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Lindenfeld Z, Chen K, Kapur S, Chang JE. Comparing Rates of Undiagnosed Hypertension and Diabetes in Patients With and Without Substance Use Disorders. J Gen Intern Med 2024; 39:1632-1641. [PMID: 38467919 PMCID: PMC11254858 DOI: 10.1007/s11606-024-08718-6] [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: 10/11/2023] [Accepted: 03/01/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Individuals with substance use disorders (SUDs) have increased risk for developing chronic conditions, though few studies assess rates of diagnosis of these conditions among patients with SUDs. OBJECTIVE To compare rates of undiagnosed hypertension and diabetes among patients with and without an SUD. DESIGN Cross-sectional analysis using electronic health record (EHR) data from 58 primary care clinics at a large, urban, healthcare system in New York. PARTICIPANTS Patients who had at least two primary care visits from 2019-2022 were included in our patient sample. Patients without an ICD-10 hypertension diagnosis or prescribed hypertension medications and with at least two blood pressure (BP) readings ≥ 140/90 mm were labeled 'undiagnosed hypertension,' and patients without a diabetes diagnosis or prescribed diabetes medications and with A1C/hemoglobin ≥ 6.5% were labeled 'undiagnosed diabetes.' MAIN MEASURES We calculated the mean number of patients with and without an ICD-10 SUD diagnosis who were diagnosed and undiagnosed for each condition. We used multivariate logistic regression to assess the association between being undiagnosed for each condition, and having an SUD diagnosis, patient demographic characteristics, clinical characteristics (body mass index, Elixhauser comorbidity count, diagnosed HIV and psychosis), the percentage of visits without a BP screening, and the total number of visits during the time period. KEY RESULTS The percentage of patients with undiagnosed hypertension (2.74%) and diabetes (22.98%) was higher amongst patients with SUD than patients without SUD. In multivariate models, controlling for other factors, patients with SUD had significantly higher odds of having undiagnosed hypertension (OR: 1.81; 95% CI: 1.48, 2.20) and undiagnosed diabetes (OR: 1.93; 1.72, 2.16). Being younger, female, and having an HIV diagnosis was also associated with significantly higher odds for being undiagnosed. CONCLUSIONS We found significant disparities in rates of undiagnosed chronic diseases among patients with SUDs, compared with patients without SUDs.
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Affiliation(s)
- Zoe Lindenfeld
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA.
| | - Kevin Chen
- Office of Ambulatory Care and Population Health, New York City Health + Hospitals, New York, NY, USA
- Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
| | - Supriya Kapur
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
| | - Ji E Chang
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
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Mahmoud KF, Finnell DS, Sereika SM, Lindsay D, Cipkala-Gaffin J, Mitchell AM. Factors Associated with Nurses' Motivation to Provide Care for Patients with Alcohol Use and Alcohol Use-Related Problems. Subst Abus 2023; 44:146-153. [PMID: 37702081 DOI: 10.1177/08897077231186232] [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: 09/14/2023]
Abstract
BACKGROUND There is a high human and economic cost associated with alcohol use and alcohol use-related problems. Nurses have a pivotal role in addressing the needs of this patient population. Purpose: The study aimed to examine the correlation between nurses' demographics/background characteristics, personal attitudes, professional attitudes, and their motivation to provide care to patients with alcohol use and alcohol use-related problems. METHODS A descriptive, cross-sectional correlational design was utilized. Nurses were recruited from four Southwestern Pennsylvania hospitals. The study variables were examined using questionnaires that explored nurses' demographic/background characteristics, their personal and professional attitudes, and motivation to care for patients with alcohol use and alcohol use-related problems. RESULTS The sample included 234 nurses. Demographic/background characteristics were identified as associated with nurse's alcohol use-related motivation, including gender, primary work setting and specialization. Previous personal experience with alcohol use-related problems (nurses themselves or co-workers), familiarity, perceived dangerousness, fear, social distance, personal responsibility beliefs and disease model were also associated with nurses' alcohol use-related motivation to care for these patients. In addition, all professional attitudes were associated with nurses' motivation toward caring for patients with alcohol use and alcohol use-related problems. CONCLUSIONS The study revealed that certain demographic/background characteristics and personal and professional attitudes were associated with nurses' motivation to provide care to this patient population. This study provides the foundation for future studies aimed at exploring predictors of nurse's motivation to care for patients with alcohol use and alcohol use-related problems.
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Affiliation(s)
- Khadejah F Mahmoud
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | | | - Susan M Sereika
- Associate Dean for Research and Education Support Services and Director of Center for Research and Evaluation, Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Dawn Lindsay
- Director of Clinical Policy, American Society of Addiction Medicine, Rockville, MD, USA
| | - Janet Cipkala-Gaffin
- Private practice and a consultant, Bariatric Surgeons at UPMC Magee-Women's Hospital, Pittsburgh, PA, USA
| | - Ann M Mitchell
- Professor of Nursing and Psychiatry, Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
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Perceptions of Patients’ Alcohol Use and Related Problems Among Primary Care Professionals in Rio de Janeiro. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00648-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Mahmoud KF, Finnell DS, Sereika SM, Lindsay D, Schmitt K, Cipkala-Gaffin J, Puskar KR, Mitchell AM. Personal and professional attitudes associated with nurses' motivation to work with patients with opioid use and opioid use-related problems. Subst Abus 2021; 42:780-787. [PMID: 33617737 DOI: 10.1080/08897077.2020.1856287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Opioid use and opioid use-related problems contribute significantly to increased morbidity rates and premature deaths as well as an increased economic burden. Nurses have key roles in providing care to this patient population; however, they often report low motivation toward working with these patients. Examining personal and professional attitudes associated with nurses' motivation to work with this population can present a valuable opportunity to enhance their willingness to intervene at an earlier stage when patients do not have a diagnosable opioid use disorder. Methods: A descriptive, correlational design was used. Nurses were recruited from four hospital settings in Southwestern Pennsylvania. Data on nurses' demographic/background characteristics, personal attitudes, professional attitudes, and motivation related to working with patients with opioid use and opioid use-related problems were collected via a paper/pencil survey and analyzed using linear regression. Results: A sample of 234 nurses were included in the final analyses. Personal attitudes associated with nurses' motivation included personal experience with a family member related to alcohol and/or other drugs, and stigma perceptions (familiarity, perceived dangerousness, fear, social distance and personal responsibility beliefs). Professional attitudes associated with nurses' motivation included working experience with substance use (SU), SU education as continuing education or other educational resources, role security, therapeutic commitment, role responsibility, and self-efficacy. Conclusions: This study's findings provide valuable information regarding the bivariate relationships between nurses' personal attitudes, professional attitudes, and motivation to work with patients with opioid use and opioid use-related problems. The study provides a base for future studies aimed at developing interventions to enhance nurses' motivation to work with this patient population particularly related to preventing the progression of opioid use to a diagnosable disorder.
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Affiliation(s)
- Khadejah F Mahmoud
- Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Deborah S Finnell
- Emerita, School of Nursing, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Susan M Sereika
- Center for Research and Evaluation, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Dawn Lindsay
- Research and Evaluation Services, Institute for Research, Education, and Training in Addictions, Pittsburgh, PA, USA
| | - Karen Schmitt
- Nursing Department, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Janet Cipkala-Gaffin
- Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Kathryn R Puskar
- Emerita, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Ann M Mitchell
- Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
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Chiodo LM, Cosmian C, Pereira K, Kent N, Sokol RJ, Hannigan JH. Prenatal Alcohol Screening During Pregnancy by Midwives and Nurses. Alcohol Clin Exp Res 2019; 43:1747-1758. [PMID: 31184777 PMCID: PMC6772020 DOI: 10.1111/acer.14114] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 05/06/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Alcohol use during pregnancy can have a variety of harmful consequences on the fetus. Lifelong effects include growth restriction, characteristic facial anomalies, and neurobehavioral dysfunction. This range of effects is known as fetal alcohol spectrum disorders (FASD). There is no amount, pattern, or timing of alcohol use during pregnancy proven safe for a developing embryo or fetus. Therefore, it is important to screen patients for alcohol use, inform them about alcohol's potential effects during pregnancy, encourage abstinence, and refer for intervention if necessary. However, how and how often nurses and midwives inquire about alcohol drinking during pregnancy or use recommended screening tools and barriers they perceive to alcohol screening has not been well established. METHODS This survey was sent to about 6,000 American midwives, nurse practitioners, and nurses who provide prenatal care about their knowledge of the effects of prenatal alcohol exposure, the prevalence of alcohol use during pregnancy, and practices for screening patients' alcohol use. Participants were recruited by e-mail from the entire membership roster of the American College of Nurse-Midwives. RESULTS There were 578 valid surveys returned (about 9.6%). Analyses showed that 37.7% of the respondents believe drinking alcohol is safe during at least one trimester of pregnancy. Only 35.2% of respondents reported screening to assess patient alcohol use. Only 23.3% reported using a specific screening tool, and few of those were validated screens recommended for use in pregnant women. Respondents who believe alcohol is safe at some point in pregnancy were significantly less likely to screen their patients. CONCLUSIONS Respondents who reported that pregnancy alcohol use is unsafe felt more prepared to educate and intervene with patients regarding alcohol use during pregnancy and FASD than respondents who reported drinking in pregnancy was safe. Perceived alcohol safety and perceived barriers to screening appeared to influence screening practices. Improving prenatal care provider knowledge about the effects of prenatal alcohol exposure and the availability of valid alcohol screening tools will improve detection of drinking during pregnancy, provide more opportunities for meaningful intervention, and ultimately reduce the incidence of FASD.
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Affiliation(s)
- Lisa M. Chiodo
- College of NursingUniversity of MassachusettsAmherstMassachusetts
| | - Caitlin Cosmian
- College of NursingUniversity of MassachusettsAmherstMassachusetts
| | - Kristy Pereira
- College of NursingUniversity of MassachusettsAmherstMassachusetts
| | - Nicole Kent
- College of NursingUniversity of MassachusettsAmherstMassachusetts
| | - Robert J. Sokol
- Department of Obstetrics & GynecologyWayne State UniversityDetroitMichigan
- C.S. Mott Center for Human Growth & DevelopmentWayne State UniversityDetroitMichigan
| | - John H. Hannigan
- Department of Obstetrics & GynecologyWayne State UniversityDetroitMichigan
- C.S. Mott Center for Human Growth & DevelopmentWayne State UniversityDetroitMichigan
- Merrill Palmer Skillman Institute for Child and Family DevelopmentWayne State UniversityDetroitMichigan
- Department of PsychologyWayne State UniversityDetroitMichigan
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Ober AJ, Watkins KE, Hunter SB, Ewing B, Lamp K, Lind M, Becker K, Heinzerling K, Osilla KC, Diamant AL, Setodji CM. Assessing and improving organizational readiness to implement substance use disorder treatment in primary care: findings from the SUMMIT study. BMC FAMILY PRACTICE 2017; 18:107. [PMID: 29268702 PMCID: PMC5740845 DOI: 10.1186/s12875-017-0673-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 11/28/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Millions of people with substance use disorders (SUDs) need, but do not receive, treatment. Delivering SUD treatment in primary care settings could increase access to treatment because most people visit their primary care doctors at least once a year, but evidence-based SUD treatments are underutilized in primary care settings. We used an organizational readiness intervention comprised of a cluster of implementation strategies to prepare a federally qualified health center to deliver SUD screening and evidence-based treatments (extended-release injectable naltrexone (XR-NTX) for alcohol use disorders, buprenorphine/naloxone (BUP/NX) for opioid use disorders and a brief motivational interviewing/cognitive behavioral -based psychotherapy for both disorders). This article reports the effects of the intervention on key implementation outcomes. METHODS To assess changes in organizational readiness we conducted pre- and post-intervention surveys with prescribing medical providers, behavioral health providers and general clinic staff (N = 69). We report on changes in implementation outcomes: acceptability, perceptions of appropriateness and feasibility, and intention to adopt the evidence-based treatments. We used Wilcoxon signed rank tests to analyze pre- to post-intervention changes. RESULTS After 18 months, prescribing medical providers agreed more that XR-NTX was easier to use for patients with alcohol use disorders than before the intervention, but their opinions about the effectiveness and ease of use of BUP/NX for patients with opioid use disorders did not improve. Prescribing medical providers also felt more strongly after the intervention that XR-NTX for alcohol use disorders was compatible with current practices. Opinions of general clinic staff about the appropriateness of SUD treatment in primary care improved significantly. CONCLUSIONS Consistent with implementation theory, we found that an organizational readiness implementation intervention enhanced perceptions in some domains of practice acceptability and appropriateness. Further research will assess whether these factors, which focus on individual staff readiness, change over time and ultimately predict adoption of SUD treatments in primary care.
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Affiliation(s)
- Allison J. Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407 USA
| | | | - Sarah B. Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407 USA
| | - Brett Ewing
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407 USA
| | - Karen Lamp
- Venice Family Clinic, 2509 Pico Boulevard, Santa Monica, CA 90405 USA
| | - Mimi Lind
- Venice Family Clinic, 2509 Pico Boulevard, Santa Monica, CA 90405 USA
| | - Kirsten Becker
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407 USA
| | - Keith Heinzerling
- UCLA Department of Family Medicine, UCLA Family Health Center, 1920 Colorado Avenue, Santa Monica, CA 90404 USA
| | - Karen C. Osilla
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407 USA
| | - Allison L. Diamant
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407 USA
- UCLA Department of Internal Medicine, Division of General Internal Medicine, 911 Broxton Avenue, Los Angeles, CA 90024 USA
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Barriers to integrating the continuum of care for opioid and alcohol use disorders in primary care: A qualitative longitudinal study. J Subst Abuse Treat 2017; 83:45-54. [PMID: 29129195 DOI: 10.1016/j.jsat.2017.09.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 11/21/2022]
Abstract
Untreated substance use disorders remain a pervasive public health problem in the United States, especially among medically-underserved and low-income populations, with opioid and alcohol use disorders (OAUD) being of particular concern. Primary care is an underutilized resource for delivering treatment for OAUD, but little is known about the organizational capacity of community-based primary care clinics to integrate treatment for OAUD. The objective of this study was to use an organizational capacity framework to examine perceived barriers to implementing the continuum of care for OAUD in a community-based primary care organization over three time points: pre-implementation (preparation), early implementation (practice), and full implementation. Clinic administrators and medical and mental health providers from two clinics participated in interviews and focus groups. Barriers were organized by type and size, and are presented over the three time points. Although some barriers persisted, most barriers decreased over time, and respondents reported feeling more efficacious in their ability to successfully deliver OAUD treatment. Findings contribute to the needed literature on building capacity to implement OAUD treatment in primary care and suggest that while barriers may be sizable and inevitable, successful implementation is still possible.
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Sapag JC, Sena BF, Bustamante IV, Bobbili SJ, Velasco PR, Mascayano F, Alvarado R, Khenti A. Stigma towards mental illness and substance use issues in primary health care: Challenges and opportunities for Latin America. Glob Public Health 2017; 13:1468-1480. [PMID: 28766377 DOI: 10.1080/17441692.2017.1356347] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Stigma towards mental illness and addictive disorders is a global problem and one of the main obstacles in tackling this issue remains the effective integration of mental health services into primary health care (PHC). In Latin America, information has significantly increased on the existence of stigma; however, little is known about effective interventions to prevent stigma and promote recovery-oriented practices in PHC. The aim of this study is to understand the existing evidence regarding mental health stigma in PHC with a special focus on the Latin American region. A scoping review of the literature related to mental health stigma in PHC was conducted. Two hundred and seventeen articles were evaluated; 74 met inclusion criteria and 14 additional articles were selected from references of search results. Results were subdivided into five different perspectives: users, family members and significant others, health professionals, contextual factors, and potential effective interventions. Only nine studies were based in Latin America, and only one described an intervention to reduce stigma in mental health services, not specifically in PHC. We found an urgent need to develop interventions to understand and reduce stigma in PHC settings, especially in Latin America.
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Affiliation(s)
- Jaime C Sapag
- a Departments of Public Health and Family Medicine, School of Medicine , Faculty of Medicine, Pontificia Universidad Católica de Chile , Santiago , Chile.,b Office of Transformative Global Health, Centre for Addiction and Mental Health , Ontario , Canada
| | - Brena F Sena
- a Departments of Public Health and Family Medicine, School of Medicine , Faculty of Medicine, Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Inés V Bustamante
- c Academic Department of Public Health, Administration and Social Sciences, Universidad Peruana Cayetano Heredia , Lima , Peru
| | - Sireesha J Bobbili
- b Office of Transformative Global Health, Centre for Addiction and Mental Health , Ontario , Canada
| | - Paola R Velasco
- a Departments of Public Health and Family Medicine, School of Medicine , Faculty of Medicine, Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Franco Mascayano
- d School of Public Health , Universidad de Chile , Santiago , Chile
| | - Rubén Alvarado
- d School of Public Health , Universidad de Chile , Santiago , Chile
| | - Akwatu Khenti
- b Office of Transformative Global Health, Centre for Addiction and Mental Health , Ontario , Canada
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Rosário F, Wojnar M, Ribeiro C. Can Doctors Be Divided Into Groups Based on Their Attitudes to Addressing Alcohol Issues in Their Patients? Analyses From a Survey of Portuguese General Practitioners. Subst Use Misuse 2017; 52:233-239. [PMID: 27759471 DOI: 10.1080/10826084.2016.1225092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The effectiveness of interventions to increase general practitioners' management of alcohol problems is affected by their attitudes toward at-risk drinkers. Tailoring training programs to general practitioners' attitudes may be useful in increasing alcohol screening and brief advice. OBJECTIVES to determine whether general practitioners could be divided into distinct groups based on their attitudes toward at-risk drinkers. Another aim of this study was to develop and validate a model for classifying general practitioners into distinct groups. METHODS A total of 234 general practitioners answered the questionnaire. Physicians' attitudes toward patients with hazardous or harmful alcohol use were measured with the Short Alcohol and Alcohol Problems Perception Questionnaire. Cluster analysis was performed to identify distinct general practitioner groups based on their attitudes toward at-risk drinkers. Logistic regression analysis was used to develop a model for predicting group membership. RESULTS Cluster analysis identified two distinct groups of general practitioners, one with more positive attitudes (adequacy = 10.8 ± 1.6, legitimacy = 11.8 ± 1.7, motivation = 9.8 ± 1.7, satisfaction = 8.1 ± 1.9, and self-esteem = 9.7 ± 2.1), the other with more negative attitudes (adequacy = 8.9 ± 1.8, legitimacy = 11.0 ± 1.8, motivation = 7.8 ± 1.6, satisfaction = 5.7 ± 2.0, and self-esteem = 6.8 ± 1.7). The predictors in the final model were self-esteem, motivation, and adequacy. The model predicted general practitioner groups on the training set with 90.4% accuracy (area under receiver operating characteristic [ROC] curve = 0.96), and maintained its predictive performance when applied to the test set (accuracy 93.6%, area under ROC curve = 0.97). CONCLUSIONS General practitioners could be divided into distinct groups based on their attitudes toward at-risk drinkers. These findings may prove useful in designing alcohol-specific training programs for general practitioners.
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Affiliation(s)
- Frederico Rosário
- a Preventive Medicine Institute, Faculty of Medicine , Lisbon , Portugal.,b Tomas Ribeiro's Primary Health Care Center , Tondela , Portugal
| | - Marcin Wojnar
- c Department of Psychiatry , Medical University of Warsaw , Warsaw , Poland
| | - Cristina Ribeiro
- a Preventive Medicine Institute, Faculty of Medicine , Lisbon , Portugal
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Kim TW, Samet JH, Cheng DM, Bernstein J, Wang N, German J, Saitz R. The spectrum of unhealthy drug use and quality of care for hypertension and diabetes: a longitudinal cohort study. BMJ Open 2015; 5:e008508. [PMID: 26692554 PMCID: PMC4691731 DOI: 10.1136/bmjopen-2015-008508] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Although it is well known that addiction is associated with adverse medical consequences, the effects of the spectrum of unhealthy drug use (illicit drug or prescription misuse) on chronic conditions such as hypertension and diabetes are understudied. This study evaluated the associations between measures of drug use (ie, frequency, severity and type) and standard quality metrics for inadequate blood pressure (BP) and blood glucose (BG) control. DESIGN Longitudinal cohort study. PARTICIPANTS Adult primary care patients with unhealthy drug use and hypertension or diabetes. SETTING Urban hospital-based primary care practice. MEASUREMENTS Outcomes were (1) inadequate BP (systolic BP ≥ 140 or diastolic BP ≥ 90) and (2) inadequate BG (glycated haemoglobin ≥ 8%) control (Healthcare Effectiveness Data and Information Set criteria). Drug use was characterised by a primary independent variable, drug use frequency, and two secondary variables, severity of use and drug type. We fit separate regression models for each drug use measure and outcome. RESULTS Overall, 40% (65/164) of the sample with hypertension had inadequate BP control and 44% (24/54) of those with diabetes had inadequate BG control. More frequent drug use was not significantly associated with inadequate BP control (adjusted OR (AOR) 0.67; 95% CI 0.31 to 1.46, highest vs lowest tertile; AOR 0.72; 95% CI 0.36 to 1.41, middle vs lowest tertile) or BG control (AOR 0.27; 95% CI 0.07 to 1.10, highest vs lowest tertile; AOR 1.01; 95% CI 0.38 to 2.69, middle vs lowest tertile). Drug use severity was also not associated with BP or BG control. Cocaine use was associated with inadequate BG control compared to marijuana use (AOR 8.82; 95% CI1.86 to 41.90). CONCLUSIONS Among primary care patients with recent drug use and hypertension or diabetes, drug type was significantly associated with inadequate BG, but not BP control. Frequency and severity of use were not significant predictors of either outcome.
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Affiliation(s)
- Theresa W Kim
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jeffrey H Samet
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Debbie M Cheng
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Judith Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Na Wang
- Data Coordinating Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jacqueline German
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Richard Saitz
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
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Glass JE, Hamilton AM, Powell BJ, Perron BE, Brown RT, Ilgen MA. Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials. Addiction 2015; 110:1404-15. [PMID: 25913697 PMCID: PMC4753046 DOI: 10.1111/add.12950] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/10/2015] [Accepted: 04/10/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Brief alcohol interventions in medical settings are efficacious in improving self-reported alcohol consumption among those with low-severity alcohol problems. Screening, Brief Intervention and Referral to Treatment initiatives presume that brief interventions are efficacious in linking patients to higher levels of care, but pertinent evidence has not been evaluated. We estimated main and subgroup effects of brief alcohol interventions, regardless of their inclusion of a referral-specific component, in increasing the utilization of alcohol-related care. METHODS A systematic review of English language papers published in electronic databases to 2013. We included randomized controlled trials (RCTs) of brief alcohol interventions in general health-care settings with adult and adolescent samples. We excluded studies that lacked alcohol services utilization data. Extractions of study characteristics and outcomes were standardized and conducted independently. The primary outcome was post-treatment alcohol services utilization assessed by self-report or administrative data, which we compared across intervention and control groups. RESULTS Thirteen RCTs met inclusion criteria and nine were meta-analyzed (n = 993 and n = 937 intervention and control group participants, respectively). In our main analyses the pooled risk ratio (RR) was = 1.08, 95% confidence interval (CI) = 0.92-1.28. Five studies compared referral-specific interventions with a control condition without such interventions (pooled RR = 1.08, 95% CI = 0.81-1.43). Other subgroup analyses of studies with common characteristics (e.g. age, setting, severity, risk of bias) yielded non-statistically significant results. CONCLUSIONS There is a lack of evidence that brief alcohol interventions have any efficacy for increasing the receipt of alcohol-related services.
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Affiliation(s)
- Joseph E. Glass
- School of Social Work, University of Wisconsin-Madison, Madison, WI
| | | | - Byron J. Powell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brian E. Perron
- School of Social Work, University of Michigan, Ann Arbor, MI
| | - Randall T. Brown
- Department of Family Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Mark A. Ilgen
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System and the Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
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Petersen Williams P, Petersen Z, Sorsdahl K, Mathews C, Everett-Murphy K, Parry CDH. Screening and Brief Interventions for Alcohol and Other Drug Use Among Pregnant Women Attending Midwife Obstetric Units in Cape Town, South Africa: A Qualitative Study of the Views of Health Care Professionals. J Midwifery Womens Health 2015. [PMID: 26220766 DOI: 10.1111/jmwh.12328] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Despite the negative consequences of alcohol and other drug use during pregnancy, few interventions for pregnant women are implemented, and little is known about their feasibility and acceptability in primary health care settings in South Africa. As part of the formative phase of screening, brief intervention, and referral to treatment for substance use among women presenting for antenatal care, the present study explored health care workers' attitudes and perceptions about screening, brief intervention, and referral to treatment among this population. METHODS Forty-three health care providers at 2 public sector midwife obstetric units in Cape Town, South Africa, were interviewed using an open-ended, semistructured interview schedule designed to identify factors that hinder or support the implementation of screening, brief intervention, and referral to treatment for substance use in these settings. Transcribed interviews were analyzed using the framework approach. RESULTS Health care providers agreed that there is a substantial need for screening, brief intervention, and referral to treatment for substance use among pregnant women and believe such services potentially could be integrated into routine care. Several women-, staff-, and clinic-level barriers were identified that could hinder the successful implementation in antenatal services. These barriers included the nondisclosure of alcohol and other drug use, the intervention being considered as an add-on service or additional work, negative staff attitudes toward implementation of an intervention, poor staff communication styles such as berating women for their behavior, lack of interest from staff, time constraints, staff shortages, overburdened workloads, and language barriers. DISCUSSION The utility of screening, brief intervention, and referral to treatment for addressing substance use among pregnant women in public health midwife obstetric units was supported, but consideration will need to be given to addressing a variety of barriers that have been identified.
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Bakhshi S, While AE. Health professionals' alcohol-related professional practices and the relationship between their personal alcohol attitudes and behavior and professional practices: a systematic review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 11:218-48. [PMID: 24366045 PMCID: PMC3924442 DOI: 10.3390/ijerph110100218] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/05/2013] [Accepted: 12/09/2013] [Indexed: 12/12/2022]
Abstract
Health professionals' personal health behaviors have been found to be associated with their practices with patients in areas such as smoking, physical activity and weight management, but little is known in relation to alcohol use. This review has two related strands and aims to: (1) examine health professionals' alcohol-related health promotion practices; and (2) explore the relationship between health professionals' personal alcohol attitudes and behaviors, and their professional alcohol-related health promotion practices. A comprehensive literature search of the Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, British Nursing Index, Web of Science, Scopus and Science Direct (2007-2013) identified 26 studies that met the inclusion criteria for Strand 1, out of which six were analyzed for Strand 2. The findings indicate that health professionals use a range of methods to aid patients who are high-risk alcohol users. Positive associations were reported between health professionals' alcohol-related health promotion activities and their personal attitudes towards alcohol (n = 2), and their personal alcohol use (n = 2). The findings have some important implications for professional education. Future research should focus on conducting well-designed studies with larger samples to enable us to draw firm conclusions and develop the evidence base.
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Affiliation(s)
- Savita Bakhshi
- Florence Nightingale School of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
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Soares J, Vargas DD, Formigoni MLODS. Knowledge and attitudes of nurses towards alcohol and related problems: the impact of an educational intervention. Rev Esc Enferm USP 2013; 47:1178-85. [DOI: 10.1590/s0080-623420130000500023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 06/26/2013] [Indexed: 11/21/2022] Open
Abstract
An exploratory study of quasi-experimental approach that aimed to verify the impact of an educational intervention on attitudes and knowledge of nurses towards alcohol use and associated problems. The sample included 185 nurses, divided into two groups: 84 submitted to a training course and formed the experimental group. Data were collected through a knowledge survey and an attitude scale. The attitudes of the participants of both groups were positive. There were no significant differences between groups in relation to knowledge. The strongest predictors of positive attitudes were possessed preparation to act with chemical dependents (OR = 2.18), "have received increased workload during graduation on the theme, 'alcohol and other drugs'" (OR = 1.70), and "completed graduate school" (OR = 2.59). The educational intervention had a positive impact on the attitudes of nurses towards alcoholics, work and interpersonal relationships with such clientele.
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Christie G, Black S, Dunbar L, Pulford J, Wheeler A. Attitudes, Skills and Knowledge Change in Child and Adolescent Mental Health Workers Following AOD Screening and Brief Intervention Training. Int J Ment Health Addict 2013. [DOI: 10.1007/s11469-012-9414-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Islam MM, Topp L, Conigrave KM, Day CA. Opioid substitution therapy clients' preferences for targeted versus general primary health-care outlets. Drug Alcohol Rev 2012; 32:211-4. [DOI: 10.1111/j.1465-3362.2012.00498.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 08/02/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | - Libby Topp
- Viral Hepatitis Epidemiology and Prevention Program; The Kirby Institute; University of New South Wales; Sydney; Australia
| | | | - Carolyn A. Day
- Discipline of Addiction Medicine; Central Clinical School (C39); University of Sydney; Sydney; Australia
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Norberg MM, Gates P, Dillon P, Kavanagh DJ, Manocha R, Copeland J. Screening and managing cannabis use: comparing GP's and nurses' knowledge, beliefs, and behavior. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2012; 7:31. [PMID: 22827931 PMCID: PMC3575313 DOI: 10.1186/1747-597x-7-31] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 07/10/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND General practitioners (GPs) and nurses are ideally placed to address the significant unmet demand for the treatment of cannabis-related problems given the numbers of people who regularly seek their care. The aim of this study was to evaluate differences between GPs and nurses' perceived knowledge, beliefs, and behaviors toward cannabis use and its screening and management. METHODS This study involved 161 nurses and 503 GPs who completed a survey distributed via conference satchels to delegates of Healthed seminars focused on topics relevant to women and children's health. Differences between GPs and nurses were analyzed using χ(2)- tests and two-sample t-tests, while logistic regression examined predictors of service provision. RESULTS GPs were more likely than nurses to have engaged in cannabis-related service provision, but also more frequently reported barriers related to time, interest, and having more important issues to address. Nurses reported less knowledge, skills, and role legitimacy. Perceived screening skills predicted screening and referral to alcohol and other drug (AOD) services, while knowing a regular user increased the likelihood of referrals only. CONCLUSIONS Approaches to increase cannabis-related screening and intervention may be improved by involving nurses, and by leveraging the relationship between nurses and doctors, in primary care.
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Affiliation(s)
- Melissa M Norberg
- National Cannabis Prevention and Information Centre, UNSW, PO Box 684, Randwick, NSW 2031, Australia.
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Abstract
PURPOSE OF REVIEW Alcohol is the world's third leading cause of ill-health and premature death. Alcohol has been found to be the most harmful drug, when considering harm to the individual and to others. With a prespecified search strategy we looked for relevant articles concerning screening, brief interventions and referral to treatment of patients with hazardous or harmful alcohol use, with a special focus on the primary healthcare implementation of these effective interventions. RECENT FINDINGS The evidence on the efficacy and effectiveness of brief interventions in primary care continues to grow and is confirmed by many recent studies, even in specific populations. The implementation of those effective interventions continues to be difficult, but successful experiences have been reported. The use of brief interventions in other healthcare settings and to address problems other than risky drinking is promising, but the evidence is far from conclusive. Some specific age groups (elderly, women and youth below 16) may deserve specifically tailored interventions. SUMMARY Alcohol is a major public health problem and brief interventions are one of the cost-effective measures that can be taken at a community level. Nevertheless, implementation of those measures is difficult. Further research is needed to identify the best implementation strategies.
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Heather N, Kaner E. Moving from efficacy trials to practical implementation of Internet-based BIs. Introduction to the special issue. Drug Alcohol Rev 2011; 29:581-3. [PMID: 20973839 DOI: 10.1111/j.1465-3362.2010.00254.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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