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Cook JL. The opioid epidemic. Best Pract Res Clin Obstet Gynaecol 2022; 85:53-58. [PMID: 36045027 DOI: 10.1016/j.bpobgyn.2022.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/06/2022] [Indexed: 12/14/2022]
Abstract
An opioid epidemic has been happening across the world since the 1990s and continues impact individuals, families, communities and societies around the globe. The epidemic has evolved from heroin misuse to the use of synthetic opioids that are easily manufactured and are readily available. Reasons for the continuing opioid epidemic are complex, and include factors related to mental health, addiction, chronic pain relief, and, now, the COVID-19 pandemic. Women have been disproportionally affected by the opioid epidemic and the physical and biosocial effects of opioid use specific to women are an important consideration for healthcare providers. Recent data show that the effects of the opioid epidemic on rates of opioid use disorder (OUD), overdoses, and the economy continue to rise, despite global efforts to understand the drivers and develop effective prevention and intervention strategies, programs, and policies.
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Affiliation(s)
- Jocelynn L Cook
- The Society of Obstetricians and Gynaecologists of Canada and the Department of Obstetrics, Gynaecology and Newborn Care, The University of Ottawa, 2781 Lancaster Rd, Suite 200, Ottawa, ON K1B 1A7, Canada.
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2
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Kokole D, Jané-Llopis E, Mercken L, Piazza M, Bustamante I, Natera Rey G, Medina P, Pérez-Gómez A, Mejía-Trujillo J, O'Donnell A, Kaner E, Gual A, Schmidt CS, Schulte B, Candel MJJM, de Vries H, Anderson P. Factors associated with primary health care providers' alcohol screening behavior in Colombia, Mexico and Peru. Subst Abus 2021; 42:1007-1015. [PMID: 33849396 DOI: 10.1080/08897077.2021.1903658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background: Screening for unhealthy alcohol use in routine consultations can aid primary health care (PHC) providers in detecting patients with hazardous or harmful consumption and providing them with appropriate care. As part of larger trial testing strategies to improve implementation of alcohol screening in PHC, this study investigated the motivational (role security, therapeutic commitment, self-efficacy) and organizational context (leadership, work culture, resources, monitoring, community engagement) factors that were associated with the proportion of adult patients screened with AUDIT-C by PHC providers in Colombia, Mexico and Peru. Additionally, the study investigated whether the effect of the factors interacted with implementation strategies and the country. Methods: Pen-and-paper questionnaires were completed by 386 providers at the start of their study participation (79% female, Mage = 39.5, 37.6% doctors, 15.0% nurses, 9.6% psychologists, 37.8% other professional roles). They were allocated to one of four intervention arms: control group; short training only; short training in presence of municipal support; and standard (long) training in presence of municipal support. Providers documented their screening practice during the five-month implementation period. Data were collected between April 2019 and March 2020. Results: Negative binomial regression analysis found an inverse relationship of role security with the proportion of screened patients. Self-efficacy was associated with an increase in the proportion of screened patients only amongst Mexican providers. Support from leadership (formal leader in organization) was the only significant organizational context factor, but only in non-control arms. Conclusion: Higher self-efficacy is a relevant factor in settings where screening practice is already ongoing. Leadership support can enhance effects of implementation strategies.
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Affiliation(s)
- Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Univ. Ramon Llull, ESADE, Barcelona, Spain.,Institute for Mental Health Policy Research, CAMH, Toronto, ON, Canada
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ines Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Guillermina Natera Rey
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, CDMX, Mexico
| | - Perla Medina
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, CDMX, Mexico
| | | | | | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Antoni Gual
- Red de Trastornos Adictivos. Instituto Carlos III, Madrid, Spain.,Addictions Unit, Psychiatry Department Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Christiane Sybille Schmidt
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Schulte
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Math J J M Candel
- Department of Methodology & Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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3
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Romero-Rodríguez E, Pérula de Torres LÁ, Ruiz Moral R, Fernández García JÁ, Parras Rejano JM, Roldán Villalobos A, Camarelles Guillem F. Training health providers to address unhealthy alcohol use in primary care: a cross-sectional, multicenter study. BMC Health Serv Res 2020; 20:877. [PMID: 32938457 PMCID: PMC7493933 DOI: 10.1186/s12913-020-05730-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 09/10/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Health professionals' training is a key element to address unhealthy alcohol use in Primary Care (PC). Education about alcohol use can be effective in improving PC provider's knowledge and skills addressing alcohol-related problems. The aim of the study was to evaluate the training of health professionals to address unhealthy alcohol use in PC. METHODS An observational, descriptive, cross-sectional, multicenter study was performed. LOCATION PC centres of the Spanish National Health System (SNHS). PARTICIPANTS Family physicians, residents and nurses completed an online questionnaire that inquired about their training (none, basic, medium or advanced), knowledge and preventive practices aimed at reducing unhealthy alcohol use. The study population was recruited via random sampling, stratified by the regions of the SNHS's PC centre, and by email invitation to members of two Spanish scientific societies of Family Medicine. RESULTS A total of 1760 professionals participated in the study. Sixty-seven percent (95% CI: 67.5-71.8) reported not having received specific training to address unhealthy alcohol use, 30% (95% CI: 27.4-31.7) reported having received basic training, and 3% (95% CI: 2.3-4.0) medium/advanced training. The training received was greater in younger providers (p < 0.001) who participated in the PAPPS (Preventive Activities and Health Promotion Programme) (p < 0.001). Higher percentages of providers with intermediate or advanced training reported performing screening for unhealthy alcohol use (p < 0.001), clinical assessment of alcohol consumption (p < 0.001), counselling of patients to reduce their alcohol intake (p < 0.001) or to abstain, in the cases of pregnant women and drivers (p < 0.001). CONCLUSION Our study reveals a low level of training among Spanish PC providers to address unhealthy alcohol use. A higher percentage of screening, clinical assessment and counselling interventions aimed at reducing unhealthy alcohol use was reported by health professionals with an intermediate or advanced level of training.
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Affiliation(s)
- Esperanza Romero-Rodríguez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
| | - Luis Ángel Pérula de Torres
- Teaching Unit of Family and Community Medicine of Cordoba, Program of Preventive Activities and Health Promotion -PAPPS- (semFYC), Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Roger Ruiz Moral
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
| | - José Ángel Fernández García
- Villarrubia Health Center, Andalusian Health Service, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Juan Manuel Parras Rejano
- Villanueva del Rey Health Center, Andalusian Health Service, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Ana Roldán Villalobos
- Teaching Unit of Family and Community Medicine of Cordoba, Carlos Castilla Del Pino Health Center, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | | | - Collaborative Group Alco-AP
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
- Teaching Unit of Family and Community Medicine of Cordoba, Program of Preventive Activities and Health Promotion -PAPPS- (semFYC), Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
- Villarrubia Health Center, Andalusian Health Service, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
- Villanueva del Rey Health Center, Andalusian Health Service, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
- Teaching Unit of Family and Community Medicine of Cordoba, Carlos Castilla Del Pino Health Center, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
- Infanta Mercedes Health Center, Madrid Health Service, PAPPS Health Education Group (semFYC), Madrid, Spain
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Lukaschek K, Schneider N, Schelle M, Kirk UB, Eriksson T, Kunnamo I, Rochfort A, Collins C, Gensichen J. Applicability of Motivational Interviewing for Chronic Disease Management in Primary Care Following a Web-Based E-Learning Course: Cross-Sectional Study. JMIR Ment Health 2019; 6:e12540. [PMID: 31033446 PMCID: PMC6658265 DOI: 10.2196/12540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/30/2019] [Accepted: 02/18/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Motivational interviewing (MI) is an established communication method for enhancing intrinsic motivation for changing health behavior. E-learning can reduce the cost and time involved in providing continuing education and can be easily integrated into individual working arrangements and the daily routines of medical professionals. Thus, a Web-based course was devised to familiarize health professionals with different levels of education and expertise with MI techniques for patients with chronic conditions. OBJECTIVE The aim of this study was to report participants' opinion on the practicality of MI (as learned in the course) in daily practice, stratified by the level of education. METHODS Participants (N=607) of the MI Web-based training course evaluated the course over 18 months, using a self-administered questionnaire. The evaluation was analyzed descriptively and stratified for the level of education (medical students, physicians in specialist training [PSTs], and general practitioners [GPs]). RESULTS Participants rated the applicability of the skills and knowledge gained by the course as positive (medical students: 94% [79/84] good; PSTs: 88.6% [109/123] excellent; and GPs: 51.3% [182/355] excellent). When asked whether they envisage the use of MI in the future, 79% (67/84) of the students stated to a certain extent, 88.6% (109/123) of the PSTs stated to a great extent, and 38.6% (137/355) of GPs stated to a great extent. Participants acknowledged an improvement of communication skills such as inviting (medical students: 85% [72/84]; PSTs: 90.2% [111/123]; GPs: 37.2% [132/355]) and encouraging (medical students: 81% [68/84]; PSTs: 45.5% [56/123]; GPs: 36.3% [129/355]) patients to talk about behavior change and conveying respect for patient's choices (medical students: 72% [61/84]; PSTs: 50.0% [61/123]; GPs: 23.4% [83/355]). CONCLUSIONS Participants confirmed the practicality of MI. However, the extent to which the practicality of MI was acknowledged as well as its expected benefits depended on the individual's level of education/expertise.
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Affiliation(s)
- Karoline Lukaschek
- Institute of General Practice and Family Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Nico Schneider
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, University of Jena, Jena, Germany.,Institute of General Practice and Family Medicine, Jena University Hospital, University of Jena, Jena, Germany
| | - Mercedes Schelle
- Institute of General Practice and Family Medicine, Jena University Hospital, University of Jena, Jena, Germany
| | - Ulrik Bak Kirk
- European Society for Quality and Safety in Family Practice, København, Denmark
| | - Tina Eriksson
- European Society for Quality and Safety in Family Practice, København, Denmark
| | - Ilkka Kunnamo
- The Finnish Medical Society Duodecim, Helsinki, Finland
| | | | | | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.,Institute of General Practice and Family Medicine, Jena University Hospital, University of Jena, Jena, Germany
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Sturm H, Rieger MA, Martus P, Ueding E, Wagner A, Holderried M, Maschmann J. Do perceived working conditions and patient safety culture correlate with objective workload and patient outcomes: A cross-sectional explorative study from a German university hospital. PLoS One 2019; 14:e0209487. [PMID: 30608945 PMCID: PMC6319813 DOI: 10.1371/journal.pone.0209487] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/06/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Workload and demands on hospital staff have been growing over recent years. To ensure patient and occupational safety, hospitals increasingly survey staff about perceived working conditions and safety culture. At the same time, routine data are used to manage resources and performance. This study aims to understand the relation between survey-derived measures of how staff perceive their work-related stress and strain and patient safety on the one hand, and routine data measures of workload and quality of care (patient safety) on the other. METHODS We administered a written questionnaire to all physicians and nurses in the inpatient units at a German university hospital. The questionnaire was an amalgam of the Copenhagen Psychosocial Questionnaire (COPSOQ), the Copenhagen Burnout Inventory (CBI) scale to assess patient-related burnout of and portions of the Hospital Survey on Patient Safety Culture (HSPSC). Indicators from administrative data used to assess workload and patient-related work-strain were: amount of overtime worked, work intensity recording of nurses, cost weight, occupancy rate and DRG-related length of stay. Quality of care was assessed using readmission rates and disease-related length of stay. Univariate associations were tested with Pearson correlations. RESULTS Response rate were 37% (224) for physicians and 39% (351) for nurses. Physicians' overtime correlated strongly with perceived quantitative demands (.706, 95% CI: 0.634 to 0.766), emotional demands (.765; 95% CI: 0.705 to 0.814), and perceived role conflicts (.655, 95% CI: 0.573 to 0.724). Nurses' work-intensity measures were associated with decreasing physician job satisfaction and with less favorable perceptions of the appropriateness of staffing (-.527, 95% CI:-0.856 to 0.107). Both professional groups showed medium to strong associations between the morbidity measure (cost weight) and role conflicts; between occupancy rates and role clarity (-.482, 95% CI: -0.782 to -0.02) and predictability of work (-.62, 95% CI: -0.848 to -0.199); and between length of stay and internal team functioning (-.555, 95% CI: -0.818 to -0.101). Higher readmission rates were associated with lower perceived patient safety (-.476, 95% CI: -0.779 to 0.006), inadequate staffing (-.702, 95% CI: -0.884 to -0.334), and worse team functioning (-.520, 95% CI: -0.801 to -0.052). Shorter disease-related length of stay was associated with better teamwork within units (-.555, 95% CI: -0.818 to -0.101) and a lower risk of physician burnout (-.588, 95% CI: -0.846 to -0.108). CONCLUSION Perceptions of hospital personnel regarding sub-optimal workplace safety and teamwork issues correlated with worse patient outcome measures. Furthermore, objective measures of overtime work as well as objective measures of workload correlated clearly with subjective work-related stress and strain. This suggests that objective workload measures (such as overtime worked) could be used to indirectly monitor job-related psychosocial strain on employees and, thus, improve not only staff wellbeing but also patient outcomes. On the other hand, listening to their personnel could help hospitals to improve patient (and employee) safety.
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Affiliation(s)
- Heidrun Sturm
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Wilhelmstraße, Tübingen, Germany
- Institute of General Practice and Interprofessional Care, University Hospital of Tübingen, Osianderstr, Tübingen, Germany
| | - Monika A. Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Wilhelmstraße, Tübingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, University Hospital of Tübingen, Silcherstraße, Tübingen, Germany
| | - Esther Ueding
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Wilhelmstraße, Tübingen, Germany
| | - Anke Wagner
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital of Tübingen, Wilhelmstraße, Tübingen, Germany
| | - Martin Holderried
- Department of Quality Management, Medical and Business Development, University Hospital of Tübingen, Hoppe-Seyler-Str, Tübingen, Germany
| | - Jens Maschmann
- University Hospital Jena, Medical Director, Bachstrasse, Jena, Germany
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Optimizing the delivery of interventions for harmful alcohol use in primary healthcare: an update. Curr Opin Psychiatry 2018; 31:324-332. [PMID: 29846264 DOI: 10.1097/yco.0000000000000435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Alcohol is a leading risk factor for ill health and premature death. Regardless of poor levels of implementation achieved after more than 30 years of research and policy advice, alcohol screening and brief advice (SBA) remains one of the best policy options. This study updates the evidence by considering recent publications on SBA for heavy drinking and alcohol use disorder in primary healthcare at a timely moment, because researchers are, at present, debating future direction of research and policy in this field. RECENT FINDINGS Systematic literature search between 1 January 2016 and 31 December 2017 was conducted for new research on alcohol SBA in primary healthcare. In all, 63 articles were included. SUMMARY Primary healthcare-based SBA programmes are effective in reducing alcohol consumption among heavier drinkers. There is low implementation of these programmes in real practice. Academia is rethinking and debating future directions.
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Anderson P, Kaner E, Keurhorst M, Bendtsen P, Steenkiste BV, Reynolds J, Segura L, Wojnar M, Kłoda K, Parkinson K, Drummond C, Okulicz-Kozaryn K, Mierzecki A, Laurant M, Newbury-Birch D, Gual A. Attitudes and Learning through Practice Are Key to Delivering Brief Interventions for Heavy Drinking in Primary Health Care: Analyses from the ODHIN Five Country Cluster Randomized Factorial Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E121. [PMID: 28134783 PMCID: PMC5334675 DOI: 10.3390/ijerph14020121] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/18/2017] [Accepted: 01/20/2017] [Indexed: 11/18/2022]
Abstract
In this paper, we test path models that study the interrelations between primary health care provider attitudes towards working with drinkers, their screening and brief advice activity, and their receipt of training and support and financial reimbursement. Study participants were 756 primary health care providers from 120 primary health care units (PHCUs) in different locations throughout Catalonia, England, The Netherlands, Poland, and Sweden. Our interventions were training and support and financial reimbursement to providers. Our design was a randomized factorial trial with baseline measurement period, 12-week implementation period, and 9-month follow-up measurement period. Our outcome measures were: attitudes of individual providers in working with drinkers as measured by the Short Alcohol and Alcohol Problems Perception Questionnaire; and the proportion of consulting adult patients (age 18+ years) who screened positive and were given advice to reduce their alcohol consumption (intervention activity). We found that more positive attitudes were associated with higher intervention activity, and higher intervention activity was then associated with more positive attitudes. Training and support was associated with both positive changes in attitudes and higher intervention activity. Financial reimbursement was associated with more positive attitudes through its impact on higher intervention activity. We conclude that improving primary health care providers' screening and brief advice activity for heavy drinking requires a combination of training and support and on-the-job experience of actually delivering screening and brief advice activity.
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Affiliation(s)
- Peter Anderson
- Institute of Health and Society, Newcastle University, Newcastle NE1 7RU, UK.
- Department of Family Medicine, Maastricht University, Maastricht 6200, The Netherlands.
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle NE1 7RU, UK.
| | - Myrna Keurhorst
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen 6525, The Netherlands.
- Centre for Nursing Research, Saxion University of Applied Sciences, Deventer 7513, The Netherlands.
| | - Preben Bendtsen
- Department of Medical Specialist, Linköping University, Motala 58183, Sweden.
- Department of Medicine and Health, Linköping University, Motala 58183, Sweden.
| | - Ben van Steenkiste
- Department of Family Medicine, Maastricht University, Maastricht 6200, The Netherlands.
| | - Jillian Reynolds
- Psychiatry Determent, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona 08003, Spain.
| | - Lidia Segura
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona 08003, Spain.
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Warsaw 02-091, Poland.
| | - Karolina Kłoda
- Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin 70-204, Poland.
| | - Kathryn Parkinson
- Institute of Health and Society, Newcastle University, Newcastle NE1 7RU, UK.
| | - Colin Drummond
- National Addiction Centre, Institute of Psychiatry, King's College London, London WC2B 5RL, UK.
- National Institute for Health Research Biomedical Research Centre for Mental Health, Maudsley NHS Foundation Trust, London SE5 8AF, UK.
| | | | - Artur Mierzecki
- Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin 70-204, Poland.
| | - Miranda Laurant
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen 6525, The Netherlands.
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen 6525, The Netherlands.
| | | | - Antoni Gual
- Psychiatry Determent, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona 08003, Spain.
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