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Morgan JR, Reif S, Stewart MT, Larochelle MR, Adams RS. Characterizing the Association Between Traumatic Brain Injury and Discontinuation of Medications for Opioid Use Disorder in a Commercially Insured Adult Population. J Head Trauma Rehabil 2024:00001199-990000000-00170. [PMID: 39019485 DOI: 10.1097/htr.0000000000000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
OBJECTIVE Extending prior research that has found that people with traumatic brain injury (TBI) experience worse substance use treatment outcomes, we examined whether history of TBI was associated with discontinuation of medication to treat opioid use disorder (MOUD), an indicator of receiving evidence-based treatment. SETTING We used MarketScan claims data to capture inpatient, outpatient, and retail pharmacy utilization from large employers in all 50 states from 2016 to 2019. PARTICIPANTS We identified adults aged 18 to 64 initiating non-methadone MOUD (ie, buprenorphine, injectable naltrexone, and oral naltrexone) in 2016-2019. The exposure was whether an individual had a TBI diagnosis in the 2 years before initiating MOUD. During this period, there were 709 individuals with TBI who were then matched with 709 individuals without TBI. DESIGN We created a retrospective cohort of matched individuals with and without TBI and used quasi-experimental methods to identify the association between TBI status and MOUD use. We estimated propensity scores by TBI status and created a 1:1 matched cohort of people with and without TBI who initiated MOUD. We used a Cox proportional hazards model to identify the association between TBI and MOUD discontinuation. MAIN MEASURE The outcome was discontinuation of MOUD (ie, a gap of 14 days or more of MOUD). RESULTS Among those initiating MOUD, the majority were under 26 years of age, male, and living in an urban setting. Nearly 60% of individuals discontinued medication by 6 months. Adults with TBI had an elevated risk of MOUD discontinuation (hazard ratio [HR] 1.13; 95% confidence interval [CI], 1.01-1.27) compared to those without TBI. Additionally, initiating oral naltrexone was associated with a higher risk of discontinuation (HR 1.63; 95% CI, 1.40-1.90). CONCLUSION We found evidence of reduced MOUD retention among people with TBI. Differences in MOUD retention may reflect health care inequities, as there are no medical contraindications to using MOUD for people with TBI or other disabilities.
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Affiliation(s)
- Jake R Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts (Dr Morgan); Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA (Dr Stewart); Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, USA (Dr Larochelle); and Rocky Mountain Mental Illness Research Education and Clinical Center, Veterans Affairs, Aurora, Colorado, USA (Dr Adams)
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Shoyer J, Ruggiero KJ, Abu K, Birk N, Conde C, Ryan P, Knutzen T, Engstrom A, Russo J, Wang J, Zatzick DF. Engaging and following physical injury survivors at risk for developing posttraumatic stress disorder symptoms: A 25 site US national study. Injury 2024; 55:111426. [PMID: 38423897 PMCID: PMC11023765 DOI: 10.1016/j.injury.2024.111426] [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: 10/13/2023] [Revised: 01/12/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Early intervention for patients at risk for Posttraumatic Stress Disorder (PTSD) relies upon the ability to engage and follow trauma-exposed patients. Recent requirements by the American College of Surgeons Committee on Trauma (College) have mandated screening and referral for patients with high levels of risk for the development of PTSD or depression. Investigations that assess factors associated with engaging and following physically injured patients may be essential in assessing outcomes related to screening, intervention, and referral. METHODS This investigation was a secondary analysis of data collected as part of a United States level I trauma center site randomized clinical trial. All 635 patients were ages ≥18 and had high PTSD symptom levels (i.e., DSM-IV PTSD Checklist score ≥35) at the time of the baseline trauma center admission. Baseline technology use, demographic, and injury characteristics were collected for patients who were followed up with over the course of the year after physical injury. Regression analyses were used to assess the associations between technology use, demographic and injury characteristics, and the attainment of follow-up outcome assessments. RESULTS Thirty-one percent of participants were missing one or more 3-, 6- or 12-month follow-up outcome assessments. Increased risk of missing one or more outcome assessments was associated with younger age (18-30 versus ≥55 Relative Risks [RR] = 1.78, 95 % Confidence Interval [CI] = 1.09, 2.91), lack of cell phone (RR = 1.32, 95 % CI = 1.01, 1.72), no internet access (RR = 1.47, 95 % CI = 1.01, 2.16), public versus private insurance (RR = 1.47, 95 % CI = 1.12, 1.92), having no chronic medical comorbidities (≥4 versus none, RR = 0.28, 95 % CI = 0.20, 0.39), and worse pre-injury mental health function (RR = 0.99, 95 % CI = 0.98, 0.99). CONCLUSIONS This multisite investigation suggests that younger and publicly insured and/or uninsured patients with barriers to cell phone and internet access may be particularly vulnerable to lapses in trauma center follow-up. Clinical research informing trauma center-based screening, intervention, and referral procedures could productively explore strategies for patients at risk for not engaging and adhering to follow-up care and outcome assessments.
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Affiliation(s)
- Jake Shoyer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Kenneth J Ruggiero
- Departments of Nursing and Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, USA
| | - Khadija Abu
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Navneet Birk
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Cristina Conde
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Paige Ryan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Tanya Knutzen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Douglas F Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
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Starks TJ, Samrock S, Lopez D, Bradford-Rogers J, Marmo J, Cain D. Testing the Effectiveness of a Motivational Interviewing Intervention to Reduce HIV Risk and Drug Use in Young Sexual Minority Men in a Community-Based Organization Setting. AIDS Behav 2024; 28:26-42. [PMID: 37803244 PMCID: PMC10873079 DOI: 10.1007/s10461-023-04191-0] [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] [Accepted: 09/19/2023] [Indexed: 10/08/2023]
Abstract
Younger sexual minority men (YSMM) remain at high risk for HIV infection and substance use increases this risk. This study evaluated the effectiveness of a (4-session) motivational interviewing (MI) intervention to reduce substance use and sexual risk taking when delivered at two community-based organizations (CBOs) in the New York City metropolitan area. Participants included 86 YSMM aged 15-29 who reported recent sexual HIV transmission risk and substance use. Overall, 86% of the sample identified as a racial or ethnic minority. Within each CBO, participants were randomized to receive either the MI intervention or enhanced treatment as usual (an HIV testing session plus PrEP information and referrals to CBO services). Contrary to hypotheses, results provided no indication that the MI intervention was associated with reductions in substance use (alcohol, cannabis, or other illicit drug use) or sexual risk taking or current PrEP use. Results are discussed in terms of challenges in real world intervention implementation, study enrollment, and the COVID-19 pandemic.
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Affiliation(s)
- Tyrel J Starks
- Department of Psychology, Hunter College, City University of New York, 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA.
- Graduate Program in Health Psychology and Clinical Practice, Graduate Center, City University of New York, New York, NY, USA.
| | - Steven Samrock
- Department of Psychology, Hunter College, City University of New York, 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
| | | | - Jesse Bradford-Rogers
- Department of Psychology, Hunter College, City University of New York, 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
| | - Jonathan Marmo
- Department of Psychology, Hunter College, City University of New York, 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
| | - Demetria Cain
- Department of Psychology, Hunter College, City University of New York, 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
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Knutzen T, Bulger E, Iles-Shih M, Hernandez A, Engstrom A, Whiteside L, Birk N, Abu K, Shoyer J, Conde C, Ryan P, Wang J, Russo J, Heagerty P, Palinkas L, Zatzick D. Stepped collaborative care versus American College of Surgeons Committee on Trauma required screening and referral for posttraumatic stress disorder: Clinical trial protocol. Contemp Clin Trials 2024; 136:107380. [PMID: 37952714 PMCID: PMC11025340 DOI: 10.1016/j.cct.2023.107380] [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: 08/10/2023] [Revised: 10/13/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Each year in the US, approximately 1.5-2.5 million individuals are so severely injured that they require inpatient hospital admissions. The American College of Surgeons Committee on Trauma (College) now requires that trauma centers have in place protocols to identify and refer hospitalized patients at risk injury psychological sequelae. Literature review revealed no investigations that have identified optimal screening, intervention, and referral procedures in the wake of the College requirement. METHODS The single-site pragmatic trial investigation will individually randomize 424 patients (212 intervention and 212 control) to a brief stepped care intervention versus College required mental health screening and referral control conditions. Blinded follow-up interviews at 1-, 3-, 6-, and 12-months post-injury will assess the symptoms of PTSD and related comorbidity for all patients. The emergency department information exchange (EDIE) will be used to capture population-level automated emergency department and inpatient utilization data for the intent-to-treat sample. The investigation aims to test the primary hypotheses that intervention patients will demonstrate significant reductions in PTSD symptoms and emergency department/inpatient utilization when compared to control patients. The study incorporates a Rapid Assessment Procedure-Informed Clinical Ethnography (RAPICE) implementation process assessment. CONCLUSIONS The overarching goal of the investigation is to advance the sustainable delivery of high-quality trauma center mental health screening, intervention, and referral procedures for diverse injury survivors. An end-of-study policy summit will harness pragmatic trial data to inform the capacity for US trauma centers to implement high-quality acute care mental health screening, intervention and referral services for diverse injured patient populations. TRIAL REGISTRATION Clinicaltrials.govNCT05632770.
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Affiliation(s)
- Tanya Knutzen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, USA.
| | - Matt Iles-Shih
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Alexandra Hernandez
- Department of Surgery, University of Washington School of Medicine, Seattle, USA.
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
| | - Navneet Birk
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Khadija Abu
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Jake Shoyer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Cristina Conde
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Paige Ryan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington School of Public Health, Seattle, USA.
| | - Larry Palinkas
- Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, USA.
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
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Beck AK, Baker AL, Britton B, Lum A, Pohlman S, Forbes E, Moore L, Barnoth D, Perkes SJ, Oldmeadow C, Carter G. Adapted motivational interviewing for brief healthcare consultations: A systematic review and meta-analysis of treatment fidelity in real-world evaluations of behaviour change counselling. Br J Health Psychol 2023; 28:972-999. [PMID: 37144242 PMCID: PMC10947272 DOI: 10.1111/bjhp.12664] [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: 11/24/2022] [Revised: 02/23/2023] [Accepted: 04/03/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Behaviour change counselling (BCC) is an adaptation of motivational interviewing (MI) designed to maximize the effectiveness of time-limited health behaviour change consultations. To improve intervention quality and understanding of treatment effects, it is recommended that evaluations of health behaviour change interventions incorporate existing fidelity frameworks (e.g. The National Institutes of Health [NIH] Behaviour Change Consortium) and ensure that treatment fidelity is assessed and reported. PURPOSE This systematic review was designed to examine (a) adherence to NIH fidelity recommendations, (b) provider fidelity to BCC and (c) impact of these variables on the real-world effectiveness of BCC for adult health behaviours and outcomes. METHODS AND RESULTS Searches of 10 electronic databases yielded 110 eligible publications describing 58 unique studies examining BCC delivered within real-world healthcare settings by existing providers. Mean study adherence to NIH fidelity recommendations was 63.31% (Range 26.83%-96.23%). Pooled effect size (Hedges g) for short-term and long-term outcomes was .19 (95% CI [.11, .27]) and .09 (95% CI [.04, .13]), respectively. In separate, random-effects meta-regressions, neither short-term nor long-term effect sizes were significantly modified by adherence to NIH fidelity recommendations. For the subgroup of short-term alcohol studies (n = 10), a significant inverse relationship was detected (Coefficient = -.0114, 95% CI [-.0187, -.0041], p = .0021). Inadequate and inconsistent reporting within the included studies precluded planned meta-regression between provider fidelity and BCC effect size. CONCLUSIONS Further evidence is needed to clarify whether adherence to fidelity recommendations modifies intervention effects. Efforts to promote transparent consideration, evaluation and reporting of fidelity are urgently needed. Research and clinical implications are discussed.
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Affiliation(s)
- Alison K. Beck
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
| | - Amanda L. Baker
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
| | - Ben Britton
- Hunter New England HealthNew LambtonNew South WalesAustralia
| | - Alistair Lum
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
| | - Sonja Pohlman
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
| | - Erin Forbes
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
| | - Lyndell Moore
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
| | - Ditte Barnoth
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
| | - Sarah J. Perkes
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
| | - Chris Oldmeadow
- Clinical Research Design and Statistical ServiceHunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
| | - Gregory Carter
- School of Medicine and Public HealthThe University of NewcastleCallaghanNew South WalesAustralia
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Heimke IM, Connelly M, Clarke A, De Mario B, Breslin MA, Furdock R, Moore TA, Vallier HA. Recidivism after orthopaedic trauma has diminished over time. Eur J Trauma Emerg Surg 2023; 49:1891-1896. [PMID: 37162555 PMCID: PMC10170426 DOI: 10.1007/s00068-023-02274-0] [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: 01/24/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE The purpose was to analyze our trauma population during two periods to assess for predictors of recidivism. METHODS Prior (2007-2011, n = 879) and recent (2014-2019, n = 954) orthopaedic trauma patients were reviewed. Recidivists were those returning with an unrelated injury. Recidivism rates were compared, and factors associated with recidivism were identified. RESULTS Recidivism decreased: 18.7% to 14.3% (p = 0.01). Mean age and sex of the two cohorts were not different. Recent recidivists were more likely to sustain gunshot wound (GSW) injuries (22.1% vs 18.9%, p = 0.09), and mental illness was more common (56.6% vs 28.1%, p < 0.0001). The recent recidivist population was less often married (12.9% vs 23.8%, p = 0.03), and both recidivist groups were often underinsured (Medicaid or uninsured: (60.6% vs 67.0%)). CONCLUSION Recidivism diminished, although more GSW and mental illness were seen. Recidivists are likely to be underinsured. The changing profile of recidivists may be attributed to socioeconomic trends and new programs to improve outcomes after trauma.
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Affiliation(s)
- Isabella M Heimke
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Madison Connelly
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Amelia Clarke
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Belinda De Mario
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Mary A Breslin
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Ryan Furdock
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Timothy A Moore
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Heather A Vallier
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA.
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Zatzick D, Palinkas L, Chambers DA, Whiteside L, Moloney K, Engstrom A, Prater L, Russo J, Wang J, Abu K, Iles-Shih M, Bulger E. Integrating pragmatic and implementation science randomized clinical trial approaches: a PRagmatic Explanatory Continuum Indicator Summary-2 (PRECIS-2) analysis. Trials 2023; 24:288. [PMID: 37085877 PMCID: PMC10122352 DOI: 10.1186/s13063-023-07313-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/17/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Over the past two decades, pragmatic and implementation science clinical trial research methods have advanced substantially. Pragmatic and implementation studies have natural areas of overlap, particularly relating to the goal of using clinical trial data to leverage health care system policy changes. Few investigations have addressed pragmatic and implementation science randomized trial methods development while also considering policy impact. METHODS The investigation used the PRagmatic Explanatory Continuum Indicator Summary-2 (PRECIS-2) and PRECIS-2-Provider Strategies (PRECIS-2-PS) tools to evaluate the design of two multisite randomized clinical trials that targeted patient-level effectiveness outcomes, provider-level practice changes and health care system policy. Seven raters received PRECIS-2 training and applied the tools in the coding of the two trials. Descriptive statistics were produced for both trials, and PRECIS-2 wheel diagrams were constructed. Interrater agreement was assessed with the Intraclass Correlation (ICC) and Kappa statistics. The Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE) qualitative approach was applied to understanding integrative themes derived from the PRECIS-2 ratings and an end-of-study policy summit. RESULTS The ICCs for the composite ratings across the patient and provider-focused PRECIS-2 domains ranged from 0.77 to 0.87, and the Kappa values ranged from 0.25 to 0.37, reflecting overall fair-to-good interrater agreement for both trials. All four PRECIS-2 wheels were rated more pragmatic than explanatory, with composite mean and median scores ≥ 4. Across trials, the primary intent-to-treat analysis domain was consistently rated most pragmatic (mean = 5.0, SD = 0), while the follow-up/data collection domain was rated most explanatory (mean range = 3.14-3.43, SD range = 0.49-0.69). RAPICE field notes identified themes related to potential PRECIS-2 training improvements, as well as policy themes related to using trial data to inform US trauma care system practice change; the policy themes were not captured by the PRECIS-2 ratings. CONCLUSIONS The investigation documents that the PRECIS-2 and PRECIS-2-PS can be simultaneously used to feasibly and reliably characterize clinical trials with patient and provider-level targets. The integration of pragmatic and implementation science clinical trial research methods can be furthered by using common metrics such as the PRECIS-2 and PRECIS-2-PS. Future study could focus on clinical trial policy research methods development. TRIAL REGISTRATION DO-SBIS ClinicalTrials.gov NCT00607620. registered on January 29, 2008. TSOS ClinicalTrials.gov NCT02655354, registered on July 27, 2015.
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Affiliation(s)
- Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Lawrence Palinkas
- Department of Children, Youth, and Families, California School of Social Work, University of Southern, Los Angeles, CA, USA
| | - David A Chambers
- Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, USA
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Laura Prater
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Khadija Abu
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Matt Iles-Shih
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Eileen Bulger
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, USA
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
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Nguyen J, Whiteside LK, Bulger EM, Veach L, Moloney K, Russo J, Nehra D, Wang J, Zatzick DF. Post-traumatic stress disorder (PTSD) symptoms and alcohol and drug use comorbidity at 25 US level I trauma centers. Trauma Surg Acute Care Open 2022; 7:e000913. [PMID: 35979039 PMCID: PMC9358953 DOI: 10.1136/tsaco-2022-000913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/13/2022] [Indexed: 11/06/2022] Open
Abstract
Background Questions regarding the extent to which post-traumatic stress disorder (PTSD) is comorbid with alcohol and drug use are particularly germane in an era when the American College of Surgeons Committee on Trauma (ACS-COT) is considering policy requiring screening, intervention and/or referral services for patients presenting with psychological sequalae of traumatic injury. Literature review revealed few multisite trauma-center-based investigations that have assessed the association between PTSD symptoms and alcohol and drug use comorbidities in injured patients. Methods This investigation was a secondary analysis of baseline data collected prior to randomization in a 25-site trauma center pragmatic clinical trial. All 635 patients included in the investigation had elevated PTSD symptom levels at the time of trauma center admission. Self-report questionnaire screening, laboratory toxicology results, and electronic health record data were combined to assess the frequencies of alcohol, stimulant (i.e., amphetamine and cocaine), opioid and marijuana use comorbidities for injured patients. Logistic regression was used to assess the associations between demographic and injury characteristics and alcohol and drug use comorbidity. Results The frequency of patients with one or more alcohol or substance use comorbidity was between 62% and 79%. Over 50% of patients were positive for one or more alcohol or cannabis comorbidity. Approximately 26% of patients were positive for stimulants and 10% for opioid comorbidity. Discussion This multisite investigation suggests that between 62% and 79% of hospitalized injury survivors with elevated PTSD symptoms have one or more alcohol or drug use comorbidity. Orchestrated ACS-COT policy and trauma center service delivery development should incorporate the key finding that a substantial majority of patients with high levels of psychological distress (eg, elevated PTSD symptoms) may have alcohol and drug use comorbidities. Level of evidence Level II (epidemiological investigation of untreated controls from a multisite randomized clinical trial) Trial registration number NCT02655354.
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Affiliation(s)
- Jefferson Nguyen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lauren K Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Laura Veach
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Deepika Nehra
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Douglas F Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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Whiteside LK, Huynh L, Morse S, Hall J, Meurer W, Banta-Green CJ, Scheuer H, Cunningham R, McGovern M, Zatzick DF. The Emergency Department Longitudinal Integrated Care (ED-LINC) intervention targeting opioid use disorder: A pilot randomized clinical trial. J Subst Abuse Treat 2022; 136:108666. [PMID: 34952745 PMCID: PMC9056018 DOI: 10.1016/j.jsat.2021.108666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/09/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Opioid use disorder (OUD) and related comorbid conditions are highly prevalent among patients presenting to emergency department (ED) settings. Research has developed few comprehensive disease management strategies for at-risk patients presenting to the ED that both decrease illicit opioid use and improve initiation and retention in medication treatment for OUD (MOUD). METHODS The research team conducted a pilot pragmatic clinical trial that randomized 40 patients presenting to a single ED to a collaborative care intervention (n = 20) versus usual care control (n = 20) conditions. Interviewers blinded to patient intervention and control group status followed-up with participants at 1, 3, and 6 months after presentation to the ED. The 3-month Emergency Department Longitudinal Integrated Care (ED-LINC) collaborative care intervention for patients at risk for OUD included: 1) a Brief Negotiated Interview at bedside, 2) overdose education and facilitation of MOUD, 3) longitudinal proactive care management, 4) utilization of the statewide health information exchange platform for 24/7 tracking of recurrent ED utilization, and 5) weekly caseload supervision that incorporated measurement-based care treatment assessment with stepped-up care for patients with recalcitrant symptoms. RESULTS Overall, the ED-LINC intervention was feasibly delivered and acceptable to patients. The pilot study achieved >80% follow-up rates at 1, 3, and 6 months. In adjusted longitudinal mixed model regression analyses, no statistically significant differences existed in days of opioid use over the past 30 days for ED-LINC intervention patients when compared to patients receiving usual care (incidence-rate ratio (IRR) 1.50, 95% CI 0.54-4.16). The unadjusted mean number of days of illicit opioid use decreased at the 1-month and 3-month follow-up time points for both groups. ED-LINC intervention patients had increased rates of MOUD initiation compared to control patients (50% versus 30%); intervention versus control comparisons did not achieve statistical significance, although power to detect significant differences in the pilot was limited. CONCLUSIONS The ED-LINC intervention for patients with OUD can be feasibly implemented and warrants testing in larger scale, adequately powered randomized pragmatic clinical trial investigations. CLINICALTRIALS gov NCT03699085.
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Affiliation(s)
- Lauren K Whiteside
- Department of Emergency Medicine & Harborview Injury Prevention and Research Center, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America.
| | - Ly Huynh
- Department of Emergency Medicine, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America.
| | - Sophie Morse
- Department of Emergency Medicine, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America.
| | - Jane Hall
- Department of Emergency Medicine, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America.
| | - William Meurer
- Department of Emergency Medicine, University of Michigan Medical School, 1500 E Medical Center Drive, Ann Arbor, MI 48109-5303, United States of America.
| | - Caleb J Banta-Green
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America.
| | - Hannah Scheuer
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America.
| | - Rebecca Cunningham
- Department of Emergency Medicine, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Rd Bldg. 10-G080, Ann Arbor, MI 48109-2800, United States of America.
| | - Mark McGovern
- Department of Psychiatry & Behavioral Sciences and Department of Medicine, Stanford University School of Medicine, 1520 Page Mill Road Suite 158, MC 5721, Stanford, CA 94305, United States of America.
| | - Douglas F Zatzick
- Department of Psychiatry & Behavioral Sciences & Harborview Injury Prevention and Research Center, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America.
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Bulger E, Johnson P, Parker L, Moloney KE, Roberts MK, Vaziri N, Seo S, Nehra D, Thomas P, Zatzick D. Nationwide Survey of Trauma Center Screening and Intervention Practices for Posttraumatic Stress Disorder, Firearm Violence, Mental Health, and Substance Use Disorders. J Am Coll Surg 2022; 234:274-287. [PMID: 35213489 PMCID: PMC10234338 DOI: 10.1097/xcs.0000000000000064] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) symptoms, firearm violence events, alcohol and drug use problems, and major depression and suicidal ideation are endemic among patients admitted to US trauma centers. Despite increasing policy importance, the current availability of screening and intervention services for this constellation of conditions in US trauma centers is unknown. STUDY DESIGN Trauma program staff at all Level I and Level II trauma centers in the US. (N = 627) were contacted to complete a survey describing screening and intervention procedures for alcohol and drug use problems, PTSD symptoms, depression and suicidality, and firearm violence. Additional questions asked trauma centers about the delivery of peer interventions and information technology capacity for screening and intervention procedures. RESULTS Fifty-one percent of trauma centers (n = 322) responded to the survey. More than 95% of responding sites endorsed routinely screening and/or intervening for alcohol use problems. Routine services addressing PTSD were less common, with 28% of centers reporting routine screening. More than 50% of sites that screened for PTSD used previously established trauma center alcohol use services. Programmatic screening and intervention for firearm injury sequelae was occurring at 30% of sites. CONCLUSION Alcohol screening and intervention is occurring frequently at US trauma centers and appears to be responsive to American College of Surgeons Committee on Trauma verification requirements. Routine screening and intervention services for PTSD and firearm injury were occurring less frequently. Regular national surveys may be a key element of tracking progress in national mental health and substance use screening, intervention, and referral policy.
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Affiliation(s)
- Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Peyton Johnson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Lea Parker
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
- Department of Psychology, Drexel University College of Arts and Sciences, Philadelphia, PA
| | - Kathleen E Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Michelle K Roberts
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
- Department of Anthropology, University of Kentucky College of Arts and Sciences, Lexington, KY
| | - Natalie Vaziri
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Sara Seo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Peter Thomas
- Powers Pyles Sutter & Verville PC, Washington, DC
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, WA
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11
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Nehra D, Bulger EM, Maier RV, Moloney KE, Russo J, Wang J, Anderson K, Zatzick DF. A Prospective US National Trauma Center Study of Firearm Injury Survivors Weapon Carriage and Posttraumatic Stress Disorder Symptoms. Ann Surg 2021; 274:e364-e369. [PMID: 34225296 PMCID: PMC8434993 DOI: 10.1097/sla.0000000000005043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the demographic, injury-related, and mental health characteristics of firearm injury patients and trace firearm weapon carriage and PTSD symptoms over the year after injury. SUMMARY AND BACKGROUND DATA Based on the increasing incidence of firearm injury and need for novel injury prevention strategies, hospital-based violence intervention programs are being implemented in US trauma centers. There is limited data on the long-term outcomes and risk behaviors of firearm injury survivors to guide this work. METHODS We conducted a secondary analysis of a pragmatic 25-trauma center randomized trial (N = 635). Baseline characteristics of firearm-injured patients (N = 128) were compared with other trauma patients. Mixed model regression was used to identify risk factors for postinjury firearm weapon carriage and PTSD symptoms. RESULTS Firearm injury patients were younger and more likely to be black, male and of lower socioeconomic status, and more likely to carry a firearm in the year before injury. Relative to preinjury, there was a significant drop in firearm weapon carriage at 3- and 6-months postinjury, followed by a return to preinjury levels at 12-months. Firearm injury was significantly and independently associated with an increased risk of postinjury firearm weapon carriage [relative risk = 2.08, 95% confidence interval (1.34, 3.22), P < 0.01] and higher PTSD symptom levels [Beta = 3.82, 95% confidence interval (1.29, 6.35), P < 0.01]. CONCLUSIONS Firearm injury survivors are at risk for firearm carriage and high PTSD symptom levels postinjury. The significant decrease in the high-risk behavior of firearm weapon carriage at 3-6 months postinjury suggests that there is an important postinjury "teachable moment" that should be targeted with preventive interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT02655354.
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Affiliation(s)
- Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Ronald V Maier
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Kathleen E Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Jin Wang
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, USA
| | - Kristina Anderson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- The Koshka Foundation, Seattle, USA
| | - Douglas F Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, USA
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12
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Traumatic Brain Injury and Opioid Use: Additional Evidence Supporting the "Perfect Storm" of Cascading Vulnerabilities. J Head Trauma Rehabil 2021; 36:303-309. [PMID: 34489381 DOI: 10.1097/htr.0000000000000730] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Zatzick D, Moloney K, Palinkas L, Thomas P, Anderson K, Whiteside L, Nehra D, Bulger E. Catalyzing the Translation of Patient-Centered Research Into United States Trauma Care Systems: A Case Example. Med Care 2021; 59:S379-S386. [PMID: 34228020 PMCID: PMC8263139 DOI: 10.1097/mlr.0000000000001564] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The expedient translation of research findings into sustainable intervention procedures is a longstanding health care system priority. The Patient-Centered Outcomes Research Institute (PCORI) has facilitated the development of "research done differently," with a central tenet that key stakeholders can be productively engaged throughout the research process. Literature review revealed few examples of whether, as originally posited, PCORI's innovative stakeholder-driven approach could catalyze the expedient translation of research results into practice. OBJECTIVES This narrative review traces the historical development of an American College of Surgeons Committee on Trauma (ACS/COT) policy guidance, facilitated by evidence supplied by the PCORI-funded studies evaluating the delivery of patient-centered care transitions. Key elements catalyzing the guidance are reviewed, including the sustained engagement of ACS/COT policy stakeholders who have the capacity to invoke system-level implementation strategies, such as regulatory mandates linked to verification site visits. Other key elements, including the encouragement of patient stakeholder voice in policy decisions and the incorporation of end-of-study policy summits in pragmatic comparative effectiveness trial design, are discussed. CONCLUSIONS Informed by comparative effectiveness trials, ACS/COT policy has expedited introduction of the patient-centered care construct into US trauma care systems. A comparative health care systems conceptual framework for transitional care which incorporates Research Lifecycle, pragmatic clinical trial and implementation science models is articulated. When combined with Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE), employed as a targeted implementation strategy, this approach may accelerate the sustainable delivery of high-quality patient-centered care transitions for US trauma care systems.
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Affiliation(s)
- Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Lawrence Palinkas
- Department of Children, Youth and Families, USC Suzanne Dworak-Peck School of Social Work, Los Angeles, CA
| | - Peter Thomas
- Powers Pyles Sutter and Verville PC, Washington, DC
| | - Kristina Anderson
- The Koshka Foundation and Department of Psychiatry and Behavioral Sciences
| | | | - Deepika Nehra
- Surgery, University of Washington School of Medicine, Seattle, WA
| | - Eileen Bulger
- Surgery, University of Washington School of Medicine, Seattle, WA
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14
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Zatzick D, Jurkovich G, Heagerty P, Russo J, Darnell D, Parker L, Roberts MK, Moodliar R, Engstrom A, Wang J, Bulger E, Whiteside L, Nehra D, Palinkas LA, Moloney K, Maier R. Stepped Collaborative Care Targeting Posttraumatic Stress Disorder Symptoms and Comorbidity for US Trauma Care Systems: A Randomized Clinical Trial. JAMA Surg 2021; 156:430-474. [PMID: 33688908 DOI: 10.1001/jamasurg.2021.0131] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance To date, few multisite investigations have evaluated early interventions for injured patients with posttraumatic stress disorder (PTSD) symptoms. Objective To simultaneously assess the effectiveness and implementation of a brief stepped collaborative care intervention targeting PTSD and comorbidity. Design, Setting, and Participants A stepped-wedge cluster randomized clinical trial was conducted at 25 US level I trauma centers. Participants included hospitalized survivors of physical injury who underwent a 2-step evaluation for PTSD symptoms. Patients reporting high levels of distress on the PTSD Checklist (PCL-C) were randomized (N = 635) per the stepped-wedge protocol to enhanced usual care control (n = 370) or intervention (n = 265) conditions. The study was conducted from January 4, 2016, through November 2018. Data analysis was performed from November 4, 2019, to December 8, 2020. Interventions The Trauma Survivors Outcomes and Support collaborative care intervention included proactive injury case management that assisted patients transitioning from hospital inpatient to outpatient and community settings. The intervention also integrated evidence-based pharmacotherapy and psychotherapeutic elements targeting PTSD symptoms and comorbidity. Main Outcomes and Measures The primary study outcome was PTSD symptoms assessed with the PCL-C at baseline in the surgical ward and at 3, 6, and 12 months postinjury. Secondary outcomes included depressive symptoms, alcohol use, and physical function. Subgroup analyses examined the effect of baseline risk factors for enduring PTSD and quality of protocol implementation on study outcomes. Primary statistical analyses were conducted using the intent-to-treat sample. Results A total of 327 men (51.5%) were included in analysis; mean (SD) age was 39.0 (14.2) years. The investigation attained follow-up of 75% to 80% of the participants at 3 to 12 months. The intervention lasted a mean (SD) of 122 (132) minutes. Mixed model regression analyses revealed statistically significant changes in PCL-C scores for intervention patients compared with control patients at 6 months (difference, -2.57; 95% CI, -5.12 to -0.03; effect size, 0.18; P < .05) but not 12 months (difference, -1.27; 95% CI, -4.26 to 1.73; effect size, 0.08; P = .35). Subgroup analyses revealed larger PTSD treatment effects for patients with 3 or more baseline risk factors for enduring PTSD and for patients, including firearm injury survivors, treated at trauma centers with good or excellent protocol implementation. Intervention effects for secondary outcomes did not attain statistical significance. Conclusions and Relevance A brief stepped collaborative care intervention was associated with significant 6-month but not 12-month PTSD symptom reductions. Greater baseline PTSD risk and good or excellent trauma center protocol implementation were associated with larger PTSD treatment effects. Orchestrated efforts targeting policy and funding should systematically incorporate the study findings into national trauma center requirements and verification criteria. Trial Registration ClinicalTrials.gov Identifier: NCT02655354.
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Affiliation(s)
- Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.,Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle
| | - Gregory Jurkovich
- Department of Surgery, UC Davis School of Medicine, Sacramento, California
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington School of Public Health, Seattle
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Doyanne Darnell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Lea Parker
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.,Department of Psychology, Drexel University College of Arts and Sciences, Philadelphia, Pennsylvania
| | - Michelle K Roberts
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.,Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle
| | - Rddhi Moodliar
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.,Department of Psychology, University of California, Los Angeles
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Jin Wang
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle
| | - Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle
| | - Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle
| | - Lawrence A Palinkas
- Department of Children, Youth and Families, USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Ronald Maier
- Department of Surgery, University of Washington School of Medicine, Seattle
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15
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Brief alcohol interventions in U.S. medical settings: A systematic review of the implementation literature. J Subst Abuse Treat 2021; 131:108456. [PMID: 34098287 DOI: 10.1016/j.jsat.2021.108456] [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: 08/12/2020] [Revised: 02/20/2021] [Accepted: 04/26/2021] [Indexed: 11/21/2022]
Abstract
This systematic review provides a synthesis of the literature on brief alcohol intervention (BAI) implementation in medical settings. We utilized the Proctor et al. (2011) taxonomy of eight implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability) to organize and describe the qualitative and quantitative literature regarding BAI implementation. An electronic search of the PubMed database identified 25 articles that met inclusion criteria. The study team independently assessed all articles for methodological quality, with the majority of studies rated as weak to moderate. Descriptive and narrative review of the included articles identified penetration and acceptability as the two most commonly reported implementation outcomes. Studies rarely reported other outcomes (e.g., fidelity, cost, sustainability, adoption). On average, studies utilized approximately six implementation strategies to facilitate implementation, with education (96%), quality management (64%), and planning (56%) strategies the most frequently reported. Promising evidence exists that patients and providers are accepting of BAI implementation efforts and implementation efforts are helpful in expanding the reach of BAIs. A theory-informed approach to selecting implementation strategies may enhance implementation success in future work. When reporting on implementation, all studies should provide detailed BAI descriptions and strategies to enhance replication efforts. We suggest study designs that balance practical outcomes with methodological rigor to maximize the quality of future studies and better inform implementation efforts.
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16
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Economic Analysis of Brief Motivational Intervention Following Trauma Related to Drugs and Alcohol. Nurs Res 2020; 69:358-366. [PMID: 32555008 DOI: 10.1097/nnr.0000000000000455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Very few studies have conducted an economic assessment of brief motivational intervention (BMI) in patients experiencing traumatic injuries related to alcohol and/or substance use. Furthermore, findings concerning the potential long-term economic benefits of BMI applied in nursing are promising but very scarce. OBJECTIVE The purpose of this study was to analyze the costs and benefits associated with the application of a BMI program by nursing staff to patients hospitalized for trauma related to substance use. METHODS An analysis of costs and benefits was conducted in a nonrandomized study of a retrospective cohort of patients. An intervention and follow-up (of 10-52 months) of patients between 16 and 70 years of age admitted for traumatic injuries in University Hospital of Granada were carried out with a cohort of 294 patients (intervention = 162 vs. no intervention = 132) between 2011 and 2016. The National Health Service's perspective on the use of medical resources and the costs associated with intervention and recidivism was considered. A cost analysis with a 5-year time frame and a subsequent analysis of sensitivity were conducted. RESULTS Direct medical costs associated with trauma recidivism were significantly lower in patients who received BMI, as compared to patients who did not receive it, &OV0556;751.82 per patient (95% CI &OV0556;13.15 to &OV0556;1,490.48) in the first year. The cost-benefit ratio of &OV0556;74.92 at 4 years reflects National Health Service savings for each euro invested in BMI. DISCUSSION The implementation of BMI programs in nursing care may be profitable from an economic standpoint, justifying the inclusion of these programs in hospitals both because of their efficacy and the potential savings incurred by the health system. This study addresses the lack of evidence regarding the economic implications linked to the effectiveness of the intervention to reduce substance use and trauma recidivism. Results identify BMI delivered in hospitals by nurses as a technique that offers the potential for reducing costs linked to trauma recidivism. The research has important practical implications for hospital nurses and doctors.
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17
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Burner E, Zhang M, Terp S, Ford Bench K, Lee J, Lam CN, Torres JR, Menchine M, Arora S. Feasibility and Acceptability of a Text Message-Based Intervention to Reduce Overuse of Alcohol in Emergency Department Patients: Controlled Proof-of-Concept Trial. JMIR Mhealth Uhealth 2020; 8:e17557. [PMID: 32496203 PMCID: PMC7303828 DOI: 10.2196/17557] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/25/2020] [Accepted: 03/28/2020] [Indexed: 01/12/2023] Open
Abstract
Background Emergency department (ED) patients have high rates of risky alcohol use, and an ED visit offers an opportunity to intervene. ED-based screening, brief intervention, and referral to treatment (SBIRT) reduces alcohol use and health care costs. Mobile health (mHealth) interventions may expand the impact of SBIRTs but are understudied in low-resource ED populations. Objective The objective of this study was to assess the feasibility of and patient satisfaction with a text-based mHealth extension of an ED screening program to reduce risky alcohol use in low-income, urban patients. Methods Research assistants screened a convenience sample of ED patients in person for risky alcohol use via the Alcohol Use Disorders Identification Test (AUDIT). Patients who reported AUDIT scores ≥8 and <20 were informed of their AUDIT score and risk. RAs invited patients with SMS text message–capable phones to receive mROAD (mobilizing to Reduce Overuse of Alcohol in the ED), an SMS text message–based extension of the ED screening program. mROAD is a 7-day program of twice-daily SMS text messages based on the National Institutes of Health’s Rethinking Drinking campaign. Participants were allocated to a control group (daily sham text messages without specific guidance on behaviors, such as “Thanks for taking part!”) or to the mROAD intervention group. Patients were interviewed at 30 days to assess acceptability, satisfaction, and changes in drinking behavior. Satisfaction was examined descriptively. Pre and post measurements of drinking behaviors and motivation were compared, as were differences in change scores between the intervention arms. Results Of 1028 patients screened, 95 (9.2%) exhibited risky alcohol use based on AUDIT, and 23/95 (24%) of those patients did not own an SMS text messaging–capable phone; this left 72/95 (76%) eligible patients. Among eligible participants, 48/72 (67%) agreed to enroll; 31/48 (65%) achieved follow-up (18/24 (75%) in the intervention group and 13/24 (55%) in the control group). Participants who completed follow-up reported high satisfaction. Changes in behavior were similar between the arms. Overall, the number of drinking days reported in the prior 30 days decreased by 5.0 (95% CI 1.7-8.3; P=.004), and the number of heavy drinking days decreased by 4.1 (95% CI 1.0 to 7.15, P=.01). Patients reported an 11-point increase (95% CI 2.6-20, P=.01, 10% overall increase) in motivation to change alcohol use via the Change Questionnaire. The were no statistical differences in drinking days, heavy drinking days, or motivation to change between the arms. Conclusions The mROAD trial was feasible. Over three-quarters of ED patients with risky alcohol use owned a text message–capable phone, and two-thirds of these patients were willing to participate; only 1 patient opted out of the intervention. Although 35% of patients were lost to follow-up at 30 days, those patients who did follow up had favorable impressions of the program; more than 90% reported that SMS text messages were a “good way to teach,” and 89% of intervention arm participants enjoyed the program and found that the messages were motivating. Both the mROAD and sham message groups showed promising changes in alcohol use and motivation to change. mROAD is a feasible intervention that may reduce rates of risky alcohol use in ED patients. Trial Registration ClinicalTrials.gov NCT02158949; https://clinicaltrials.gov/ct2/show/NCT02158949
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Affiliation(s)
- Elizabeth Burner
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States
| | - Mark Zhang
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States
| | - Sophie Terp
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States.,Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States
| | - Kelsey Ford Bench
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States
| | - Joshua Lee
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States
| | - Chun Nok Lam
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States
| | - Jesus R Torres
- School of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Michael Menchine
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States.,Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States
| | - Sanjay Arora
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, United States.,Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States
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Valenstein-Mah H, Greer N, McKenzie L, Hansen L, Strom TQ, Wiltsey Stirman S, Wilt TJ, Kehle-Forbes SM. Effectiveness of training methods for delivery of evidence-based psychotherapies: a systematic review. Implement Sci 2020; 15:40. [PMID: 32460866 PMCID: PMC7251851 DOI: 10.1186/s13012-020-00998-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 05/07/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Extensive efforts have been made to train mental health providers in evidence-based psychotherapies (EBPs); there is increasing attention focused on the methods through which providers are trained to deliver EBPs. Evaluating EBP training methods is an important step in determining which methods are most effective in increasing provider skill and improving client outcomes. METHODS We searched MEDLINE (Ovid) and PsycINFO for randomized controlled trials published from 1990 through June 2019 that evaluated EBP training methods to determine the effectiveness of EBP training modalities on implementation (provider and cost) and client outcomes. Eligible studies (N = 28) were evaluated for risk of bias, and the overall strength of evidence was assessed for each outcome. Data was extracted by a single investigator and confirmed by a second; risk of bias and strength of evidence were independently rated by two investigators and determined by consensus. RESULTS Overall, EBP training improved short-term provider satisfaction, EBP knowledge, and adherence compared to no training or self-study of training materials (low to moderate strength of evidence). Training in an EBP did not increase treatment adoption compared to no training or self-study. No specific active EBP training modality was found to consistently increase provider EBP knowledge, skill acquisition/adherence, competence, adoption, or satisfaction compared to another active training modality. Findings were mixed regarding the additive benefit of post-training consultation on these outcomes. No studies evaluated changes in provider outcomes with regards to training costs and few studies reported on client outcomes. LIMITATIONS The majority of included studies had a moderate risk of bias and strength of evidence for the outcomes of interest was generally low or insufficient. Few studies reported effect sizes. The ability to identify the most effective EBP training methods was limited by low strength of evidence for the outcomes of interest and substantial heterogeneity among studies. CONCLUSIONS EBP training may have increased short-term provider satisfaction, EBP knowledge, and adherence though not adoption. Evidence was insufficient on training costs and client outcomes. Future research is needed on EBP training methods, implementation, sustainability, client outcomes, and costs to ensure efforts to train providers in EBPs are effective, efficient, and durable. TRIAL REGISTRATION The protocol for this review is registered in PROSPERO (CRD42018093381).
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Affiliation(s)
- Helen Valenstein-Mah
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, 2450 Riverside Avenue, F282/2A West, Minneapolis, MN, 55454, USA.
| | - Nancy Greer
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA.,Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Lauren McKenzie
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA.,Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Lucas Hansen
- Minneapolis VA Health Care System, Minneapolis, MN, USA.,University of St. Thomas, Minneapolis, MN, USA
| | - Thad Q Strom
- Oscar G. Johnson VA Medical Center, Iron Mountain, MI, USA
| | - Shannon Wiltsey Stirman
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Healthcare System, Palo Alto, CA, USA.,Stanford University, Palo Alto, CA, USA
| | - Timothy J Wilt
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA.,Minneapolis VA Health Care System, Minneapolis, MN, USA.,Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Shannon M Kehle-Forbes
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA.,Minneapolis VA Health Care System, Minneapolis, MN, USA.,Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.,National Center for PTSD Women's Health Sciences Division, VA Boston Healthcare System, Boston, MA, USA
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19
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Scheuer H, Engstrom A, Thomas P, Moodliar R, Moloney K, Walen ML, Johnson P, Seo S, Vaziri N, Martinez A, Maier R, Russo J, Sieber S, Anziano P, Anderson K, Bulger E, Whiteside L, Heagerty P, Palinkas L, Zatzick D. A comparative effectiveness trial of an information technology enhanced peer-integrated collaborative care intervention versus enhanced usual care for US trauma care systems: Clinical study protocol. Contemp Clin Trials 2020; 91:105970. [PMID: 32119926 PMCID: PMC9677945 DOI: 10.1016/j.cct.2020.105970] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/18/2020] [Accepted: 02/22/2020] [Indexed: 11/18/2022]
Abstract
Annually approximately 2-3 million Americans are so severely injured that they require inpatient hospitalization. The study team, which includes patients, clinical researchers, front-line provider and policy maker stakeholders, has been working together for over a decade to develop interventions that target improvements for US trauma care systems nationally. This pragmatic randomized trial compares a multidisciplinary team collaborative care intervention that integrates front-line trauma center staff with peer interventionists, versus trauma team notification of patient emotional distress with mental health consultation as enhanced usual care. The peer-integrated collaborative care intervention will be supported by a novel emergency department exchange health information technology platform. A total of 424 patients will be randomized to peer-integrated collaborative care (n = 212) and surgical team notification (n = 212) conditions. The study hypothesizes that patient's randomized to peer integrated collaborative care intervention will demonstrate significant reductions in emergency department health service utilization, severity of patient concerns, post traumatic stress disorder symptoms, and physical limitations when compared to surgical team notification. These four primary outcomes will be followed-up at 1- 3-, 6-, 9- and 12-months after injury for all patients. The Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE) method will be used to assess implementation processes. Data from the primary outcome analysis and implementation process assessment will be used to inform an end-of-study policy summit with the American College of Surgeons Committee on Trauma. The policy summit will facilitate acute care practice changes related to patient-centered care transitions over the course of a single 5-year funding cycle. Trial registration: (Clinicaltrials.govNCT03569878).
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Affiliation(s)
- Hannah Scheuer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
| | - Peter Thomas
- Powers Pyles Sutter & Verville PC, 501 M Street, NW, Seventh Floor, Washington, DC 20005, United States of America.
| | - Rddhi Moodliar
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
| | - Mary Lou Walen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
| | - Peyton Johnson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
| | - Sara Seo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
| | - Natalie Vaziri
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
| | - Alvaro Martinez
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
| | - Ronald Maier
- Department of Surgery, University of Washington School of Medicine, 410 9th Ave., Seattle, WA 98104, United States of America.
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
| | - Stella Sieber
- Molecular Genomics Core/Microarray Group, National Institute of Environmental Health Sciences, P.O. Box 12233, Mail Drop D2-04, Durham, N.C 27709, United States of America.
| | - Pete Anziano
- Shepherd Center, 2020 Peachtree Road NW, Atlanta, GA 30309-1465, United States of America.
| | - Kristina Anderson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America; The Koshka Foundation, United States of America.
| | - Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, 410 9th Ave., Seattle, WA 98104, United States of America.
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104, United States of America.
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington School of Public Health, 1705 NE Pacific St., Seattle, WA 98195, United States of America.
| | - Lawrence Palinkas
- Department of Children, Youth and Families, USC Suzanne Dworak-Peck School of Social Work, 669 W 34(th) St., Los Angeles, CA 90089, United States of America.
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Ave., Box 359911, Seattle, WA 98104, United States of America.
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Psychological morbidity and functional impairment following traumatic pelvic injury. Injury 2020; 51:978-983. [PMID: 32081393 DOI: 10.1016/j.injury.2020.02.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 02/04/2020] [Accepted: 02/09/2020] [Indexed: 02/02/2023]
Abstract
Pelvic injuries often result from high-energy trauma and lead to significant functional impairment. While the physical outcomes of these injuries have been widely studied, the psychological consequences remain largely unexplored. The purpose of this study was to examine psychosocial and functional outcomes of patients with pelvic trauma in the year after injury. The sample (N = 32) consisted of adult patients with traumatic pelvic injures, as defined by ICD-9 codes, who were admitted to a Level I Trauma Center for at least 24 h. Participants were primarily female (53%) with a mean age of 48.7 years (SD = 17.9). Demographic, injury-related, and psychosocial data (e.g., posttraumatic stress disorder (PTSD), depression, alcohol use, quality of life, pain, return to work) were gathered at the time of hospitalization as well as at 3-, 6-, and 12 month follow-ups. Mixed regression models were used to examine the outcome variables over time. There were significant decreases in pain and alcohol use at each follow-up compared to baseline. However, despite the decrease, the levels of pain and alcohol use remained high. Physical and mental health also decreased significantly, indicating worsened functioning and lowered quality of life. Neither PTSD nor depression changed significantly over time, indicating that participants' symptoms were not likely to improve. These data suggest that sustaining a traumatic pelvic injury increases the risk of diminished quality of life, both mentally and physically. Even one-year post-injury, participants experienced moderate physical pain and higher levels of PTSD, depression, and problematic alcohol use than would be expected in the general population. These findings highlight the need for an interdisciplinary approach to treating patients with pelvic injuries, including psychological screening and intervention in acute care and throughout recovery.
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21
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Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE) in Pragmatic Clinical Trials of Mental Health Services Implementation: Methods and Applied Case Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:255-270. [PMID: 30488143 PMCID: PMC7427407 DOI: 10.1007/s10488-018-0909-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pragmatic clinical trials of mental health services are increasingly being developed to establish comparative effectiveness, influence sustainable implementation, and address real world policy decisions. However, use of time and resource intensive qualitative methods in pragmatic trials may be inconsistent with the aims of efficiency and cost minimization. This paper introduces a qualitative method known as Rapid Assessment Procedure-Informed Clinical Ethnography (RAPICE) that combines the techniques of Rapid Assessment Procedures with clinical ethnography. A case study is presented to illustrate how RAPICE can be used to efficiently understand pragmatic trial implementation processes and associated real world policy implications.
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22
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Randomized Trial of Screening and Brief Intervention to Reduce Injury and Substance Abuse in an urban Level I Trauma Center. Drug Alcohol Depend 2020; 208:107792. [PMID: 32028253 DOI: 10.1016/j.drugalcdep.2019.107792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/26/2019] [Accepted: 11/30/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The TIP (Traumatic Injury Prevention) Project evaluated the impact on post-injury drug use of two brief motivational interventions compared to brief advice (BA) among injured patients who use drugs. METHOD Three-group, single blind, randomized controlled trial in a Level 1Trauma Center enrolled 395 admitted patients with drug positive toxicology screen or verbal report of drug use in the previous 30 days. 34% were Hispanic, 45% non-Hispanic White, 16% non-Hispanic Black. 88% smoked marijuana, 28% used cocaine and 11% prescription opioids. Brief Advice (BA) provided advice to abstain from drugs, educational materials and referral to community resources. Brief Motivational Intervention (BMI) additionally included a 30-45 minute session, with assessment feedback, based on motivational interviewing. BMI + B included a telephone booster 4-weeks post-intervention. Drug use as measured by percent days abstinent and total abstinence, derived from the Timeline Follow back was the primary outcome. RESULTS A significant reduction from baseline was observed at 3, 6, and 12 months in the primary outcomes of any drug use (excluding alcohol); cannabis and cocaine, the most frequently used drugs, were analyzed individually. There were no between group differences or group X time interactions. Similarly, there were no between groups differences on secondary outcomes including perceived health status, re-injury, arrest, incarceration, alcohol and drug treatment, employment, AA attendance, homelessness, physical abuse, and problems associated with alcohol and drug use. CONCLUSIONS The study does not support use of these enhanced motivational interventions over brief advice for trauma patients with a positive screen for drug use.
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23
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Assessment and Management of Psychiatric Symptoms Among Adults With Mild Traumatic Brain Injury. Concussion 2020. [DOI: 10.1016/b978-0-323-65384-8.00005-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Darnell D, Parker L, Engstrom A, Fisher D, Diteman K, Dunn C. Evaluation of a Level I trauma center provider training in patient-centered alcohol brief interventions using the Behavior Change Counseling Index rated by standardized patients. Trauma Surg Acute Care Open 2019; 4:e000370. [PMID: 31922018 PMCID: PMC6937416 DOI: 10.1136/tsaco-2019-000370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/22/2019] [Accepted: 12/02/2019] [Indexed: 12/30/2022] Open
Abstract
Background Traumatic injury requiring hospitalization is common in the USA and frequently related to alcohol consumption. The American College of Surgeons requires that Level I and II verified trauma centers implement universal alcohol screening and brief intervention for injured patients. We examined whether Level I trauma center provider skill in patient-centered alcohol brief interventions improved after training and whether professional role (eg, nursing, social work) and education were associated with these skills. Methods We present evaluation data collected as part of training in alcohol brief interventions embedded within a larger clinical trial of a collaborative care intervention targeting posttraumatic stress disorder and related comorbidities. Sixty-five providers from 25 US Level I trauma centers engaged in a 1-day workshop, with 2 hours dedicated to training in patient-centered alcohol brief interventions followed by 6 months of weekly coaching in a collaborative care model. Providers completed standardized patient role-plays prior to and 6 months after the workshop training. The standardized patient actors rated provider quality of alcohol brief interventions immediately after each role-play using the Behavior Change Counseling Index (BECCI), a pragmatic measure designed to assess the quality of behavior change counseling, an adaptation of motivational interviewing suitable for brief healthcare consultations about behavior change. Results Seventy-two percent of providers completed both standardized patient role-play assessments. A statistically significant improvement in overall BECCI scores (t(41)=−2.53, p=0.02, Cohen’s d=−0.39) was observed among those providers with available pre–post data. Provider professional role was associated with BECCI scores at pre-training (F(3, 58)=11.25, p<0.01) and post-training (F(3, 41)=8.10, p<0.01). Discussion Findings underscore the need for training in patient-centered alcohol brief interventions and suggest that even a modest training helps providers engage in a more patient-centered way during a role-play assessment. Level of evidence Level V, therapeutic/care management.
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Affiliation(s)
- Doyanne Darnell
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Lea Parker
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Allison Engstrom
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Dylan Fisher
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Kaylie Diteman
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Christopher Dunn
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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25
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Afshar M, Phillips A, Karnik N, Mueller J, To D, Gonzalez R, Price R, Cooper R, Joyce C, Dligach D. Natural language processing and machine learning to identify alcohol misuse from the electronic health record in trauma patients: development and internal validation. J Am Med Inform Assoc 2019; 26:254-261. [PMID: 30602031 DOI: 10.1093/jamia/ocy166] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/17/2018] [Indexed: 11/13/2022] Open
Abstract
Objective Alcohol misuse is present in over a quarter of trauma patients. Information in the clinical notes of the electronic health record of trauma patients may be used for phenotyping tasks with natural language processing (NLP) and supervised machine learning. The objective of this study is to train and validate an NLP classifier for identifying patients with alcohol misuse. Materials and Methods An observational cohort of 1422 adult patients admitted to a trauma center between April 2013 and November 2016. Linguistic processing of clinical notes was performed using the clinical Text Analysis and Knowledge Extraction System. The primary analysis was the binary classification of alcohol misuse. The Alcohol Use Disorders Identification Test served as the reference standard. Results The data corpus comprised 91 045 electronic health record notes and 16 091 features. In the final machine learning classifier, 16 features were selected from the first 24 hours of notes for identifying alcohol misuse. The classifier's performance in the validation cohort had an area under the receiver-operating characteristic curve of 0.78 (95% confidence interval [CI], 0.72 to 0.85). Sensitivity and specificity were at 56.0% (95% CI, 44.1% to 68.0%) and 88.9% (95% CI, 84.4% to 92.8%). The Hosmer-Lemeshow goodness-of-fit test demonstrates the classifier fits the data well (P = .17). A simpler rule-based keyword approach had a decrease in sensitivity when compared with the NLP classifier from 56.0% to 18.2%. Conclusions The NLP classifier has adequate predictive validity for identifying alcohol misuse in trauma centers. External validation is needed before its application to augment screening.
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Affiliation(s)
- Majid Afshar
- Health Sciences Division, Burn and Shock Trauma Research Institute, Stritch School of Medicine, Loyola University, Maywood, Illinois, USA.,Health Sciences Division, Center for Health Outcomes and Informatics Research, Loyola University, Maywood, Illinois, USA.,Department of Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, Illinois, USA
| | - Andrew Phillips
- Department of Computer Science, Loyola University, Chicago, Illinois, USA
| | - Niranjan Karnik
- Department of Psychiatry, Rush University Medical Center, Chicago, Illinois, USA
| | - Jeanne Mueller
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Daniel To
- Health Sciences Division, Burn and Shock Trauma Research Institute, Stritch School of Medicine, Loyola University, Maywood, Illinois, USA
| | - Richard Gonzalez
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Ron Price
- Health Sciences Division, Center for Health Outcomes and Informatics Research, Loyola University, Maywood, Illinois, USA
| | - Richard Cooper
- Department of Computer Science, Loyola University, Chicago, Illinois, USA
| | - Cara Joyce
- Health Sciences Division, Center for Health Outcomes and Informatics Research, Loyola University, Maywood, Illinois, USA.,Department of Computer Science, Loyola University, Chicago, Illinois, USA
| | - Dmitriy Dligach
- Health Sciences Division, Center for Health Outcomes and Informatics Research, Loyola University, Maywood, Illinois, USA.,Department of Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, Illinois, USA
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26
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Implementing and Evaluating SBIRT for Alcohol Use at a Level 1 Trauma Center: A Behavioral Medicine Approach. J Clin Psychol Med Settings 2019; 27:376-384. [DOI: 10.1007/s10880-019-09681-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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27
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van der Westhuizen C, Myers B, Malan M, Naledi T, Roelofse M, Stein DJ, Lahri S, Sorsdahl K. Implementation of a screening, brief intervention and referral to treatment programme for risky substance use in South African emergency centres: A mixed methods evaluation study. PLoS One 2019; 14:e0224951. [PMID: 31730623 PMCID: PMC6858052 DOI: 10.1371/journal.pone.0224951] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/24/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Screening, brief intervention, and referral to treatment (SBIRT) for risky substance use is infrequently included in routine healthcare in low-resourced settings. A SBIRT programme, adopted by the Western Cape provincial government within an alcohol harm reduction strategy, employed various implementation strategies executed by a diverse team to translate an evidence-based intervention into services at three demonstration sites before broader programme scale-up. This paper evaluates the implementation of this programme delivered by facility-based counsellors in South African emergency centres. METHOD Guided by the Consolidated Framework for Implementation Research, this mixed methods study evaluated the feasibility, acceptability, appropriateness and adoption of this task-shared SBIRT programme. Quantitative data were extracted from routinely collected health information. Qualitative interviews were conducted with 40 stakeholders in the programme's second year. RESULTS In the first year, 13 136 patients were screened and 4 847 (37%) patients met criteria for risky substance use. Of these patients, 83% received the intervention, indicating programme feasibility. The programme was adopted into routine services and found to be acceptable and appropriate, particularly by stakeholders familiar with the emergency environment. These stakeholders highlighted the burden of substance-related harm in emergency centres and favourable patient responses to SBIRT. However, some stakeholders expressed scepticism of the behaviour change approach and programme compatibility with emergency centre operations. Furthermore, adoption was both facilitated and hampered by a top-down directive from provincial leadership to implement SBIRT, while rapid implementation limited effective engagement with a diverse stakeholder group. CONCLUSION This is one of the first studies to address SBIRT implementation in low-resourced settings. The results show that SBIRT implementation and adoption was largely successful, and provide valuable insights that should be considered prior to implementation scale-up. Recommendations include ensuring ongoing monitoring and evaluation, and early stakeholder engagement to improve implementation readiness and programme compatibility in the emergency setting.
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Affiliation(s)
- Claire van der Westhuizen
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Megan Malan
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Tracey Naledi
- Western Cape Department of Health, Cape Town, South Africa
- School of Public Health Medicine & Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Dan J. Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Sa’ad Lahri
- Department of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
- Khayelitsha Hospital Emergency Services, Cape Town, South Africa
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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McCarty CA, Zatzick D, Hoopes T, Payne K, Parrish R, Rivara FP. Collaborative care model for treatment of persistent symptoms after concussion among youth (CARE4PCS-II): Study protocol for a randomized, controlled trial. Trials 2019; 20:567. [PMID: 31533799 PMCID: PMC6749638 DOI: 10.1186/s13063-019-3662-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 08/19/2019] [Indexed: 11/26/2022] Open
Abstract
Background Currently, there is limited evidence to guide intervention and service delivery coordination for youth who suffer a concussion and subsequently experience persistent post-concussive symptoms (PCS) (Lumba-Brown et al. JAMA Pediatr 172(11):e182853, 2018; Lumba-Brown A et al. JAMA Pediatr 172(11):e182847, 2018). We have developed a collaborative care intervention with embedded cognitive-behavioral therapy, care management, and stepped-up psychotropic medication consultation to address persistent PCS and related psychological comorbidities. The CARE4PCS-II study was designed to assess whether adolescents with persistent symptoms after sports-related concussion will demonstrate better outcomes when receiving this collaborative care intervention compared to a usual care (control) condition. Methods/design This investigation is a randomized comparative effectiveness trial to receive intervention (collaborative care) or control (usual care). Two hundred sports-injured male and female adolescents aged 11–18 years with three or more post-concussive symptoms that persist for at least 1 month but less than 9 months after injury will be recruited and randomized into the study. The trial focuses on the effects of the intervention on post-concussive, depressive, and anxiety symptoms measured 3, 6, and 12 months after baseline. Discussion The CARE4PCS II study is a large comparative effectiveness trial targeting symptomatic improvements in sports injured adolescents after concussion. The study is unique in its adaptation of the collaborative care model to a broad spectrum of primary care, sports medicine, and school settings. The investigation incorporates novel elements such as the delivery of CBT through HIPAA complaint video conferenceing technology and has excellent widespread dissemination potential should effectiveness be demonstrated. Trial registration ClinicalTrials.gov, NCT03034720. Registered on January 27, 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3662-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carolyn A McCarty
- Seattle Children's Research Institute, P.O. Box 5371, M/S: CW8-5, Seattle, WA, 98145-5005, USA. .,Department of Pediatrics, University of Washington, Seattle, USA.
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center 325 9th Avenue, Box 359911, Seattle, WA, 98104-2499, USA
| | - Teah Hoopes
- Seattle Children's Research Institute, P.O. Box 5371, M/S: CW8-5, Seattle, WA, 98145-5005, USA
| | - Katelyn Payne
- Seattle Children's Research Institute, P.O. Box 5371, M/S: CW8-5, Seattle, WA, 98145-5005, USA
| | - Rebecca Parrish
- Seattle Children's Research Institute, P.O. Box 5371, M/S: CW8-5, Seattle, WA, 98145-5005, USA
| | - Frederick P Rivara
- Seattle Children's Research Institute, P.O. Box 5371, M/S: CW8-5, Seattle, WA, 98145-5005, USA.,Department of Pediatrics, University of Washington, Seattle, USA
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Culp BL, Roden-Foreman JW, Thomas EV, McShan EE, Bennett MM, Martin KR, Powers MB, Foreman ML, Petrey LB, Warren AM. Better with age? A comparison of geriatric and non-geriatric trauma patients' psychological outcomes 6 months post-injury. Cogn Behav Ther 2018; 48:406-418. [PMID: 30392449 DOI: 10.1080/16506073.2018.1533578] [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: 10/27/2022]
Abstract
This is the first study to compare both physical and psychological outcomes in geriatric and non-geriatric patients (n = 268) at baseline and 6 months post-trauma. Demographic, clinical, and psychological data, including screens for alcohol use, depressive symptoms, and post-traumatic stress symptoms (PTSS) were collected from 67 geriatric patients (70.7 ± 8.0 years) and 201 non-geriatric patients (40.2 ± 12.8 years) admitted to a Level I trauma center for ≥ 24 h. Geriatric patients were significantly less likely to screen positive for alcohol use at baseline, and depression, PTSS, and alcohol use at follow-up. When not controlling for discharge to rehabilitation or nursing facility, geriatric patients had significantly lower odds of alcohol use at follow-up. There was no significant difference in injury severity, resilience, or pre-trauma psychological status between the two groups. Results indicate that geriatric trauma patients fare better than their younger counterparts at 6 months post-trauma on measures of alcohol use, depression, and PTSS. Screenings and interventions for both age groups could improve psychological health post-trauma, but younger patients may require additional attention.
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Affiliation(s)
- Brittney L Culp
- a Department of Surgery, Baylor Scott & White - Grapevine , Grapevine , TX , USA
| | - Jacob W Roden-Foreman
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Estrella V Thomas
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Evan Elizabeth McShan
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Monica M Bennett
- c Baylor Scott & White Health, Center for Clinical Effectiveness , Dallas , TX , USA
| | - Katherine Riley Martin
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Mark B Powers
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Michael L Foreman
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Laura B Petrey
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
| | - Ann Marie Warren
- b Division of Trauma, Critical Care & Acute Care Surgery, Baylor University Medical Center , Dallas , TX , USA
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Veach LJ, Moro RR, Miller P, Reboussin BA, Ivers NN, Rogers JL, O'Brien MC. Alcohol Counseling in Hospital Trauma: Examining Two Brief Interventions. JOURNAL OF COUNSELING AND DEVELOPMENT 2018. [DOI: 10.1002/jcad.12199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Regina R. Moro
- Department of Counselor Education; Boise State University
| | | | - Beth A. Reboussin
- Department of Biostatistical Sciences; Wake Forest School of Medicine
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Veach LJ, Shilling EH. Trauma-informed supervision: Counselors in a Level I hospital trauma center. CLINICAL SUPERVISOR 2018. [DOI: 10.1080/07325223.2018.1438324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Laura J. Veach
- Department of Surgery, Wake Forest School of Medicine, Winston Salem, NC, USA
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Palmu R, Partonen T, Suominen K, Vuola J, Isometsä E. Alcohol use and smoking in burn patients at the Helsinki Burn Center. Burns 2018; 44:158-167. [DOI: 10.1016/j.burns.2017.05.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/11/2017] [Accepted: 05/25/2017] [Indexed: 11/29/2022]
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Sunshine JE, Dwyer-Lindgren L, Chen A, Sharar SR, Palmisano EB, Bulger EM, Mokdad AH. Alcohol-impaired driving in US counties, 2002-2012. Popul Health Metr 2018; 16:2. [PMID: 29391033 PMCID: PMC5793384 DOI: 10.1186/s12963-018-0158-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 01/15/2018] [Indexed: 01/16/2023] Open
Abstract
Background Excessive alcohol consumption and alcohol-impaired driving remain significant public health problems, leading to considerable morbidity and mortality, particularly among younger populations. Methods Using data from the Behavioral Risk Factor Surveillance System (BRFSS), we employed a small areas modeling strategy to estimate the county-level annual prevalence of alcohol-impaired driving in every United States county for the years 2002 through 2012, the latest year in which county identifiers were publicly available. Results Alcohol-impaired driving episodes declined from 157.0 million in 2002 (prevalence 3.8%: 95% uncertainty interval [UI], 3.7%–4.0%) to 129.7 million in 2012 (prevalence 3.7%: 95% UI, 3.5%–3.8%), a 17.4% decline. There is considerable variation in the prevalence of alcohol-impaired driving at the county level, ranging from 2.0% in the Sitka City Borough of Alaska to 9.3% in Nance County, Nebraska. Clusters of increased alcohol-impaired driving were observed in Northern Wisconsin (Marinette, Florence, Forest, Vilas, Oneida, Iron counties), North Dakota (Cavalier, Pembina, Walsh, Ramsey, Nelson, Benson, Eddy counties) and Montana (Sheridan, Daniels, Roosevelt, Valley, Phillips, Petroleum, Garfield counties). Conclusions This study showed guarded progress with respect to the occurrence of alcohol-impaired driving episodes in the US from 2002 to 2012. Because these data rely on self-report, this likely represents an underestimate of the true prevalence of alcohol-impaired driving in the US. As the US continues to have several million episodes of alcohol-impaired driving each month, renewed efforts are needed to mitigate this high-risk health behavior.
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Affiliation(s)
- Jacob E Sunshine
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, USA.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Laura Dwyer-Lindgren
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Alan Chen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Sam R Sharar
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, USA.,Harborview Injury Prevention and Research Center, University of Washington, Seattle, USA
| | - Erin B Palmisano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Eileen M Bulger
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, USA.,Department of Surgery, Harborview Medical Center, University of Washington, Seattle, USA
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.
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Borsari B, Apodaca TR, Jackson KM, Fernandez A, Mastroleo NR, Magill M, Barnett NP, Carey KB. Trajectories of in-session change language in brief motivational interventions with mandated college students. J Consult Clin Psychol 2017; 86:158-168. [PMID: 29172594 DOI: 10.1037/ccp0000255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Brief motivational interventions (BMIs) are currently the most efficacious individual intervention for mandated college students. However, little is known about how BMIs facilitate client language in relation to subsequent changes in alcohol use and problems in mandated student samples. METHOD The current study used the Motivational Interviewing Skills Code (MISC 2.0; Miller, Moyers, Ernst, & Amrhein, 2003) to code BMI sessions (N = 252) from 2 randomized clinical trials that led to significant reductions in alcohol use and alcohol-related problems in mandated student drinkers. A proportion of change language was calculated for each decile (1st to 10th) of the BMI sessions. RESULTS Latent class analyses of in-session speech indicated that there were 3 distinct trajectories of change language over the course of the session: high (n = 59), increasing (n = 122), and low (n = 71). Members of the high trajectory group showed higher rates of alcohol-related problems prior to the BMI and members of the low trajectory group were more likely to be male. Six months following the BMI, members of the high and low trajectory groups demonstrated significant reductions in alcohol use and problems, and members of the increasing trajectory group only reduced alcohol-related problems. CONCLUSIONS Associations among the 3 trajectories of client change language and subsequent reductions in alcohol use and problems partially supported the technical hypothesis of MI efficacy. Client factors as well as the nature of the discussion of personalized feedback may determine the link between in-session client language and subsequent behavior change. (PsycINFO Database Record
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Affiliation(s)
- Brian Borsari
- Mental Health Service, San Francisco VA Medical Center
| | | | | | - Anne Fernandez
- Department of Behavioral and Social Sciences, Brown University
| | | | - Molly Magill
- Department of Behavioral and Social Sciences, Brown University
| | - Nancy P Barnett
- Department of Behavioral and Social Sciences, Brown University
| | - Kate B Carey
- Department of Behavioral and Social Sciences, Brown University
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Hicks R, Johnson S, Porter AC, Zatzick D. The 5th Annual One Mind Summit: Lessons Learned About "Science Informing Brain Health Policies and Practice". J Neurotrauma 2017; 34:2833-2839. [PMID: 28351324 PMCID: PMC5647496 DOI: 10.1089/neu.2016.4821] [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] [Indexed: 11/13/2022] Open
Abstract
Advances in science frequently precede changes in clinical care by several years or even decades. To better understand the path to translation, we invited experts to share their perspectives at the 5th Annual One Mind Summit: "Science Informing Brain Health Policies and Practice," which was held on May 24-25, 2016, in Crystal City, VA. While the translation of brain research throughout the pipeline-from basic science research to patient care-was discussed, the focus was on the implementation of "best evidence" into patient care. The Summit identified key steps, including the need for professional endorsement and clinical guidelines or policies, acceptance by regulators and payers, dissemination and training for clinicians, patient advocacy, and learning healthcare models. The path to implementation was discussed broadly, as well as in the context of a specific project to implement concussion screening in emergency and urgent care centers throughout the United States.
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Affiliation(s)
| | | | | | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
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The Acceptability and Feasibility of Screening for Alcohol and Drug Misuse in a Hospital Emergency Department. ADDICTIVE DISORDERS & THEIR TREATMENT 2017; 16:111-120. [PMID: 28883782 PMCID: PMC5566165 DOI: 10.1097/adt.0000000000000108] [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] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Objectives: Screening and brief intervention (SBI) is an evidence-based technique for reducing harmful consumption of alcohol and other drugs, which has been shown to be effective in Emergency Departments (EDs). The feasibility of SBI in the ED, however, remains contentious and no studies have been conducted on this topic in a New Zealand ED. Materials and Methods: This study recruited 8 experienced ED nurses who attempted to provide SBI, using the ASSIST-Lite tool, to as many of their patients as possible over one calendar month. All nurses participated in a comprehensive 1-day training workshop on the administration and interpretation of the ASSIST-Lite and linked brief intervention. Results: Only 46 (11.79%) of the 390 eligible patients were given the opportunity to participate over the data collection period. Analysis of the data showed there was a significant, negative correlation between the number of patients in the ED and the average number of screens that were performed by the nurses, and that the number of screens waned immediately after SBI training. Following the data collection period, the nurse participants were interviewed about their experience. These interviews revealed 3 main themes that contextualized the willingness to, but inherent difficulty of, administering the SBI within the ED environment. Conclusions: High patient-to-nurse ratios in the ED currently preclude nurses from providing consistent SBI to all eligible patients; however, there are several practical considerations highlighted here that might help nurses increase the participation rate.
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Doumas DM, Esp S, Miller R. Impact of Brief Intervention Workshops on Addiction Provider Knowledge, Skills, Negative Attitudes, and Interest in Implementing Evidence-Based Practices. JOURNAL OF DRUG EDUCATION 2017; 47:121-137. [PMID: 30253656 DOI: 10.1177/0047237918800985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study evaluated the impact of Motivational Interviewing (MI) and Screening, Brief Intervention, and Referral to Treatment (SBIRT) workshops on posttraining knowledge, skills, negative attitudes, and interest in implementing evidence-based practices (EBPs). Participants ( N = 70) were primarily mental health counselor (41.4%), social workers (20.0%), substance abuse counselors (15.7%), school counselors (5.7%), and nursing professionals (4.3%) who selected the 1- or 2-day workshop for continuing education credit. Participants attended either a Basic MI training workshop (1 day) or a Basic MI training plus an advanced MI/SBIRT training workshop (2 days) to assess if exposure to two EBPs would improve training outcomes. Participants in both the 1-day and 2-day workshops reported posttraining increased perceived knowledge and skills, decreased negative attitudes toward EBPs, and increased interest in implementing EBPs from pretraining to posttraining. There were no differences between participants in the Basic MI or MI plus advanced MI/SBIRT training conditions. Implications for reducing the research-practice gap in EBPs are discussed.
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Affiliation(s)
- Diana M Doumas
- 1 Department of Counselor Education, Institute for the Study of Behavioral Health and Addiction, Boise State University, ID, USA
| | - Susan Esp
- 1 Department of Counselor Education, Institute for the Study of Behavioral Health and Addiction, Boise State University, ID, USA
| | - Raissa Miller
- 1 Department of Counselor Education, Institute for the Study of Behavioral Health and Addiction, Boise State University, ID, USA
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Cordovilla-Guardia S, Fernández-Mondéjar E, Vilar-López R, Navas JF, Portillo-Santamaría M, Rico-Martín S, Lardelli-Claret P. Effect of a brief intervention for alcohol and illicit drug use on trauma recidivism in a cohort of trauma patients. PLoS One 2017; 12:e0182441. [PMID: 28813444 PMCID: PMC5559089 DOI: 10.1371/journal.pone.0182441] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 07/18/2017] [Indexed: 11/19/2022] Open
Abstract
Objective Estimate the effectiveness of brief interventions in reducing trauma recidivism in hospitalized trauma patients who screened positive for alcohol and/or illicit drug use. Methods Dynamic cohort study based on registry data from 1818 patients included in a screening and brief intervention program for alcohol and illicit drug use for hospitalized trauma patients. Three subcohorts emerged from the data analysis: patients who screened negative, those who screened positive and were offered brief intervention, and those who screened positive and were not offered brief intervention. Follow-up lasted from 10 to 52 months. Trauma-free survival, adjusted hazard rate ratios (aHRR) and adjusted incidence rate ratios (aIRR) were calculated, and complier average causal effect (CACE) analysis was used. Results We found a higher cumulative risk of trauma recidivism in the subcohort who screened positive. In this subcohort, an aHRR of 0.63 (95% CI: 0.41–0.95) was obtained for the group offered brief intervention compared to the group not offered intervention. CACE analysis yielded an estimated 52% reduction in trauma recidivism associated with the brief intervention. Conclusion The brief intervention offered during hospitalization in trauma patients positive for alcohol and/or illicit drug use can halve the incidence of trauma recidivism.
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Affiliation(s)
- Sergio Cordovilla-Guardia
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
- * E-mail:
| | - Enrique Fernández-Mondéjar
- Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Granada, Granada, Spain
- Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - Raquel Vilar-López
- Department of Personality, Evaluation and Psychological Treatment. University of Granada, Granada, Spain
- Addictive Disorders Network, RTA Instituto de Salud Carlos III, Spanish Ministry, Spain
- Mind, Brain and Behavior Research Centre, University of Granada, Granada, Spain
| | - Juan F. Navas
- Mind, Brain and Behavior Research Centre, University of Granada, Granada, Spain
- Department of Experimental Psychology. University of Granada, Granada, Spain
| | | | - Sergio Rico-Martín
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
| | - Pablo Lardelli-Claret
- Instituto de Investigación Biosanitaria IBS, Granada, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain. CIBER of Epidemiology and Public Health. Spain
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Yue JK, Ngwenya LB, Upadhyayula PS, Deng H, Winkler EA, Burke JF, Lee YM, Robinson CK, Ferguson AR, Lingsma HF, Cnossen MC, Pirracchio R, Korley FK, Vassar MJ, Yuh EL, Mukherjee P, Gordon WA, Valadka AB, Okonkwo DO, Manley GT. Emergency department blood alcohol level associates with injury factors and six-month outcome after uncomplicated mild traumatic brain injury. J Clin Neurosci 2017; 45:293-298. [PMID: 28789959 DOI: 10.1016/j.jocn.2017.07.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022]
Abstract
The relationship between blood alcohol level (BAL) and mild traumatic brain injury (mTBI) remains in need of improved characterization. Adult patients suffering mTBI without intracranial pathology on computed tomography (CT) from the prospective Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study with emergency department (ED) Glasgow Coma Scale (GCS) 13-15 and recorded blood alcohol level (BAL) were extracted. BAL≥80-mg/dl was set as proxy for excessive use. Multivariable regression was performed for patients with six-month Glasgow Outcome Scale-Extended (GOSE; functional recovery) and Wechsler Adult Intelligence Scale Processing Speed Index Composite Score (WAIS-PSI; nonverbal processing speed), using BAL≥80-mg/dl and <80-mg/dl cohorts, adjusting for demographic/injury factors. Overall, 107 patients were aged 42.7±16.8-years, 67.3%-male, and 80.4%-Caucasian; 65.4% had BAL=0-mg/dl, 4.6% BAL<80-mg/dl, and 30.0% BAL≥80-mg/dl (range 100-440-mg/dl). BAL differed across loss of consciousness (LOC; none: median 0-mg/dl [interquartile range (IQR) 0-0], <30-min: 0-mg/dl [0-43], ≥30-min: 224-mg/dl [50-269], unknown: 108-mg/dl [0-232]; p=0.002). GCS<15 associated with higher BAL (19-mg/dl [0-204] vs. 0-mg/dl [0-20]; p=0.013). On univariate analysis, BAL≥80-mg/dl associated with less-than-full functional recovery (GOSE≤7; 38.1% vs. 11.5%; p=0.025) and lower WAIS-PSI (92.4±12.7, 30th-percentile vs. 105.1±11.7, 63rd-percentile; p<0.001). On multivariable regression BAL≥80-mg/dl demonstrated an odds ratio of 8.05 (95% CI [1.35-47.92]; p=0.022) for GOSE≤7 and an adjusted mean decrease of 8.88-points (95% CI [0.67-17.09]; p=0.035) on WAIS-PSI. Day-of-injury BAL>80-mg/dl after uncomplicated mTBI was associated with decreased GCS score and prolongation of reported LOC. BAL may be a biomarker for impaired return to baseline function and decreased nonverbal processing speed at six-months postinjury. Future confirmatory studies are needed.
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Affiliation(s)
- John K Yue
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Laura B Ngwenya
- Department of Neurological Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Pavan S Upadhyayula
- Department of Neurological Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Hansen Deng
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Ethan A Winkler
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - John F Burke
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Young M Lee
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Caitlin K Robinson
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Adam R Ferguson
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Hester F Lingsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maryse C Cnossen
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA; Division of Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Frederick K Korley
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mary J Vassar
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Esther L Yuh
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Pratik Mukherjee
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Wayne A Gordon
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex B Valadka
- Department of Neurological Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA.
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Christensen KS, Oernboel E, Zatzick D, Russo J. Screening for depression: Rasch analysis of the structural validity of the PHQ-9 in acutely injured trauma survivors. J Psychosom Res 2017; 97:18-22. [PMID: 28606494 DOI: 10.1016/j.jpsychores.2017.03.117] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Patient Health Questionnaire (PHQ-9) is widely used for screening of depression in acutely injured trauma survivors. Rasch analysis has been used to evaluate its measurement characteristics. This paper aims: 1) to assess the psychometric properties of the nine PHQ-9 items and 2) to determine the structural validity of using the total PHQ-9 score as a clinical outcome measure. METHODS PHQ-9 data for 937 persons aged 18-60years admitted to 20 level 1 trauma centers in the United States were included. Good model fit indicates that all items contribute to a single underlying trait. RESULTS Item 2 demonstrated misfit to the Rasch model, and six items showed disordered response categories. Ordered response categories were achieved for all nine items after modifying the original four-point scoring system into a three-point system. Person separation reliability was acceptable (0.80) for discriminating between groups of patients. Dimensionality testing supported combining the nine items into a total score. No significant differential item functioning was observed for sex and age group. CONCLUSION Despite some minor problems with its measurement structure, the short nine-item version of the PHQ seems to be an economic and valid instrument for the screening of depression in adults admitted to level 1 trauma centers.
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Affiliation(s)
- Kaj Sparle Christensen
- Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark.
| | - Eva Oernboel
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - Doug Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
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Stead M, Parkes T, Nicoll A, Wilson S, Burgess C, Eadie D, Fitzgerald N, McKell J, Reid G, Jepson R, McAteer J, Bauld L. Delivery of alcohol brief interventions in community-based youth work settings: exploring feasibility and acceptability in a qualitative study. BMC Public Health 2017; 17:357. [PMID: 28438195 PMCID: PMC5404319 DOI: 10.1186/s12889-017-4256-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 04/11/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Alcohol Brief Interventions (ABIs) are increasingly being delivered in community-based youth work settings. However, little attention has been paid to how they are being implemented in such settings, or to their feasibility and acceptability for practitioners or young people. The aim of this qualitative study was to explore the context, feasibility and acceptability of ABI delivery in youth work projects across Scotland. METHODS Individual, paired and group interviews were conducted with practitioners and young people in nine community projects that were either involved in the delivery of ABIs or were considering doing so in the near future. A thematic analysis approach was used to analyse data. RESULTS ABIs were delivered in a diverse range of youth work settings including the side of football pitches, on the streets as part of outreach activities, and in sexual health drop-in centres for young people. ABI delivery differed in a number of important ways from delivery in other health settings such as primary care, particularly in being largely opportunistic and flexible in nature. ABIs were adapted by staff in line with the ethos of their project and their own roles, and to avoid jeopardising their relationships with young people. Young people reacted positively to the idea of having conversations about alcohol with youth project workers, but confirmed practitioners' views about the importance of these conversations taking place in the context of an existing trusting relationship. CONCLUSION ABIs were feasible in a range of youth work settings with some adaptation. Acceptability to staff was strongly influenced by perceived benefits, and the extent to which ABIs fitted with their project's ethos. Young people were largely comfortable with such conversations. Future implementation efforts should be based on detailed consideration of current practice and contexts. Flexible models of delivery, where professional judgement can be exercised over defined but adaptable content, may be better appreciated by staff and encourage further development of ABI activity.
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Affiliation(s)
- Martine Stead
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA UK
| | - Tessa Parkes
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA UK
| | - Avril Nicoll
- Nursing, Midwifery and Allied Health Professions Research Unit, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA UK
| | - Sarah Wilson
- Faculty of Social Science, Colin Bell Building, University of Stirling, Stirling, FK9 4LA UK
| | - Cheryl Burgess
- Faculty of Social Science, Colin Bell Building, University of Stirling, Stirling, FK9 4LA UK
| | - Douglas Eadie
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA UK
| | - Niamh Fitzgerald
- Institute for Social Marketing, UK Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA UK
| | - Jennifer McKell
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA UK
| | | | - Ruth Jepson
- The Scottish Collaboration for Public Health Research (SCPHRP), 20 West Richmond Street, Edinburgh, EH8 9DX UK
| | - John McAteer
- The Scottish Collaboration for Public Health Research (SCPHRP), 20 West Richmond Street, Edinburgh, EH8 9DX UK
| | - Linda Bauld
- Institute for Social Marketing, UK Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA UK
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Kazemi DM, Jacobs DG, Portwood SG, Veach L, Zhou W, Hurley MJ. Trauma Center Youth Violence Screening and Brief Interventions: A Multisite Pilot Feasibility Study. VIOLENCE AND VICTIMS 2017; 32:251-264. [PMID: 28130901 DOI: 10.1891/0886-6708.vv-d-15-00141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Every day, 16 American youths between the ages of 10 and 24 years are murdered; 84% of these fatalities involve a firearm. Nearly half of traumatic youth deaths result from violence-related injuries. In 2013, 580,250 youth suffered nonfatal, assault-related injuries, necessitating emergency department treatment. The aim of this multisite pilot study was to examine the process, feasibility, and challenges of violence brief interventions (VBIs). The participants were youth between 15 and 25 years of age, at 2 major Level 1 trauma centers (TCs; TC1, TC2) in the Southeastern United States. Eligible participants (N = 38; TC1: n = 20, TC2: n = 18) received at least 1 VBI during their hospital stay, which provided information about individual screening results and elicited patients' perspectives on violent and risky behaviors. More participants at TC2 than at TC1 completed 2 VBI sessions. Barriers to and support of implementation were identified at both sites, and factors for improving implementation were identified, including the need for staff support through clinical guidelines and coordinated prevention and outreach programs. Further research is needed to identify factors for successful implementation of VBIs in TCs.
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Brereton R, Gerdtz M. Alcohol and Other Drug (AOD) Education for Hospital Staff: An Integrative Literature Review. Issues Ment Health Nurs 2017; 38:42-60. [PMID: 27960576 DOI: 10.1080/01612840.2016.1248876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Alcohol and Other Drug (AOD) education amongst hospital staff is often inadequate. This leads to suboptimal care of patients and is a missed opportunity for early identification and treatment. This integrative review evaluates the core features of current education for hospital-based doctors and nurses in AOD, including country of origin, content, duration, and pedagogy. The majority of included studies were conducted in the USA (72%), target alcohol rather than AOD in general (72%), adopted a purely medical model of treatment (94%), and utilised a Screening, Brief Intervention, and Referral to Treatment (SBIRT) model (94%). The overall quality of the studies was weak-moderate, which led to small effect sizes in most studies and limits the generalizability of any conclusions. More high quality research trials are needed to establish the core features of effective AOD education for hospital staff. Future research should include a focus on the psychosocial context of addiction, other drug use and the impact of negative attitudes on care delivery.
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Affiliation(s)
| | - Marie Gerdtz
- b School of Nursing, University of Melbourne , Melbourne , Australia
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Grossbard J, Malte CA, Lapham G, Pagulayan K, Turner AP, Rubinsky AD, Bradley KA, Saxon AJ, Hawkins EJ. Prevalence of Alcohol Misuse and Follow-Up Care in a National Sample of OEF/OIF VA Patients With and Without TBI. Psychiatr Serv 2017; 68:48-55. [PMID: 27476804 PMCID: PMC5704906 DOI: 10.1176/appi.ps.201500290] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Information on prevalence and management of alcohol misuse among Afghanistan and Iraq veterans with traumatic brain injury (TBI) is limited. This study compared rates of alcohol misuse and follow-up care-brief intervention (BI) and addiction treatment-among Afghanistan and Iraq veterans with and without TBI receiving care from the Department of Veterans Affairs (VA). METHODS The sample included veterans ages 18 and older screened with the Alcohol Use Disorders Identification Test alcohol consumption questions (AUDIT-C) in 2012 who received VA health care in the prior year (N=358,417). Overall and age-specific estimates of alcohol misuse (AUDIT-C score ≥5) were compared for men and women with and without TBI by logistic regression. BI and addiction treatment after screening were compared between groups by using multivariable logistic regression. RESULTS Alcohol misuse was higher among men with TBI than among men without TBI (20.3%, 95% confidence interval [CI]=19.9-20.8, versus 16.4%, CI=16.3-16.6) and among women with TBI than among women without TBI (6.8%, CI=5.8-8.1, versus 5.6%, CI=5.4-5.8); younger (age <30) patients with TBI had the highest rates. BI rates did not differ by TBI status (76.4%-80.2%). Addiction treatment rates for those with severe misuse were higher among those with TBI (men, 20.0%, CI=18.4-21.6, versus 15.4%, CI=14.9-15.9; women, 36.6%, CI=21.8-51.3, versus 21.1%, CI=18.2-24.0). CONCLUSIONS Alcohol misuse is common among Iraq and Afghanistan veterans with TBI, particularly young men. BI rates were high and did not vary by TBI status, although addiction treatment rates were higher among patients with TBI than among those without TBI.
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Affiliation(s)
- Joel Grossbard
- Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: )
| | - Carol A Malte
- Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: )
| | - Gwen Lapham
- Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: )
| | - Kathleen Pagulayan
- Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: )
| | - Aaron P Turner
- Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: )
| | - Anna D Rubinsky
- Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: )
| | - Katharine A Bradley
- Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: )
| | - Andrew J Saxon
- Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: )
| | - Eric J Hawkins
- Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: )
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Combat-Acquired Traumatic Brain Injury, Posttraumatic Stress Disorder, and Their Relative Associations With Postdeployment Binge Drinking. J Head Trauma Rehabil 2016; 31:13-22. [PMID: 25310293 DOI: 10.1097/htr.0000000000000082] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine whether experiencing a traumatic brain injury (TBI) on a recent combat deployment was associated with postdeployment binge drinking, independent of posttraumatic stress disorder (PTSD). METHODS Using the 2008 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel, an anonymous survey completed by 28 546 personnel, the study sample included 6824 personnel who had a combat deployment in the past year. Path analysis was used to examine whether PTSD accounted for the total association between TBI and binge drinking. MAIN MEASURES The dependent variable, binge drinking days, was an ordinal measure capturing the number of times personnel drank 5+ drinks on one occasion (4+ for women) in the past month. Traumatic brain injury level captured the severity of TBI after a combat injury event exposure: TBI-AC (altered consciousness only), TBI-LOC of 20 or less (loss of consciousness up to 20 minutes), and TBI-LOC of more than 20 (loss of consciousness >20 minutes). A PTSD-positive screen relied on the standard diagnostic cutoff of 50+ on the PTSD Checklist-Civilian. RESULTS The final path model found that while the direct effect of TBI (0.097) on binge drinking was smaller than that of PTSD (0.156), both were significant. Almost 70% of the total effect of TBI on binge drinking was from the direct effect; only 30% represented the indirect effect through PTSD. CONCLUSION Further research is needed to replicate these findings and to understand the underlying mechanisms that explain the relationship between TBI and increased postdeployment drinking.
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Borsari B, Apodaca TR, Yurasek A, Monti PM. Does mental status impact therapist and patient communication in emergency department brief interventions addressing alcohol use? J Subst Abuse Treat 2016; 73:1-8. [PMID: 28017179 DOI: 10.1016/j.jsat.2016.10.002] [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: 05/05/2016] [Revised: 09/18/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
Motivational interviewing (MI) is often incorporated into screening, brief intervention, and referral to treatment (SBIRT) interventions in critical care settings to address alcohol and other drug use. However, cognitive status has been linked to differential response to MI sessions in emergency department (ED) settings. The current study examined one possible explanation for this differential response: whether higher versus lower mental status impacts patient response to clinician statements during MI sessions conducted in an ED. Participants were 126 patients receiving an MI-based single-session alcohol brief intervention, and 13 therapists who provided treatment. Participants completed a mental status exam (MSE) as part of the screening process. Intervention sessions were audio-taped, and transcribed and coded using the Motivational Interviewing Skills Code (MISC 2.0; Miller, Moyers, Ernst, & Amrhein, 2003). The MISC 2.0 coded therapist behaviors that are related to the use of motivational interviewing, and patient language reflecting movement toward (change talk) or away from (sustain talk) changing personal alcohol use. Overall, patients responded in a similar manner to therapist MI behaviors regardless of high versus low level of mental functioning at the time of the intervention. Group differences emerged on patient response to only three specific therapist skills: giving information, open questions, and complex reflection. Thus, the differential effects of SBIRT in critical care settings do not appear to be a result of differences in the therapist and patient communication process.
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Affiliation(s)
- Brian Borsari
- Mental Health Service (116B), San Francisco VA Medical Center, 4150 Clement St., San Francisco, CA 94121; Department of Behavioral and Social Sciences, and Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI 02912; Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA 94143.
| | - Timothy R Apodaca
- Children's Mercy Kansas City, 2401 Gillham Rd., Kansas City, MO, 64108; University of Missouri-Kansas City School of Medicine, 3901 Rainbow Blvd, Kansas City, KS 66103
| | - Ali Yurasek
- Department of Behavioral and Social Sciences, and Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI 02912
| | - Peter M Monti
- Department of Behavioral and Social Sciences, and Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI 02912
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Alghnam S, Castillo R. Traumatic injuries and persistent opioid use in the USA: findings from a nationally representative survey. Inj Prev 2016; 23:87-92. [DOI: 10.1136/injuryprev-2016-042059] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 08/04/2016] [Accepted: 08/10/2016] [Indexed: 12/20/2022]
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Koleszar JC, Childs BR, Vallier HA. Frequency of Recidivism in Patients With Orthopedic Trauma. Orthopedics 2016; 39:300-6. [PMID: 27359281 DOI: 10.3928/01477447-20160623-05] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 04/20/2016] [Indexed: 02/03/2023]
Abstract
The goals of this study were to determine the frequency of trauma recidivism and to identify risk factors. The authors hypothesized that substance abuse and mental illness would be associated with recidivism. They performed a retrospective review of 879 patients who were treated surgically for high-energy fractures over a period of 4 years. Recidivism was defined as presentation to the trauma center for a new, unrelated injury. A recurrent recidivist was a repeat patient who returned for more than 1 additional injury. The study identified 164 (18.7%) patients who returned with a new injury. Mean age of recidivists was 37.1 years vs 40.7 years for nonrecidivists (P=.025). Of the recidivists, 80% were male, and this group was more likely to be unmarried (76.2% vs 67.2%, P=.044) and unemployed (40.4% vs 19.6%, P<.0001). Recidivists were also more likely to be uninsured (33.5% vs 17.8%, P<.0001) or to have Medicaid coverage (33.5% vs 23.2%, P<.0001). Recidivists were more likely to have used alcohol (47.2% vs 32.0%, P=.0007) or to be intoxicated (32.4% vs 21.2%, P=.005) and to use tobacco (66.2% vs 50.2%, P=.0003) or recreational drugs (59.1% vs 43.2%, P=.0004) at baseline. The rate of documented mental illness was also higher in repeat patients than in nonrepeat patients (28.1% vs 20.0%, P=.03). These findings showed that recidivism is common, occurring overall in 18.7% of the study sample within a mean of 2.9 years. Factors associated with recidivism included age younger than 40 years, unmarried status, substance use, unemployment, and lack of insurance coverage. The greatest independent risk factors for recidivism were Medicaid insurance or no insurance and a history of a gunshot wound or assault. [Orthopedics. 2016; 39(5):300-306.].
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Fletcher S, O'Donnell M, Forbes D. Personality and trajectories of posttraumatic psychopathology: A latent change modelling approach. J Anxiety Disord 2016; 42:1-9. [PMID: 27235835 DOI: 10.1016/j.janxdis.2016.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/12/2016] [Accepted: 05/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Survivors of traumatic events may develop a range of psychopathology, across the internalizing and externalizing dimensions of disorder and associated personality traits. However, research into personality-based internalizing and externalizing trauma responses has been limited to cross-sectional investigations of PTSD comorbidity. Personality typologies may present an opportunity to identify and selectively intervene with survivors at risk of posttraumatic disorder. Therefore this study examined whether personality prospectively influences the trajectory of disorder in a broader trauma-exposed sample. METHODS During hospitalization for a physical injury, 323 Australian adults completed the Multidimensional Personality Questionnaire-Brief Form and Structured Clinical Interview for DSM-IV, with the latter readministered 3 and 12 months later. Latent profile analysis conducted on baseline personality scores identified subgroups of participants, while latent change modelling examined differences in disorder trajectories. RESULTS Three classes (internalizing, externalizing, and normal personality) were identified. The internalizing class showed a high risk of developing all disorders. Unexpectedly, however, the normal personality class was not always at lowest risk of disorder. Rather, the externalizing class, while more likely than the normal personality class to develop substance use disorders, were less likely to develop PTSD and depression. CONCLUSIONS Results suggest that personality is an important mechanism in influencing the development and form of psychopathology after trauma, with internalizing and externalizing subtypes identifiable in the early aftermath of injury. These findings suggest that early intervention using a personality-based transdiagnostic approach may be an effective method of predicting and ultimately preventing much of the burden of posttraumatic disorder.
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Affiliation(s)
- Susan Fletcher
- Phoenix Australia and Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.
| | - Meaghan O'Donnell
- Phoenix Australia and Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - David Forbes
- Phoenix Australia and Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
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Thomas P, Seale JP, Johnson JA, Dhabliwala J, Kitchens D, Okosun IS, Stokes NA, Ashley D. Impact of a Quality Improvement Intervention to Increase Brief Alcohol and Drug Interventions on a Level I Trauma Service. Am Surg 2016. [DOI: 10.1177/000313481608200524] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Screening and brief intervention (SBI) decreases alcohol use and related consequences among trauma patients. Although SBI is required in Level I and II trauma centers, implementation often is difficult. This study used the Plan-Do-Study-Act approach to identify and implement measures to increase the number of patients receiving SBI at a Level I trauma center. A multidisciplinary Quality Improvement Committee with representation from the Trauma Service and SBI Team met monthly during 2011. Stepwise interventions included identifying a resident “champion” responsible for screening, brief intervention, and referral to treatment, including an SBI report at monthly trauma conferences, and incorporating SBI into the trauma order set. Outcomes measures were number of patients screened, patients screening positive, and the number of patients receiving SBI. At baseline, 170 of 362 patients (47%) were screened, 68/170 (40%) had positive screens, and 30/68 (44% of those with positive screens) received SBI services. Quarter 2 saw increases in patients screened—275/437 (63%), patients screening positive (106/275; 39%) and those receiving SBI (60/106; 57%). Increases culminated in Quarter 4 with screening 401/466 (86%; P < 0.001) patients, 208/401 (52%; P < 0.001) patients screening positive, and 114 patients (55%; P = 0.296) receiving services. Use of similar quality improvement measures nationwide could improve rates of provision of this important service.
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Affiliation(s)
- Princess Thomas
- Department of Surgery, Medical Center, Navicent Health, Macon, Georgia
- Mercer University School of Medicine, Macon, Georgia
| | - J. Paul Seale
- Department of Family Medicine, Medical Center, Navicent Health, Macon, Georgia
- Mercer University School of Medicine, Macon, Georgia
| | - J. Aaron Johnson
- Institute of Public and Preventive Health, Augusta University, Augusta, Georgia
| | - Jason Dhabliwala
- Department of Family Medicine, Medical Center, Navicent Health, Macon, Georgia
- Mercer University School of Medicine, Macon, Georgia
| | - Debra Kitchens
- Department of Surgery, Medical Center, Navicent Health, Macon, Georgia
| | - Ike S. Okosun
- School of Public Health, Georgia State University, Atlanta, Georgia
| | - Nathan A. Stokes
- Mercer University School of Medicine, Macon, Georgia
- Department of Emergency Medicine, Medical Center, Navicent Health, Macon, Georgia
| | - Dennis Ashley
- Department of Surgery, Medical Center, Navicent Health, Macon, Georgia
- Mercer University School of Medicine, Macon, Georgia
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