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Evans SK, Ober AJ, Korn AR, Peltz A, Friedmann PD, Page K, Murray-Krezan C, Huerta S, Ryzewicz SJ, Tarhuni L, Nuckols TK, E Watkins K, Danovitch I. Contextual barriers and enablers to establishing an addiction-focused consultation team for hospitalized adults with opioid use disorder. Addict Sci Clin Pract 2024; 19:31. [PMID: 38671482 PMCID: PMC11046820 DOI: 10.1186/s13722-024-00461-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Hospitalization presents an opportunity to begin people with opioid use disorder (OUD) on medications for opioid use disorder (MOUD) and link them to care after discharge; regrettably, people admitted to the hospital with an underlying OUD typically do not receive MOUD and are not connected with subsequent treatment for their condition. To address this gap, we launched a multi-site randomized controlled trial to test the effectiveness of a hospital-based addiction consultation team (the Substance Use Treatment and Recovery Team (START)) consisting of an addiction medicine specialist and care manager team that provide collaborative care and a specified intervention to people with OUD during the inpatient stay. Successful implementation of new practices can be impacted by organizational context, though no previous studies have examined context prior to implementation of addiction consultation services (ACS). This study assessed pre-implementation context for implementing a specialized ACS and tailoring it accordingly. METHODS We conducted semi-structured interviews with hospital administrators, physicians, physician assistants, nurses, and social workers at the three study sites between April and August 2021 before the launch of the pragmatic trial. Using an analytical framework based on the Consolidated Framework for Implementation Research, we completed a thematic analysis of interview data to understand potential barriers or enablers and perceptions about acceptability and feasibility. RESULTS We interviewed 28 participants across three sites. The following themes emerged across sites: (1) START is an urgently needed model for people with OUD; (2) Intervention adaptations are recommended to meet local and cultural needs; (3) Linking people with OUD to community clinicians is a highly needed component of START; (4) It is important to engage stakeholders across departments and roles throughout implementation. Across sites, participants generally saw a need for change from usual care to support people with OUD, and thought the START was acceptable and feasible to implement. Differences among sites included tailoring the START to support the needs of varying patient populations and different perceptions of the prevalence of OUD. CONCLUSIONS Hospitals planning to implement an ACS in the inpatient setting may wish to engage in a systematic pre-implementation contextual assessment using a similar framework to understand and address potential barriers and contextual factors that may impact implementation. Pre-implementation work can help ensure the ACS and other new practices fit within each unique hospital context.
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Affiliation(s)
- Sandra K Evans
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA.
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Ariella R Korn
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Alex Peltz
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Peter D Friedmann
- Department of Medicine, University of Massachusetts Chan Medical School-Baystate and Baystate Health, 3601 Main Street, 3rd Floor, 01107, Springfield, MA, USA
| | - Kimberly Page
- University of New Mexico Health Sciences Center, 1 University, MSC10 5550, 87133, Albuquerque, NM, USA
| | - Cristina Murray-Krezan
- Departement of Medicine, University of Pittsburgh School of Medicine, 200 Meyran Ave, Suite 300, 15213, Pittsburgh, PA, USA
| | - Sergio Huerta
- University of New Mexico Health Sciences Center, 1 University, MSC10 5550, 87133, Albuquerque, NM, USA
| | - Stephen J Ryzewicz
- Department of Medicine, University of Massachusetts Chan Medical School-Baystate and Baystate Health, 3601 Main Street, 3rd Floor, 01107, Springfield, MA, USA
| | - Lina Tarhuni
- University of New Mexico Health Sciences Center, 1 University, MSC10 5550, 87133, Albuquerque, NM, USA
| | - Teryl K Nuckols
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, 90048, West Hollywood, CA, USA
| | - Katherine E Watkins
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Itai Danovitch
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, 90048, West Hollywood, CA, USA
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Ogunbajo A, Todd I, Zajdman D, Anderson A, Wali S, Diamant A, Ladapo JA, Ober AJ. Statin use for cardiovascular disease prevention: perceptions among people living with HIV in the United States. BMC Prim Care 2024; 25:116. [PMID: 38632550 PMCID: PMC11022377 DOI: 10.1186/s12875-024-02370-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND People living with HIV (PLWH) may be at heightened risk for cardiovascular disease (CVD). Statin use and lifestyle changes reduce the risk of CVD but remain under-prescribed among PLWH. The objective of this study was to characterize knowledge of CVD and statin use, current usage, barriers to taking statins, and information desired by PLWH to improve statin uptake among PLWH in Los Angeles, CA. METHODS Between April 2019 and April 2020, we conducted four focus group discussions (n = 37) with patients across three public community health clinics that serve PLWH in Los Angeles County, California. All clinics participated in a larger study to improve statin prescribing for PLWH. We asked about knowledge of statins, willingness to take a statin, possible barriers to statin usage, preferred information sources for health information, and desired information about statins. We utilized standard qualitative content analysis methods to identify themes. RESULTS We found a range in the awareness of statins, with some participants reporting never having heard of statins while others had a history of statin use. There were concerns about the potential long-term effect of statin use, but participants expressed willingness to use CVD medications generally and statins specifically, especially if recommended by their healthcare provider. Participants also expressed interest in potential alternatives to statin usage such as exercising regularly and nutritious eating. CONCLUSIONS More interventions are needed to increase statin use among PLWH to improve CVD outcomes, which also has implications for HIV progression. Clinics should aim to increase patient and provider knowledge about CVD risk and statin use for PLWH and provide shared decision-making tools that are easy to use and culturally appropriate.
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Affiliation(s)
| | - Ivy Todd
- RAND Corporation, Pittsburgh, PA, United States of America
| | - Deborah Zajdman
- RAND Corporation, Santa Monica, VA, United States of America
| | | | - Soma Wali
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, United States of America
| | - Allison Diamant
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, United States of America
| | - Joseph A Ladapo
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, United States of America
| | - Allison J Ober
- RAND Corporation, Arlington, VA, United States of America
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Osilla KC, Manuel JK, Becker K, Nameth K, Burgette L, Ober AJ, DeYoreo M, Lodge BS, Hurley B, Watkins KE. It takes a village: A pilot study of a group telehealth intervention for support persons affected by opioid use disorder. J Subst Use Addict Treat 2024; 161:209290. [PMID: 38272117 DOI: 10.1016/j.josat.2024.209290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 11/28/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Opioid use disorder (OUD) has devastating effects on individuals, families, and communities. The Community Reinforcement and Family Training (CRAFT) is a Support Person (SP)-focused intervention that aims to increase SPs' communication strategies, positive reinforcement/rewards, and social support. This pilot study, called eINSPIRE (INtegrating Support Persons Into REcovery), adapted CRAFT for delivery via group telehealth. The aims were to evaluate the feasibility, acceptability, and preliminary effectiveness of this intervention on patient buprenorphine retention and SP mental health. METHODS The study recruited patients receiving buprenorphine treatment in a primary care setting across five community health centers with their SP (N = 100 dyads). SP participants were randomly assigned to receive usual care (UC) or the eINSPIRE intervention. We interviewed Patients and SPs at baseline and three months later. The study collected patient buprenorphine retention data from the electronic medical record three months post-baseline. RESULTS About 88 % (656/742) of potentially eligible patients were able to nominate a SP and 69 % (100/145) of nominated SPs were eligible and consented to the study. eINSPIRE groups had low reach (25 % of SPs attended), but high exposure (M = 7 of 10 sessions attended) and acceptability (classes helped them with their patient's OUD). The proportion of eINSPIRE patients (68 %) and UC patients (53 %) retained on buprenorphine at follow-up were similar (p = 0.203). SPs in both conditions reported similar reductions in their depression, anxiety, and impairment symptoms. CONCLUSIONS Preliminary data suggest that eINSPIRE groups may not be feasible in primary care without further adaptations for this population. A future study with a larger sample size is needed to elucidate the observed distribution differences in buprenorphine retention. Future research should also explore methods to reduce barriers to SP session attendance to improve the reach of this evidence-based intervention.
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Affiliation(s)
- Karen Chan Osilla
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1070 Arastradero Road, Palo Alto, CA 94304, United States.
| | - Jennifer K Manuel
- University of California San Francisco, Department of Psychiatry and Behavioral Sciences, 675 18th St, San Francisco, CA 94143, United States; San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA 94121, United States
| | - Kirsten Becker
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, United States
| | - Katherine Nameth
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1070 Arastradero Road, Palo Alto, CA 94304, United States
| | - Lane Burgette
- RAND Corporation, 1200 S Hayes St, Arlington, VA 22202, United States
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, United States
| | - Maria DeYoreo
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, United States
| | | | - Brian Hurley
- University of California Los Angeles, Department of Family Medicine, 10833 Le Conte Avenue, Los Angeles, CA 90095, United States; County of Los Angeles, Department of Public Health, Bureau of Substance Abuse Prevention and Control 1000 S. Fremont Avenue, Alhambra, CA 91803, United States
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Ober AJ, Dopp AR, Clingan SE, Curtis ME, Lin C, Calhoun S, Larkins S, Black M, Hanano M, Osterhage KP, Baldwin LM, Saxon AJ, Hichborn EG, Marsch LA, Mooney LJ, Hser YI. Stakeholder perspectives on a telemedicine referral and coordination model to expand medication treatment for opioid use disorder in rural primary care clinics. J Subst Use Addict Treat 2024; 156:209194. [PMID: 37863356 DOI: 10.1016/j.josat.2023.209194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/11/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION Opioid overdose deaths are increasing rapidly in the United States. Medications for opioid use disorder (MOUD) are effective and can be delivered in primary care, but uptake has been limited in rural communities. Referral to and coordination with an external telemedicine (TM) vendor by rural primary care clinics for MOUD (TM-MOUD) may increase MOUD access for rural patients, but we know little about perspectives on this model among key stakeholders. As part of a TM-MOUD feasibility study, we explored TM-MOUD acceptability and feasibility among personnel and patients from seven rural primary care clinics and a TM-MOUD vendor. METHODS We conducted virtual interviews or focus groups with clinic administrators (n = 7 interviews), clinic primary care and behavioral health providers (8 groups, n = 30), other clinic staff (9 groups, n = 37), patients receiving MOUD (n = 16 interviews), TM-MOUD vendor staff (n = 4 interviews), and vendor-affiliated behavioral health and prescribing providers (n = 17 interviews). We asked about experiences with and acceptability of MOUD (primarily buprenorphine) and telemedicine (TM) and a TM-MOUD referral and coordination model. We conducted content analysis to identify themes and participants quantitatively rated acceptability of TM-MOUD elements on a 4-item scale. RESULTS Perceived benefits of vendor-based TM-MOUD included reduced logistical barriers, more privacy and less stigma, and access to services not available locally (e.g., counseling, pain management). Barriers included lack of internet or poor connectivity in patients' homes, limited communication and trust between TM-MOUD and clinic providers, and questions about the value to the clinic of TM-MOUD referral to external vendor. Acceptability ratings for TM-MOUD were generally high; they were lowest among frontline staff. CONCLUSIONS Rural primary care clinic personnel, TM-MOUD vendor personnel, and patients generally perceived referral from primary care to a TM-MOUD vendor to hold potential for increasing access to MOUD in rural communities. Increasing TM-MOUD uptake requires buy-in and understanding among staff of the TM-MOUD workflow, TM services offered, requirements for patients, advantages over clinic-based or TM services from clinic providers, and identification of appropriate patients. Poverty, along with patient hesitation to initiate treatment, creates substantial barriers to MOUD treatment generally; insufficient internet availability creates a substantial barrier to TM-MOUD.
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Affiliation(s)
| | | | - Sarah E Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Megan E Curtis
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, CA, USA
| | - Stacy Calhoun
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Sherry Larkins
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Megan Black
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Maria Hanano
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Katie P Osterhage
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Andrew J Saxon
- Veterans Affairs Puget Sound Health Care System, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Emily G Hichborn
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Larissa J Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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Evans SK, Dopp A, Meredith LS, Ober AJ, Osilla KC, Komaromy M, Watkins KE. Findings from an Organizational Context Survey to Inform the Implementation of a Collaborative Care Study for Co-occurring Disorders. J Behav Health Serv Res 2024; 51:4-21. [PMID: 37537428 PMCID: PMC10733218 DOI: 10.1007/s11414-023-09851-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/05/2023]
Abstract
Primary care is an opportune setting to deliver treatments for co-occurring substance use and mental health disorders; however, treatment delivery can be challenging due multi-level implementation barriers. Documenting organizational context can provide insight into implementation barriers and the adaptation of new processes into usual care workflows. This study surveyed primary care and behavioral health staff from 13 clinics implementing a collaborative care intervention for opioid use disorders co-occurring with PTSD and/or depression as part of a multisite randomized controlled trial. A total of 323 completed an online survey for a 60% response rate. The Consolidated Framework for Implementation Research guided this assessment of multi-level factors that influence implementation. Most areas for improvement focused on inner setting (organizational level) constructs whereas individual-level constructs tended to be strengths. This work addresses a research gap regarding how organizational analyses can be used prior to implementation and provides practical implications for researchers and clinic leaders.
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Affiliation(s)
- Sandra K Evans
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Alex Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Lisa S Meredith
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Karen C Osilla
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA, 94305, USA
| | - Miriam Komaromy
- Boston Medical Center, Grayken Center for Addiction, One Boston Medical Center Place, Boston, MA, 02118, USA
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Ober AJ, Osilla KC, Klein DJ, Burgette LF, Leamon I, Mazer MW, Messineo G, Collier S, Korouri S, Watkins KE, IsHak W, Nuckols T, Danovitch I. Pilot randomized controlled trial of a hospital-based substance use treatment and recovery team (START) to improve initiation of medication for alcohol or opioid use disorder and linkage to follow-up care. J Subst Use Addict Treat 2023; 150:209063. [PMID: 37156424 DOI: 10.1016/j.josat.2023.209063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/06/2022] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES We conducted a pilot randomized controlled trial (RCT) to explore whether a hospital inpatient addiction consult team (Substance Use Treatment and Recovery Team [START]) based on collaborative care was feasible, acceptable to patients, and whether it could improve uptake of medication in the hospital and linkage to care after discharge, as well as reduce substance use and hospital readmission. The START consisted of an addiction medicine specialist and care manager who implemented a motivational and discharge planning intervention. METHODS We randomized inpatients age ≥ 18 with a probable alcohol or opioid use disorder to receive START or usual care. We assessed feasibility and acceptability of START and the RCT, and we conducted an intent-to-treat analysis on data from the electronic medical record and patient interviews at baseline and 1-month postdischarge. The study compared RCT outcomes (medication for alcohol or opioid use disorder, linkage to follow-up care after discharge, substance use, hospital readmission) between arms by fitting logistic and linear regression models. FINDINGS Of 38 START patients, 97 % met with the addiction medicine specialist and care manager; 89 % received ≥8 of 10 intervention components. All patients receiving START found it to be somewhat or very acceptable. START patients had higher odds of initiating medication during the inpatient stay (OR 6.26, 95 % CI = 2.38-16.48, p < .001) and being linked to follow-up care (OR 5.76, 95 % CI = 1.86-17.86, p < .01) compared to usual care patients (N = 50). The study found no significant differences between groups in drinking or opioid use; patients in both groups reported using fewer substances at the 1-month follow-up. CONCLUSIONS Pilot data suggest START and RCT implementation are feasible and acceptable and that START may facilitate medication initiation and linkage to follow-up for inpatients with an alcohol or opioid use disorder. A larger trial should assess effectiveness, covariates, and moderators of intervention effects.
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Affiliation(s)
- Allison J Ober
- RAND Corporation, Santa Monica, CA, United States of America.
| | - Karen C Osilla
- Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - David J Klein
- RAND Corporation, Santa Monica, CA, United States of America
| | - Lane F Burgette
- RAND Corporation, Santa Monica, CA, United States of America
| | - I Leamon
- RAND Corporation, Santa Monica, CA, United States of America
| | - Mia W Mazer
- Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | | | - Stacy Collier
- Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Samuel Korouri
- Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | | | - Waghui IsHak
- Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Teryl Nuckols
- Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Itai Danovitch
- Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
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Uscher-Pines L, McCullough CM, Sousa JL, Lee SD, Ober AJ, Camacho D, Kapinos KA. Changes in In-Person, Audio-Only, and Video Visits in California's Federally Qualified Health Centers, 2019-2022. JAMA 2023; 329:1219-1221. [PMID: 37039799 PMCID: PMC10091174 DOI: 10.1001/jama.2023.1307] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Tarn DM, Shih KJ, Ober AJ, Hunter SB, Watkins KE, Martinez J, Montero A, McCreary M, Leamon I, Sheehe J, Bromley E. Perspectives Regarding Medications for Opioid Use Disorder Among Individuals with Mental Illness. Community Ment Health J 2023; 59:345-356. [PMID: 35906435 PMCID: PMC9859922 DOI: 10.1007/s10597-022-01012-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 07/15/2022] [Indexed: 01/25/2023]
Abstract
Most people with co-occurring opioid use disorder (OUD) and mental illness do not receive effective medications for treating OUD. To investigate perspectives of adults in a publicly-funded mental health system regarding medications for OUD (MOUD), we conducted semi-structured telephone interviews with 13 adults with OUD (current or previous diagnosis) receiving mental health treatment. Themes that emerged included: perceiving or using MOUDs as a substitute for opioids or a temporary solution to prevent withdrawal symptoms; negative perceptions about methadone/methadone clinics; and viewing MOUD use as "cheating". Readiness to quit was important for patients to consider MOUDs. All participants were receptive to discussing MOUDs with their mental health providers and welcomed the convenience of receiving care for their mental health and OUD at the same location. In conclusion, clients at publicly-funded mental health clinics support MOUD treatment, signaling a need to expand access and build awareness of MOUDs in these settings.
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Affiliation(s)
- Derjung M Tarn
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, USA. .,Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA, 90024, USA.
| | - Kevin J Shih
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | | | | | | | | | - Alanna Montero
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Michael McCreary
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - John Sheehe
- LA County Department of Mental Health, Los Angeles, USA
| | - Elizabeth Bromley
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
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Uscher-Pines L, Arora N, Jones M, Lee A, Sousa JL, McCullough CM, Lee S, Martineau M, Predmore Z, Whaley CM, Ober AJ. Experiences of Health Centers in Implementing Telehealth Visits for Underserved Patients During the COVID-19 Pandemic: Results from the Connected Care Accelerator Initiative. Rand Health Q 2022; 9:2. [PMID: 36238021 PMCID: PMC9519102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In early 2020, as the coronavirus disease 2019 (COVID-19) pandemic emerged, widespread social-distancing efforts suspended much of the delivery of nonurgent health care. Telehealth proved to be a viable alternative to in-person care, at least on a temporary basis, and utilization skyrocketed. Many Federally Qualified Health Centers (FQHCs) serving low-income patients started delivering telehealth visits in high volume in March 2020 to help maintain access to care. This sudden and dramatic change in health care delivery posed numerous challenges. Health centers had to quickly make changes to technology, workflows, and staffing to accommodate telehealth visits. To support health centers in these efforts, the California Health Care Foundation established the Connected Care Accelerator (CCA) program, a quality improvement initiative that was launched in July 2020. RAND researchers evaluated the progress of FQHCs that participated in the CCA initiative by investigating changes in telehealth utilization and health center staff experiences with implementation. In this research, researchers review recent literature on telehealth implementation in safety net settings. They also present new information on the experiences of the 45 CCA health centers, drawing from data on visit trends, interviews with health center leaders, and surveys of health center providers and staff. Telehealth has the potential to increase access to care and deliver care that is more convenient and patient-centered; however, ongoing research is needed to ensure that telehealth is implemented in a way that ensures high-quality care and health equity.
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Otiashvili D, Kirtadze I, Mgebrishvili T, Beselia A, Tabatadze M, Vardanashvili I, Ober AJ. Implementation and evaluation of a syringe vending machine trial in Tbilisi, Georgia. Int J Drug Policy 2022; 103:103649. [PMID: 35299004 DOI: 10.1016/j.drugpo.2022.103649] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Syringe vending machines (SVM) have proven to be an effective vehicle for providing an uninterrupted supply of sterile equipment to PWID, but they have not been implemented or disseminated broadly. The aim of this study was to implement and evaluate outcomes of introducing SVM in Tbilisi, Georgia. METHODS We installed SVM at five HIV prevention sites in 10 locations in Tbilisi, Georgia and studied implementation over 20 months. We used the RE-AIM framework to assess outcomes across four RE-AIM domains: reach, effectiveness at providing syringe access, adoption and implementation. RESULTS Reach. SVM reached 8% of the target population. Effectiveness at Providing Syringe Access. SVM dispensed 14% of all syringes distributed by HIV prevention services. Using SVM was associated with PWID receiving more sterile syringes from HIV prevention outlets. Adoption. All HIV prevention sites (N=5) invited to implement SVM agreed to participate. Sixty one percent of PWID who received SVM access cards used SVM at least once. Women and young PWID were more likely to use SVM compared to other PWID. IMPLEMENTATION At some sites adherence of the outreach staff to the operational protocol was suboptimal. CONCLUSIONS SVM are an acceptable, feasible and effective intervention for improving access to sterile injection equipment for PWID. Future research will need to elaborate approaches to build the sense of ownership and improve motivation of the field staff to engage with the new intervention, and to examine strategies for attracting groups of PWID who are not in contact with prevention and treatment services.
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Affiliation(s)
- David Otiashvili
- Addiction Research Center Alternative Georgia, 14A Nutsubidze Street, office 2, Tbilisi 0177, Georgia; School of Natural Sciences and Medicine, Ilia State University, 3/5 Kakutsa Cholokashvili Ave., Tbilisi 0162, Georgia.
| | - Irma Kirtadze
- Addiction Research Center Alternative Georgia, 14A Nutsubidze Street, office 2, Tbilisi 0177, Georgia; School of Arts and Sciences, Ilia State University, 3/5 Kakutsa Cholokashvili Ave., Tbilisi 0162, Georgia
| | - Tamar Mgebrishvili
- Addiction Research Center Alternative Georgia, 14A Nutsubidze Street, office 2, Tbilisi 0177, Georgia
| | - Ada Beselia
- Addiction Research Center Alternative Georgia, 14A Nutsubidze Street, office 2, Tbilisi 0177, Georgia
| | - Mzia Tabatadze
- Addiction Research Center Alternative Georgia, 14A Nutsubidze Street, office 2, Tbilisi 0177, Georgia
| | - Irina Vardanashvili
- School of Business, Ilia State University, 3/5 Kakutsa Cholokashvili Ave., Tbilisi 0162, Georgia
| | - Allison J Ober
- RAND Corporation, 1776 Main Street PO Box 2138 Santa Monica, CA 90407-2138, United States
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11
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Ober AJ, Hunter SB, McCullough CM, Leamon I, McCreary M, Beas I, Montero A, Tarn DM, Bromley E, Hurley B, Sheehe J, Martinez J, Watkins KE. Opioid Use Disorder Among Clients of Community Mental Health Clinics: Prevalence, Characteristics, and Treatment Willingness. Psychiatr Serv 2022; 73:271-279. [PMID: 34281359 PMCID: PMC8770719 DOI: 10.1176/appi.ps.202000818] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined the prevalence of co-occurring opioid use disorder and willingness to engage in treatment among clients of eight Los Angeles County Department of Mental Health outpatient clinics. METHODS Adults presenting for an appointment over a 2-week period were invited to complete a voluntary, anonymous health survey. Clients who indicated opioid use in the past year were offered a longer survey assessing probable opioid use disorder. Willingness to take medication and receive treatment also was assessed. RESULTS In total, 3,090 clients completed screening. Among these, 8% had a probable prescription (Rx) opioid use disorder and 2% a probable heroin use disorder. Of the clients with probable Rx opioid use or heroin use disorder, 49% and 25% were female, respectively. Among those with probable Rx opioid use disorder, 43% were Black, 33% were Hispanic, and 12% were White, and among those with probable heroin use disorder, 24% were Black, 22% were Hispanic, and 39% were White. Seventy-eight percent of those with Rx opioid use disorder had never received any treatment, and 82% had never taken a medication for this disorder; 39% of those with heroin use disorder had never received any treatment, and 39% had never received a medication. The strongest predictor of willingness to take a medication was believing that it would help stop opioid use (buprenorphine, β=13.54, p=0.003, and naltrexone long-acting injection, β=15.83, p<0.001). CONCLUSIONS These findings highlight the need to identify people with opioid use disorder and to educate clients in mental health settings about medications for these disorders.
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Affiliation(s)
| | | | | | - Isabel Leamon
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407
| | | | - Ivan Beas
- David Geffen School of Medicine at UCLA
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12
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Dangerfield DT, Ober AJ, Anderson JN, Gorbach P, Bluthenthal RN. Observational "go-alongs" of follow-up HIV care visits of two virally suppressed Black sexual minority men. Public Health Nurs 2022; 39:153-160. [PMID: 34403517 PMCID: PMC8766864 DOI: 10.1111/phn.12960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE This study explored potentially underreported healthcare contexts, clinical experiences, and motivations for adherence in care among virally suppressed Black sexual minority men (BSMM) living with HIV (LWHIV) in Baltimore, MD. METHODS Go-alongs with two virally suppressed BSMM LWHIV supplemented 27 in-depth interviews of a larger qualitative study guided by Positive Deviance and Life Course Theory. The go-alongs involved accompanying participants' follow-up HIV care visit to obtain a better account of contextual healthcare factors. Observations focused on (1) clinic location and resources, (2) sources of HIV and sexuality stigma or support in the clinic, and (3) patient-provider interactions. RESULTS We found that facilitators and barriers to viral suppression for BSMM LWHIV included structural factors (i.e., healthcare setting, facility, and services), quality of patient-provider interactions, and personal motivations to achieve viral suppression. CONCLUSION Clinic accessibility, co-located clinical services, and rapport with clinicians and healthcare staff could be key contextual conditions that facilitate retention in care among BSMM LWHIV.
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Affiliation(s)
| | - Allison J. Ober
- Policy and Behavioral Science Researcher, RAND Corporation, Los Angeles, CA, USA
| | - Janeane N. Anderson
- Assitant Professor, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Pamina Gorbach
- Professor, University of California Los Angeles, Los Angeles, CA, USA
| | - Ricky N. Bluthenthal
- Professor, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
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13
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Dangerfield DT, Ober AJ, Li MJ, Allen S, Bluthenthal RN. HIV Treatment Adherence Strategies Among Virally Suppressed Black Sexual Minority Men in Baltimore, Maryland, and Los Angeles, California: A Theory-Based Qualitative Study. J Assoc Nurses AIDS Care 2022; 33:54-62. [PMID: 34939988 PMCID: PMC8718261 DOI: 10.1097/jnc.0000000000000304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Indexed: 01/03/2023]
Abstract
ABSTRACT The goals and strategies of Black sexual minority men living with HIV (BSMMLWH) who achieve viral suppression require further investigation. This study explored treatment adherence strategies among BSMMLWH with sustained viral suppression. We conducted 27 in-depth qualitative interviews with BSMMLWH in Baltimore, Maryland, and Los Angeles, California, between December 2018 and May 2019. Interviews included questions guided by Positive Deviance and Life Course theoretical frameworks regarding multilevel factors and explicit strategies for antiretroviral therapy adherence. Themes regarding intentional, age group-specific strategies such as using technology (among younger men) and taking HIV medications with other daily pills (among older men) were identified. Participants also reported symbiotic goals and values that encouraged adherence, such as having a desire to live, strong familial relationships with clinicians, and support networks. Identifying personal goals and having supportive clinical and social relationships could be key to improving treatment adherence and viral suppression among BSMMLWH.
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Affiliation(s)
| | | | - Michael J. Li
- Department of Family Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Sophia Allen
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Ricky N. Bluthenthal
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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14
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Otiashvili D, Kirtadze I, Mgebrishvili T, Beselia A, Tabatadze M, Otiashvili N, Ober AJ, Iguchi MY. Smart Syringe Vending Machines: Research Capabilities and Implications for Research Data Collection. J Stud Alcohol Drugs 2021. [DOI: 10.15288/jsad.2021.82.752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- David Otiashvili
- Addiction Research Center Alternative Georgia, Tbilisi, Georgia
- School of Natural Sciences and Medicine, Ilia State University, Tbilisi, Georgia
| | - Irma Kirtadze
- Addiction Research Center Alternative Georgia, Tbilisi, Georgia
- School of Natural Sciences and Medicine, Ilia State University, Tbilisi, Georgia
| | | | - Ada Beselia
- Addiction Research Center Alternative Georgia, Tbilisi, Georgia
| | - Mzia Tabatadze
- Addiction Research Center Alternative Georgia, Tbilisi, Georgia
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15
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Otiashvili D, Kirtadze I, Mgebrishvili T, Beselia A, Tabatadze M, Otiashvili N, Ober AJ, Iguchi MY. Smart Syringe Vending Machines: Research Capabilities and Implications for Research Data Collection. J Stud Alcohol Drugs 2021; 82:752-757. [PMID: 34762034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE Syringe vending machines (SVMs) are intended to supplement the standard syringe exchange programs to access hard-to-reach groups and to cover unserved geographical areas. This report describes how we adapted SVMs to deliver interventions and collect research data as part of a study of smart SVMs (SSVMs) in Tbilisi, Georgia. METHOD To create SSVMs, we upgraded commercial vending machines and developed a computer program to track and record interactions and to display messages related to study procedures. Preferred locations for SSVMs, product specifications, and the mode of operation were determined through formative input from people who inject drugs (PWID). SSVMs were installed near pharmacies and serve both the general population and PWID. The "hidden" interactive menu for the PWID prevention kits was displayed on the screen only when a special plastic card was used. The plastic cards were distributed to the clients of fixed syringe exchange programs and to their peers who were not in contact with harm-reduction services. RESULTS Ten SSVMs were operational in Tbilisi as of March 2021, with more than 800 PWID using them on a regular basis. More than half of sterile equipment kits were distributed during weekends and night hours. CONCLUSIONS Our innovative SSVM integrates features for intervention delivery and research data collection. It can be used for testing a variety of interventions beyond syringes (e.g., distribution of HIV/hepatitis C virus self-tests) and provides opportunities for serving various at-risk groups that might not otherwise access these products and services (e.g., men who have sex with men, commercial sex workers).
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Affiliation(s)
- David Otiashvili
- Addiction Research Center Alternative Georgia, Tbilisi, Georgia
- School of Natural Sciences and Medicine, Ilia State University, Tbilisi, Georgia
| | - Irma Kirtadze
- Addiction Research Center Alternative Georgia, Tbilisi, Georgia
- School of Arts and Sciences, Ilia State University, Tbilisi, Georgia
| | | | - Ada Beselia
- Addiction Research Center Alternative Georgia, Tbilisi, Georgia
| | - Mzia Tabatadze
- Addiction Research Center Alternative Georgia, Tbilisi, Georgia
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16
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Ober AJ, Takada S, Zajdman D, Todd I, Horwich T, Anderson A, Wali S, Ladapo JA. Factors affecting statin uptake among people living with HIV: primary care provider perspectives. BMC Fam Pract 2021; 22:215. [PMID: 34717560 PMCID: PMC8556944 DOI: 10.1186/s12875-021-01563-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/05/2021] [Indexed: 11/23/2022]
Abstract
Background Cardiovascular disease (CVD) is a major cause of morbidity and mortality among people living with HIV (PLWH), but statin therapy, safe and effective for PLWH, is under-prescribed. This study examined clinic leadership and provider perceptions of factors associated with statin prescribing for PLWH receiving care in eight community health clinics across Los Angeles, California. Methods We conducted semi-structured telephone interviews with clinic leadership and providers across community health clinics participating in a larger study (INSPIRE) aimed at improving statin prescribing through education and feedback. Clinics included federally qualified health centers (N = 5), community clinics (N = 1) and county-run ambulatory care clinics (N = 2). Leadership and providers enrolled in INSPIRE (N = 39) were invited to participate in an interview. We used the Consolidated Framework for Implementation Research (CFIR) to structure our interview guide and analysis. We used standard qualitative content analysis methods to identify themes within CFIR categories; we also assessed current CVD risk assessment and statin-prescribing practices. Results Participants were clinic leaders (n = 6), primary care physicians with and without an HIV specialization (N = 6, N = 6, respectively), infectious diseases specialists (N = 12), nurse practitioners, physician assistants and registered nurses (N = 7). Ninety-five percent of providers from INSPIRE participated in an interview. We found that CVD risk assessment for PLWH is standard practice but that there is variation in risk assessment practices and that providers are unsure whether or how to adjust the risk threshold to account for HIV. Time, clinic and patient priorities impede ability to conduct CVD risk assessment with PLWH. Conclusions Providers desire more data and standard practice guidance on prescribing statins for PLWH, including estimates of the effect of HIV on CVD, how to adjust the CVD risk threshold to account for HIV, which statins are best for people on antiretroviral therapy and on shared decision-making around prescribing statins to PLWH. While CVD risk assessment and statin prescribing fits within the mission and workflow of primary care, clinics may need to emphasize CVD risk assessment and statins as priorities in order to improve uptake.
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Affiliation(s)
| | - Sae Takada
- RAND Corporation, Santa Monica, CA, USA.,Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, USA
| | | | - Ivy Todd
- RAND Corporation, Santa Monica, CA, USA
| | - Tamara Horwich
- Division of Cardiology, Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, USA
| | - Abraelle Anderson
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, USA
| | - Soma Wali
- Olive View - UCLA Medical Center, Sylmar, CA, USA
| | - Joseph A Ladapo
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, USA
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17
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Storholm ED, Ober AJ, Mizel ML, Matthews L, Sargent M, Todd I, Zajdman D, Green H. Primary Care Providers' Knowledge, Attitudes, and Beliefs About HIV Pre-Exposure Prophylaxis (PrEP): Informing Network-Based Interventions. AIDS Educ Prev 2021; 33:325-344. [PMID: 34370571 PMCID: PMC8559721 DOI: 10.1521/aeap.2021.33.4.325] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Increasing access to pre-exposure prophylaxis (PrEP) in primary care settings for patients who may be at risk for HIV could help to increase PrEP uptake, which has remained low among certain key risk populations. The current study conducted interviews with primary care providers identified from national claims data as having either high or low likelihood of serving PrEP-eligible patients based on their prescribing practices for other sexually transmitted infections. The study yielded important information about primary care providers' knowledge, attitudes, and beliefs about PrEP, as well as the barriers and facilitators to prescribing PrEP. Key recommendations for a provider-focused intervention to increase PrEP prescribing among primary care providers, including increasing patient education to increase demand from providers, enhancing provider education, leveraging technology, and instituting standardized sexual health checks, are provided with the goal of informing network-based interventions.
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Affiliation(s)
- Erik D. Storholm
- San Diego State University, School of Public Health, San Diego, CA, United States
- RAND Corporation, Santa Monica, CA, United States
| | | | | | | | | | - Ivy Todd
- RAND Corporation, Santa Monica, CA, United States
| | | | - Hank Green
- RAND Corporation, Santa Monica, CA, United States
- Indiana University Bloomington School of Public Health, Bloomington, IN, United States
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18
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Ogunbajo A, Storholm ED, Ober AJ, Bogart LM, Reback CJ, Flynn R, Lyman P, Morris S. Multilevel Barriers to HIV PrEP Uptake and Adherence Among Black and Hispanic/Latinx Transgender Women in Southern California. AIDS Behav 2021. [PMID: 33515132 DOI: 10.1007/s10461-021-03159-2]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Black and Hispanic/Latinx transgender women in the United States (U.S.) are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) reduces risk of HIV infection but PrEP uptake remains low among Black and Hispanic/Latinx transgender women. Between July 2018 and August 2019, we conducted individual interviews with 30 Black and Hispanic/Latinx transgender women who were prescribed PrEP through a PrEP demonstration project and 10 healthcare providers who provide PrEP services to transgender women in Los Angeles and San Diego, California. The interviews assessed general attitudes, experiences, and beliefs about PrEP as well as individual-, interpersonal-, community-, and structural-level barriers to PrEP uptake and adherence. PrEP adherence was assessed by collecting quantitative intracellular tenofovir-diphosphate (TFV-DP) levels in retrospect on batched, banked dried blood spot (DBS) samples. We utilized qualitative content analysis to identify themes from the interviews. Findings indicated the presence of individual-level barriers including cost concerns, mental health issues, substance use, and concerns about PrEP side effects including hormone interaction. Interpersonal-level barriers included the influence of intimate/romantic partners and the impact of patient-provider communication. Community-level barriers consisted of experiencing stigma and negative community opinions about PrEP use as well as having negative experiences in healthcare settings. Structural-level barriers included unreliable transportation, employment, and housing insecurity. Interventions aiming to increase PrEP uptake and adherence among Black and Hispanic/Latinx transgender women in the U.S. should employ a multilevel approach to addressing the needs of transgender women, especially the structural barriers that have greatly limited the use of PrEP.
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Affiliation(s)
- Adedotun Ogunbajo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, USA
- RAND Corporation, Santa Monica, CA, USA
- Department of Family Medicine, Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles, Los Angeles, CA, USA
| | - Allison J Ober
- RAND Corporation, Santa Monica, CA, USA
- Department of Family Medicine, Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles, Los Angeles, CA, USA
| | - Laura M Bogart
- RAND Corporation, Santa Monica, CA, USA
- Department of Family Medicine, Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles, Los Angeles, CA, USA
| | - Cathy J Reback
- Department of Family Medicine, Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles, Los Angeles, CA, USA
- Friends Research Institute, Los Angeles, CA, USA
| | - Risa Flynn
- Los Angeles LGBT Center, Los Angeles, CA, USA
| | | | - Sheldon Morris
- AntiViral Research Center, San Diego School of Medicine, University of California, San Diego, CA, USA
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19
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Watkins KE, Hunter SB, Cohen CC, Leamon I, Hurley B, McCreary M, Ober AJ. Organizational Capacity and Readiness to Provide Medication for Individuals with Co-Occurring Alcohol Use Disorders in Public Mental Health Settings. Adm Policy Ment Health 2021; 48:707-717. [PMID: 33387128 PMCID: PMC8628547 DOI: 10.1007/s10488-020-01103-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
Alcohol use disorders (AUD) in individuals with mental illness are largely untreated. The purpose of this study was to identify gaps in organizational capacity and readiness to provide medications for AUD in outpatient public mental health clinics. We selected a purposive sample of eight publicly funded outpatient mental health clinics operated by the Los Angeles County Department of Mental Health; clinics were chosen to maximize heterogeneity. Guided by theories of organizational capacity and readiness and research on the adoption of pharmacotherapy for AUD in primary and specialty care treatment settings, we conducted semi-structured interviews and focus groups with administrators, providers and staff, and a qualitative analysis of the results. Respondents described significant organizational capacity and behavioral readiness constraints to providing medication treatment for AUD. Both groups articulated a perception that mental health clinics were not designed to provide co-occurring AUD treatment because of large caseloads, staffing configurations, and time constraints that did not support the delivery of appropriate treatment, and a lack of protocols and workflow procedures. We documented organizational capacity and readiness constraints which impede the delivery of medication treatment for AUD in a large mental helth system. While some constraints have straightforward solutions, others require structural changes to the way care is delivered, and state-level funding and policy changes.
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Affiliation(s)
| | - Sarah B Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | | | - Isabel Leamon
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Brian Hurley
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Michael McCreary
- Health Services and Society, UCLA Semel Institute for Neuroscience & Human Behavior, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
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20
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Taylor J, Ober AJ, Kilmer B, Caulkins JP, Iguchi MY. Community perspectives on supervised consumption sites: Insights from four U.S. counties deeply affected by opioids. J Subst Abuse Treat 2021; 131:108397. [PMID: 34098293 DOI: 10.1016/j.jsat.2021.108397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND To address the overdose crisis in the United States, expert groups have been nearly unanimous in calls for increasing access to evidence-based treatment and overdose reversal drugs. In some places there have also been calls for implementing supervised consumption sites (SCSs). Some cities-primarily in coastal urban areas-have explored the feasibility and acceptability of introducing them. However, the perspectives of community stakeholders from more inland and rural areas that have also been hard hit by opioids are largely missing from the literature. METHODS To examine community attitudes about implementing SCSs for people who use opioids (PWUO) in areas with acute opioid problems, the research team conducted in-depth interviews and focus groups in four counties: Ashtabula and Cuyahoga Counties in Ohio, and Carroll and Hillsborough Counties in New Hampshire, two states with high rates of opioid overdose. Participants were policy, treatment, and criminal justice professionals, frontline harm reduction and service providers, and PWUO. RESULTS Key informants noted benefits to SCSs, but also perceived potential drawbacks such as that they may enable opioid use, and potential practical barriers, including lack of desire among PWUO to travel to an SCS after purchasing opioids and fear of arrest. Key informants generally believed their communities likely would not currently accept SCSs due to cultural, resource, and practical barriers. They viewed publication of evidence on SCSs and community education as essential for fostering acceptance. CONCLUSIONS Despite cultural and other barriers, implementation of SCSs may be more feasible in urban communities with existing (and perhaps more long-standing) harm reduction programs, greater treatment resources, and adequate transportation, particularly if there is strong evidence to support them.
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Affiliation(s)
- Jirka Taylor
- Drug Policy Research Center, RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, United States of America.
| | - Allison J Ober
- Drug Policy Research Center, RAND Corporation, 1776 Main St., Santa Monica, CA 90407, United States of America
| | - Beau Kilmer
- Drug Policy Research Center, RAND Corporation, 1776 Main St., Santa Monica, CA 90407, United States of America
| | - Jonathan P Caulkins
- Carnegie Mellon University Heinz College, 5000 Forbes Avenue, Pittsburgh, PA 15213, United States of America
| | - Martin Y Iguchi
- Drug Policy Research Center, RAND Corporation, 1776 Main St., Santa Monica, CA 90407, United States of America
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21
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Hser YI, Ober AJ, Dopp AR, Lin C, Osterhage KP, Clingan SE, Mooney LJ, Curtis ME, Marsch LA, McLeman B, Hichborn E, Lester LS, Baldwin LM, Liu Y, Jacobs P, Saxon AJ. Is telemedicine the answer to rural expansion of medication treatment for opioid use disorder? Early experiences in the feasibility study phase of a National Drug Abuse Treatment Clinical Trials Network Trial. Addict Sci Clin Pract 2021; 16:24. [PMID: 33879260 PMCID: PMC8056373 DOI: 10.1186/s13722-021-00233-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/09/2021] [Indexed: 11/14/2022] Open
Abstract
Telemedicine (TM) enabled by digital health technologies to provide medical services has been considered a key solution to increasing health care access in rural communities. With the immediate need for remote care due to the COVID-19 pandemic, many health care systems have rapidly incorporated digital technologies to support the delivery of remote care options, including medication treatment for individuals with opioid use disorder (OUD). In responding to the opioid crisis and the COVID-19 pandemic, public health officials and scientific communities strongly support and advocate for greater use of TM-based medication treatment for opioid use disorder (MOUD) to improve access to care and have suggested that broad use of TM during the pandemic should be sustained. Nevertheless, research on the implementation and effectiveness of TM-based MOUD has been limited. To address this knowledge gap, the National Drug Abuse Treatment Clinical Trials Network (CTN) funded (via the NIH HEAL Initiative) a study on Rural Expansion of Medication Treatment for Opioid Use Disorder (Rural MOUD; CTN-0102) to investigate the implementation and effectiveness of adding TM-based MOUD to rural primary care for expanding access to MOUD. In preparation for this large-scale, randomized controlled trial incorporating TM in rural primary care, a feasibility study is being conducted to develop and pilot test implementation procedures. In this commentary, we share some of our experiences, which include several challenges, during the initial two-month period of the feasibility study phase. While these challenges could be due, at least in part, to adjusting to the COVID-19 pandemic and new workflows to accommodate the study, they are notable and could have a substantial impact on the larger, planned pragmatic trial and on TM-based MOUD more broadly. Challenges include low rates of identification of risk for OUD from screening, low rates of referral to TM, digital device and internet access issues, workflow and capacity barriers, and insurance coverage. These challenges also highlight the lack of empirical guidance for best TM practice and quality remote care models. With TM expanding rapidly, understanding implementation and demonstrating what TM approaches are effective are critical for ensuring the best care for persons with OUD.
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Affiliation(s)
- Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA.
| | | | | | - Chunqing Lin
- Center for Community Health, Semel Institute for Neuroscience and Human Behavior, University of California At Los Angeles, Los Angeles, CA, USA
| | - Katie P Osterhage
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Sarah E Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Larissa J Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | - Megan E Curtis
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Bethany McLeman
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Emily Hichborn
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Laurie S Lester
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Yanping Liu
- Center for Clinical Trials Network, National Institute On Drug Abuse, Bethesda, MD, USA
| | - Petra Jacobs
- Center for Clinical Trials Network, National Institute On Drug Abuse, Bethesda, MD, USA
| | - Andrew J Saxon
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
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22
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Abstract
This study describes trends in use of in-person, telephone, and video primary care and behavioral health visits to California Federally Qualified Health Centers from 2019 to August 2020 before and during the coronavirus disease 2019 (COVID-19) pandemic.
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Affiliation(s)
| | | | - Maggie Jones
- Center for Community Health and Evaluation at Kaiser Permanente Washington Health Research Institute, Seattle
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Bromley E, Tarn DM, McCreary M, Hurley B, Ober AJ, Watkins KE. Attitudes about medications for alcohol use disorder among individuals with serious mental illness: A health belief model analysis. J Subst Abuse Treat 2020; 114:108007. [PMID: 32527506 DOI: 10.1016/j.jsat.2020.108007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 03/09/2020] [Accepted: 04/08/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Medications for alcohol use disorder (MAUD) are underutilized in mental health settings. Increasing use of MAUD requires increasing both the availability of these medications and the demand by individuals who could benefit. Few studies have explored the views of individuals with severe mental illness and alcohol use disorder about MAUD. We sought to examine, among individuals treated in publicly funded community mental health clinics, perceived need for and attitudes toward MAUD. METHODS We conducted 8 focus groups with 87 participants treated in public mental health clinics in Los Angeles County. We aimed to include individuals with a current or past AUD diagnosis and individuals helping others (e.g., a family member) who drink. We examined responses using domains associated with the Health Belief Model to identify factors that shape acceptance of MAUD. RESULTS Participants were 53% female; most were minorities. Average age was 47 years (SD = 11). Twenty-four reported never drinking, 13 of whom had a current or past diagnosis of AUD. Twenty-two reported drinking 4 or more times per week. Three-quarters had not heard of naltrexone. Participants understood that alcohol use has severe adverse consequences and perceived themselves to be highly susceptible to these consequences. Regarding attitudes toward MAUD, participants described an internal locus of control (e.g., their own desires, actions, and effort) as central to addressing problem drinking; this shaped their views that MAUD would have only modest benefits and potentially high burden. Those individuals who had tried MAUD expressed the most optimism about its effectiveness. CONCLUSIONS Participants worried MAUD would impede the development of self-control over drinking by fostering dependence on medication and undermining self-discipline. Client education and counseling that emphasizes MAUD as a tool to build clients' self-control may increase demand for these medications in mental health settings.
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Affiliation(s)
- Elizabeth Bromley
- Center for Health Services and Society, Jane and Terry Semel Institute, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 10920 Wilshire Blvd, Suite 300, Los Angeles, CA 90024, United States of America; RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States of America.
| | - Derjung M Tarn
- Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA 90024, United States of America
| | - Michael McCreary
- Center for Health Services and Society, Jane and Terry Semel Institute, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 10920 Wilshire Blvd, Suite 300, Los Angeles, CA 90024, United States of America
| | - Brian Hurley
- Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA 90024, United States of America; Los Angeles County Department of Health Services, 313 N Figueroa Street, Los Angeles, CA 90012, United States of America
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States of America
| | - Katherine E Watkins
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States of America
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Guerrero E, Ober AJ, Howard DL, Khachikian T, Kong Y, van Deen WK, Valdez A, Trotzky-Sirr R, Menchine M. Organizational factors associated with practitioners' support for treatment of opioid use disorder in the emergency department. Addict Behav 2020; 102:106197. [PMID: 31862684 PMCID: PMC7547528 DOI: 10.1016/j.addbeh.2019.106197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/25/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite the significant increase in emergency room visits for opioid overdose, only few emergency departments (ED) have implemented best practices to treat people with opioid use disorders (OUD). Some implementation gaps may be due to practitioner factors; such as support for medication-assisted treatment (MAT) for OUD in the ED. In this study, we explore the relationship between inner setting characteristics of the EDs (e.g., leadership, readiness for change, organizational climate) and practitioner support for OUD treatment and attitudes towards people with OUD. METHODS We surveyed 241 ED practitioners (e.g., physicians, nurses, social workers) at one of the largest EDs in the United States. We used analysis of variance and chi-square global tests to compare responses from ED practitioners in differing roles. We also conducted five multivariate logistic regressions to explore associations between ED inner setting characteristics and five antecedents of implementation; ED practitioner (1) supports MAT for OUD in the ED, (2) supports best practices to treat OUD, (3) has self-efficacy to treat OUD, (4) has stereotypes of people who use drugs, and (5) has optimism to treat people with OUD. RESULTS We found nurses were more likely than physicians to support MAT for OUD in the ED and delivering other best practices to treat OUD. At the same time, nurses had greater bias than physicians against working with patients suffering from OUD. We also found the ED's climate for innovation and practitioners' readiness for change were positively associated with support for MAT for OUD in the ED and using best practices to treat OUD. CONCLUSIONS Findings suggest that professional roles and some ED inner setting factors play an important role in antecedents of implementation of OUD treatment in the ED. To prepare EDs to effectively respond to the current opioid overdose epidemic, it is critical to further understand the impact of these organizational factors on the implementation of evidence-based OUD treatment practices in the nation.
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Affiliation(s)
- Erick Guerrero
- I-LEAD Institute - Research to End Healthcare Disparities Corp, 150 Ocean Park Blvd, Santa Monica, CA, USA.
| | | | - Daniel L Howard
- Texas A&M University, Public Policy Research Institute, College Station, TX, USA.
| | | | - Yinfei Kong
- Mihaylo College of Business and Economics, California State University, Fullerton, CA, USA
| | - Welmoed K van Deen
- Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, CA, USA.
| | - Avelardo Valdez
- School of Social Work, University of Southern California, Los Angeles, CA, USA.
| | - Rebecca Trotzky-Sirr
- Emergency Department, Los Angeles County + University of Southern California, Los Angeles, CA, USA.
| | - Michael Menchine
- Emergency Department, Los Angeles County + University of Southern California, Los Angeles, CA, USA.
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25
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Takada S, Ober AJ, Currier JS, Goldstein NJ, Horwich TB, Mittman BS, Shu SB, Tseng CH, Vijayan T, Wali S, Cunningham WE, Ladapo JA. Reducing cardiovascular risk among people living with HIV: Rationale and design of the INcreasing Statin Prescribing in HIV Behavioral Economics REsearch (INSPIRE) randomized controlled trial. Prog Cardiovasc Dis 2020; 63:109-117. [PMID: 32084445 DOI: 10.1016/j.pcad.2020.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 02/16/2020] [Indexed: 12/26/2022]
Abstract
Cardiovascular disease (CVD) is a major cause of morbidity among people living with HIV (PLWH). Statins can safely and effectively reduce CVD risk in PLWH, but evidence-based statin therapy is under-prescribed in PLWH. Developed using an implementation science framework, INcreasing Statin Prescribing in HIV Behavioral Economics REsearch (INSPIRE) is a stepped-wedge cluster randomized trial that addresses organization-, clinician- and patient-level barriers to statin uptake in Los Angeles community health clinics serving racially and ethnically diverse PLWH. After assessing knowledge about statins and barriers to clinician prescribing and patient uptake, we will design, implement and measure the effectiveness of (1) educational interventions targeting leadership, clinicians, and patients, followed by (2) behavioral economics-informed clinician feedback on statin uptake. In addition, we will assess implementation outcomes, including changes in clinician acceptability of statin prescribing for PLWH, clinician acceptability of the education and feedback interventions, and cost of implementation.
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Affiliation(s)
- Sae Takada
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | | | - Judith S Currier
- Division of Infectious Diseases, Department of Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Noah J Goldstein
- UCLA Anderson School of Management, Los Angeles, CA, USA; Department of Psychology, UCLA, Los Angeles, CA, USA
| | - Tamara B Horwich
- Division of Cardiology, Department of Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Brian S Mittman
- Division of Health Services Research & Implementation Science, Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Suzanne B Shu
- UCLA Anderson School of Management, Los Angeles, CA, USA
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Tara Vijayan
- Division of Infectious Diseases, Department of Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Soma Wali
- Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - William E Cunningham
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Joseph A Ladapo
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
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Otiashvili D, Kirtadze I, Vardanashvili I, Tabatadze M, Ober AJ. Perceived acceptability of and willingness to use syringe vending machines: results of a cross-sectional survey of out-of-service people who inject drugs in Tbilisi, Georgia. Harm Reduct J 2019; 16:21. [PMID: 30898120 PMCID: PMC6429706 DOI: 10.1186/s12954-019-0292-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 03/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background The growing HIV epidemic in Eastern Europe and Central Asia has been driven by high rates of injection drug use. The Republic of Georgia has among the highest injection drug use rates globally, with a prevalence of 2.24%. The reach of evidence-based HIV prevention interventions like needle and syringe programs (NSP) among people who inject drugs (PWID) has remained below rates that could significantly impact the epidemic. Syringe vending machines (SVM) are an effective and cost-effective supplement to standard NSP; if acceptable to PWID, SVM could reach hard-to-reach PWID and cover geographic areas where fixed or mobile NSPs do not operate. The aim of this study was to assess the perceived acceptability of SVM among out-of-service (harm reduction or substance use treatment) PWID in Tbilisi, Georgia. Methodology Participants were recruited using respondent-driven sampling (RDS) to participate in cross-sectional, face-to-face interviews. We conducted individual interviews using a structured questionnaire that covered participants’ socio-demographics, drug use practices, and perceived acceptability of SVM. Uni-variate analyses were employed for data analysis. Results The final sample (n = 149) was almost exclusively male with a mean age of 42.2 years and mean years of injection drug use of 14.4 years. Heroin, buprenorphine, and stimulants were the main drugs injected. Eighty-five percent of the sample had never received any harm reduction services, and 30% had never been tested for HIV. Fifteen percent of the sample reported sharing injection equipment with others during last month. All but one participant agreed that PWID would benefit from SVM and 145 (97%) said they would personally use SVM. Ninety percent of those sampled stated that they would use HIV self-tests if available from vending machines. The most highly endorsed features of SVM were provision of free injection equipment, no need to deal with pharmacies, uninterrupted 24/7 access, and availability of HIV self-testing kits. Discussion Perceived acceptability of syringe vending machines was extremely high among PWID not currently receiving any harm reduction or treatment services, with strong support indicated for uninterrupted free access to sterile injection equipment, privacy, and anonymity. Introducing SVM in Georgia holds the potential to deliver significant public health benefits by attracting hard-to-reach PWID, reducing unsafe injection behavior, and contributing to HIV testing uptake and linkage to care.
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Affiliation(s)
- David Otiashvili
- Addiction Research Centre Alternative Georgia, 14A Nutsubidze Street, Office 2, 0177, Tbilisi, Georgia.
| | - Irma Kirtadze
- Addiction Research Centre Alternative Georgia, 14A Nutsubidze Street, Office 2, 0177, Tbilisi, Georgia.,School of Arts and Sciences, Ilia State University, 3/5 Kakutsa Cholokashvili Ave., 0162, Tbilisi, Georgia
| | - Irina Vardanashvili
- School of Arts and Sciences, Ilia State University, 3/5 Kakutsa Cholokashvili Ave., 0162, Tbilisi, Georgia
| | - Mzia Tabatadze
- Addiction Research Centre Alternative Georgia, 14A Nutsubidze Street, Office 2, 0177, Tbilisi, Georgia.,School of Business, Ilia State University, 3/5 Kakutsa Cholokashvili Ave., 0162, Tbilisi, Georgia
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
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Dangerfield DT, Ober AJ, Smith LR, Shoptaw S, Bluthenthal R. Exploring and Adapting a Conceptual Model of Sexual Positioning Practices and Sexual Risk Among HIV-Negative Black Men Who Have Sex With Men. J Sex Res 2018; 55:1022-1032. [PMID: 29466064 PMCID: PMC6105556 DOI: 10.1080/00224499.2018.1433287] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Estimates show a 50% lifetime human immunodeficiency virus (HIV) risk among Black men who have sex with men (BMSM) in the United States(U.S.). Studying the dynamics of sexual positioning practices among BMSM could provide insights into the disparities observed among U.S. groups of men who have sex with men (MSM). This study explored sexual positioning dynamics among HIV-negative BMSM and how they aligned with a theoretical model of sexual positioning and HIV/sexually transmitted infection (STI) risk among MSM. In-depth qualitative interviews were conducted with 29 HIV-negative BMSM between ages 25 and 35 in Los Angeles. Comments related to sexual behaviors were reviewed for relevance regarding oral or anal sexual positioning practices. Data presented represent the range of themes related to decision making regarding sexual positioning. Personal preference, partner attraction, HIV avoidance, and feeling obligated to practice partner preferences influenced sexual positioning. Drug use also affected decision making and was sometimes preferred in order to practice receptive anal intercourse. These variables build on the conceptual model of sexual positioning practices and sexual risk, and add understanding to the relationship between preferences, practices, and risk management. Future research on risk among HIV-negative BMSM should quantify the relative impact of personal preferences, partner attraction, partner type, compromise, and substance use on sexual positioning practices and risk.
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Affiliation(s)
| | | | - Laramie R. Smith
- University of California, San Diego, Division of Global Public Health, La Jolla, CA
| | - Steven Shoptaw
- University of California, Los Angeles, Department of Family Medicine, Los Angeles, CA
| | - Ricky Bluthenthal
- University of Southern California Keck School of Medicine, Department of Preventive Medicine, Los Angeles, CA
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Ober AJ, Watkins KE, McCullough CM, Setodji CM, Osilla K, Hunter SB. Patient predictors of substance use disorder treatment initiation in primary care. J Subst Abuse Treat 2018; 90:64-72. [PMID: 29866385 PMCID: PMC6336395 DOI: 10.1016/j.jsat.2018.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 04/07/2018] [Accepted: 04/08/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Primary care clinics are opportune settings in which to deliver substance use disorder (SUD) treatment, but little is known about which patients initiate treatment in these settings. METHODS Using secondary data from a RCT that aimed to integrate SUD treatment into a federally qualified health center (FQHC) using an organizational readiness and collaborative care (CC) intervention, we examined patient-level predictors of initiation of evidence-based practices for opioid and/or alcohol use disorders (OAUDs): a brief behavioral treatment (BT) based on motivational interviewing and cognitive behavioral therapy and medication-assisted treatment (MAT) (extended-release injectable naltrexone (XR-NTX) for patients with an alcohol use disorder or opioid use disorder and buprenorphine/naloxone (BUP/NX) for patients with an opioid use disorder). Using the Andersen model of health care access, we tested bivariate and multivariate logistic regression models to assess associations between patient factors and initiation of BT and MAT. RESULTS Twenty-three percent of all participants (N = 392) received BT and 13% received MAT. In the multivariate model examining factors associated with initiation of BT, being of "other" or "multiple" races compared with being White (OR = 0.45, CI = 0.22, 0.92), being homeless (OR = 0.45, CI = 0.21, 0.97) and having been arrested within 90 days of baseline (OR = 0.21 CI = 0.63, 0.69) were associated with significantly lower odds of initiating BT. Greater self-stigma (OR = 1.60, CI = 1.06, 2.42), receiving MAT (OR = 5.52, CI = 2.34, 12.98), and having received the CC study intervention (OR = 12.95, CI = 5.91, 28.37) were associated with higher odds of initiating BT. In the multivariate model examining patient factors associated with initiating MAT, older age (OR = 1.07, CI = 1.03, 1.11), female gender (OR = 3.05, CI = 1.25, 7.46), having a diagnosis of heroin abuse or dependence (with or without alcohol abuse or dependence compared with have a diagnosis of alcohol dependence only (OR = 3.03, CI = 1.17, 7.86), and having received at least one session of BT (OR = 6.42, CI = 2.59, 15.94), were associated with higher odds of initiating MAT. CONCLUSIONS Individuals who initiate BT for OAUDs in a FQHC are less likely to be homeless and more likely to have greater self-stigma. Those who receive MAT are more likely to be of older age, female, and to have a diagnosis of heroin abuse or dependence, with or without concomitant alcohol abuse or dependence, rather than alcohol abuse or dependence alone. Receiving collaborative care (e.g., a warm handoff, and follow-up by a care coordinator) may be critical to initiating BT. Receiving at least one session of BT is associated with higher odds of receiving MAT, and receiving MAT is associated with higher odds of receiving BT. The Andersen model of health care access provides some insight into who initiates BT and MAT for OAUD treatment in FQHC-based primary care; further research is needed to explore system-level factors that may also influence treatment initiation.
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Affiliation(s)
- Allison J Ober
- RAND Corporation, 1776 Main Street Santa Monica, CA 90407, USA.
| | | | | | | | - Karen Osilla
- RAND Corporation, 1776 Main Street Santa Monica, CA 90407, USA.
| | - Sarah B Hunter
- RAND Corporation, 1776 Main Street Santa Monica, CA 90407, USA.
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Hunter SB, Ober AJ, McCullough CM, Storholm ED, Iyiewuare PO, Pham C, Watkins KE. Sustaining alcohol and opioid use disorder treatment in primary care: a mixed methods study. Implement Sci 2018; 13:83. [PMID: 29914524 PMCID: PMC6006923 DOI: 10.1186/s13012-018-0777-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/07/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Efforts to integrate substance use disorder treatment into primary care settings are growing. Little is known about how well primary care settings can sustain treatment delivery to address substance use following the end of implementation support. METHODS Data from two clinics operated by one multi-site federally qualified health center (FQHC) in the US, including administrative data, staff surveys, interviews, and focus groups, were used to gather information about changes in organizational capacity related to alcohol and opioid use disorder (AOUD) treatment delivery during and after a multi-year implementation intervention was executed. Treatment practices from the intervention period were compared to practices after the intervention period to examine whether the practices were sustained. Data from staff surveys and interviews were used to examine the factors related to sustainment. RESULTS The two clinics sustained multiple components of AOUD care 1 year following the end of implementation support, including care coordination, psychotherapy, and medication-assisted treatment. Some of the practices were modified over time, for example, screening became less frequent by design, while use of care coordination and psychotherapy for AOUDs expanded. Participants identified staff training and funding for medications as key challenges to sustaining treatment. CONCLUSIONS Following a multi-year implementation intervention, a large FQHC continued to deliver AOUD treatment. Access to external funding and staff support appeared to be critical elements for sustaining care over time. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT01810159.
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Affiliation(s)
- Sarah B Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
| | | | - Erik D Storholm
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
| | | | - Chau Pham
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
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Osilla KC, Watkins KE, D'Amico EJ, McCullough CM, Ober AJ. Effects of motivational interviewing fidelity on substance use treatment engagement in primary care. J Subst Abuse Treat 2018; 87:64-69. [PMID: 29471928 DOI: 10.1016/j.jsat.2018.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Primary care (PC) may be an opportune setting to engage patients with opioid and alcohol use disorders (OAUDs) in treatment. We examined whether motivational interviewing (MI) fidelity was associated with engagement in primary care-based OAUD treatment in an integrated behavioral health setting. METHODS We coded 42 first session therapy recordings and examined whether therapist MI global ratings and behavior counts were associated with patient engagement, defined as the patient receiving one shot of extended-release injectable naltrexone or any combination of at least two additional behavioral therapy, sublingual buprenorphine/naloxone prescriptions, or OAUD-related medical visits within 30days of their initial behavioral therapy visit. RESULTS Autonomy/support global ratings were higher in the non-engaged group (OR=0.28, 95%CI: 0.09-0.93; p=0.037). No other MI fidelity ratings were significantly associated with engagement. CONCLUSION We did not find positive associations between MI fidelity and engagement in primary care-based OAUD treatment. More research with larger samples is needed to examine how providing autonomy/support to patients who are not ready to change may affect engagement. PRACTICE IMPLICATIONS Training providers to strategically use MI to reinforce change as opposed to the status quo is needed. This may be especially important in primary care where patients may not be specifically seeking help for their OAUDs.
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Affiliation(s)
- Karen Chan Osilla
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA.
| | | | | | | | - Allison J Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
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Ober AJ, Watkins KE, Hunter SB, Ewing B, Lamp K, Lind M, Becker K, Heinzerling K, Osilla KC, Diamant AL, Setodji CM. Assessing and improving organizational readiness to implement substance use disorder treatment in primary care: findings from the SUMMIT study. BMC Fam Pract 2017; 18:107. [PMID: 29268702 PMCID: PMC5740845 DOI: 10.1186/s12875-017-0673-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 11/28/2017] [Indexed: 11/25/2022]
Abstract
Background Millions of people with substance use disorders (SUDs) need, but do not receive, treatment. Delivering SUD treatment in primary care settings could increase access to treatment because most people visit their primary care doctors at least once a year, but evidence-based SUD treatments are underutilized in primary care settings. We used an organizational readiness intervention comprised of a cluster of implementation strategies to prepare a federally qualified health center to deliver SUD screening and evidence-based treatments (extended-release injectable naltrexone (XR-NTX) for alcohol use disorders, buprenorphine/naloxone (BUP/NX) for opioid use disorders and a brief motivational interviewing/cognitive behavioral –based psychotherapy for both disorders). This article reports the effects of the intervention on key implementation outcomes. Methods To assess changes in organizational readiness we conducted pre- and post-intervention surveys with prescribing medical providers, behavioral health providers and general clinic staff (N = 69). We report on changes in implementation outcomes: acceptability, perceptions of appropriateness and feasibility, and intention to adopt the evidence-based treatments. We used Wilcoxon signed rank tests to analyze pre- to post-intervention changes. Results After 18 months, prescribing medical providers agreed more that XR-NTX was easier to use for patients with alcohol use disorders than before the intervention, but their opinions about the effectiveness and ease of use of BUP/NX for patients with opioid use disorders did not improve. Prescribing medical providers also felt more strongly after the intervention that XR-NTX for alcohol use disorders was compatible with current practices. Opinions of general clinic staff about the appropriateness of SUD treatment in primary care improved significantly. Conclusions Consistent with implementation theory, we found that an organizational readiness implementation intervention enhanced perceptions in some domains of practice acceptability and appropriateness. Further research will assess whether these factors, which focus on individual staff readiness, change over time and ultimately predict adoption of SUD treatments in primary care.
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Affiliation(s)
- Allison J Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | | | - Sarah B Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Brett Ewing
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Karen Lamp
- Venice Family Clinic, 2509 Pico Boulevard, Santa Monica, CA, 90405, USA
| | - Mimi Lind
- Venice Family Clinic, 2509 Pico Boulevard, Santa Monica, CA, 90405, USA
| | - Kirsten Becker
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Keith Heinzerling
- UCLA Department of Family Medicine, UCLA Family Health Center, 1920 Colorado Avenue, Santa Monica, CA, 90404, USA
| | - Karen C Osilla
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Allison L Diamant
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.,UCLA Department of Internal Medicine, Division of General Internal Medicine, 911 Broxton Avenue, Los Angeles, CA, 90024, USA
| | - Claude M Setodji
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
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Kulesza M, Watkins KE, Ober AJ, Osilla KC, Ewing B. Internalized stigma as an independent risk factor for substance use problems among primary care patients: Rationale and preliminary support. Drug Alcohol Depend 2017; 180:52-55. [PMID: 28869858 PMCID: PMC5648632 DOI: 10.1016/j.drugalcdep.2017.08.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Little is known about internalized stigma among primary care patients, and whether the presence of internalized stigma is related to the severity of substance use problems independent of substance use-related variables. We sought to examine the relationship between internalized stigma and substance use problems among primary care patients with opioid or alcohol use disorders (OAUDs). METHODS We present baseline data from 393 primary care patients who were enrolled in a study of collaborative care for OAUDs. Regression analyses examined the relationship between internalized stigma and substance use problems, controlling for demographics, psychiatric comorbidity, and quantity/frequency of use. RESULTS The majority of participants reported thinking, at least sometimes, that they "have permanently screwed up" their lives (60%), and felt "ashamed" (60%), and "out of place in the world" (51%) as a result of their opioid or alcohol use. Higher internalized stigma was significantly related to more substance use problems (β=2.68, p<0.01), even after the effects of covariates were accounted for. Stigma added 22%, out of 51% total variance explained, leading to a significant improvement in prediction of substance use problems. CONCLUSIONS Among this group of primary care patients with OAUDs, rates of internalized stigma were comparable to those reported in specialty substance use treatment settings. Consistent with extant specialty care literature, our results suggest that internalized stigma may be a unique contributor that is associated with treatment outcomes, such as substance use problems, among primary care patients with OAUDs.
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Affiliation(s)
| | | | - Allison J Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
| | - Karen C Osilla
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
| | - Brett Ewing
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
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Watkins KE, Ober AJ, Lamp K, Lind M, Setodji C, Osilla KC, Hunter SB, McCullough CM, Becker K, Iyiewuare PO, Diamant A, Heinzerling K, Pincus HA. Collaborative Care for Opioid and Alcohol Use Disorders in Primary Care: The SUMMIT Randomized Clinical Trial. JAMA Intern Med 2017; 177:1480-1488. [PMID: 28846769 PMCID: PMC5710213 DOI: 10.1001/jamainternmed.2017.3947] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/24/2017] [Indexed: 11/14/2022]
Abstract
Importance Primary care offers an important and underutilized setting to deliver treatment for opioid and/or alcohol use disorders (OAUD). Collaborative care (CC) is effective but has not been tested for OAUD. Objective To determine whether CC for OAUD improves delivery of evidence-based treatments for OAUD and increases self-reported abstinence compared with usual primary care. Design, Setting, and Participants A randomized clinical trial of 377 primary care patients with OAUD was conducted in 2 clinics in a federally qualified health center. Participants were recruited from June 3, 2014, to January 15, 2016, and followed for 6 months. Interventions Of the 377 participants, 187 were randomized to CC and 190 were randomized to usual care; 77 (20.4%) of the participants were female, of whom 39 (20.9%) were randomized to CC and 38 (20.0%) were randomized to UC. The mean (SD) age of all respondents at baseline was 42 (12.0) years, 41(11.7) years for the CC group, and 43 (12.2) yearsfor the UC group. Collaborative care was a system-level intervention, designed to increase the delivery of either a 6-session brief psychotherapy treatment and/or medication-assisted treatment with either sublingual buprenorphine/naloxone for opioid use disorders or long-acting injectable naltrexone for alcohol use disorders. Usual care participants were told that the clinic provided OAUD treatment and given a number for appointment scheduling and list of community referrals. Main Outcomes and Measures The primary outcomes were use of any evidence-based treatment for OAUD and self-reported abstinence from opioids or alcohol at 6 months. The secondary outcomes included the Healthcare Effectiveness Data and Information Set (HEDIS) initiation and engagement measures, abstinence from other substances, heavy drinking, health-related quality of life, and consequences from OAUD. Results At 6 months, the proportion of participants who received any OAUD treatment was higher in the CC group compared with usual care (73 [39.0%] vs 32 [16.8%]; logistic model adjusted OR, 3.97; 95% CI, 2.32-6.79; P < .001). A higher proportion of CC participants reported abstinence from opioids or alcohol at 6 months (32.8% vs 22.3%); after linear probability model adjustment for covariates (β = 0.12; 95% CI, 0.01-0.23; P = .03). In secondary analyses, the proportion meeting the HEDIS initiation and engagement measures was also higher among CC participants (initiation, 31.6% vs 13.7%; adjusted OR, 3.54; 95% CI, 2.02-6.20; P < .001; engagement, 15.5% vs 4.2%; adjusted OR, 5.89; 95% CI, 2.43-14.32; P < .001) as was abstinence from opioids, cocaine, methamphetamines, marijuana, and any alcohol (26.3% vs 15.6%; effect estimate, β = 0.13; 95% CI, 0.03-0.23; P = .01). Conclusions and Relevance Among adults with OAUD in primary care, the SUMMIT collaborative care intervention resulted in significantly more access to treatment and abstinence from alcohol and drugs at 6 months, than usual care. Trial Registration clinicaltrials.gov Identifier: NCT01810159.
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Affiliation(s)
| | | | - Karen Lamp
- Venice Family Clinic, Los Angeles, California
| | - Mimi Lind
- Venice Family Clinic, Los Angeles, California
| | | | | | | | | | | | | | | | | | - Harold Alan Pincus
- RAND Corporation, Santa Monica, California
- Columbia University and New York-Presbyterian Hospital, New York
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Hunter SB, Rutter CM, Ober AJ, Booth MS. Building capacity for continuous quality improvement (CQI): A pilot study. J Subst Abuse Treat 2017; 81:44-52. [PMID: 28847454 DOI: 10.1016/j.jsat.2017.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Little is known about the feasibility, effectiveness, and sustainability of CQI approaches in substance use disorder treatment settings. METHODS In the initial phase of this study, eight programs were randomly assigned to receive a CQI intervention or to a waitlist control condition to obtain preliminary information about potential effectiveness. In the second phase, the initially assigned control programs received the CQI intervention to gain additional information about intervention feasibility while sustainability was explored among the initially assigned intervention programs. RESULTS AND CONCLUSIONS Although CQI was feasible and sustainable, demonstrating its effectiveness using administrative data was challenging suggesting the need to better align performance measurement systems with CQI efforts. Further, although the majority of staff were enthusiastic about utilizing this approach and reported provider and patient benefits, many noted that dedicated time was needed in order to implement and sustain it.
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Affiliation(s)
- Sarah B Hunter
- Drug Policy Research Center, RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
| | - Carolyn M Rutter
- Drug Policy Research Center, RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
| | - Allison J Ober
- Drug Policy Research Center, RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
| | - Marika S Booth
- Drug Policy Research Center, RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
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Bogart LM, Elliott MN, Ober AJ, Klein DJ, Hawes-Dawson J, Cowgill BO, Uyeda K, Schuster MA. Home Sweet Home: Parent and Home Environmental Factors in Adolescent Consumption of Sugar-Sweetened Beverages. Acad Pediatr 2017; 17:529-536. [PMID: 28143794 PMCID: PMC5495605 DOI: 10.1016/j.acap.2017.01.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 01/18/2017] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Sugar-sweetened beverages (SSBs) are key contributors to obesity among youth. We investigated associations among parental and home-related factors (parental attitudes and consumption; home availability) regarding 3 types of SSBs-soda, sports drinks, and fruit-flavored drinks-with consumption of each type of SSB in a general school-based sample of adolescents. METHODS Data were collected across 3 school semesters, from 2009 to 2011. A total of 1313 seventh grade student-parent dyads participated. Students completed in-class surveys across 9 schools in a large Los Angeles school district; their parents completed telephone interviews. Youth were asked about their SSB consumption (soda, sports drinks, and fruit-flavored drinks), and parents were asked about their attitudes, consumption, and home availability of SSBs. RESULTS We estimated expected rates of youth SSB consumption for hypothetical parents at very low (5th) and very high (95th) percentiles for home/parental risk factors (ie, they consumed little, had negative attitudes, and did not keep SSBs in the home; or they consumed a lot, had positive attitudes, and did keep SSBs in the home). Youth of lower-risk parents (at the 5th percentile) were estimated to drink substantially less of each type of beverage than did youth of higher-risk parents (at the 95th percentile). For example, youth with higher-risk parents averaged nearly double the SSB consumption of youth of lower-risk parents (2.77 vs 1.37 glasses on the previous day; overall model significance F22,1312 = 3.91, P < .001). CONCLUSIONS Results suggest a need to focus on parental and home environmental factors when intervening to reduce youths' SSB consumption.
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Affiliation(s)
- Laura M. Bogart
- RAND Corporation, 1776 Main St, P.O. Box 2138, Santa Monica, CA, 90407-2138,Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, 02115,Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115
| | - Marc N. Elliott
- RAND Corporation, 1776 Main St, P.O. Box 2138, Santa Monica, CA, 90407-2138
| | - Allison J. Ober
- RAND Corporation, 1776 Main St, P.O. Box 2138, Santa Monica, CA, 90407-2138
| | - David J. Klein
- RAND Corporation, 1776 Main St, P.O. Box 2138, Santa Monica, CA, 90407-2138,Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, 02115
| | | | - Burton O. Cowgill
- Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles Young Drive South, A2-125 CHS, Box 9569000, Los Angeles, CA 90095-6900
| | - Kimberly Uyeda
- Community Partners and Medi-Cal Programs, Student Health and Human Services, Los Angeles Unified School District, 333 South Beaudry Ave, 29th floor, Los Angeles, CA 90017
| | - Mark A. Schuster
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, 02115,Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115
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Watkins KE, Ober AJ, Lamp K, Lind M, Diamant A, Osilla KC, Heinzerling K, Hunter SB, Pincus HA. Implementing the Chronic Care Model for Opioid and Alcohol Use Disorders in Primary Care. Prog Community Health Partnersh 2017; 11:397-407. [PMID: 29332853 PMCID: PMC6124482 DOI: 10.1353/cpr.2017.0047] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Effective treatments for opioid and alcohol use disorders (OAUD) are available, yet only a small percentage of those needing treatment receive it. OBJECTIVES This paper describes a collaborative planning and development process used by researchers and community providers to apply the chronic care model to the delivery of treatment for OAUD in primary care. The goal was to develop and implement an intervention that would support the delivery of brief psychotherapy and medication-assisted treatment (MAT). METHODS We used focus groups and interviews to identify barriers and facilitators, and organized the results using the chronic care model. We then identified implementation strategies, the intended organizational changes, and the materials necessary to carry out each strategy, and pilot-tested the process. RESULTS AND CONCLUSIONS We describe the methods and outcomes of the collaborative planning and development process, and discuss implications of the work for the integration of substance use treatment with primary care.
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Pacula RL, Hunter SB, Ober AJ, Osilla KC, Vardavas R, Blanchard JC, DeVries D, Drabo EF, Leuschner KJ, Stewart W, Walters J. Preventing, Identifying, and Treating Prescription Drug Misuse Among Active-Duty Service Members. Rand Health Q 2017; 7:8. [PMID: 29057158 PMCID: PMC5644774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Prescription drug misuse (PDM) is of critical concern for the military because of its potential impact on military readiness, the health and well-being of military personnel, and associated health care costs. The purpose of this study is to summarize insights gleaned from a series of activities that the RAND Corporation undertook for the Deputy Assistant Secretary of Defense for Readiness to address this important health and military readiness issue. The authors completed a review of U.S. Department of Defense policies and a comprehensive literature review of clinical guidelines and the empirical literature on the prevention and treatment of PDM and conducted individual face-to-face interviews with 66 health and behavioral health care providers at nine medical treatment facilities across three regions within the contiguous United States to identify best practices in the prevention, identification, and treatment of PDM and the extent to which those practices are known and followed. The study also presents the framework of an analytic tool that, once informed by data available to the military but not available to the authors, can assist the military in predicting future trends in PDM based on current demographics of active-duty service members and rates of injury and prescribing of prescription drugs. The findings from this work led the authors to formulate a set of key insights that they believe might improve the rapid identification and treatment of service members dealing with PDM, thereby improving future force readiness.
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Ober AJ, Sussell J, Kilmer B, Saunders J, Heckathorn DD. Using Respondent-Driven Sampling to Recruit Illegal Drug Purchasers to Evaluate a Drug Market Intervention. Eval Rev 2016; 40:87-121. [PMID: 27468944 DOI: 10.1177/0193841x16656313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Violent drug markets are not as prominent as they once were in the United States, but they still exist and are associated with significant crime and lower quality of life. The drug market intervention (DMI) is an innovative strategy that uses focused deterrence, community engagement, and incapacitation to reduce crime and disorder associated with these markets. Although studies show that DMI can reduce crime and overt drug activity, one perspective is prominently missing from these evaluations: those who purchase drugs. OBJECTIVES This study explores the use of respondent-driven sampling (RDS)-a statistical sampling method-to approximate a representative sample of drug users who purchased drugs in a targeted DMI market to gain insight into the effect of a DMI on market dynamics. METHODS Using RDS, we recruited individuals who reported hard drug use (crack or powder cocaine, heroin, methamphetamine, or illicit use of prescriptions opioids) in the last month to participate in a survey. The main survey asked about drug use, drug purchasing, and drug market activity before and after DMI; a secondary survey asked about network characteristics and recruitment. CONCLUSIONS Our sample of 212 respondents met key RDS assumptions, suggesting that the characteristics of our weighted sample approximate the characteristics of the drug user network. The weighted estimates for market purchasers are generally valid for inferences about the aggregate population of customers, but a larger sample size is needed to make stronger inferences about the effects of a DMI on drug market activity.
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Ober AJ, Watkins KE, Hunter SB, Lamp K, Lind M, Setodji CM. An organizational readiness intervention and randomized controlled trial to test strategies for implementing substance use disorder treatment into primary care: SUMMIT study protocol. Implement Sci 2015; 10:66. [PMID: 25951953 PMCID: PMC4432875 DOI: 10.1186/s13012-015-0256-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/23/2015] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Millions of people who need treatment for substance use disorders (SUD) do not receive it. Evidence-based practices for treating SUD exist, and some are appropriate for delivery outside of specialty care settings. Primary care is an opportune setting in which to deliver SUD treatment because many individuals see their primary care providers at least once a year. Further, the Patient Protection and Affordable Care Act (PPACA) increases coverage for SUD treatment and is increasing the number of individuals seeking primary care services. In this article, we present the protocol for a study testing the effects of an organizational readiness and service delivery intervention on increasing the uptake of SUD treatment in primary care and on patient outcomes. METHODS/DESIGN In a randomized controlled trial, we test the combined effects of an organizational readiness intervention consisting of implementation tools and activities and an integrated collaborative care service delivery intervention based on the Chronic Care Model on service system (patient-centered care, utilization of substance use disorder treatment, utilization of health care services and adoption and sustainability of evidence-based practices) and patient (substance use, consequences of use, health and mental health, and satisfaction with care) outcomes. We also use a repeated measures design to test organizational changes throughout the study, such as acceptability, appropriateness and feasibility of the practices to providers, and provider intention to adopt the practices. We use provider focus groups, provider and patient surveys, and administrative data to measure outcomes. DISCUSSION The present study responds to critical gaps in health care services for people with substance use disorders, including the need for greater access to SUD treatment and greater uptake of evidence-based practices in primary care. We designed a multi-level study that combines implementation tools to increase organizational readiness to adopt and sustain evidence-based practices (EBPs) and tests the effectiveness of a service delivery intervention on service system and patient outcomes related to SUD services. TRIAL REGISTRATION Current controlled trials: NCT01810159.
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Affiliation(s)
- Allison J Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | | | - Sarah B Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | - Karen Lamp
- Venice Family Clinic, 604 Rose Avenue, Venice, CA, 90291, USA.
| | - Mimi Lind
- Venice Family Clinic, 604 Rose Avenue, Venice, CA, 90291, USA.
| | - Claude M Setodji
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
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Ober AJ, Miles JNV, Ewing B, Tucker JS, D'Amico EJ. Risk for inhalant initiation among middle school students: understanding individual, family, and peer risk and protective factors. J Stud Alcohol Drugs 2014; 74:835-40. [PMID: 24172109 DOI: 10.15288/jsad.2013.74.835] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Because initiation of inhalants at an early age is associated with a range of health and behavioral problems, including an increased likelihood of inhalant dependence (based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), we conducted discrete time survival analyses to determine the role of time-invariant and time-variant (over five waves) risk and protective factors as well as grade in inhalant initiation among middle school students. METHOD The current study uses data from 3,215 students who were initially surveyed as sixth graders in 2008-2009 and were resurveyed in seventh and eighth grades. Students were part of a larger substance use prevention trial conducted in greater Los Angeles. The sample is racially/ethnically diverse (54% Hispanic/Latino, 16% Asian, 14% White, 3% African American) and 51% male. RESULTS Seventeen percent of youths initiated inhalants during middle school. Higher drug refusal self-efficacy, familism (i.e., values related to family), and parental respect were associated with decreased odds of inhalant initiation. Having a significant adult or older sibling who used substances was associated with increased risk of initiation, but adult influence declined linearly and by the end of seventh grade was no longer a risk factor. Self-rated popularity was associated with inhalant initiation in seventh grade only, and perceived substance use by peers was associated with inhalant initiation in sixth grade only. CONCLUSIONS The influence of adults, siblings, and peers on inhalant use may be strongest in sixth and seventh grade. Interventions to prevent inhalant initiation should target sixth and seventh graders, address influence by family and peers, and provide skills training to improve drug refusal self-efficacy.
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Ober AJ, Martino SC, Ewing B, Tucker JS. If you provide the test, they will take it: factors associated with HIV/STI Testing in a representative sample of homeless youth in Los Angeles. AIDS Educ Prev 2012; 24:350-362. [PMID: 22827904 PMCID: PMC3408628 DOI: 10.1521/aeap.2012.24.4.350] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Homeless youth are at high risk for human immunodeficiency virus (HIV) and other sexually transmitted infections (STI), yet those at greatest risk may never have been tested for HIV or STI. In a probability sample of sexually active homeless youth in Los Angeles (n = 305), this study identifies factors associated with HIV/STI testing status. Most youth (85%) had ever been tested and 47% had been tested in the past 3 months. Recent testing was significantly more likely among youth who self-identified as gay, were Hispanic, injected drugs, and used drop-in centers, and marginally more likely among youth with more depressive symptoms. Drop-in center use mediated the association of injection drug use with HIV/STI testing. HIV/STI testing was unrelated to sexual risk behavior. Drop-in centers can play an important role in facilitating testing, including among injection drug users, but more outreach is needed to encourage testing in other at-risk subgroups.
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Affiliation(s)
- Allison J Ober
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138, USA.
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Ober AJ, Iguchi MY, Weiss RE, Gorbach PM, Heimer R, Ouellet LJ, Shoptaw S, Anglin MD, Zule WA. The relative role of perceived partner risks in promoting condom use in a three-city sample of high-risk, low-income women. AIDS Behav 2011; 15:1347-58. [PMID: 20976538 PMCID: PMC3180610 DOI: 10.1007/s10461-010-9840-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We examined the effect of women’s perceptions of sexual partner risks on condom use. Women from three US cities (n = 1,967) were recruited to provide data on HIV risks. In univariate models, increased odds of condom use were associated with perceiving that partners had concurrent partners and being unaware of partners': (a) HIV status, (b) bisexuality, (c) concurrency; and/or (d) injection drug use. In multivariate models, neither being unaware of the four partner risk factors nor perceiving a partner as being high risk was associated with condom use. Contextual factors associated with decreased odds of condom use were having sex with a main partner, homelessness in the past year, alcohol use during sex, and crack use in the past 30 days. Awareness of a partner’s risks may not be sufficient for increasing condom use. Contextual factors, sex with a main partner in particular, decrease condom use despite awareness of partner risk factors.
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Affiliation(s)
- Allison J Ober
- Integrated Substance Abuse Programs, David Geffen School of Medicine, Semel Institute for Neuroscience and Behavior, University of California, Los Angeles, 90025, USA.
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Bogart LM, Walt LC, Pavlovic JD, Ober AJ, Brown N, Kalichman SC. Cognitive strategies affecting recall of sexual behavior among high-risk men and women. Health Psychol 2008; 26:787-93. [PMID: 18020852 DOI: 10.1037/0278-6133.26.6.787] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Most sexual health research depends on self-reported information, but little is known about the ways in which individuals arrive at their responses to sexual behavior questions. The purpose of the present research was to investigate the cognitive strategies and contextual cues used to recall sexual behaviors among men and women at high risk for HIV. DESIGN 102 men and 106 women were recruited from a public health sexually transmitted disease clinic (mean age = 31 years; 45% African American, 50% White) and asked to think aloud as they responded to questions about number of lifetime sexual partners and frequency of vaginal and oral sex (in the past 2 weeks or 3 months). MAIN OUTCOME MEASURES Transcripts of participant interviews were coded for the different types of cognitive strategies and contextual cues that were used to recall counts of sexual partners and behaviors. RESULTS Multivariate logistic regressions indicated that respondents tended to enumerate each instance of behavior when recalling low frequencies of behavior and small numbers of partners and to use rate-based estimates or general impression strategies when recalling high frequencies and numbers. Most respondents did not use self-generated contextual cues. CONCLUSION Results suggest that reports of high frequencies of sexual behavior or large numbers of partners are approximations. For valid and reliable assessment, researchers should direct respondents to recall sexual behavior in small, manageable chunks through the use of interviewer prompts.
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Affiliation(s)
- Laura M Bogart
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
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Abstract
Recent studies have reported a much lower rate of headache prevalence for Australian college students as compared with those for two campuses in the United States. We present such data here for a third U.S. campus and make several comparisons of these data for the four campuses. While the gender difference of higher female over male headache frequency was found for all four campuses, the same measure for combined genders is reliably higher for all three U.S. groups over their Australian counterpart and there are significant differences among the U.S. groups as well. Possible reasons for these campus differences in headache prevalence are outlined and discussed and further research is indicated.
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Affiliation(s)
- D G Forgays
- Department of Psychology, University of Vermont, Burlington 05405
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