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Examining Relational Dimensions of Service Encounters for Disadvantaged People Who Use Drugs. J Addict Nurs 2022; 33:159-167. [DOI: 10.1097/jan.0000000000000479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Petersén E, Thurang A, Berman AH. Staff experiences of encountering and treating outpatients with substance use disorder in the psychiatric context: a qualitative study. Addict Sci Clin Pract 2021; 16:29. [PMID: 33971959 PMCID: PMC8112046 DOI: 10.1186/s13722-021-00235-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background High comorbidity exists between mental illness and substance use disorders (SUD). Patients in psychiatry living with problematic alcohol or drug consumption can experience a sense of exclusion, where seeking help for SUD can be perceived as stigmatizing. The aim of this study is to illuminate staff experiences of encountering patients with SUD within the psychiatric outpatient context. Methods The study was exploratory, with a qualitative design. Interviews with outpatient psychiatry managers and focus groups with clinical staff focused on the experience of encountering patients with SUD. Data were evaluated using content analysis inspired by phenomenological-hermeneutic methodology. Results Three themes were identified and each illuminated by two sub-themes. Bridging the organizational gap included sub-themes of having an established collaboration and facing difficulties in the collaboration; Having beliefs about the patient you encounter included sub-themes of working with patients who are exposed to prejudicial thoughts and expressing prejudicial thoughts about the patient. Striving to achieve a therapeutic alliance included sub-themes of having a feeling of developing together and supporting the patient towards recovery. Conclusion A life-world perspective, used to interpret results, indicated that caring for patients with SUD in psychiatry was perceived as difficult, where collaboration between psychiatry and addiction care was often experienced as problematic. Based on these findings, we believe that the current gap between the psychiatry and addiction care could be reduced to some extent by offering patients digital treatment for SUD. In this way, patients could remain under the care of their regular psychiatric clinic without having to physically visit SUD services. Thus, a virtual bridge could be established to bring psychiatry and addiction care closer to each other for the patients’ benefit. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-021-00235-9.
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Affiliation(s)
- Elisabeth Petersén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Anna Thurang
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Anne H Berman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Department of Psychology, Uppsala University, Uppsala, Sweden
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Kendall CE, Boucher LM, Donelle J, Martin A, Marshall Z, Boyd R, Oickle P, Diliso N, Pineau D, Renaud B, LeBlanc S, Tyndall M, Bayoumi AM. Engagement in primary health care among marginalized people who use drugs in Ottawa, Canada. BMC Health Serv Res 2020; 20:837. [PMID: 32894114 PMCID: PMC7487534 DOI: 10.1186/s12913-020-05670-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There may be less primary health care engagement among people who use drugs (PWUD) than among the general population, even though the former have greater comorbidity and more frequent use of emergency department care. We investigated factors associated with primary care engagement among PWUD. METHODS The Participatory Research in Ottawa: Understanding Drugs (PROUD) cohort study meaningfully engaged and trained people with lived experience to recruit and survey marginalized PWUD between March-December 2013. We linked this survey data to provincial-level administrative databases held at ICES. We categorized engagement in primary care over the 2 years prior to survey completion as: not engaged (< 3 outpatient visits to the same family physician) versus engaged in care (3+ visits to the same family physician). We used multivariable logistic regression to determine factors associated with engagement in primary care. RESULTS Characteristics of 663 participants included a median age of 43 years, 76% men, and 67% living in the two lowest income quintile neighborhoods. Despite high comorbidity and a median of 4 (interquartile range 0-10) primary care visits in the year prior to survey completion, only 372 (56.1%) were engaged in primary care. Engagement was most strongly associated with the following factors: receiving provincial benefits, including disability payments (adjusted odds ratio [AOR] 4.14 (95% confidence interval [CI] 2.30 to 7.43)) or income assistance (AOR 3.69 (95% CI 2.00 to 6.81)), having ever taken methadone (AOR 3.82 (95% CI 2.28 to 6.41)), mental health comorbidity (AOR 3.43 (95% CI 2.19 to 5.38)), and having stable housing (AOR 2.09 (95% CI 1.29 to 3.38)). CONCLUSIONS Despite high comorbidity, engagement in primary care among PWUD was low. Our findings suggest that social care (housing, disability, and income support) and mental health care are associated with improved primary care continuity; integration of these care systems with primary care and opioid substitution therapy may lessen the significant morbidity and acute care use among PWUD.
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Affiliation(s)
- Claire E. Kendall
- Bruyère Research Institute, 43 Bruyère Street, Annex E, Ottawa, Ontario K1N 5C8 Canada
| | - Lisa M. Boucher
- Bruyère Research Institute, 43 Bruyère Street, Annex E, Ottawa, Ontario K1N 5C8 Canada
| | - Jessy Donelle
- ICES, Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Box 684, Administrative Services Building, 1st Floor, Ottawa, Ontario K1Y 4E9 Canada
| | - Alana Martin
- Somerset West Community Health Centre, 55 Eccles Street, Ottawa, Ontario K1R 6S3 Canada
- PROUD Community Advisory Committee, Ottawa, Ontario Canada
| | - Zack Marshall
- School of Social Work, McGill University, 3506 University Street, Room 421, Montreal, Quebec H3A 2A7 Canada
| | - Rob Boyd
- Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, Ontario, K1N 1C7 Canada
| | - Pam Oickle
- Ottawa Public Health, 179 Clarence Street, Ottawa, Ontario, K1N 1B3 Canada
| | - Nicola Diliso
- PROUD Community Advisory Committee, Ottawa, Ontario Canada
| | - Dave Pineau
- PROUD Community Advisory Committee, Ottawa, Ontario Canada
| | - Brad Renaud
- PROUD Community Advisory Committee, Ottawa, Ontario Canada
| | - Sean LeBlanc
- PROUD Community Advisory Committee, Ottawa, Ontario Canada
- Drug Users Advocacy League, Ottawa, Ontario Canada
| | - Mark Tyndall
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Ahmed M. Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael’s Hospital; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8 Canada
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Jones AL, Kertesz SG, Hausmann LRM, Mor MK, Suo Y, Pettey WBP, Schaefer JH, Gundlapalli AV, Gordon AJ. Primary care experiences of veterans with opioid use disorder in the Veterans Health Administration. J Subst Abuse Treat 2020; 113:107996. [PMID: 32359670 DOI: 10.1016/j.jsat.2020.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 01/16/2020] [Accepted: 02/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND While patients with substance use disorders (SUDs) are thought to encounter poor primary care experiences, the perspectives of patients with opioid use disorder (OUD), specifically, are unknown. This study compares the primary care experiences of patients with OUD, other SUDs and no SUD in the Veterans Health Administration. METHODS The sample included Veterans who responded to the national Patient-Centered Medical Home Survey of Healthcare Experiences of Patients, 2013-2015. Respondents included 3554 patients with OUD, 36,175 with other SUDs, and 756,386 with no SUD; 742 OUD-diagnosed patients received buprenorphine. Multivariable multinomial logistic regressions estimated differences in the probability of reporting positive and negative experiences (0-100 scale) for patients with OUD, compared to patients with other SUDs and no SUD, and for OUD-diagnosed patients treated versus not treated with buprenorphine. RESULTS Of all domains, patients with OUD reported the least positive experiences with access (31%) and medication decision-making (35%), and the most negative experiences with self-management support (35%) and provider communication (23%). Compared to the other groups, patients diagnosed with OUD reported fewer positive and/or more negative experiences with access, communication, office staff, provider ratings, comprehensiveness, care coordination, and self-management support (adjusted risk differences[aRDs] range from |2.9| to |7.0|). Among OUD-diagnosed patients, buprenorphine was associated with more positive experiences with comprehensiveness (aRD = 8.3) and self-management support (aRD = 7.1), and less negative experiences with care coordination (aRD = -4.9) and medication shared decision-making (aRD = -5.4). CONCLUSIONS In a national sample, patients diagnosed with OUD encounter less positive and more negative experiences than other primary care patients, including those with other SUDs. Buprenorphine treatment relates positively to experiences with care comprehensiveness, medication decisions, and care coordination. As stakeholders encourage more primary care providers to manage OUD, it will be important for healthcare systems to attend to patient access and experiences with care in these settings.
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Affiliation(s)
- Audrey L Jones
- Informatics, Decision Enhancement and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Division of Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Stefan G Kertesz
- Birmingham VA Medical Center, Birmingham, AL, USA; University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
| | - Leslie R M Hausmann
- Center for Health Equity and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Maria K Mor
- Center for Health Equity and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
| | - Ying Suo
- Informatics, Decision Enhancement and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Division of Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Warren B P Pettey
- Informatics, Decision Enhancement and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Division of Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - James H Schaefer
- Department of Veterans Affairs Office of Reporting, Analytics, Performance, Improvement and Deployment, Durham, NC, USA.
| | - Adi V Gundlapalli
- Informatics, Decision Enhancement and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Division of Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Adam J Gordon
- Informatics, Decision Enhancement and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Division of Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Davis EL, Kelly PJ, Deane FP, Baker AL, Buckingham M, Degan T, Adams S. The relationship between patient-centered care and outcomes in specialist drug and alcohol treatment: A systematic literature review. Subst Abus 2019; 41:216-231. [DOI: 10.1080/08897077.2019.1671940] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Esther L. Davis
- Illawarra Institute for Mental Health and School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Peter J. Kelly
- Illawarra Institute for Mental Health and School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Frank P. Deane
- Illawarra Institute for Mental Health and School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Amanda L. Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Mark Buckingham
- Kedesh Rehabilitation Services, Berkeley, New South Wales, Australia
| | - Tayla Degan
- Illawarra Institute for Mental Health and School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sarah Adams
- Illawarra Shoalhaven Local Health District Drug & Alcohol Service, Wollongong, New South Wales, Australia
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Differences in Experiences With Care Between Homeless and Nonhomeless Patients in Veterans Affairs Facilities With Tailored and Nontailored Primary Care Teams. Med Care 2019; 56:610-618. [PMID: 29762272 DOI: 10.1097/mlr.0000000000000926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Homeless patients describe poor experiences with primary care. In 2012, the Veterans Health Administration (VHA) implemented homeless-tailored primary care teams (Homeless Patient Aligned Care Team, HPACTs) that could improve the primary care experience for homeless patients. OBJECTIVE To assess differences in primary care experiences between homeless and nonhomeless Veterans receiving care in VHA facilities that had HPACTs available (HPACT facilities) and in VHA facilities lacking HPACTs (non-HPACT facilities). RESEARCH DESIGN We used multivariable multinomial regressions to estimate homeless versus nonhomeless patient differences in primary care experiences (categorized as negative/moderate/positive) reported on a national VHA survey. We compared the homeless versus nonhomeless risk differences (RDs) in reporting negative or positive experiences in 25 HPACT facilities versus 485 non-HPACT facilities. SUBJECTS Survey respondents from non-HPACT facilities (homeless: n=10,148; nonhomeless: n=309,779) and HPACT facilities (homeless: n=2022; nonhomeless: n=20,941). MEASURES Negative and positive experiences with access, communication, office staff, provider rating, comprehensiveness, coordination, shared decision-making, and self-management support. RESULTS In non-HPACT facilities, homeless patients reported more negative and fewer positive experiences than nonhomeless patients. However, these patterns of homeless versus nonhomeless differences were reversed in HPACT facilities for the domains of communication (positive experience RDs in non-HPACT versus HPACT facilities=-2.0 and 2.0, respectively); comprehensiveness (negative RDs=2.1 and -2.3), shared decision-making (negative RDs=1.2 and -1.8), and self-management support (negative RDs=0.1 and -4.5; positive RDs=0.5 and 8.0). CONCLUSIONS VHA facilities with HPACT programs appear to offer a better primary care experience for homeless versus nonhomeless Veterans, reversing the pattern of relatively poor primary care experiences often associated with homelessness.
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Jones AL, Hausmann LRM, Haas GL, Mor MK, Cashy JP, Schaefer JH, Gordon AJ. A national evaluation of homeless and nonhomeless veterans' experiences with primary care. Psychol Serv 2018; 14:174-183. [PMID: 28481602 DOI: 10.1037/ser0000116] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Persons who are homeless, particularly those with mental health and/or substance use disorders (MHSUDs), often do not access or receive continuous primary care services. In addition, negative experiences with primary care might contribute to homeless persons' avoidance and early termination of MHSUD treatment. The patient-centered medical home (PCMH) model aims to address care fragmentation and improve patient experiences. How homeless persons with MHSUDs experience care within PCMHs is unknown. This study compared the primary care experiences of homeless and nonhomeless veterans with MHSUDs receiving care in the Veterans Health Administration's medical home environment, called Patient Aligned Care Teams. The sample included VHA outpatients who responded to the national 2013 PCMH-Survey of Health Care Experiences of Patients (PCMH-SHEP) and had a past-year MSHUD diagnosis. Veterans with evidence of homelessness (henceforth "homeless") were identified through VHA administrative records. PCMH-SHEP survey respondents included 67,666 veterans with MHSUDs (9.2% homeless). Compared with their nonhomeless counterparts, homeless veterans were younger, more likely to be non-Hispanic Black and nonmarried, had less education, and were more likely to live in urban areas. Homeless veterans had elevated rates of most MHSUDs assessed, indicating significant co-occurrence. After controlling for these differences, homeless veterans reported more negative and fewer positive experiences with communication; more negative provider ratings; and more negative experiences with comprehensiveness, care coordination, medication decision-making, and self-management support than nonhomeless veterans. Homeless persons with MHSUDs may need specific services that mitigate negative care experiences and encourage their continuation in longitudinal primary care services. (PsycINFO Database Record
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Affiliation(s)
- Audrey L Jones
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System
| | - Leslie R M Hausmann
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System
| | - Gretchen L Haas
- VISN 4 Mental Illness Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System
| | - Maria K Mor
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System
| | - John P Cashy
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System
| | - James H Schaefer
- Department of Veterans Affairs Office of Analytics and Business Intelligence
| | - Adam J Gordon
- VA Center for Health Equity Research and Promotion, VISN4 Mental Illness Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System
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Dong X, Bergren S, Simon MA. Cross-Sectional and Longitudinal Association Between Trust in Physician and Depressive Symptoms Among U.S. Community-Dwelling Chinese Older Adults. J Gerontol A Biol Sci Med Sci 2017; 72:S125-S130. [PMID: 28575268 PMCID: PMC5861912 DOI: 10.1093/gerona/glx036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/22/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Depression is a major public health concern among older adults and health care professionals play a vital role in screening and treatment. However, this process may be impeded by issues like lack of trust in physician (TIP). This study aims to examine the cross-sectional and longitudinal relationships between TIP and depressive symptoms among Chinese older adults in the Chicago area. METHODS Data were collected through the Population Study of Chinese Elderly (PINE), a longitudinal cohort study of Chinese older adults in the greater Chicago area. A total of 2,713 Chinese older adults completed both waves of data collection. TIP was measured through the Trust in Physician scale from Anderson and Dedrick (Anderson LA, Dedrick RF. Development of the Trust in Physician scale: a measure to assess interpersonal trust in patient-physician relationships. Psychol Rep. 1990;67(3 Pt 2):1091-1100. doi:10.2466/pr0.1990.67.3f.1091) (range: 11-55). Depressive symptoms were measured through Patient Health Questionnaire-9. RESULTS Every one point higher in TIP is associated with being 2% less likely to have any depressive symptoms (odds ratio [OR] 0.98, 0.97-0.99) in cross-sectional analysis. Longitudinally, every one-point increase in TIP score was associated with a 2% lower risk of depressive symptoms at Wave 2 (OR 0.98, 0.97-0.99). Improved TIP over 2 years was associated with 25% decreased risk of having any depressive symptoms at Wave 2 (OR 0.75, 0.63-0.89). Additionally, highest tertile of TIP change was associated with a 31% decreased risk of any depressive symptoms compared to lowest tertile (OR 0.68, 0.55-0.84). DISCUSSION Improved TIP over 2 years is associated with less risk of experiencing depressive symptoms. Future research should examine possible pathways and routes of intervention to improve mental health among older adults.
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Affiliation(s)
- XinQi Dong
- Chinese Health, Aging, and Policy Program, Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois
| | - Stephanie Bergren
- Chinese Health, Aging, and Policy Program, Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Bray JW, Aden B, Eggman AA, Hellerstein L, Wittenberg E, Nosyk B, Stribling JC, Schackman BR. Quality of life as an outcome of opioid use disorder treatment: A systematic review. J Subst Abuse Treat 2017; 76:88-93. [PMID: 28190543 PMCID: PMC5402314 DOI: 10.1016/j.jsat.2017.01.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The recent opioid epidemic has prompted renewed interest in opioid use disorder treatment, but there is little evidence regarding health-related quality-of-life (HRQoL) outcomes in treatment programs. Measuring HRQoL represents an opportunity to consider outcomes of opioid use disorder treatment that are more patient-centered and more relevant to overall health than abstinence alone. We conducted a systematic literature review to explore the extent to which the collection of HRQoL by opioid treatment programs is documented in the treatment program literature. MATERIALS AND METHODS We searched PubMed, Embase PsycINFO and Web of Science for papers published between 1965 and 2015 that reported HRQoL outcome measures from substance abuse treatment programs. RESULTS Of the 3014 unduplicated articles initially identified for screening, 99 articles met criteria for further review. Of those articles, 7 were unavailable in English; therefore 92 articles were reviewed. Of these articles, 44 included any quality-of-life measure, 17 of which included validated HRQoL measures, and 10 supported derivation of quality-adjusted life year utility weights. The most frequently used validated measure was the Addiction Severity Index (ASI). Non-U.S. and more recent studies were more likely to include a measure of HRQoL. CONCLUSIONS HRQoL measures are rarely used as outcomes in opioid treatment programs. The field should incorporate HRQoL measures as standard practice, especially measures that can be used to derive utility weights, such as the SF-12 or EQ-5D. These instruments provide policy makers with evidence on the impact of programs on patients' lives and with data to quantify the value of investing in opioid use disorder treatments.
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Affiliation(s)
- Jeremy W Bray
- Department of Economics, The University of North Carolina at Greensboro, PO Box 26170, Greensboro, NC 27402, United States.
| | - Brandon Aden
- Department of Medicine, Weill Cornell Medical College, 409 E 60th Street, New York, NY 10022, United States; Department of Healthcare Policy & Research, Weill Cornell Medical College, 425 E 61st Street, New York, NY 10065, United States.
| | - Ashley A Eggman
- Department of Healthcare Policy & Research, Weill Cornell Medical College, 425 E 61st Street, New York, NY 10065, United States.
| | - Leah Hellerstein
- Department of Healthcare Policy & Research, Weill Cornell Medical College, 425 E 61st Street, New York, NY 10065, United States.
| | - Eve Wittenberg
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, Boston, MA 02115, United States.
| | - Bohdan Nosyk
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C. V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, B.C. V5A 1S6, Canada.
| | - Judy C Stribling
- Samuel J. Wood Library, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, United States.
| | - Bruce R Schackman
- Department of Medicine, Weill Cornell Medical College, 409 E 60th Street, New York, NY 10022, United States; Department of Healthcare Policy & Research, Weill Cornell Medical College, 425 E 61st Street, New York, NY 10065, United States.
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Turpin A, Shier ML. Supporting Intrapersonal Development in Substance Use Disorder Programs: A Conceptual Framework for Client Assessment. JOURNAL OF EVIDENCE-INFORMED SOCIAL WORK 2017; 14:131-146. [PMID: 28388336 DOI: 10.1080/23761407.2017.1302860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Improvements to intrapersonal development of clients involved with substance use disorder treatment programs has widely been recognized as contributing to the intended goal of reducing substance misuse behaviors. This study sought to identify a broad framework of primary outcomes related to the intrapersonal development of clients in treatment for substance misuse. METHOD Using qualitative research methods, individual interviews were conducted with program participants (n = 41) at three treatment programs to identify the ways in which respondents experienced intrapersonal development through participation in treatment. RESULTS The findings support the development of a conceptual model that captures the importance and manifestation of achieving improvements in the following outcomes: self-awareness, coping ability, self-worth, outlook, and self-determination. DISCUSSION The findings provide a conceptual framework for client assessment that captures a broad range of the important intrapersonal development factors utilized as indicators for client development and recovery that should be measured in tandem during assessment.
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Affiliation(s)
- Aaron Turpin
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Ontario , Canada
| | - Micheal L Shier
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Ontario , Canada
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Jones AL, Mor MK, Cashy JP, Gordon AJ, Haas GL, Schaefer JH, Hausmann LRM. Racial/Ethnic Differences in Primary Care Experiences in Patient-Centered Medical Homes among Veterans with Mental Health and Substance Use Disorders. J Gen Intern Med 2016; 31:1435-1443. [PMID: 27325318 PMCID: PMC5130946 DOI: 10.1007/s11606-016-3776-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/12/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patient-Centered Medical Homes (PCMH) may be effective in managing care for racial/ethnic minorities with mental health and/or substance use disorders (MHSUDs). How such patients experience care in PCMH settings is relatively unknown. OBJECTIVE We aimed to examine racial/ethnic differences in experiences with primary care in PCMH settings among Veterans with MHSUDs. DESIGN We used multinomial regression methods to estimate racial/ethnic differences in PCMH experiences reported on a 2013 national survey of Veterans Affairs patients. PARTICPANTS Veterans with past-year MHSUD diagnoses (n = 65,930; 67 % White, 20 % Black, 11 % Hispanic, 1 % American Indian/Alaska Native[AI/AN], and 1 % Asian/Pacific Island[A/PI]). MAIN MEASURES Positive and negative experiences from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) PCMH Survey. RESULTS Veterans with MHSUDs reported the lowest frequency of positive experiences with access (22 %) and the highest frequency of negative experiences with self-management support (30 %) and comprehensiveness (16 %). Racial/ethnic differences (as compared to Whites) were observed in all seven healthcare domains (p values < 0.05). With access, Blacks and Hispanics reported more negative (Risk Differences [RDs] = 2 .0;3.6) and fewer positive (RDs = -2 .3;-2.3) experiences, while AI/ANs reported more negative experiences (RD = 5.7). In communication, Blacks reported fewer negative experiences (RD = -1.3); AI/ANs reported more negative (RD = 3.6) experiences; and AI/ANs and APIs reported fewer positive (RD = -6.5, -6.7) experiences. With office staff, Hispanics reported fewer positive experiences (RDs = -3.0); AI/ANs and A/PIs reported more negative experiences (RDs = 3.4; 3.7). For comprehensiveness, Blacks reported more positive experiences (RD = 3.6), and Hispanics reported more negative experiences (RD = 2.7). Both Blacks and Hispanics reported more positive (RDs = 2.3; 4.2) and fewer negative (RDs = -1.8; -1.9) provider ratings, and more positive experiences with decision making (RDs = 2.4; 3.0). Blacks reported more positive (RD = 3.9) and fewer negative (RD = -5.1) experiences with self-management support. CONCLUSIONS In a national sample of Veterans with MHSUDs, potential deficiencies were observed in access, self-management support, and comprehensiveness. Racial/ethnic minorities reported worse experiences than Whites with access, comprehensiveness, communication, and office staff helpfulness/courtesy.
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Affiliation(s)
- Audrey L Jones
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, University Drive (151C), Building 30, Pittsburgh, PA, 15240-1001, USA.
| | - Maria K Mor
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - John P Cashy
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Adam J Gordon
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gretchen L Haas
- VISN4 Mental Illness Research, Education, and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - James H Schaefer
- Department of Veterans Affairs Office of Analytics and Business Intelligence, Durham, NC, USA
| | - Leslie R M Hausmann
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Ompad DC, Giobazolia TT, Barton SC, Halkitis SN, Boone CA, Halkitis PN, Kapadia F, Urbina A. Drug use among HIV+ adults aged 50 and older: findings from the GOLD II study. AIDS Care 2016; 28:1373-7. [PMID: 27145363 DOI: 10.1080/09540121.2016.1178704] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Understanding the nexus of aging, HIV, and substance use is key to providing appropriate services and support for their aging, HIV seropositive patients. The proportion of PLWHA aged 50 and older is growing due to a variety of factors like decreases in mortality due to highly active retroviral therapy and non-negligible HIV incidence. We describe prevalence of alcohol, tobacco, and other drug use and participation in substance use treatment and 12-step programs among 95 HIV-positive patients aged 50 and older engaged in care. Most (73.7%) smoked cigarettes in their lifetime and 46.3% were current smokers. Most were at medium (81.1%) or high risk (13.7%) for an alcohol use disorder. With respect to illicit drug use, 48.4% had used marijuana, cocaine, crack, methamphetamines, heroin, and/or prescription opiates without a prescription in the last 12 months; 23.2% met criteria for drug dependence. Marijuana was the most commonly reported illicit drug (32.6%) followed by cocaine and crack (10.5% each), heroin and prescription opiates (7.4% each), and methamphetamines (6.3%). Among those who had not used drugs in the past 12 months, 36.7% had been in a substance use treatment program and 26.5% had participated in a 12-step program in their lifetime; 8.2% were currently in treatment and 16.3% were currently participating in a 12-step program. Among those who had used an illicit drug in the past 12 months, 37.0% had never been in treatment, 34.8% had been in treatment in their lifetime, and 28.3% were currently in treatment. With respect to 12-step programs, 27.3% of those meeting dependence criteria had never participated, 45.5% had participated in their lifetimes, and 27.3% were currently participating. Our findings suggest that older adults in HIV care settings could benefit from Screening, Brief Intervention, and Referral to Treatment interventions and/or integrated services for substance abuse and medical treatment.
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Affiliation(s)
- Danielle C Ompad
- a College of Global Public Health, New York University , New York , NY , USA.,b Center for Health, Identity, Behavior, and Prevention Studies, New York University , New York , NY , USA.,c Center for Drug Use and HIV Research , Rory Meyers College of Nursing, New York University , New York , NY , USA
| | - Tatiana T Giobazolia
- b Center for Health, Identity, Behavior, and Prevention Studies, New York University , New York , NY , USA
| | - Staci C Barton
- b Center for Health, Identity, Behavior, and Prevention Studies, New York University , New York , NY , USA
| | - Sophia N Halkitis
- b Center for Health, Identity, Behavior, and Prevention Studies, New York University , New York , NY , USA
| | - Cheriko A Boone
- b Center for Health, Identity, Behavior, and Prevention Studies, New York University , New York , NY , USA.,f Department of Sociomedical Sciences , Columbia University, Mailman School of Public Health , New York , NY , USA.,g School of Social Work , Columbia University , New York , NY , USA
| | - Perry N Halkitis
- a College of Global Public Health, New York University , New York , NY , USA.,b Center for Health, Identity, Behavior, and Prevention Studies, New York University , New York , NY , USA.,c Center for Drug Use and HIV Research , Rory Meyers College of Nursing, New York University , New York , NY , USA.,d Department of Population Health , Langone Medical Center, New York University , New York , NY , USA.,e Department of Applied Psychology , Steinhardt School of Culture, Education, and Human Development, New York University , New York , NY , USA
| | - Farzana Kapadia
- a College of Global Public Health, New York University , New York , NY , USA.,b Center for Health, Identity, Behavior, and Prevention Studies, New York University , New York , NY , USA.,c Center for Drug Use and HIV Research , Rory Meyers College of Nursing, New York University , New York , NY , USA.,d Department of Population Health , Langone Medical Center, New York University , New York , NY , USA
| | - Antonio Urbina
- h Mount Sinai Institute for Advanced Medicine , New York , NY , USA
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Duncan LG, Mendoza S, Hansen H. Buprenorphine Maintenance for Opioid Dependence in Public Sector Healthcare: Benefits and Barriers. JOURNAL OF ADDICTION MEDICINE AND THERAPEUTIC SCIENCE 2015; 1:31-36. [PMID: 27088135 PMCID: PMC4830502 DOI: 10.17352/2455-3484.000008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Since its U.S. FDA approval in 2002, buprenorphine has been available for maintenance treatment of opiate dependence in primary care physicians' offices. Though buprenorphine was intended to facilitate access to treatment, disparities in utilization have emerged; while buprenorphine treatment is widely used in private care setting, public healthcare integration of buprenorphine lags behind. RESULTS Through a review of the literature, we found that U.S. disparities are partly due to a shortage of certified prescribers, concern of patient diversion, as well as economic and institutional barriers. Disparity of buprenorphine treatment dissemination is concerning since buprenorphine treatment has specific characteristics that are especially suited for low-income patient population in public sector healthcare such as flexible dosing schedules, ease of concurrently treating co-morbidities such as HIV and hepatitis C, positive patient attitudes towards treatment, and the potential of reducing addiction treatment stigma. CONCLUSION As the gap between buprenorphine treatment in public sector settings and private sector settings persists in the U.S., current research suggests ways to facilitate its dissemination.
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Affiliation(s)
| | | | - Helena Hansen
- New York University; The Nathan S. Kline Institute for Psychiatric Research
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14
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Experience of primary care among homeless individuals with mental health conditions. PLoS One 2015; 10:e0117395. [PMID: 25659142 PMCID: PMC4319724 DOI: 10.1371/journal.pone.0117395] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 12/23/2014] [Indexed: 11/29/2022] Open
Abstract
The delivery of primary care to homeless individuals with mental health conditions presents unique challenges. To inform healthcare improvement, we studied predictors of favorable primary care experience among homeless persons with mental health conditions treated at sites that varied in degree of homeless-specific service tailoring. This was a multi-site, survey-based comparison of primary care experiences at three mainstream primary care clinics of the Veterans Administration (VA), one homeless-tailored VA clinic, and one tailored non-VA healthcare program. Persons who accessed primary care service two or more times from July 2008 through June 2010 (N = 366) were randomly sampled. Predictor variables included patient and organization characteristics suggested by the patient perception model developed by Sofaer and Firminger (2005), with an emphasis on mental health. The primary care experience was assessed with the Primary Care Quality-Homeless (PCQ-H) questionnaire, a validated survey instrument. Multiple regression identified predictors of positive experiences (i.e. higher PCQ-H total score). Significant predictors of a positive experience included a site offering tailored service design, perceived choice among providers, and currently domiciled status. There was an interaction effect between site and severe psychiatric symptoms. For persons with severe psychiatric symptoms, a homeless-tailored service design was significantly associated with a more favorable primary care experience. For persons without severe psychiatric symptoms, this difference was not significant. This study supports the importance of tailored healthcare delivery designed for homeless persons’ needs, with such services potentially holding special relevance for persons with mental health conditions. To improve patient experience among the homeless, organizations may want to deliver services that are tailored to homelessness and offer a choice of providers.
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Kertesz SG, Holt CL, Steward JL, Jones RN, Roth DL, Stringfellow E, Gordon AJ, Kim TW, Austin EL, Henry SR, Kay Johnson N, Shanette Granstaff U, O'Connell JJ, Golden JF, Young AS, Davis LL, Pollio DE. Comparing homeless persons' care experiences in tailored versus nontailored primary care programs. Am J Public Health 2013; 103 Suppl 2:S331-9. [PMID: 24148052 DOI: 10.2105/ajph.2013.301481] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We compared homeless patients' experiences of care in health care organizations that differed in their degree of primary care design service tailoring. METHODS We surveyed homeless-experienced patients (either recently or currently homeless) at 3 Veterans Affairs (VA) mainstream primary care settings in Pennsylvania and Alabama, a homeless-tailored VA clinic in California, and a highly tailored non-VA Health Care for the Homeless Program in Massachusetts (January 2011-March 2012). We developed a survey, the "Primary Care Quality-Homeless Survey," to reflect the concerns and aspirations of homeless patients. RESULTS Mean scores at the tailored non-VA site were superior to those from the 3 mainstream VA sites (P < .001). Adjusting for patient characteristics, these differences remained significant for subscales assessing the patient-clinician relationship (P < .001) and perceptions of cooperation among providers (P = .004). There were 1.5- to 3-fold increased odds of an unfavorable experience in the domains of the patient-clinician relationship, cooperation, and access or coordination for the mainstream VA sites compared with the tailored non-VA site; the tailored VA site attained intermediate results. CONCLUSIONS Tailored primary care service design was associated with a superior service experience for patients who experienced homelessness.
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Affiliation(s)
- Stefan G Kertesz
- Stefan G. Kertesz, Erika L. Austin, N. Kay Johnson, and U. Shanette Granstaff are with the Birmingham VA Medical Center, Birmingham, AL. Cheryl L. Holt is with the University of Maryland, Baltimore. Jocelyn L. Steward is with the University of Alabama, Birmingham. Richard N. Jones is with Brown University, Providence, RI. David L. Roth is with Johns Hopkins University, Baltimore, MD. Erin Stringfellow is with Washington University, St. Louis, MO. Adam J. Gordon is with the VA Pittsburgh Healthcare System, Pittsburgh, PA. Theresa W. Kim is with the Boston Medical Center and the Boston Healthcare for the Homeless Program, Boston, MA. Stephen Randal Henry, Joya F. Golden, and Alexander S. Young are with the VA Medical Center, Greater Los Angeles, Los Angeles, CA. James J. O'Connell is with the Boston Health Care for the Homeless Program, Boston. Lori L. Davis is with the Tuscaloosa VA Medical Center, Tuscaloosa, AL. David E. Pollio is with the University of Alabama, Tuscaloosa
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Levola J, Kaskela T, Holopainen A, Sabariego C, Tourunen J, Cieza A, Pitkänen T. Psychosocial difficulties in alcohol dependence: a systematic review of activity limitations and participation restrictions. Disabil Rehabil 2013; 36:1227-39. [DOI: 10.3109/09638288.2013.837104] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ozawa S, Sripad P. How do you measure trust in the health system? A systematic review of the literature. Soc Sci Med 2013; 91:10-4. [PMID: 23849233 DOI: 10.1016/j.socscimed.2013.05.005] [Citation(s) in RCA: 172] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 01/26/2013] [Accepted: 05/07/2013] [Indexed: 10/26/2022]
Abstract
People's trust in the health system plays a role in explaining one's access to and utilization of medical care, adherence to medications, continuity of care, and even self-reported health status. Yet it is not easy to find trust measures and understand what they are measuring. A systematic review of scales and indices identified 45 measures of trust within the health system with an average of 12 questions each, which quantified levels of trust among various relationships across the health system. Existing evidence was narrow in scope, where half examined the relationship between doctors/nurses and patients, and the majority were designed, tested and validated in the United States. We developed a health systems trust content area framework, where we identified that honesty, communication, confidence and competence were captured frequently in these measures, with less focus on concepts such as fidelity, system trust, confidentiality and fairness. Half of the measures employed a qualitative method in the design of these measures and 33% were pilot tested. Reporting of test-retest reliability and inter-rater reliability were less common. This review identifies a need to develop measurements of trust beyond doctor-patient relationships and outside of U.S. contexts, and strengthen the rigor of existing trust measures. Greater development and use of trust measures in the health system could improve monitoring and evaluation efforts, which may in turn result in better health outcomes.
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Affiliation(s)
- Sachiko Ozawa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States.
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18
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Gallagher N, MacFarlane A, Murphy AW, Freeman GK, Glynn LG, Bradley CP. Service users' and caregivers' perspectives on continuity of care in out-of-hours primary care. QUALITATIVE HEALTH RESEARCH 2013; 23:407-421. [PMID: 23258113 DOI: 10.1177/1049732312470521] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Modernization policies in primary care, such as the introduction of out-of-hours general practice cooperatives, signify a marked departure from many service users' traditional experiences of continuity of care. We report on a case study of accounts of service users with chronic conditions and their caregivers of continuity of care in an out-of-hours general practice cooperative in Ireland. Using Strauss and colleagues' Chronic Illness Trajectory Framework, we explored users' and caregivers' experiences of continuity in this context. Whereas those dealing with "routine trajectories" were largely satisfied with their experiences, those dealing with "problematic trajectories" (characterized by the presence of, for example, multimorbidity and complex care regimes) had considerable concerns about continuity of experiences in this service. Results highlight that modernization policies that have given rise to out-of-hours cooperatives have had a differential impact on service users with chronic conditions and their caregivers, with serious consequences for those who have "problematic" trajectories.
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Blair IV, Steiner JF, Fairclough DL, Hanratty R, Price DW, Hirsh HK, Wright LA, Bronsert M, Karimkhani E, Magid DJ, Havranek EP. Clinicians' implicit ethnic/racial bias and perceptions of care among Black and Latino patients. Ann Fam Med 2013; 11:43-52. [PMID: 23319505 PMCID: PMC3596038 DOI: 10.1370/afm.1442] [Citation(s) in RCA: 261] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We investigated whether clinicians' explicit and implicit ethnic/racial bias is related to black and Latino patients' perceptions of their care in established clinical relationships. METHODS We administered a telephone survey to 2,908 patients, stratified by ethnicity/race, and randomly selected from the patient panels of 134 clinicians who had previously completed tests of explicit and implicit ethnic/racial bias. Patients completed the Primary Care Assessment Survey, which addressed their clinicians' interpersonal treatment, communication, trust, and contextual knowledge. We created a composite measure of patient-centered care from the 4 subscales. RESULTS Levels of explicit bias were low among clinicians and unrelated to patients' perceptions. Levels of implicit bias varied among clinicians, and those with greater implicit bias were rated lower in patient-centered care by their black patients as compared with a reference group of white patients (P = .04). Latino patients gave the clinicians lower ratings than did other groups (P <.0001), and this did not depend on the clinicians' implicit bias (P = .98). CONCLUSIONS This is among the first studies to investigate clinicians' implicit bias and communication processes in ongoing clinical relationships. Our findings suggest that clinicians' implicit bias may jeopardize their clinical relationships with black patients, which could have negative effects on other care processes. As such, this finding supports the Institute of Medicine's suggestion that clinician bias may contribute to health disparities. Latinos' overall greater concerns about their clinicians appear to be based on aspects of care other than clinician bias.
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Affiliation(s)
- Irene V Blair
- Department of Psychology and Neuro-science, University of Colorado Boulder, 80309-0345, USA.
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Bonhomme J, Shim RS, Gooden R, Tyus D, Rust G. Opioid addiction and abuse in primary care practice: a comparison of methadone and buprenorphine as treatment options. J Natl Med Assoc 2012; 104:342-50. [PMID: 23092049 DOI: 10.1016/s0027-9684(15)30175-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Opioid abuse and addiction have increased in frequency in the United States over the past 20 years. In 2009, an estimated 5.3 million persons used opioid medications nonmedically within the past month, 200000 used heroin, and approximately 9.6% of African Americans used an illicit drug. Racial and ethnic minorities experience disparities in availability and access to mental health care, including substance use disorders. Primary care practitioners are often called upon to differentiate between appropriate, medically indicated opioid use in pain management vs inappropriate abuse or addiction. Racial and ethnic minority populations tend to favor primary care treatment settings over specialty mental health settings. Recent therapeutic advances allow patients requiring specialized treatment for opioid abuse and addiction to be managed in primary care settings. The Drug Addiction Treatment Act of 2000 enables qualified physicians with readily available short-term training to treat opioid-dependent patients with buprenorphine in an office-based setting, potentially making primary care physicians active partners in the diagnosis and treatment of opioid use disorders. Methadone and buprenorphine are effective opioid replacement agents for maintenance and/or detoxification of opioid-addicted individuals. However, restrictive federal regulations and stigmatization of opioid addiction and treatment have limited the availability of methadone. The opioid partial agonist-antagonist buprenorphine/naloxone combination has proven an effective alternative. This article reviews the literature on differences between buprenorphine and methadone regarding availability, efficacy, safety, side-effects, and dosing, identifying resources for enhancing the effectiveness of medication-assisted recovery through coordination with behavioral/psychological counseling, embedded in the context of recovery-oriented systems of care.
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Affiliation(s)
- Jean Bonhomme
- Department of Psychiatry and Behavioral Sciences,Morehouse School of Medicine, Atlanta, Georgia, USA.
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Allensworth-Davies D, Cheng DM, Smith PC, Samet JH, Saitz R. The Short Inventory of Problems-Modified for Drug Use (SIP-DU): validity in a primary care sample. Am J Addict 2012; 21:257-62. [PMID: 22494228 DOI: 10.1111/j.1521-0391.2012.00223.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Primary care physicians can help drug-dependent patients mitigate adverse drug use consequences; instruments validated in primary care to measure these consequences would aid in this effort. This study evaluated the validity of the Short Inventory of Problems-Alcohol and Drugs modified for Drug Use (SIP-DU) among subjects recruited from a primary care clinic (n= 106). SIP-DU internal consistency was evaluated using Cronbach's alphas, convergent validity by correlating the total SIP-DU score with the DAST-10, and construct validity by analyzing the factor structure. The SIP-DU demonstrated high internal consistency (Cronbach's alpha for overall scale .95, subscales .72-.90) comparable with other SIP versions and correlated well with the DAST-10 (r= .70). Confirmatory factor analysis suggested an unacceptable fit of previously proposed factors; exploratory factor analyses suggested a single factor of drug use consequences. The SIP-DU offers primary care clinicians a valid and practical assessment tool for drug use consequences.
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Affiliation(s)
- Donald Allensworth-Davies
- Data Coordinating Center, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA.
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Bohnert ASB, Zivin K, Welsh DE, Kilbourne AM. Ratings of patient-provider communication among veterans: serious mental illnesses, substance use disorders, and the moderating role of trust. HEALTH COMMUNICATION 2011; 26:267-274. [PMID: 21390974 DOI: 10.1080/10410236.2010.549813] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Many individuals with a mental illness are not satisfied with their communication with their primary provider. The present study examined the relationship of serious mental illness (SMI), substance use disorder (SUD), and trust for the provider with provider communication. The sample included Veterans Administration (VA) patients throughout the United States who either had a SMI diagnosis (schizophrenia or bipolar disorder) or were in a random sample of non-SMI patients (total N=8,089). Latent class (LC) modeling identified three classes of provider communication ratings in the sample: very good, good, and poor. In LC regression, poor trust for the provider was associated with a decrease in the likelihood of being in the "very good" or "good" compared to the "poor" provider communication ratings group, and the decrease was significantly greater for VA patients with a SMI or SUD diagnosis than those without. Training providers on creating trust is particularly important for those who serve patients with SMI and SUD diagnoses.
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Affiliation(s)
- Amy S B Bohnert
- VA National Serious Mental Illness Treatment Resource and Evaluation Center and the Health Services, Research and Development Center of Excellence, Ann Arbor, Michigan 48109, USA.
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Green TC, Kershaw T, Lin H, Heimer R, Goulet JL, Kraemer KL, Gordon AJ, Maisto SA, Day NL, Bryant K, Fiellin DA, Justice AC. Patterns of drug use and abuse among aging adults with and without HIV: a latent class analysis of a US Veteran cohort. Drug Alcohol Depend 2010; 110:208-20. [PMID: 20395074 PMCID: PMC3087206 DOI: 10.1016/j.drugalcdep.2010.02.020] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 02/23/2010] [Accepted: 02/24/2010] [Indexed: 10/19/2022]
Abstract
This study characterized the extent and patterns of self-reported drug use among aging adults with and without HIV, assessed differences in patterns by HIV status, and examined pattern correlates. Data derived from 6351 HIV-infected and uninfected adults enrolled in an eight-site matched cohort, the Veterans Aging Cohort Study (VACS). Using clinical variables from electronic medical records and socio-demographics, drug use consequences, and frequency of drug use from baseline surveys, we performed latent class analyses (LCA) stratified by HIV status and adjusted for clinical and socio-demographic covariates. Participants were, on average, age 50 (range 22-86), primarily male (95%) and African-American (64%). Five distinct patterns emerged: non-users, past primarily marijuana users, past multidrug users, current high consequence multidrug users, and current low consequence primarily marijuana users. HIV status strongly influenced class membership. Non-users were most prevalent among HIV uninfected (36.4%) and current high consequence multidrug users (25.5%) were most prevalent among HIV-infected. While problems of obesity marked those not currently using drugs, current users experienced higher prevalences of medical or mental health disorders. Multimorbidity was highest among past and current multidrug users. HIV-infected participants were more likely than HIV-uninfected participants to be current low consequence primarily marijuana users. In this sample, active drug use and abuse were common. HIV-infected and uninfected Veterans differed on extent and patterns of drug use and on important characteristics within identified classes. Findings have the potential to inform screening and intervention efforts in aging drug users with and without HIV.
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Affiliation(s)
- Traci C Green
- Division of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States.
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Abstract
AIMS This study aimed to project the number of people aged 50 years or older with substance use disorder (alcohol/illicit drug dependence or abuse) in the United States in 2020. DESIGN Logistic regression models were applied to estimate parameters predicting past-year substance use disorder using the 2002-06 National Survey on Drug Use and Health data. We applied these parameters to the projected US 2020 population to estimate the number of adults aged 50 or older with substance use disorder in 2020. SETTING Non-institutionalized US residences. PARTICIPANTS Representative sample of the US civilian, non-institutionalized population. MEASUREMENTS Substance use disorder is classified based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. FINDINGS Due to the large population size and high substance use rate of the baby-boom cohort, the number of adults aged 50 or older with substance use disorder is projected to double from 2.8 million (annual average) in 2002-06 to 5.7 million in 2020. Increases are projected for all examined gender, race/ethnicity and age groups. CONCLUSIONS Our estimates provide critical information for policymakers to allocate resources and develop prevention and treatment approaches to address future needs of the US older adult population with substance use disorder.
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Affiliation(s)
- Beth Han
- Office of Applied Studies, Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services, Rockville, MD, USA.
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Saitz R, Horton NJ, Cheng DM, Samet JH. Alcohol counseling reflects higher quality of primary care. J Gen Intern Med 2008; 23:1482-6. [PMID: 18618204 PMCID: PMC2518021 DOI: 10.1007/s11606-008-0574-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 10/29/2007] [Accepted: 02/25/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Some primary care physicians do not conduct alcohol screening because they assume their patients do not want to discuss alcohol use. OBJECTIVES To assess whether (1) alcohol counseling can improve patient-perceived quality of primary care, and (2) higher quality of primary care is associated with subsequent decreased alcohol consumption. DESIGN A prospective cohort study. SUBJECTS Two hundred eighty-eight patients in an academic primary care practice who had unhealthy alcohol use. MEASUREMENTS The primary outcome was quality of care received [measured with the communication, whole-person knowledge, and trust scales of the Primary Care Assessment Survey (PCAS)]. The secondary outcome was drinking risky amounts in the past 30 days (measured with the Timeline Followback method). RESULTS Alcohol counseling was significantly associated with higher quality of primary care in the areas of communication (adjusted mean PCAS scale scores: 85 vs. 76) and whole-person knowledge (67 vs. 59). The quality of primary care was not associated with drinking risky amounts 6 months later. CONCLUSIONS Although quality of primary care may not necessarily affect drinking, brief counseling for unhealthy alcohol use may enhance the quality of primary care.
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Affiliation(s)
- Richard Saitz
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118, USA.
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Fabius R, Frazee SG. The "trusted clinician": an alternative approach to worksite health promotion? Am J Health Promot 2008; 22:suppl 1-7, iii. [PMID: 18251124 DOI: 10.4278/ajhp.22.3.tahp-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A trusted primary care clinician located in the workplace and serving all employees is presented as a desirable model for delivering prevention services to employees in this edition of The Art of Health Promotion. Many of the clinical studies that support this model are reviewed by the authors and their implications are discussed. Finally, the authors call for large scale experimentation to test the potential of the model to improve health risks status, lifestyle behaviors and health care utilization and cost.
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