailoring interventions to severity may be important to examine in future research.
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Affiliation(s)
- Jona R. Frohlich
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Corresponding author at: Department of Psychology, University of Manitoba, 190 Dysart Rd., Winnipeg, Manitoba R3T 2N2, Canada.
| | - Karli K. Rapinda
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Michael P. Schaub
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Andreas Wenger
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Christian Baumgartner
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Edward A. Johnson
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Matthijs Blankers
- Arkin Mental Health Care, University of Amsterdam, Amsterdam, Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
- Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, Netherlands
| | - David D. Ebert
- Department of eMental Health, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | | | - Jeffrey D. Wardell
- Department of Psychology, York University, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jason D. Edgerton
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, MB, Canada
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Kenney A, Cox N, Bryan MA, Cochran G. Brief intervention medication therapy management: Establishment of an opioid misuse intervention model delivered in a community pharmacy. Am J Health Syst Pharm 2021; 78:310-319. [PMID: 33386733 PMCID: PMC7868881 DOI: 10.1093/ajhp/zxaa389] [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] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Medication expertise and close patient contact position community pharmacists to make significant contributions to combatting the opioid epidemic. This position facilitated the development and initial implementation of the Brief Intervention Medication Therapy Management (BIMTM) model to detect and address patient opioid misuse. BIMTM is an intervention consisting of 9 sessions. One medication management session is delivered by a pharmacist in a community pharmacy setting, and the remaining sessions are delivered telephonically by a patient navigator to follow up with goals established with the pharmacist and address concomitant health concerns that increase risk for misuse. METHODS We employed the Consolidated Framework for Implementation Research (CFIR) to summarize and present key findings from 4 distinct studies. CFIR domains addressed were (1) intervention characteristics, (2) outer setting, (3) inner setting, (4) process, and (5) characteristics of individuals. The study results show sequential development of evidence for BIMTM. RESULTS A multistate cross-sectional pharmacist survey (n = 739) demonstrated limited pharmacist training and/or resources to address misuse, suggesting the need for external intervention development. Our multistakeholder intervention planning project showed limitations of current evidence-based models of care and of intervention implementation, which resulted in construction of the BIMTM. A multisite cross-sectional screening survey of patients (n = 333) established an electronic misuse screening protocol within 4 community pharmacies and identified opioid misuse in 15% of screened patients; among those patients, 98% had concomitant health conditions that contribute to the risk of opioid misuse. Presentation of study results to pharmacy leaders produced commitment for intervention implementation and a partnership to develop a grant proposal supporting this action. Our small-scale randomized trial evinced success in recruitment and retention and BIMTM patient benefit. The small-scale randomized trial likewise showed high levels of satisfaction with BIMTM. CONCLUSION The establishment of BIMTM supports community pharmacist identification and intervention with patients engaged in misuse. Continued use of this research-based strategy may further empower pharmacists to address the opioid epidemic.
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Affiliation(s)
- Amy Kenney
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Nicholas Cox
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - M Aryana Bryan
- University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | - Gerald Cochran
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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Barnes TS, Lajarca A, Bernales R, Alvaran PJJ, Abe FS, Adonay F, Allam AG, Baluyut AS, de Castro RO, Ignacio CS, Lantican TLD, Lapuz EL, Lasay J, Mananggit MR, Meers J, Moog SJ, Palaniappan G, Palmieri C, Parke CR, Rosales JS, Tapel M, Tolentino J, Turni C, Villarba L, Villar EC, Blackall PJ. Latent class analysis identifies multimorbidity patterns in pigs with respiratory disease. Prev Vet Med 2020; 186:105209. [PMID: 33243483 DOI: 10.1016/j.prevetmed.2020.105209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 10/23/2022]
Abstract
Respiratory disease is one of the major causes of losses to the pig industry worldwide. The pig subsector is the largest component of the livestock sector in the Philippines. Using lung scoring, this study aimed to estimate the prevalence of thoracic lesions in slaughter-age pigs in two provinces in the Philippines (Batangas and Albay) and define classes for respiratory health of pigs characterised by different patterns of thoracic lesions. A total of 260 pigs from Batangas and 300 pigs from Albay from either commercial or backyard farm types were included in this cross-sectional study. Lungs were scored for cranio-ventral pneumonia (0-55) and pleurisy (0-3). Presence or absence of pericarditis as well as focal dorso-caudal pneumonia were recorded. Latent class analyses considering four indicator variables, and province and farm type as covariates were used to explore different patterns of thoracic lesions across the study populations. Using a threshold of ≥7, the prevalence of a high lung score was 51.9% (95% confidence interval [CI]: 42.3-61.4%) and 13.7% (95% CI: 8.1-22.2%) in Batangas and Albay, respectively. Similarly, the prevalence of a pleurisy score of ≥1 was 56.9% (95% CI: 37.5-74.4%) and 5.0% (95% CI: 2.9-8.4%), pericarditis 24.6% (95%CI: 10.1-48.6%) and 1.7% (95%CI: 0.3-6.7%) and focal dorso-caudal pneumonia lesions 7.7% (95% CI: 3.7-15.5%) and 0% (97.5% one-sided CI: 0-1.2%), respectively. Latent class analyses identified four classes based on lung score, pleurisy score and the presence/absence of pericarditis: "healthy", "mild respiratory disease", "moderate pneumonia", and "multi-lesion". The relative frequency of these classes differed with province and farm type. Most pigs from Albay were "healthy", whereas in Batangas most pigs from commercial farms were "multi-lesion" and those from backyard farms were in the "mild respiratory disease" class. This study has provided baseline data on thoracic lesions in slaughter-age pigs for the provinces of Batangas and Albay in the Philippines. Targeting farms and areas where "multi-lesion pigs" are most common and further research to identify risk factors for particular classes should maximize impact of future control measures. The latent class analysis approach used could be applied more widely and could add value to analysis of multi-morbidity data collected routinely as part of ongoing monitoring schemes.
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Affiliation(s)
- Tamsin S Barnes
- The University of Queensland, School of Veterinary Science, Gatton, QLD, 4343, Australia; The University of Queensland, Queensland Alliance for Agriculture and Food Innovation, Brisbane, QLD, 4102, Australia.
| | | | | | | | | | | | - Alvin G Allam
- Dept. of Agriculture 3 - RADDL, Pampanga, Philippines
| | | | - Ronilo O de Castro
- Livestock Research Division DOST-PCAARRD, Los Baños, Laguna, Philippines
| | | | | | | | - Jommel Lasay
- City Veterinary Office of Lipa City, Batangas, Philippines
| | | | - Joanne Meers
- The University of Queensland, School of Veterinary Science, Gatton, QLD, 4343, Australia
| | - Sarah Jane Moog
- Provincial Veterinary Office of Batangas, Batangas, Philippines
| | - Gomathy Palaniappan
- The University of Queensland, Queensland Alliance for Agriculture and Food Innovation, Brisbane, QLD, 4102, Australia
| | - Chiara Palmieri
- The University of Queensland, School of Veterinary Science, Gatton, QLD, 4343, Australia
| | - Christopher R Parke
- The University of Queensland, School of Veterinary Science, Gatton, QLD, 4343, Australia
| | | | - Marlon Tapel
- Provincial Veterinary Office of Albay, Albay, Philippines
| | | | - Conny Turni
- The University of Queensland, Queensland Alliance for Agriculture and Food Innovation, Brisbane, QLD, 4102, Australia
| | | | - Edwin C Villar
- Livestock Research Division DOST-PCAARRD, Los Baños, Laguna, Philippines
| | - Patrick J Blackall
- The University of Queensland, Queensland Alliance for Agriculture and Food Innovation, Brisbane, QLD, 4102, Australia
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Cochran G, Field C, Foreman M, Ylioja T, Brown CVR. Effects of brief intervention on subgroups of injured patients who drink at risk levels. Inj Prev 2016; 22:221-5. [PMID: 26124071 PMCID: PMC4726485 DOI: 10.1136/injuryprev-2015-041596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/12/2015] [Indexed: 11/04/2022]
Abstract
Alcohol-related injuries are a major source of admission for trauma care. Screening and brief intervention (SBI) for injured patients can result in decreased drinking and risk behaviors. It is not clear SBI is equally beneficial for all injured patients. A secondary data analysis of 553 patients admitted to two Level-1 trauma centers was conducted. Latent class analysis was used to identify patient subgroups based on injury-related risks and consequences of alcohol use. Intervention effects on drinking were examined among subgroups. Five subgroups were identified. Drinking improved in patients reporting multiple risks and injuries/accidents and drinking and driving. Patients that reported drinking and driving and taking foolish risks or fighting while drinking and taking foolish risks did not show improvements. Trauma centers may benefit from targeting interventions based on injury-related risks and consequences of alcohol use. Further research is needed to test bedside approaches for tailored interventions.
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Affiliation(s)
- Gerald Cochran
- University of Pittsburgh, Assistant Professor, School of Social Work, School of Medicine, Department of Psychiatry, 4200 Forbes Ave. #2006, Pittsburgh PA, 15260, Phone: (412) 624-2325, Fax: (412) 624-6323
| | - Craig Field
- University of Texas, El Paso, Department of Psychology, El Paso TX, USA
| | | | - Thomas Ylioja
- University of Pittsburgh, School of Social Work, Pittsburgh PA, USA
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