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Tilhou AS, Burns M, Chachlani P, Chen Y, Dague L. How Does Telehealth Expansion Change Access to Healthcare for Patients With Different Types of Substance Use Disorders? SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:473-485. [PMID: 38494728 PMCID: PMC11179974 DOI: 10.1177/29767342241236028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND Patients with substance use disorders (SUDs) exhibit low healthcare utilization despite high medical need. Telehealth could boost utilization, but variation in uptake across SUDs is unknown. METHODS Using Wisconsin Medicaid enrollment and claims data from December 1, 2018, to December 31, 2020, we conducted a cohort study of telemedicine uptake in the all-ambulatory and the primary care setting during telehealth expansion following the COVID-19 public health emergency (PHE) onset (March 14, 2020). The sample included continuously enrolled (19 months), nonpregnant, nondisabled adults aged 19 to 64 years with opioid (OUD), alcohol (AUD), stimulant (StimUD), or cannabis (CannUD) use disorder or polysubstance use (PSU). Outcomes: total and telehealth visits in the week, and fraction of visits in the week completed by telehealth. Linear and fractional regression estimated changes in in-person and telemedicine utilization. We used regression coefficients to calculate the change in telemedicine utilization, the proportion of in-person decline offset by telemedicine uptake ("offset"), and the share of visits completed by telemedicine ("share"). RESULTS The cohort (n = 16 756) included individuals with OUD (34.8%), AUD (30.1%), StimUD (9.5%), CannUD (9.5%), and PSU (19.7%). Total and telemedicine utilization varied by group post-PHE. All-ambulatory: total visits dropped for all, then rose above baseline for OUD, PSU, and AUD. Telehealth expansion was associated with visit increases: OUD: 0.489, P < .001; PSU: 0.341, P < .001; StimUD: 0.160, P < .001; AUD: 0.132, P < .001; CannUD: 0.115, P < .001. StimUD exhibited the greatest telemedicine share. Primary care: total visits dropped for all, then recovered for OUD and CannUD. Telemedicine visits rose most for PSU: 0.021, P < .001; OUD: 0.019, P < .001; CannUD: 0.011, P < .001; AUD: 0.010, P < .001; StimUD: 0.009, P < .001. PSU and OUD exhibited the greatest telemedicine share, while StimUD exhibited the lowest. Telemedicine fully offset declines for OUD only. CONCLUSIONS Telehealth expansion helped maintain utilization for OUD and PSU; StimUD and CannUD showed less responsiveness. Telehealth expansion could widen gaps in utilization by SUD type.
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Affiliation(s)
- Alyssa Shell Tilhou
- Department of Family Medicine, Boston University Medical Center, Boston, MA, USA
| | - Marguerite Burns
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Preeti Chachlani
- Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI, USA
| | - Ying Chen
- Department of Risk and Insurance, Wisconsin School of Business, University of Wisconsin-Madison, Madison, WI, USA
| | - Laura Dague
- The Bush School of Government and Public Service, Texas A&M University, College Station, TX, USA
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Tilhou A, Baldwin M, Alves J. No Time to Wait: Leveraging Primary Care to Treat Stimulant Use Disorder. Am J Prev Med 2024:S0749-3797(24)00145-4. [PMID: 38762205 DOI: 10.1016/j.amepre.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/20/2024]
Affiliation(s)
- Alyssa Tilhou
- Department of Family Medicine, Boston Medical Center, Boston, Massachusetts.
| | - Marielle Baldwin
- Department of Family Medicine, Boston Medical Center, Boston, Massachusetts
| | - Justin Alves
- Department of Family Medicine, Boston Medical Center, Boston, Massachusetts
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Richelle L, Dramaix-Wilmet M, Vanderhofstadt Q, Kornreich C. Cluster analysis of medical students' attitudes regarding people who use drugs: a first step to design a tailored education program. BMC MEDICAL EDUCATION 2024; 24:490. [PMID: 38702647 PMCID: PMC11067200 DOI: 10.1186/s12909-024-05380-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/31/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION People with substance use disorder (SUD) deal with stigmatization in various areas of life, including healthcare system. In this study, we investigated the attitudes of final-year medical students towards SUD people and attempted to understand their influence. METHODS We conducted a two-stage cluster analysis (hierarchical ascending classification followed by K-means clustering) based on the "beSAAS". We administrated this 23-item questionnaire to 923 final-year medical students in Belgium (response rate = 71,1%). Sociodemographic characteristics were compared between the clusters. RESULTS Four clusters of students with specific characteristics were identified in this study. The first, "The Inclusives" (including 27,9% of respondents) had the least negative attitudes; they wanted to specialize mainly in psychiatry and gynecology. The second, "The Centrists" (23,6%) consisted mainly of male students. They had many private and professional experiences with substance use and considered themselves less healthy than others did. Most wanted to specialize in pediatrics and general practice. Their attitudes were slightly negative towards people with SUD. The third, "The Moralists" (27,6%), were mainly older, from non-European countries, had the least experience with substance use (or contact mainly in hospitals), had the less high mother's level of education and reported excellent health. They were heading toward other specialties. They had the most stereotypes and moralism, and less treatment optimism. The fourth, "The Specialist care-oriented" (20,8%), were the most in favor of specialized treatment. This group had a higher proportion of Belgian, females, and students who had specific contact with this population. They especially intended to specialize in internal medicine. CONCLUSION This study revealed 4 profiles of medical students with different attitudes towards SUD people. "The Moralists", including more than a quarter of the respondents, were characterized by strong stereotypes and moralism and little treatment optimism. These clusters could contribute to the design of a learner-centered program aimed at addressing stigma within the main curriculum.
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Affiliation(s)
- Lou Richelle
- Unité de Recherche en Soins Primaires ULB, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.
- Département de Médecine Générale, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.
| | - Michele Dramaix-Wilmet
- Département d'Epidémiologie et de Biostatistiques, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Quentin Vanderhofstadt
- Unité de Recherche en Soins Primaires ULB, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
- Département de Médecine Générale, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Charles Kornreich
- Unité de Recherche en Soins Primaires ULB, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
- Laboratoire de Psychologie Médicale et d'Addictologie, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
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Isaacs AN, Mitchell EKL. Mental health integrated care models in primary care and factors that contribute to their effective implementation: a scoping review. Int J Ment Health Syst 2024; 18:5. [PMID: 38331913 PMCID: PMC10854062 DOI: 10.1186/s13033-024-00625-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/01/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND In the state of Victoria, Australia, the 111-day lockdown due to the COVID-19 pandemic exacerbated the population's prevailing state of poor mental health. Of the 87% of Australians who visit their GP annually, 71% of health problems they discussed related to psychological issues. This review had two objectives: (1) To describe models of mental health integrated care within primary care settings that demonstrated improved mental health outcomes that were transferable to Australian settings, and (2) To outline the factors that contributed to the effective implementation of these models into routine practice. METHODS A scoping review was undertaken to synthesise the evidence in order to inform practice, policymaking, and research. Data were obtained from PubMed, CINAHL and APA PsycINFO. RESULTS Key elements of effective mental health integrated care models in primary care are: Co-location of mental health and substance abuse services in the primary care setting, presence of licensed mental health clinicians, a case management approach to patient care, ongoing depression monitoring for up to 24 months and other miscellaneous elements. Key factors that contributed to the effective implementation of mental health integrated care in routine practice are the willingness to accept and promote system change, integrated physical and mental clinical records, the presence of a care manager, adequate staff training, a healthy organisational culture, regular supervision and support, a standardised workflow plan and care pathways that included clear role boundaries and the use of outcome measures. The need to develop sustainable funding mechanisms has also been emphasized. CONCLUSION Integrated mental health care models typically have a co-located mental health clinician who works closely with the GP and the rest of the primary care team. Implementing mental health integrated care models in Australia requires a 'whole of system' change. Lessons learned from the Mental Health Nurse Incentive Program could form the foundation on which this model is implemented in Australia.
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Affiliation(s)
- Anton N Isaacs
- Monash University School of Rural Health, Sargeant Street, PO Box 723, Warragul, VIC, 3820, Australia.
| | - Eleanor K L Mitchell
- Monash University School of Rural Health, Corner of Victoria Street & Day Street, PO Box 1497, Bairnsdale, VIC, 3875, Australia
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Wellensiek J, Specka M, Just J, Banger M, Bonnet U, Scherbaum N. Patient Perspectives on Pharmacotherapy of Alcohol Dependence. PHARMACOPSYCHIATRY 2024; 57:21-29. [PMID: 38052239 DOI: 10.1055/a-2190-4842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Pharmacotherapy with drugs like naltrexone or acamprosate is a well-evaluated element in the treatment of alcohol dependence (AD). However, in many countries, these medications are rarely administered. The objective of the present study was to identify from patients' perspective factors that prevent the initiation and compliance with pharmacological treatment of AD. METHODS Patients from inpatient alcohol withdrawal treatment underwent a standardized interview. Questions included socio-demographic data, history of AD, treatment history, knowledge and personal experience regarding pharmacotherapy of AD, and personal views about the causes of AD. RESULTS Three hundred patients (mean age 47.3 years, 27.7% female, mean duration of AD 8.9 years, 67% with a history of previous inpatient withdrawal treatment) were included. The majority of patients (58.7%) already knew drugs for the pharmacotherapy of AD. Thirty percent had ever used such medications, most often acamprosate. Except for disulfiram, pharmacotherapy of AD had lasted only a few weeks, on average. Medication usually had been applied without additional psychotherapy. No severe side effects were reported. Patients had often stopped pharmacotherapy on their own, when assuming they had reached stable abstinence. Openness to start pharmacotherapy for AD was currently stated by 67% of the total sample. In multiple logistic regression, openness was predicted by having a concept of AD as a medical disease and by a shorter duration of AD. DISCUSSION To improve the administration of pharmacotherapy for AD implementation strategies should be systematically developed and evaluated with a focus on the concept of AD as a medical disease.
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Affiliation(s)
- Julian Wellensiek
- LVR Hospital Bonn, Department of Addiction Disorders and Psychotherapy, Bonn, Germany
| | - Michael Specka
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Johannes Just
- Witten/Herdecke University, Faculty of Health, Department of Medicine, Witten, Germany
| | - Markus Banger
- LVR Hospital Bonn, Department of Addiction Disorders and Psychotherapy, Bonn, Germany
| | - Udo Bonnet
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg/Essen, Castrop-Rauxel, Germany
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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Welch S, Moles R, Viardot A, Deweerd P, Daly S, Lee K. Connecting the Dots of Care: A pilot study linking Aboriginal and/or Torres Strait Islander peoples with diabetes care in hospital, using hospital pharmacists. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100351. [PMID: 37965249 PMCID: PMC10641541 DOI: 10.1016/j.rcsop.2023.100351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
Background Diabetes is common among Aboriginal and/or Torres Strait Islander peoples, yet often undetected in hospital. Objective To identify how urban hospital pharmacists can detect if Aboriginal and/or Torres Strait Islander patients have diabetes or a higher chance of getting diabetes. Methods A multi-methods study used data from patients, and researcher field notes. Aboriginal and/or Torres Strait Islander peoples admitted to hospital over 12-weeks (July-October 2021) were prospectively identified from admissions lists. A hospital pharmacist-researcher visited eligible patients. Consenting participants had their blood glucose and HbA1c checked. Participants with HbA1c > 6.5% (no known diabetes) or 7% (known diabetes) were referred for endocrinology review during their stay. Test results and resultant diabetes plan were shared with their general practitioner. Two days after discharge, participants were called to gauge views on their hospital-based diabetes care. Barcode technology recorded pharmacist time. Voice-recorded field notes were thematically analysed. Ethics approval was obtained. Results Seventy-two patients were eligible for inclusion, 67/72 (93%) consented to take part. Sixty-one (91%) patients returned a HbA1c < 6.5, of which, 4/61 (6.5%) returned a HbA1c, 6-6.4. They were contacted to yarn about diabetes prevention. Six of the 67 (9%) qualified for endocrine review, 5 had known diabetes, one newly diagnosed. None were known to endocrinology. All participants telephoned were satisfied with their hospital-based diabetes care. Pharmacist time for initial introductory yarn, consenting process, organisation of HbA1c and results discussion was 20 min or 40 min if referred for endocrine review. Field notes guided understanding of service implementation. Conclusion This novel pharmacist-led diabetes screening service for Aboriginal and/or Torres Strait Islander peoples appeared to provide a unique opportunity for screening and referral links in a holistic way. Future research is required to test this model by upscaling to include more pharmacists and other chronic disease screening and referral pathways.
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Affiliation(s)
- Susan Welch
- St. Vincent's Hospital, 390 Victoria St., Darlinghurst 2010, Australia
- University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Camperdown, Sydney, N.S.W 2006, Australia
| | - Rebekah Moles
- University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Camperdown, Sydney, N.S.W 2006, Australia
| | - Alexander Viardot
- St. Vincent's Hospital, 390 Victoria St., Darlinghurst 2010, Australia
- Garvan Institute, University of New South Wales, Randwick, Sydney, N.S.W. 2010, Australia
| | - Pauline Deweerd
- St. Vincent's Hospital, 390 Victoria St., Darlinghurst 2010, Australia
| | - Scott Daly
- St. Vincent's Hospital, 390 Victoria St., Darlinghurst 2010, Australia
| | - Kylie Lee
- University of Sydney, Addiction Medicine, Faculty of Medicine and Health, Camperdown, Sydney 2006, Australia
- The Edith Collins Centre, Camperdown, Sydney, 2006, Australia
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Vic 3083, Australia
- Burnet Institute, Melbourne, Vic 3004, Australia
- National Drug Research Institute, Curtin University, Perth, WA, 6045, Australia
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McNeely J, McLeman B, Gardner T, Nesin N, Amarendran V, Farkas S, Wahle A, Pitts S, Kline M, King J, Rosa C, Marsch L, Rotrosen J, Hamilton L. Implementation of substance use screening in rural federally-qualified health center clinics identified high rates of unhealthy alcohol and cannabis use among adult primary care patients. Addict Sci Clin Pract 2023; 18:56. [PMID: 37726839 PMCID: PMC10510292 DOI: 10.1186/s13722-023-00404-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 07/31/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Screening for substance use in rural primary care clinics faces unique challenges due to limited resources, high patient volumes, and multiple demands on providers. To explore the potential for electronic health record (EHR)-integrated screening in this context, we conducted an implementation feasibility study with a rural federally-qualified health center (FQHC) in Maine. This was an ancillary study to a NIDA Clinical Trials Network study of screening in urban primary care clinics (CTN-0062). METHODS Researchers worked with stakeholders from three FQHC clinics to define and implement their optimal screening approach. Clinics used the Tobacco, Alcohol, Prescription Medication, and Other Substance (TAPS) Tool, completed on tablet computers in the waiting room, and results were immediately recorded in the EHR. Adult patients presenting for annual preventive care visits, but not those with other visit types, were eligible for screening. Data were analyzed for the first 12 months following implementation at each clinic to assess screening rates and prevalence of reported unhealthy substance use, and documentation of counseling using an EHR-integrated clinical decision support tool, for patients screening positive for moderate-high risk alcohol or drug use. RESULTS Screening was completed by 3749 patients, representing 93.4% of those with screening-eligible annual preventive care visits, and 18.5% of adult patients presenting for any type of primary care visit. Screening was self-administered in 92.9% of cases. The prevalence of moderate-high risk substance use detected on screening was 14.6% for tobacco, 30.4% for alcohol, 10.8% for cannabis, 0.3% for illicit drugs, and 0.6% for non-medical use of prescription drugs. Brief substance use counseling was documented for 17.4% of patients with any moderate-high risk alcohol or drug use. CONCLUSIONS Self-administered EHR-integrated screening was feasible to implement, and detected substantial alcohol, cannabis, and tobacco use in rural FQHC clinics. Counseling was documented for a minority of patients with moderate-high risk use, possibly indicating a need for better support of primary care providers in addressing substance use. There is potential to broaden the reach of screening by offering it at routine medical visits rather than restricting to annual preventive care visits, within these and other rural primary care clinics.
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Affiliation(s)
- Jennifer McNeely
- Department of Population Health, Section on Tobacco, Alcohol and Drug Use, New York University Grossman School of Medicine, 180 Madison Ave., 17th Floor, New York, NY, 10016, USA.
| | - Bethany McLeman
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Evergreen Center, Suite 315, Lebanon, NH, 03766, USA
| | - Trip Gardner
- Penobscot Community Health Care (PCHC), 103 Maine Avenue, Bangor, ME, 04401, USA
| | - Noah Nesin
- Penobscot Community Health Care (PCHC), 103 Maine Avenue, Bangor, ME, 04401, USA
| | - Vijay Amarendran
- Penobscot Community Health Care (PCHC), 103 Maine Avenue, Bangor, ME, 04401, USA
| | - Sarah Farkas
- Department of Psychiatry, New York University Grossman School of Medicine, 1 Park Ave, New York, NY, 10016, USA
| | - Aimee Wahle
- The Emmes Company, 401 N. Washington St., Rockville, MD, 20850, USA
| | - Seth Pitts
- The Emmes Company, 401 N. Washington St., Rockville, MD, 20850, USA
| | - Margaret Kline
- The Emmes Company, 401 N. Washington St., Rockville, MD, 20850, USA
| | - Jacquie King
- The Emmes Company, 401 N. Washington St., Rockville, MD, 20850, USA
| | - Carmen Rosa
- National Institute on Drug Abuse, c/o NIH Mail Center, NIDA 3@FN MSC 6022, 16071 Industrial Drive-Dock 11, Gaithersburg, MD, 20892, USA
| | - Lisa Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Evergreen Center, Suite 315, Lebanon, NH, 03766, USA
| | - John Rotrosen
- Department of Psychiatry, New York University Grossman School of Medicine, 1 Park Ave, New York, NY, 10016, USA
| | - Leah Hamilton
- Department of Population Health, Section on Tobacco, Alcohol and Drug Use, New York University Grossman School of Medicine, 180 Madison Ave., 17th Floor, New York, NY, 10016, USA
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA, 98101, USA
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Richelle L, Dramaix-Wilmet M, Kacenelenbogen N, Kornreich C. Exploratory Factor Analysis of a French Adapted Version of the Substance Abuse Attitude Survey among Medical Students in Belgium. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5356. [PMID: 37047970 PMCID: PMC10094367 DOI: 10.3390/ijerph20075356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/23/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
To evaluate the impact of a new Substance Use Disorder (SUD) education program on medical students' attitudes, we selected the Substance Abuse Attitude Survey (SAAS) questionnaire, which we adapted to our curriculum and cultural context. To validate this adapted version, we conducted an exploratory factor analysis following the administration of our 29-item bSAAS questionnaire to 657 medical students in Belgium (response rate: 71.1%). Twenty-three items correlated to three factors; namely, "Stereotypes and moralism", "Treatment optimism" and "Specialized treatment" were retained (70% of total variance explained, Cronbach's alpha = 0.80) and constituted the new questionnaire called beSAAS. The factor "Specialized treatment" stood out from previous studies, which could be explained by our target population and the impact of the formal, informal and hidden curricula in medical education. This study was able to highlight certain factors influencing stereotypical representations such as age, gender, origin, personal or professional experience with substance use. Our study allowed us to retain the beSAAS as a good questionnaire to evaluate SUD stigma and highlighted interesting findings to improve SUD training in medicine. Further studies are needed to complete its validity and reliability.
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Affiliation(s)
- Lou Richelle
- Unité de Recherche en Soins Primaires ULB, Faculty of Medicine, Université Libre de Bruxelles, 1070 Bruxelles, Belgium
- Département de Médecine Générale, Faculty of Medicine, Université Libre de Bruxelles, 1070 Bruxelles, Belgium
| | - Michèle Dramaix-Wilmet
- Département d’Epidémiologie et de Biostatistiques, School of Public Health, Université Libre de Bruxelles, 1070 Bruxelles, Belgium
| | - Nadine Kacenelenbogen
- Unité de Recherche en Soins Primaires ULB, Faculty of Medicine, Université Libre de Bruxelles, 1070 Bruxelles, Belgium
- Département de Médecine Générale, Faculty of Medicine, Université Libre de Bruxelles, 1070 Bruxelles, Belgium
| | - Charles Kornreich
- Unité de Recherche en Soins Primaires ULB, Faculty of Medicine, Université Libre de Bruxelles, 1070 Bruxelles, Belgium
- Laboratoire de Psychologie Médicale et d’Addictologie, Faculty of Medicine, Université Libre de Bruxelles, 1020 Bruxelles, Belgium
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Hyland CJ, McDowell MJ, Bain PA, Huskamp HA, Busch AB. Integration of pharmacotherapy for alcohol use disorder treatment in primary care settings: A scoping review. J Subst Abuse Treat 2023; 144:108919. [PMID: 36332528 PMCID: PMC10321472 DOI: 10.1016/j.jsat.2022.108919] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 09/01/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) represents the most prevalent addiction in the United States. Integration of AUD treatment in primary care settings would expand care access. The objective of this scoping review is to examine models of AUD treatment in primary care that include pharmacotherapy (acamprosate, disulfiram, naltrexone). METHODS The team undertook a search across MEDLINE, PsycINFO, CINAHL, the Cochrane Central Register of Controlled Trials, and Web of Science on May 21, 2021. Eligibility criteria included: patient population ≥ 18 years old, primary care-based setting, US-based study, presence of an intervention to promote AUD treatment, and prescription of FDA-approved AUD pharmacotherapy. Study design was limited to controlled trials and observational studies. We assessed study bias using a modified Oxford Centre for Evidence-based Medicine Rating Framework quality rating scheme. RESULTS The qualitative synthesis included forty-seven papers, representing 25 primary studies. Primary study sample sizes ranged from 24 to 830,825 participants and many (44 %) were randomized controlled trials. Most studies (80 %) included a nonpharmacologic intervention for AUD: 56 % with brief intervention, 40 % with motivational interviewing, and 12 % with motivational enhancement therapy. A plurality of studies (48 %) included mixed pharmacologic interventions, with administration of any combination of naltrexone, acamprosate, and/or disulfiram. Of the 47 total studies included, 68 % assessed care initiation and engagement. Fewer studies (15 %) explored practices surrounding screening for or diagnosing AUD. Outcome measures included receipt of pharmacotherapy and alcohol consumption, which about half of studies included (53 % and 51 %, respectively). Many of these outcomes showed significant findings in favor of integrated care models for AUD. CONCLUSIONS The integration of AUD pharmacotherapy in primary care settings may be associated with improved process and outcome measures of care. Future research should seek to understand the varied experiences across care integration models.
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Affiliation(s)
- Colby J Hyland
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States of America.
| | - Michal J McDowell
- Department of Psychiatry, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114, United States of America
| | - Paul A Bain
- Countway Library of Medicine, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, United States of America.
| | - Haiden A Huskamp
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, United States of America.
| | - Alisa B Busch
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, United States of America; McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, MA 02478, United States of America.
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Magidson JF, Belus JM, Seitz-Brown CJ, Tralka H, Safren SA, Daughters SB. Act Healthy: A Randomized Clinical Trial Evaluating a Behavioral Activation Intervention to Address Substance Use and Medication Adherence Among Low-Income, Black/African American Individuals Living with HIV/AIDS. AIDS Behav 2022; 26:102-115. [PMID: 34173895 PMCID: PMC8808422 DOI: 10.1007/s10461-021-03354-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
There is a need for parsimonious behavioral interventions to support HIV and substance use treatment outcomes for low-income, Black/African American individuals living with HIV. This randomized clinical trial (N = 61) evaluated Act Healthy (AH), an integrated behavioral intervention to reduce substance use and improve medication adherence, compared to supportive counseling (SC) plus Life-Steps medication adherence counseling on substance use, craving, adherence-related outcomes, and depression over one year. Participants in AH had significantly steeper decreases in cravings compared to SC, but no significant differences in substance use. Across both groups, there was a significant increase in probability of being on antiretroviral therapy (ART) (86% on ART at 12 months vs. 56% at baseline), and a significant decrease in medication nonadherence. Findings provide preliminary support for an intervention to reduce cravings and strategies to improve ART use in a hard-to-reach, vulnerable population at high risk for poor treatment outcomes and ongoing HIV transmission. TRIAL REGISTRATION: ClinicalTrials.gov trial registration number: identifier: NCT01351454. Retrospectively registered on May 10, 2011.
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Affiliation(s)
- Jessica F Magidson
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, USA.
| | - Jennifer M Belus
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, USA
| | - C J Seitz-Brown
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, USA
| | - Hannah Tralka
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, Maryland, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, UNC Chapel-Hill, Chapel Hill, NC, USA
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