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Mohamed SF, Kisia L, Mashiashi I, Mair F, Wisdom JP, Bunn C, Gray C, Kibe PM, Sanya RE, Karugu CH, Mtenga SM, Binyaruka P, Asiki G. Policies for type 2 diabetes and non-communicable disease management during the COVID-19 pandemic in Kenya and Tanzania: a desk review and views of decision-makers. BMJ Open 2024; 14:e073261. [PMID: 38531573 DOI: 10.1136/bmjopen-2023-073261] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic caused disruptions in care that adversely affected the management of non-communicable diseases (NCDs) globally. Countries have responded in various ways to support people with NCDs during the pandemic. This study aimed to identify policy gaps, if any, in the management of NCDs, particularly diabetes, during COVID-19 in Kenya and Tanzania to inform recommendations for priority actions for NCD management during any future similar crises. METHODS We undertook a desk review of pre-existing and newly developed national frameworks, policy models and guidelines for addressing NCDs including type 2 diabetes. This was followed by 13 key informant interviews with stakeholders involved in NCD decision-making: six in Kenya and seven in Tanzania. Thematic analysis was used to analyse the documents. RESULTS Seventeen guidance documents were identified (Kenya=10; Tanzania=7). These included pre-existing and/or updated policies/strategic plans, guidelines, a letter, a policy brief and a report. Neither country had comprehensive policies/guidelines to ensure continuity of NCD care before the COVID-19 pandemic. However, efforts were made to update pre-existing documents and several more were developed during the pandemic to guide NCD care. Some measures were put in place during the COVID-19 period to ensure continuity of care for patients with NCDs such as longer supply of medicines. Inadequate attention was given to monitoring and evaluation and implementation issues. CONCLUSION Kenya and Tanzania developed and updated some policies/guidelines to include continuity of care in emergencies. However, there were gaps in the documents and between policy/guideline documents and practice. Health systems need to establish disaster preparedness plans that integrate attention to NCD care to enable them to better handle severe disruptions caused by emergencies such as pandemics. Such guidance needs to include contingency planning to enable adequate resources for NCD care and must also address evaluation of implementation effectiveness.
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Affiliation(s)
- Shukri F Mohamed
- Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Lyagamula Kisia
- Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Irene Mashiashi
- Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Frances Mair
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Christopher Bunn
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - Cindy Gray
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - Peter M Kibe
- Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Richard E Sanya
- Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Caroline H Karugu
- Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Sally M Mtenga
- Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Peter Binyaruka
- Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Gershim Asiki
- Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
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2
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Shaukat A, Wolf J, Ryder K, Wisdom JP, Church TR. Multilevel Interventions to Improve Colorectal Cancer Screening in an Urban Native American Community: A Pilot Randomized Clinical Trial. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00197-6. [PMID: 38365095 DOI: 10.1016/j.cgh.2024.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/18/2024]
Abstract
Native Americans have the highest burden of colorectal cancer (CRC) and the lowest rates of CRC screening across the United States.1 The disparities in CRC screening were made worse during the pandemic, creating an unmet need to implement evidence-based, multilevel interventions to improve CRC screening uptake. This can be achieved through an organized outreach program with identification of screen-eligible individuals using health records from the clinic; and a screening program with the following: (1) a mailed invitation, (2) a package of materials so patients can complete a fecal immunochemical test (FIT) kit from their homes, (3) reminder calls and a letter, and (4) navigation to a diagnostic colonoscopy.2-5 We conducted a pilot randomized controlled trial of a program of outreach vs usual care for completion of CRC screening at an urban clinic serving the Native American community. Applying the Consolidated Framework for Implementation Research (CFIR),6 we also conducted patient and provider interviews to understand barriers and facilitators to the organized program and CRC screening in general.
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Affiliation(s)
- Aasma Shaukat
- Division of Gastroenterology, Department of Medicine, New York University Grossman School of Medicine, New York, New York.
| | - Jack Wolf
- Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, Minnesota; Division of Biostatisitcs, University of Minneosta School of Public Health, Minneapolis, Minnesota
| | - Kyle Ryder
- Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, Minnesota; Division of Biostatisitcs, University of Minneosta School of Public Health, Minneapolis, Minnesota
| | | | - Timothy R Church
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota
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3
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Gustavson AM, Miller MJ, Boening N, Wisdom JP, Burke RE, Hagedorn HJ. Applying i-PARIHS to Identify Emerging Innovations in Hospital Discharge Decision Making in Response to System Stress: A Qualitative Study. Res Sq 2023:rs.3.rs-3189638. [PMID: 37645780 PMCID: PMC10462240 DOI: 10.21203/rs.3.rs-3189638/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background The purpose of this qualitative study was to use a Learning Health System approach to identify factors influencing the emergence of innovation in rehabilitation hospital discharge decision-making during the Coronavirus 2019 (COVID-19) pandemic. Methods Rehabilitation clinicians were recruited from the Veterans Affairs Health Care System and participated in individual semi-structured interviews guided by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Data were analyzed using a rapid qualitative, deductive team-based approach informed by directed content analysis. Results Twenty-three rehabilitation clinicians representing physical (N = 11) and occupational therapy (N = 12) participated in the study. Three primary themes were generated: (1) Recipients: innovations emerged as approaches to communicating discharge recommendations changed (in-person to virtual) and strong patient/family preferences to discharge to the home challenged collaborative goal setting; (2) Context: the ability of rehabilitation clinicians to innovate and the form of innovations were influenced by the broader hospital system, interdisciplinary team dynamics, and policy fluctuations; (3) Innovation: emerging innovations in discharge processes included perceived increases in team collaboration, shifts in caseload prioritization, and alternative options for post-acute care. Conclusions Our findings reinforce that rehabilitation clinicians developed innovative strategies to quickly adapt to multiple systems-level factors that were changing in the face of the COVID-19 pandemic. Future research is needed to assess the impact of innovations, remediate unintended consequences, and evaluate the implementation of promising innovations to respond to emerging healthcare delivery needs more rapidly.
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4
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Ajeen R, Ajeen D, Wisdom JP, Greene JA, Lepage T, Sjoelin C, Melvin T, Hagan TE, Hunter KF, Peters A, Mercer R, Brancu M. The impact of trauma-informed design on psychological well-being in homeless shelters. Psychol Serv 2023; 20:680-689. [PMID: 36326660 DOI: 10.1037/ser0000724] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Trauma-informed design is an emerging concept that combines elements of interior design, environmental psychology, and clinical psychology. Previous reports describe the potential impact of the physical space and design of homeless shelters on positive psychological outcomes (Pable, 2012). However, there is little known research on these outcomes. This article provides preliminary support for positive outcomes through a program evaluation of a trauma-informed design of resident bedrooms at two homeless shelters in North Carolina. Residents (n = 61) were asked to take a presurvey (before room design) and postsurvey (after design) that assessed their experiences of preparedness, hopefulness, and safety. Among those who completed both pre and postsurveys (n = 43), there was a statistically significant improvement in all three factors following the design, with the largest effect sizes for safety and total score average. Additionally, qualitative findings indicate participants felt the design updates increased their experiences of dignity (n = 17) and safety (n = 13), with some indicating increased feelings of hope (n = 4). We discuss implications for other homeless shelters, as well as similar institutions that support people in transitional housing. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Rawan Ajeen
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | | | | | - Jeffrey A Greene
- School of Education, University of North Carolina at Chapel Hill
| | - Tina Lepage
- Lepage Associates Psychological and Psychiatric Services
| | | | | | | | | | - Ava Peters
- Lepage Associates Psychological and Psychiatric Services
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5
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Bass SB, Kelly PJA, Pandit-Kerr S, Pilla J, Morris K, Larsen E, Wisdom JP, Torralva PR. “It's my frenemy”: A qualitative exploration of knowledge and perceptions of fentanyl use during the COVID-19 pandemic in people who use drugs at a syringe services program in Philadelphia, PA. Front Public Health 2022; 10:882421. [PMID: 35937263 PMCID: PMC9353520 DOI: 10.3389/fpubh.2022.882421] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Exacerbated by the COVID-19 pandemic and the proliferation of fentanyl and fentanyl analogs, overdose deaths have surged in the United States, making it important to understand how individuals who use drugs experience and perceive the risks of fentanyl use and how it has changed during the COVID-19 pandemic. Methods Twenty clients from a Philadelphia syringe services program completed a questionnaire and in-depth interview about their fentanyl experiences from January to March 2021. These interviews were transcribed and analyzed using thematic analysis methods. Results Sixty percent of participants were female and racial/ethnic minority. Participants indicated they believed fentanyl use accounted for most Philadelphia opioid-related overdoses and understood that fentanyl was different from other opioids. Fentanyl use was characterized as “all-consuming” by taking over lives and inescapable. While most perceived their risk of fentanyl overdose as high, there was low interest in and reported use of harm reduction strategies such as fentanyl test strips. The COVID-19 pandemic was noted to have negative effects on fentanyl availability, use and overdose risk, as well as mental health effects that increase drug use. Conclusions The divide between perceived risk and uptake of protective strategies could be driven by diminished self-efficacy as it relates to acting on and engaging with resources available at the syringe services program and represents a potential intervention target for harm reduction intervention uptake. But the COVID-19 pandemic has exacerbated risks due to fentanyl use, making an effective, accessible, and well-timed intervention important to address the disconnect between perceived overdose risk and use of preventive behaviors.
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Affiliation(s)
- Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, PA, United States
- Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, PA, United States
- *Correspondence: Sarah Bauerle Bass
| | - Patrick J. A. Kelly
- Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, PA, United States
| | | | - Jenine Pilla
- Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, PA, United States
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6
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Hagedorn HJ, Wisdom JP, Gerould H, Pinsker E, Brown R, Dawes M, Dieperink E, Myrick DH, Oliva EM, Wagner TH, Harris AHS. Alcohol use disorder pharmacotherapy and treatment in primary care (ADaPT-PC) trial: Impact on identified barriers to implementation. Subst Abus 2022; 43:1043-1050. [PMID: 35467489 DOI: 10.1080/08897077.2022.2060444] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: A minority of individuals meeting diagnostic criteria for alcohol use disorders (AUD) receive any type of formal treatment. Developing options for AUD treatment within primary care settings is imperative to increase treatment access. A multi-faceted implementation intervention including provider and patient education, clinician reminders, development of local champions and ongoing facilitation was designed to enhance access to AUD pharmacotherapy in primary care settings at three large Veterans Health Administration (VHA) facilities. This qualitative study compared pre-implementation barriers to post-implementation barriers identified via provider interviews to identify those barriers addressed and not addressed by the intervention to better understand the limited impact of the intervention. Methods: Following the nine-month implementation period, primary care providers at the three participating facilities took part in qualitative interviews to collect perceptions regarding which pre-implementation barriers had and had not been successfully addressed by the intervention. Participants included 20 primary care providers from three large VHA facilities. Interviews were coded using common coding techniques for qualitative data using the Consolidated Framework for Implementation Research (CFIR) codebook. Summary reports were created for each CFIR construct for each facility and the impact of each CFIR construct on implementation was coded as positive, neutral, or negative. Results: Some barriers identified during pre-implementation interviews were no longer identified as barriers in the post-implementation interviews. These included Relative Advantage, Relative Priority, and Knowledge & Beliefs about the Innovation. However, Compatibility, Design Quality & Packaging, and Available Resources remained barriers at the end of the implementation period. No substantial new barriers were identified. Conclusions: The implementation intervention appears to have been successful at addressing barriers that could be mitigated with traditional educational approaches. However, the intervention did not adequately address structural and organizational barriers to implementation. Recommendations for enhancing future interventions are provided.
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Affiliation(s)
- Hildi J Hagedorn
- Veterans Affairs Health Services Research and Development Center for Care Delivery & Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.,Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | | | - Heather Gerould
- Veterans Affairs Health Services Research and Development Center for Care Delivery & Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Erika Pinsker
- Veterans Affairs Health Services Research and Development Center for Care Delivery & Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Randall Brown
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Michael Dawes
- VA Boston Healthcare System, Brockton, MA, USA.,Boston University Medical School, Boston, MA, USA
| | - Eric Dieperink
- Veterans Affairs Health Services Research and Development Center for Care Delivery & Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.,Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Donald Hugh Myrick
- Center for Drug and Alcohol Problems, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA.,Department of Psychiatry and Behavioral Services, Medical University of South Carolina, Charleston, SC, USA
| | - Elizabeth M Oliva
- Veterans Affairs Health Services Research and Development Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Menlo Park, CA, USA
| | - Todd H Wagner
- Health Economics Resource Center, Palo Alto Veterans Affairs Health Care System, Menlo Park, CA, USA
| | - Alex H S Harris
- Veterans Affairs Health Services Research and Development Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Menlo Park, CA, USA
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7
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Koffel E, Branson M, Amundson E, Wisdom JP. "Sign Me Up, I'm Ready!": Helping Patients Prescribed Sleeping Medication Engage with Cognitive Behavioral Therapy for Insomnia (CBT-I). Behav Sleep Med 2021; 19:629-639. [PMID: 33063548 DOI: 10.1080/15402002.2020.1828085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE/BACKGROUND Cognitive behavioral therapy for insomnia (CBT-I) provides safe and effective insomnia care without the risk of harm associated with sleeping medications. Unfortunately, few patients with insomnia engage with CBT-I, with most using sedative hypnotics instead. This study conducted focus groups with patients with insomnia who were treated with sleeping medication, including older adults, women, and patients with chronic pain. The goal was to explore the perspectives of high-risk, CBT-I naïve patients on increasing access and engagement with CBT-I. PARTICIPANTS Participants included 29 Veterans with insomnia who had been prescribed sleeping medication in the last year and had not previously engaged with CBT-I. METHODS Semi-structured 90-min focus groups were used to 1) explore messages and appropriate channels for a CBT-I social marketing campaign, 2) determine patient preferences for self-management CBT-I tools, and 3) determine patient opinions on alternative provider-delivered forms of CBT-I. Thematic analysis was used to identify conceptual themes. RESULTS Three main themes were identified. First, patient education is necessary but not sufficient. Patients recommended multiple outreach attempts through multiple channels to motivate tired and overwhelmed insomnia patients to engage with CBT-I. Second, patients gravitated toward a stepped-care approach. Most would start with self-management CBT-I tools, moving on to provider-delivered CBT-I if needed. Finally, patients appreciated being able to choose from a menu of CBT-I delivery options and would use multiple options simultaneously. CONCLUSIONS These findings suggest promising opportunities to increase the use of CBT-I for high-risk patients through patient education and provision of self-management CBT-I tools.
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Affiliation(s)
- Erin Koffel
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN
| | - Mariah Branson
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN
| | - Erin Amundson
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
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8
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Waddell EN, Springer SA, Marsch LA, Farabee D, Schwartz RP, Nyaku A, Reeves R, Goldfeld K, McDonald RD, Malone M, Cheng A, Saunders EC, Monico L, Gryczynski J, Bell K, Harding K, Violette S, Groblewski T, Martin W, Talon K, Beckwith N, Suchocki A, Torralva R, Wisdom JP, Lee JD. Long-acting buprenorphine vs. naltrexone opioid treatments in CJS-involved adults (EXIT-CJS). J Subst Abuse Treat 2021; 128:108389. [PMID: 33865691 PMCID: PMC8384640 DOI: 10.1016/j.jsat.2021.108389] [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] [Received: 08/31/2020] [Revised: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
The EXIT-CJS (N = 1005) multisite open-label randomized controlled trial will compare retention and effectiveness of extended-release buprenorphine (XR-B) vs. extended-release naltrexone (XR-NTX) to treat opioid use disorder (OUD) among criminal justice system (CJS)-involved adults in six U.S. locales (New Jersey, New York City, Delaware, Oregon, Connecticut, and New Hampshire). With a pragmatic, noninferiority design, this study hypothesizes that XR-B (n = 335) will be noninferior to XR-NTX (n = 335) in retention-in-study-medication treatment (the primary outcome), self-reported opioid use, opioid-positive urine samples, opioid overdose events, and CJS recidivism. In addition, persons with OUD not eligible or interested in the RCT will be recruited into an enhanced treatment as usual arm (n = 335) to examine usual care outcomes in a quasi-experimental observational cohort.
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Affiliation(s)
- Elizabeth Needham Waddell
- School of Public Health and OHSU School of Medicine, Oregon Health & Science University, United States of America
| | | | | | | | | | - Amesika Nyaku
- The State University of New Jersey, New Jersey Medical School, United States of America
| | - Rusty Reeves
- Rutgers, University Correctional Health Care, Rutgers - Robert Wood Johnson Medical School, United States of America
| | | | | | - Mia Malone
- Friends Research Institute, United States of America
| | - Anna Cheng
- Friends Research Institute, United States of America
| | | | - Laura Monico
- Friends Research Institute, United States of America
| | | | | | - Kasey Harding
- Community Health Center, Inc, United States of America
| | | | | | | | - Kasey Talon
- ROAD to a Better Life, United States of America
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9
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Gustavson AM, Rauzi MR, Lahn MJ, Olson HSN, Ludescher M, Bazal S, Roddy E, Interrante C, Berg E, Wisdom JP, Fink HA. Practice Considerations for Adapting in-Person Groups to Telerehabilitation. Int J Telerehabil 2021; 13:e6374. [PMID: 34345348 PMCID: PMC8287704 DOI: 10.5195/ijt.2021.6374] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The Coronavirus-2019 (COVID-19) pandemic has shifted research and healthcare system priorities, stimulating literature on implementation and evaluation of telerehabilitation for a variety of patient populations. While there is substantial literature on individual telerehabilitation, evidence about group telerehabilitation remains limited despite its increasing use by rehabilitation providers. Therefore, the purpose of this manuscript is to describe our expert team's consensus on practice considerations for adapting in-person group rehabilitation to group telerehabilitation to provide rapid guidance during a pandemic and create a foundation for sustainability of group telerehabilitation beyond the pandemic's end.
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Affiliation(s)
- Allison M Gustavson
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Veterans Affairs Healthcare System, Minneapolis, MN, USA
| | - Michelle R Rauzi
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Molly J Lahn
- Physical Medicine and Rehabilitation, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 5, USA
| | - Hillari S N Olson
- Physical Medicine and Rehabilitation, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 5, USA
| | - Melissa Ludescher
- Physical Medicine and Rehabilitation, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 5, USA
| | - Stephanie Bazal
- Physical Medicine and Rehabilitation, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 5, USA
| | - Elizabeth Roddy
- Physical Medicine and Rehabilitation, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 5, USA
| | - Christine Interrante
- Physical Medicine and Rehabilitation, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 5, USA
| | - Estee Berg
- Physical Medicine and Rehabilitation, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 5, USA
| | | | - Howard A Fink
- Geriatric Research Education and Clinical Center, Veterans Affairs Healthcare System, Minneapolis, MN, USA.,Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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10
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Gustavson AM, Wisdom JP, Kenny ME, Salameh HA, Ackland PE, Clothier B, Noorbaloochi S, Gordon AJ, Hagedorn HJ. Early impacts of a multi-faceted implementation strategy to increase use of medication treatments for opioid use disorder in the Veterans Health Administration. Implement Sci Commun 2021; 2:20. [PMID: 33588952 PMCID: PMC7885503 DOI: 10.1186/s43058-021-00119-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 01/28/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Despite the risk of negative sequelae from opioid use disorder (OUD) and clinical guidelines for the use of effective medication treatment for OUD (M-OUD), many Veterans Health Administration (VHA) providers and facilities lag in providing M-OUD. An intensive external facilitation intervention may enhance uptake in low-adopting VHA facilities by engaging stakeholders from multiple clinical settings within a facility (e.g., mental health, primary care, pain specialty clinic, substance use disorder clinics). Our study identified pre-intervention determinants of implementation through qualitative interviews, described strategies employed during the first 6 months of intensive external facilitation, and explored patterns of implementation determinants in relation to early outcomes. METHODS Guided by the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, we interviewed stakeholders at low-adopting VHA facilities prior to external facilitation, employed a rapid qualitative analytic process, presented findings during facility visits, and collaboratively created facilitation action plans to achieve goals set by the facilities that would increase M-OUD uptake. The primary outcome was the Substance Use Disorder (SUD)-16, which is a VHA facility-level performance metric consisting of the percent of patients receiving M-OUD among those with an OUD diagnosis. We examined the relationship between pre-implementation factors and 6-month SUD-16 outcomes. RESULTS Across eight VHA facilities, we interviewed 68 participants. Implementation determinants included barriers and facilitators across innovation, context, and recipients constructs of i-PARIHS. Each facility selected goals based on the qualitative results. At 6 months, two facilities achieved most goals and two facilities demonstrated progress. The SUD-16 from baseline to 6 months significantly improved in two facilities (8.4% increase (95 % confidence interval [CI] 4.4-12.4) and 9.9% increase (95% CI 3.6-16.2), respectively). Six-month implementation outcomes showed that the extent to which M-OUD aligns with existing clinical practices and values was a primary factor at all facilities, with six of eight facilities perceiving it as both a barrier and facilitator. External health system barriers were most challenging for facilities with the smallest change in SUD-16. CONCLUSIONS Early impacts of a multi-faceted implementation approach demonstrated a strong signal for positively impacting M-OUD prescribing in low-adopting VHA facilities. This signal indicates that external facilitation can influence adoption of M-OUD at the facility level in the early implementation phase. These short-term wins experienced by stakeholders may encourage continued adoption and long-term sustainability M-OUD.
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Affiliation(s)
- Allison M Gustavson
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Mail Code #152, Minneapolis, MN, 55417, USA.
| | | | - Marie E Kenny
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Mail Code #152, Minneapolis, MN, 55417, USA
| | - Hope A Salameh
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Mail Code #152, Minneapolis, MN, 55417, USA
| | - Princess E Ackland
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Mail Code #152, Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota, Minneapolis, USA
| | - Barbara Clothier
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Mail Code #152, Minneapolis, MN, 55417, USA
| | - Siamak Noorbaloochi
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Mail Code #152, Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota, Minneapolis, USA
| | - Adam J Gordon
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA.,Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Salt Lake City, Utah, USA.,Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Hildi J Hagedorn
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Mail Code #152, Minneapolis, MN, 55417, USA.,Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN, 55455, USA
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11
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Koffel E, Amundson E, Wisdom JP. Exploring the Meaning of Cognitive Behavioral Therapy for Insomnia for Patients with Chronic Pain. Pain Med 2021; 21:67-75. [PMID: 31271434 DOI: 10.1093/pm/pnz144] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Insomnia is one of the most common, persistent, and distressing symptoms associated with chronic pain. Cognitive behavioral therapy for insomnia (CBT-I) is the firstline treatment for insomnia, but patient preferences and perspectives about CBT-I within the context of chronic pain are unknown. The current qualitative study sought to understand the experience of CBT-I among patients with chronic pain, including aspects of CBT-I that were found to be difficult (e.g., pain as a specific barrier to adherence/dropout), changes in sleep and pain functioning after CBT-I, and aspects of CBT-I that were appreciated. DESIGN Qualitative semistructured interviews. METHODS We conducted individual semistructured interviews with 17 veterans with chronic pain and insomnia who had recently participated in CBT-I, as well as their CBT-I therapists, and used thematic analysis to identify conceptual themes. RESULTS Results revealed that patients and CBT-I therapists found changing sleep habits during CBT-I challenging due to anxiety and temporary increases in fatigue, but did not identify major pain-related barriers to adhering to CBT-I recommendations; patients experienced better sleep, mood, energy, and socialization after CBT-I despite minimal changes in pain intensity; and patients highly valued CBT-I as a personalized treatment for sleep and strongly recommended it for other patients with chronic pain. CONCLUSIONS Findings of improved sleep and functional outcomes support efforts to incorporate CBT-I into chronic pain treatment, including educating patients and providers about the strong feasibility of improving sleep and quality of life despite ongoing pain.
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Affiliation(s)
- Erin Koffel
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota.,Departments of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Erin Amundson
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota.,Departments of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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12
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Albino J, Wisdom JP. Introduction to The Psychologist-Manager Journal Special Issue on Women Psychologists in Management and Leadership. The Psychologist-Manager Journal 2020. [DOI: 10.1037/mgr0000110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Felner JK, Wisdom JP, Williams T, Katuska L, Haley SJ, Jun HJ, Corliss HL. Stress, Coping, and Context: Examining Substance Use Among LGBTQ Young Adults With Probable Substance Use Disorders. Psychiatr Serv 2020; 71:112-120. [PMID: 31640522 PMCID: PMC7002176 DOI: 10.1176/appi.ps.201900029] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [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] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The authors qualitatively examined how lesbian, gay, bisexual, transgender, and queer (LGBTQ) young adults with probable substance use disorders conceptualized their substance use vis-à-vis their LGBTQ identities. METHODS Individual, in-depth, semistructured interviews were conducted with 59 LGBTQ young adults (ages 21-34) who were participants in a larger longitudinal cohort study and who met criteria for a probable substance use disorder. Data were analyzed via iterative, thematic analytic processes. RESULTS Participants' narratives highlighted processes related to minority stress that shape substance use, including proximal LGBTQ stressors (e.g., self-stigma and expectations of rejection) and distal LGBTQ stressors (e.g., interpersonal and structural discrimination) and associated coping. Participants also described sociocultural influences, including the ubiquitous availability of substances within LGBTQ social settings, as salient contributors to their substance use and development of substance use disorders. Participants who considered themselves transgender or other gender minorities, all of whom identified as sexual minorities, described unique stressors and coping at the intersection of their minority identities (e.g., coping with two identity development and disclosure periods), which shaped their substance use over time. CONCLUSIONS Multilevel minority stressors and associated coping via substance use in adolescence and young adulthood, coupled with LGBTQ-specific sociocultural influences, contribute to the development of substance use disorders among some LGBTQ young adults. Treatment providers should address clients' substance use vis-à-vis their LGBTQ identities and experiences with related stressors and sociocultural contexts and adopt culturally humble and LGBTQ-affirming treatment approaches. Efforts to support LGBTQ youths and young adults should focus on identifying ways of socializing outside of substance-saturated environments.
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Affiliation(s)
- Jennifer K Felner
- School of Public Health and Institute for Behavioral and Community Health, San Diego State University, San Diego (Felner, Jun, Corliss); Wisdom Consulting, New York (Wisdom); Department of Epidemiology and Biostatistics (Williams) and Department of Health Policy and Management (Haley), Graduate School of Public Health and Health Policy, City University of New York, New York; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston (Katuska)
| | - Jennifer P Wisdom
- School of Public Health and Institute for Behavioral and Community Health, San Diego State University, San Diego (Felner, Jun, Corliss); Wisdom Consulting, New York (Wisdom); Department of Epidemiology and Biostatistics (Williams) and Department of Health Policy and Management (Haley), Graduate School of Public Health and Health Policy, City University of New York, New York; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston (Katuska)
| | - Tenneill Williams
- School of Public Health and Institute for Behavioral and Community Health, San Diego State University, San Diego (Felner, Jun, Corliss); Wisdom Consulting, New York (Wisdom); Department of Epidemiology and Biostatistics (Williams) and Department of Health Policy and Management (Haley), Graduate School of Public Health and Health Policy, City University of New York, New York; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston (Katuska)
| | - Laura Katuska
- School of Public Health and Institute for Behavioral and Community Health, San Diego State University, San Diego (Felner, Jun, Corliss); Wisdom Consulting, New York (Wisdom); Department of Epidemiology and Biostatistics (Williams) and Department of Health Policy and Management (Haley), Graduate School of Public Health and Health Policy, City University of New York, New York; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston (Katuska)
| | - Sean J Haley
- School of Public Health and Institute for Behavioral and Community Health, San Diego State University, San Diego (Felner, Jun, Corliss); Wisdom Consulting, New York (Wisdom); Department of Epidemiology and Biostatistics (Williams) and Department of Health Policy and Management (Haley), Graduate School of Public Health and Health Policy, City University of New York, New York; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston (Katuska)
| | - Hee-Jin Jun
- School of Public Health and Institute for Behavioral and Community Health, San Diego State University, San Diego (Felner, Jun, Corliss); Wisdom Consulting, New York (Wisdom); Department of Epidemiology and Biostatistics (Williams) and Department of Health Policy and Management (Haley), Graduate School of Public Health and Health Policy, City University of New York, New York; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston (Katuska)
| | - Heather L Corliss
- School of Public Health and Institute for Behavioral and Community Health, San Diego State University, San Diego (Felner, Jun, Corliss); Wisdom Consulting, New York (Wisdom); Department of Epidemiology and Biostatistics (Williams) and Department of Health Policy and Management (Haley), Graduate School of Public Health and Health Policy, City University of New York, New York; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston (Katuska)
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Jun HJ, Webb-Morgan M, Felner JK, Wisdom JP, Haley SJ, Austin SB, Katuska LM, Corliss HL. Sexual orientation and gender identity disparities in substance use disorders during young adulthood in a United States longitudinal cohort. Drug Alcohol Depend 2019; 205:107619. [PMID: 31678835 PMCID: PMC7437659 DOI: 10.1016/j.drugalcdep.2019.107619] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 02/21/2019] [Revised: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND This study examined associations of sexual orientation and gender identity with prevalence of substance use disorders (SUDs) and co-occurring multiple SUDs in the past 12-months during young adulthood in a United States longitudinal cohort. METHODS Questionnaires self-administered in 2010 and 2015 assessed probable past 12-month nicotine dependence, alcohol abuse and dependence, and drug abuse and dependence among 12,428 participants of an ongoing cohort study when they were ages 20-35 years. Binary or multinomial logistic regressions using generalized estimating equations were used to estimate differences by sexual orientation and gender identity in the odds of SUDs and multiple SUDs, stratified by sex assigned at birth. RESULTS Compared with completely heterosexuals (CH), sexual minority (SM; i.e., mostly heterosexual, bisexual, lesbian/gay) participants were generally more likely to have a SUD, including multiple SUDs. Among participants assigned female at birth, adjusted odds ratios (AORs) for SUDs comparing SMs to CHs ranged from 1.61 to 6.97 (ps<.05); among participants assigned male at birth, AORs ranged from 1.30 to 3.08, and were statistically significant for 62% of the estimates. Apart from elevated alcohol dependence among gender minority participants assigned male at birth compared with cisgender males (AOR: 2.30; p < .05), gender identity was not associated with prevalence of SUDs. CONCLUSIONS Sexual and gender minority (SGM) young adults disproportionately evidence SUDs, as well as co-occurring multiple SUDs. Findings related to gender identity and bisexuals assigned male at birth should be interpreted with caution due to small sample sizes. SUD prevention and treatment efforts should focus on SGM young adults.
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Affiliation(s)
- Hee-Jin Jun
- School of Public Health, San Diego State University, San Diego, CA, USA,Institute for Behavioral and Community Health, San Diego State University, San Diego, CA
| | - Megan Webb-Morgan
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Jennifer K. Felner
- School of Public Health, San Diego State University, San Diego, CA, USA,Institute for Behavioral and Community Health, San Diego State University, San Diego, CA
| | | | - Sean J. Haley
- Department of Health Policy and Management, School of Public Health, City University of New York, New York, NY, USA
| | - S. Bryn Austin
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Laura M. Katuska
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Heather L. Corliss
- School of Public Health, San Diego State University, San Diego, CA, USA,Institute for Behavioral and Community Health, San Diego State University, San Diego, CA,Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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15
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Hagedorn HJ, Wisdom JP, Gerould H, Pinsker E, Brown R, Dawes M, Dieperink E, Myrick DH, Oliva EM, Wagner TH, Harris AHS. Implementing alcohol use disorder pharmacotherapy in primary care settings: a qualitative analysis of provider-identified barriers and impact on implementation outcomes. Addict Sci Clin Pract 2019; 14:24. [PMID: 31291996 PMCID: PMC6617941 DOI: 10.1186/s13722-019-0151-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/23/2019] [Indexed: 11/14/2022] Open
Abstract
Background Despite the high prevalence of alcohol use disorders (AUDs), in 2016, only 7.8% of individuals meeting diagnostic criteria received any type of AUD treatment. Developing options for treatment within primary care settings is imperative to increase treatment access. As part of a trial to implement AUD pharmacotherapy in primary care settings, this qualitative study analyzed pre-implementation provider interviews using the Consolidated Framework for Implementation Research (CFIR) to identify implementation barriers. Methods Three large Veterans Health Administration facilities participated in the implementation intervention. Local providers were trained to serve as implementation/clinical champions and received external facilitation from the project team. Primary care providers received a dashboard of patients with AUD for case identification, educational materials, and access to consultation from clinical champions. Veterans with AUD diagnoses received educational information in the mail. Prior to the start of implementation activities, 24 primary care providers (5–10 per site) participated in semi-structured interviews. Transcripts were analyzed using common coding techniques for qualitative data using the CFIR codebook Innovation/Intervention Characteristics, Outer Setting, Inner Setting, and Characteristics of Individuals domains. Number and type of barriers identified were compared to quantitative changes in AUD pharmacotherapy prescribing rates. Results Four major barriers emerged across all three sites: complexity of providing AUD pharmacotherapy in primary care, the limited compatibility of AUD treatment with existing primary care processes, providers’ limited knowledge and negative beliefs about AUD pharmacotherapy and providers’ negative attitudes toward patients with AUD. Site specific barriers included lack of relative advantage of providing AUD pharmacotherapy in primary care over current practice, complaints about the design quality and packaging of implementation intervention materials, limited priority of addressing AUD in primary care and limited available resources to implement AUD pharmacotherapy in primary care. Conclusions CFIR constructs were useful for identifying pre-implementation barriers that informed refinements to the implementation intervention. The number and type of pre-implementation barriers identified did not demonstrate a clear relationship to the degree to which sites were able to improve AUD pharmacotherapy prescribing rate. Site-level implementation process factors such as leadership support and provider turn-over likely also interacted with pre-implementation barriers to drive implementation outcomes. Electronic supplementary material The online version of this article (10.1186/s13722-019-0151-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hildi J Hagedorn
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, 55417, USA. .,Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN, 55455, USA.
| | | | - Heather Gerould
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, 55417, USA
| | - Erika Pinsker
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, 55417, USA
| | - Randall Brown
- William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA.,Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53715, USA
| | - Michael Dawes
- Substance Abuse Treatment Program, South Texas Veterans Affairs Health Care System, San Antonio, TX, 78229, USA.,Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
| | - Eric Dieperink
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, 55417, USA.,Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN, 55455, USA
| | - Donald Hugh Myrick
- Center for Drug and Alcohol Problems, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, 29401, USA.,Department of Psychiatry and Behavioral Services, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Elizabeth M Oliva
- Veterans Affairs Health Services Research and Development Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Menlo Park, CA, 94025, USA
| | - Todd H Wagner
- Health Economics Resource Center, Palo Alto Veterans Affairs Health Care System, Menlo Park, CA, 94025, USA
| | - Alex H S Harris
- Veterans Affairs Health Services Research and Development Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Menlo Park, CA, 94025, USA
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16
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Koffel E, Amundson E, Polusny G, Wisdom JP. "You're Missing Out on Something Great": Patient and Provider Perspectives on Increasing the Use of Cognitive Behavioral Therapy for Insomnia. Behav Sleep Med 2019; 18:358-371. [PMID: 30907144 PMCID: PMC6759412 DOI: 10.1080/15402002.2019.1591958] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Indexed: 10/27/2022]
Abstract
Objective/Background: Cognitive behavioral therapy for insomnia (CBT-I) is the most effective treatment for insomnia but is severely underutilized. One of the key reasons for underuse is lack of knowledge among patients and primary care providers, but effective methods and materials for increasing knowledge are unknown. This study conducted in-depth interviews with CBT-I patients and their CBT-I providers to explore their perceptions on increasing utilization of CBT-I. Participants: Participants included patients who had engaged in CBT-I (N = 17) and CBT-I providers (N = 7). Methods: Semistructured interviews were used to explore the CBT-I referral process, recommendations for increasing uptake of CBT-I, and opinions on CBT-I self-management, with thematic analysis used to identify conceptual themes. Findings were compared and contrasted across patients who completed versus prematurely discontinued therapy and patients versus CBT-I providers. Results: Three main themes of referral, selling, and delivery were identified. Regarding referral, patients had not heard of nor requested CBT-I. Proactive outreach is crucial in populations in which insomnia is so common that it becomes normalized. For selling, patients and CBT-I providers had powerful testimonials that could be used to "sell" treatment using a peer-to-peer approach. Finally, for delivery, patients and CBT-I providers were ambivalent about alternative delivery formats and emphasized the need for personal contact. Although technology may be useful in advertising and delivering CBT-I, it will be important to ensure that these approaches promote rather than discourage engagement in CBT-I. Conclusions: These findings suggest promising opportunities to increase the use of CBT-I, including direct-to-consumer marketing.
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Affiliation(s)
- Erin Koffel
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN
| | - Erin Amundson
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Grace Polusny
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN
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Haley SJ, Pinsker EA, Gerould H, Wisdom JP, Hagedorn HJ. Patient perspectives on alcohol use disorder pharmacotherapy and integration of treatment into primary care settings. Subst Abus 2019; 40:501-509. [DOI: 10.1080/08897077.2019.1576089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Sean J. Haley
- Department of Health Policy and Management and Center for Innovation in Mental Health, Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - Erika A. Pinsker
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine, School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Heather Gerould
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | | | - Hildi J. Hagedorn
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
- Department of Psychiatry, School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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18
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Wani RJ, Wisdom JP, Wilson FA. Emergency Department Utilization for Substance Use-Related Disorders and Assessment of Treatment Facilities in New York State, 2011-2013. Subst Use Misuse 2019; 54:482-494. [PMID: 30380976 DOI: 10.1080/10826084.2018.1517801] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Annually, 1.8 million New York (NY) residents experience substance use disorders (SUDs). Even though emergency departments (EDs) continue to experience high numbers of SUD-related visits, only 15% receive treatment. OBJECTIVES This study estimates hospital-based EDs rates for SUDs in the State of New York. Also, the geographic distribution of substance use treatment centers and EDs are mapped to correlate utilization with access to care. METHODS The 2011-2013 Healthcare Cost and Utilization Project's NY State Emergency Department Database provided information on utilization of services in EDs, charges, diagnoses, and discharge, as well as patient demographic variables. All patients within NY who had visited the ED for SUDs comprised the study population. Geographic mapping of EDs and substance abuse treatment centers at the county-level is based on data from the National Emergency Department Inventory and National Survey of Substance Abuse Treatment Services, respectively. RESULTS A total of 492,419 ED visits for SUDs were reported through 2011-2013. Despite NY's Medicaid expansion in 2012, ED visits increased in 2013. About $856 million was spent in treating SUDs in EDs, with average charge of $1,764 per visit. Conclusions/Importance: Alcohol and drug-induced mental disorders are increasingly prevalent in New York's EDs. There is a need to develop health policies and programs to improve access to care for SUDs in urban states.
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Affiliation(s)
- Rajvi J Wani
- a Department of Health Services Research, Administration and Policy, College of Public Health , University of Nebraska Medical Center , Omaha , Nebraska , USA
| | - Jennifer P Wisdom
- b Graduate School of Public Health and Health Policy, Department of Health Policy and Management, Center for Innovation in Mental Health , City University of New York , New York , New York , USA
| | - Fernando A Wilson
- a Department of Health Services Research, Administration and Policy, College of Public Health , University of Nebraska Medical Center , Omaha , Nebraska , USA
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Abstract
Background Tobacco use is the world’s leading preventable cause of illness and death and the most important risk factor for non-communicable diseases (NCDs), particularly cardiovascular and chronic respiratory diseases (heart attack, stroke, congestive obstructive pulmonary disease, and lung cancer). Tobacco control is one of the World Health Organization’s “best-buys” interventions to prevent NCDs. This study assessed the use of a multi-sectoral approach (MSA) in developing and implementing tobacco control policies in South Africa and Togo. Methods This two-country case study consisted of a document review of tobacco control policies and of key informant interviews (N = 56) about the content, context, stakeholders, and strategies employed throughout policy formulation and implementation in South Africa and Togo. To guide our analysis, we used the Comprehensive Framework for Multi-Sectoral Approach to Health Policy, which is built around four major constructs of context, content, stakeholders and strategies. Results The findings show that the formulation of tobacco control policies in both countries was driven locally by the political, historical, social and economic contexts, and globally by the adoption WHO Framework Convention on Tobacco Control (FCTC). In both countries, the health department led policy formulation and implementation. The stakeholders involved in South Africa were more diverse, proactive and dynamic than those in Togo, whereas the strategies employed were more straightforward in Togo than in South Africa. The extent of understanding and use of MSA in both countries consisted of an inter-sectoral action for health, whereby the health department strove to collaborate with other sectors within and outside the government. Consequently, information sharing was identified as the main outcome of the interactions between institutions and interest groups within and across three critical sectors of the state, namely the public (government), the private and the civil society. Conclusion Tobacco control policies in South Africa and Togo were formulated and implemented from an inter-sectoral approach perspective, which relied heavily on information transfer between stakeholders and less on collaborative problem-solving approach. Incorporation of multiple stakeholders allowed both countries to formulate policies to meet FCTC goals for tobacco control and NCD reduction.
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Affiliation(s)
- Saliyou Sanni
- School of Health Systems and Public Health, Faculty of Heath Sciences, University of Pretoria, Pretoria, South Africa.
| | - Charles Hongoro
- School of Health Systems and Public Health, Faculty of Heath Sciences, University of Pretoria, Pretoria, South Africa.,Population Health, Health Systems and Innovation, Human Sciences Research Council, Pretoria, South Africa
| | - Catherine Ndinda
- Economic Performance and Development, Human Sciences Research Council, Pretoria, South Africa
| | - Jennifer P Wisdom
- City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
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Wisdom JP, Juma P, Mwagomba B, Ndinda C, Mapa-Tassou C, Assah F, Nkhata M, Mohamed SF, Oladimeji O, Oladunni O, Oluwasanu M, Sanni S, Mbanya JC, Kyobutungi C. Influence of the WHO framework convention on tobacco control on tobacco legislation and policies in sub-Saharan Africa. BMC Public Health 2018; 18:954. [PMID: 30168395 PMCID: PMC6117626 DOI: 10.1186/s12889-018-5827-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization's Framework Convention on Tobacco Control, enforced in 2005, was a watershed international treaty that stipulated requirements for signatories to govern the production, sale, distribution, advertisement, and taxation of tobacco to reduce its impact on health. This paper describes the timelines, context, key actors, and strategies in the development and implementation of the treaty and describes how six sub-Saharan countries responded to its call for action on tobacco control. METHODS A multi-country policy review using case study design was conducted in Cameroon, Kenya, Nigeria, Malawi, South Africa, and Togo. All documents related to the WHO Framework Convention on Tobacco Control and individual country implementation of tobacco policies were reviewed, and key informant interviews related to the countries' development and implementation of tobacco policies were conducted. RESULTS Multiple stakeholders, including academics and activists, led a concerted effort for more than 10 years to push the WHO treaty forward despite counter-marketing from the tobacco industry. Once the treaty was enacted, Cameroon, Kenya, Nigeria, Malawi, South Africa, and Togo responded in unique ways to implement tobacco policies, with differences associated with the country's socio-economic context, priorities of country leaders, industry presence, and choice of strategies. All the study countries except Malawi have acceded to and ratified the WHO tobacco treaty and implemented tobacco control policy. CONCLUSIONS The WHO Framework Convention on Tobacco Control provided an unprecedented opportunity for global action against the public health effects of tobacco including non-communicable diseases. Reviewing how six sub-Saharan countries responded to the treaty to mobilize resources and implement tobacco control policies has provided insight for how to utilise international regulations and commitments to accelerate policy impact on the prevention of non-communicable diseases.
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Affiliation(s)
| | - Pamela Juma
- African Population Health Research Centre, Nairobi, Kenya
| | - Beatrice Mwagomba
- Lighthouse Trust, Lilongwe, Malawi
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- Global Health Implementation Programme, School of Medicine, University of St. Andrews, St. Andrews, Scotland
| | - Catherine Ndinda
- Human Science Research Council, Pretoria, South Africa
- University of KwaZulu-Natal, Durban, South Africa
| | - Clarisse Mapa-Tassou
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Health of Population in Transition Research Group (HoPiT), Yaoundé, Cameroon
| | - Felix Assah
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Health of Population in Transition Research Group (HoPiT), Yaoundé, Cameroon
| | - Misheck Nkhata
- Anthropology Department, Catholic University of Malawi, Lilongwe, Malawi
- Department of Anthropology, Durham University, Durham, England
| | | | - Oladepo Oladimeji
- African Regional Health Education Centre, Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Opeyemi Oladunni
- African Regional Health Education Centre, Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Mojisola Oluwasanu
- African Regional Health Education Centre, Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Saliyou Sanni
- School of Health Systems and Public Health, Faculty of Heath Sciences, University of Pretoria, Pretoria, South Africa
| | - Jean-Claude Mbanya
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Health of Population in Transition Research Group (HoPiT), Yaoundé, Cameroon
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21
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Juma PA, Mohamed SF, Matanje Mwagomba BL, Ndinda C, Mapa-tassou C, Oluwasanu M, Oladepo O, Abiona O, Nkhata MJ, Wisdom JP, Mbanya JC. Non-communicable disease prevention policy process in five African countries. BMC Public Health 2018; 18:961. [PMID: 30168393 PMCID: PMC6117619 DOI: 10.1186/s12889-018-5825-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The increasing burden of non-communicable diseases (NCDs) in sub-Saharan Africa is causing further burden to the health care systems that are least equipped to deal with the challenge. Countries are developing policies to address major NCD risk factors including tobacco use, unhealthy diets, harmful alcohol consumption and physical inactivity. This paper describes NCD prevention policy development process in five African countries (Kenya, South Africa, Cameroon, Nigeria, Malawi), including the extent to which WHO "best buy" interventions for NCD prevention have been implemented. METHODS The study applied a multiple case study design, with each country as a separate case study. Data were collected through document reviews and key informant interviews with national-level decision-makers in various sectors. Data were coded and analyzed thematically, guided by Walt and Gilson policy analysis framework that examines the context, content, processes and actors in policy development. RESULTS Country-level policy process has been relatively slow and uneven. Policy process for tobacco has moved faster, especially in South Africa but was delayed in others. Alcohol policy process has been slow in Nigeria and Malawi. Existing tobacco and alcohol policies address the WHO "best buy" interventions to some extent. Food-security and nutrition policies exist in almost all the countries, but the "best buy" interventions for unhealthy diet have not received adequate attention in all countries except South Africa. Physical activity policies are not well developed in any study countries. All have recently developed NCD strategic plans consistent with WHO global NCD Action Plan but these policies have not been adequately implemented due to inadequate political commitment, inadequate resources and technical capacity as well as industry influence. CONCLUSION NCD prevention policy process in many African countries has been influenced both by global and local factors. Countries have the will to develop NCD prevention policies but they face implementation gaps and need enhanced country-level commitment to support policy NCD prevention policy development for all risk factors and establish mechanisms to attain better policy outcomes while considering other local contextual factors that may influence policy implementation such as political support, resource allocation and availability of local data for monitoring impacts.
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Affiliation(s)
- Pamela A. Juma
- African Population and Health Research Center, Nairobi, Kenya
| | | | | | | | - Clarisse Mapa-tassou
- African Regional Health Education Centre, Department of Health Promotion and Education, Yaoundé, Cameroon
- Health of Population in Transition Research Group (HoPiT), Yaoundé, Cameroon
| | - Mojisola Oluwasanu
- Health of Population in Transition Research Group (HoPiT), Yaoundé, Cameroon
| | | | - Opeyemi Abiona
- Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Misheck J. Nkhata
- Anthropology Department, Catholic University of Malawi, Blantyre, Malawi
| | | | - Jean-Claude Mbanya
- African Regional Health Education Centre, Department of Health Promotion and Education, Yaoundé, Cameroon
- Health of Population in Transition Research Group (HoPiT), Yaoundé, Cameroon
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Sanni S, Wisdom JP, Ayo-Yusuf OA, Hongoro C. Multi-Sectoral Approach to Noncommunicable Disease Prevention Policy in Sub-Saharan Africa: A Conceptual Framework for Analysis. Int J Health Serv 2018; 49:371-392. [DOI: 10.1177/0020731418774203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Conceptual frameworks for health policy analysis guide investigations into interactions between institutions, interests, and ideas to identify how to improve policy decisions and outcomes. This review assessed constructs from current frameworks and theories of health policy analysis to (1) develop a preliminary synthesis of findings from selected frameworks and theories; (2) analyze relationships between elements of those frameworks and theories to construct an overarching framework for health policy analysis; and then, (3) apply that overarching framework to analyze tobacco control policies in Togo and in South Africa. This Comprehensive Framework for Multi-Sectoral Approach to Health Policy Analysis has 4 main constructs: context, content, stakeholders, and strategies. When applied to analyze tobacco control policy processes in Togo and in South Africa, it identified a shared goal in both countries to have a policy content that is compliant with the provisions of international tobacco treaties and differences in strategic interactions between institutions (e.g., tobacco industry, government structures) and in the political context of tobacco control policy process. These findings highlight the need for context-specific political mapping identifying the interests of all stakeholders and strategies for interaction between health and other sectors when planning policy formulation or implementation.
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Affiliation(s)
- Saliyou Sanni
- School of Health Systems and Public Health, Faculty of Heath Sciences, University of Pretoria, Pretoria, South Africa
| | - Jennifer P. Wisdom
- City University of New York Graduate School of Public Health and Health Policy, New York, USA
| | - Olalekan A. Ayo-Yusuf
- Office of the Executive Dean, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Charles Hongoro
- School of Health Systems and Public Health, Faculty of Heath Sciences, University of Pretoria, Pretoria, South Africa
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Pretoria, South Africa
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Harris AHS, Brown R, Dawes M, Dieperink E, Myrick DH, Gerould H, Wagner TH, Wisdom JP, Hagedorn HJ. Effects of a multifaceted implementation intervention to increase utilization of pharmacological treatments for alcohol use disorders in the US Veterans Health Administration. J Subst Abuse Treat 2017; 82:107-112. [PMID: 29021108 DOI: 10.1016/j.jsat.2017.09.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/15/2017] [Accepted: 09/05/2017] [Indexed: 11/20/2022]
Abstract
Over 16 million Americans meet diagnostic criteria for alcohol use disorder (AUD), but only 7.8% of them receive formal treatment each year. Safe and effective pharmacological treatments for AUD exist; however, they are rarely prescribed. Therefore, we developed and pilot tested a multifaceted implementation intervention to improve consideration and receipt of effective pharmacologic treatments for AUD, focusing on primary care settings where patients have the most frequent contact with healthcare systems. The intervention included training of local providers to serve as champions and a website for primary care providers that included educational materials, a case-finding dashboard, and contact information for local and national clinical experts. We also mailed patients educational material about treatment options. The intervention was implemented at three large facilities of the Veterans Health Administration (VHA). An interrupted time series design, analyzed with segmented logistic regression, was used to evaluate the intervention's effects. The odds of a patient with AUD receiving one of the AUD medications was increasing throughout the pre-implementation period, and the rate of change (slope) increased significantly in the implementation period. Translating these numbers into percentages, at baseline 2.9% of patients filled a prescription for an AUD medication within 30days of a primary care visit. This increased to 3.8% by the end of the pre-implementation period (increasing 0.037% per month), and increased to 5.2% by the end of the implementation period (increasing 0.142% per month). However, the intervention effect was not significant when control sites were added, suggesting that improvement may have been driven by secular trends rather than solely by this intervention. Although the intervention was feasible, it was not effective. Continued analysis of process and implementation data including qualitative interviews with key stakeholders, may elucidate the reasons this intervention was not successful and ways to strengthen its effects.
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Affiliation(s)
- Alex H S Harris
- Veterans Affairs Health Services Research and Development Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Menlo Park, CA 94025, USA.
| | - Randall Brown
- William S. Middleton Memorial Veterans Hospital, Madison, WI 53705, USA; Department of Family Medicine, University of Wisconsin School of Medicineand Public Health, Madison, WI 53715, USA.
| | - Michael Dawes
- Substance Abuse Treatment Program, South Texas Veterans Affairs Health Care System, San Antonio, TX 78229, USA; Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
| | - Eric Dieperink
- Veterans Affairs Health Services Research and Development Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 55417, USA; Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN 55455, USA.
| | - Donald Hugh Myrick
- Mental Health Service Line, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC 29401, USA; Addiction Sciences Division, Department of Psychiatry and Behavioral Services, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Heather Gerould
- Veterans Affairs Health Services Research and Development Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 55417, USA.
| | - Todd H Wagner
- Health Economics Resource Center, Palo Alto Veterans Affairs Health Care System, Menlo Park, CA 94025, USA.
| | - Jennifer P Wisdom
- Department of Health Policy and Management, Graduate School of Public Health and Health Policy, City University of New York, NY 10027, USA.
| | - Hildi J Hagedorn
- Veterans Affairs Health Services Research and Development Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN 55417, USA; Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN 55455, USA.
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Haley SJ, Ponce Terashima J, Hoffman KA, Cuba Fuentes MS, Wisdom JP. Barriers to Primary Care in Lima, Peru. World Medical & Health Policy 2017. [DOI: 10.1002/wmh3.227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research. Adm Policy Ment Health 2016; 42:533-44. [PMID: 24193818 DOI: 10.1007/s10488-013-0528-y] [Citation(s) in RCA: 2842] [Impact Index Per Article: 355.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Purposeful sampling is widely used in qualitative research for the identification and selection of information-rich cases related to the phenomenon of interest. Although there are several different purposeful sampling strategies, criterion sampling appears to be used most commonly in implementation research. However, combining sampling strategies may be more appropriate to the aims of implementation research and more consistent with recent developments in quantitative methods. This paper reviews the principles and practice of purposeful sampling in implementation research, summarizes types and categories of purposeful sampling strategies and provides a set of recommendations for use of single strategy or multistage strategy designs, particularly for state implementation research.
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Affiliation(s)
- Lawrence A Palinkas
- School of Social Work, University of Southern California, 669 W. 34th Street, Los Angeles, CA, 90089-0411, USA,
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26
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Abstract
Building on a narrative synthesis of adoption theories by Wisdom et al. (2013), this review identifies 118 measures associated with the 27 adoption predictors in the synthesis. The distribution of measures is uneven across the predictors and predictors vary in modifiability. Multiple dimensions and definitions of predictors further complicate measurement efforts. For state policymakers and researchers, more effective and integrated measurement can advance the adoption of complex innovations such as evidence-based practices.
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Affiliation(s)
- Ka Ho Brian Chor
- Center for Mental Health Implementation and Dissemination Science in States for Children, Adolescents, and Families (IDEAS Center), Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University School of Medicine, 1 Park Avenue, 7th Floor, New York, NY, 10016, USA,
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Wu S, Duan N, Wisdom JP, Kravitz RL, Owen RR, Sullivan JG, Wu AW, Di Capua P, Hoagwood KE. Integrating Science and Engineering to Implement Evidence-Based Practices in Health Care Settings. Adm Policy Ment Health 2016; 42:588-92. [PMID: 25217100 DOI: 10.1007/s10488-014-0593-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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] [Indexed: 12/31/2022]
Abstract
Integrating two distinct and complementary paradigms, science and engineering, may produce more effective outcomes for the implementation of evidence-based practices in health care settings. Science formalizes and tests innovations, whereas engineering customizes and optimizes how the innovation is applied tailoring to accommodate local conditions. Together they may accelerate the creation of an evidence-based healthcare system that works effectively in specific health care settings. We give examples of applying engineering methods for better quality, more efficient, and safer implementation of clinical practices, medical devices, and health services systems. A specific example was applying systems engineering design that orchestrated people, process, data, decision-making, and communication through a technology application to implement evidence-based depression care among low-income patients with diabetes. We recommend that leading journals recognize the fundamental role of engineering in implementation research, to improve understanding of design elements that create a better fit between program elements and local context.
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Affiliation(s)
- Shinyi Wu
- School and Social Work, Edward R. Roybal Institute on Aging, and Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, 669 West 34th Street, Montgomery Ross Fisher Building, Los Angeles, CA, 90089-0411, USA,
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28
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Hagedorn HJ, Brown R, Dawes M, Dieperink E, Myrick DH, Oliva EM, Wagner TH, Wisdom JP, Harris AHS. Enhancing access to alcohol use disorder pharmacotherapy and treatment in primary care settings: ADaPT-PC. Implement Sci 2016; 11:64. [PMID: 27164835 PMCID: PMC4862158 DOI: 10.1186/s13012-016-0431-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/30/2016] [Indexed: 01/07/2023] Open
Abstract
Background Only 7.8 % of individuals meeting diagnostic criteria for alcohol use disorder (AUD) receive treatment in a given year. Most individuals with AUDs are identified in primary care (PC) settings and referred to substance use disorders (SUD) clinics; however, only a minority of those referred attend treatment services. Safe and effective pharmacological treatments for AUD exist, but they are rarely prescribed by PC providers. The objective of this study is to refine, implement, and evaluate an intervention to integrate pharmacological AUD treatment options into PC settings. This paper provides a detailed description of the intervention design and the evaluation components. Methods/design Three large Veterans Health Administration (VHA) facilities are participating in the intervention. The intervention targets stakeholder groups with tailored strategies based on implementation theory and prior research identifying barriers to implementation of AUD pharmacotherapy. Local SUD providers and primary care mental health integration (PCMHI) providers are trained to serve as local implementation/clinical champions and receive external facilitation. PC providers receive access to consultation from local and national clinical champions, educational materials, and a dashboard of patients with AUD on their caseloads for case identification. Veterans with AUD diagnoses receive educational information in the mail just prior to a scheduled PC visit. Effectiveness of the intervention will be evaluated through an interrupted time series with matched controls to monitor change in facility level AUD pharmacotherapy prescribing rates. Following Stetler’s four-phase formative evaluation (FE) strategy, FE methods include (1) developmental FE (pre-implementation interviews with champions, PC providers, and Veterans), (2) implementation-focused FE (tracking attendance at facilitation meetings, academic detailing efforts by local champions, and patient dashboard utilization), (3) progress-focused FE (tracking rates of AUD pharmacotherapy prescribing and rates of referral to PCMHI and SUD specialty care), and (4) interpretive FE (post-implementation interviews with champions and PC providers). Analysis of FE data will be guided by the Consolidated Framework for Implementation Research (CFIR). Discussion If demonstrated to be successful, this implementation strategy will provide a replicable, feasible, and relative low-cost method for integrating AUD treatment services into PC settings, thereby increasing access to AUD treatment.
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Affiliation(s)
- Hildi J Hagedorn
- Veterans Affairs Health Services Research and Development Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, 55417, USA. .,Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN, 55455, USA.
| | - Randall Brown
- William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA.,Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53715, USA
| | - Michael Dawes
- Substance Abuse Treatment Program, South Texas Veterans Affairs Health Care System, San Antonio, TX, 78229, USA.,Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
| | - Eric Dieperink
- Veterans Affairs Health Services Research and Development Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, 55417, USA.,Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN, 55455, USA
| | - Donald Hugh Myrick
- Center for Drug and Alcohol Problems, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, 29401, USA.,Department of Psychiatry and Behavioral Services, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Elizabeth M Oliva
- Veterans Affairs Health Services Research and Development Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Menlo Park, CA, 94025, USA
| | - Todd H Wagner
- Health Economics Resource Center, Palo Alto Veterans Affairs Health Care System, Menlo Park, CA, 94025, USA
| | - Jennifer P Wisdom
- Department of Health Policy, George Washington University, Washington, DC, 20052, USA
| | - Alex H S Harris
- Veterans Affairs Health Services Research and Development Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Menlo Park, CA, 94025, USA
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29
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Abstract
Many theoretical frameworks seek to describe the dynamic process of the implementation of innovations. Little is known, however, about factors related to decisions to adopt innovations and how the likelihood of adoption of innovations can be increased. Using a narrative synthesis approach, this paper compared constructs theorized to be related to adoption of innovations proposed in existing theoretical frameworks in order to identify characteristics likely to increase adoption of innovations. The overall goal was to identify elements across adoption frameworks that are potentially modifiable and, thus, might be employed to improve the adoption of evidence-based practices. The review identified 20 theoretical frameworks that could be grouped into two broad categories: theories that mainly address the adoption process (N = 10) and theories that address adoption within the context of implementation, diffusion, dissemination, and/or sustainability (N = 10). Constructs of leadership, operational size and structure, innovation fit with norms and values, and attitudes/motivation toward innovations each are mentioned in at least half of the theories, though there were no consistent definitions of measures for these constructs. A lack of precise definitions and measurement of constructs suggests further work is needed to increase our understanding of adoption of innovations.
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Affiliation(s)
- Jennifer P Wisdom
- George Washington University, 2121 Eye Street Suite 601, Washington, DC, 20052, USA,
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30
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Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research. Adm Policy Ment Health 2015. [PMID: 24193818 DOI: 10.1007/s10488-013-0528-y.purposeful] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Purposeful sampling is widely used in qualitative research for the identification and selection of information-rich cases related to the phenomenon of interest. Although there are several different purposeful sampling strategies, criterion sampling appears to be used most commonly in implementation research. However, combining sampling strategies may be more appropriate to the aims of implementation research and more consistent with recent developments in quantitative methods. This paper reviews the principles and practice of purposeful sampling in implementation research, summarizes types and categories of purposeful sampling strategies and provides a set of recommendations for use of single strategy or multistage strategy designs, particularly for state implementation research.
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Affiliation(s)
- Lawrence A Palinkas
- School of Social Work, University of Southern California, 669 W. 34th Street, Los Angeles, CA, 90089-0411, USA,
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31
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Gopalan G, Fuss A, Wisdom JP. Multiple Family Groups for Child Behavior Difficulties Retention Among Child Welfare-Involved Caregivers. Res Soc Work Pract 2015; 25:564-577. [PMID: 26527856 PMCID: PMC4627717 DOI: 10.1177/1049731514543526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
UNLABELLED Among children who remain at home with their permanent caregivers following a child welfare investigation, few who manifest emotional and behavioral difficulties actually engage in mental health treatment. The Multiple Family Group service delivery model to reduce childhood disruptive behavior disorders (MFG) has shown promise in engaging child welfare-involved families. This qualitative study examines caregiver perceptions of factors that influence retention in MFGs among child welfare-involved families. METHODS Twenty-five predominantly Black and Hispanic adult (ages 26-57) female caregivers with child welfare services involvement participated in individual, in-depth interviews about their experience with MFGs. Transcribed interview data were thematically coded guided by grounded theory methodology. Emergent themes were subsequently organized into a conceptual framework. RESULTS Within the overarching influence of child welfare services involvement, specific components of MFGs influencing retention included the quality of interaction among group members, group facilitators' attentive approach with caregivers, supports designed to overcome logistical barriers (i.e., child care, transportation expenses, meals), and perceptions of MFG content and activities as fun and helpful. Caregiver factors, including their mental health and personal characteristics, as well as children's behavior, (i.e., observed changes in behavioral difficulties) were also associated with retention. CONCLUSIONS High acceptability suggest utility for implementing MFGs within settings serving child welfare involved families, with additional modifications to tailor to setting and client features.
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Affiliation(s)
- Geetha Gopalan
- University of Maryland School of Social Work, New York University Silver School of Social Work
| | - Ashley Fuss
- New York University Silver School of Social Work
| | - Jennifer P Wisdom
- The George Washington University, Columbia University and New York State Psychiatric Institute
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Green CA, Duan N, Gibbons RD, Hoagwood KE, Palinkas LA, Wisdom JP. Approaches to Mixed Methods Dissemination and Implementation Research: Methods, Strengths, Caveats, and Opportunities. Adm Policy Ment Health 2015; 42:508-23. [PMID: 24722814 PMCID: PMC4363010 DOI: 10.1007/s10488-014-0552-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [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] [Indexed: 11/26/2022]
Abstract
Limited translation of research into practice has prompted study of diffusion and implementation, and development of effective methods of encouraging adoption, dissemination and implementation. Mixed methods techniques offer approaches for assessing and addressing processes affecting implementation of evidence-based interventions. We describe common mixed methods approaches used in dissemination and implementation research, discuss strengths and limitations of mixed methods approaches to data collection, and suggest promising methods not yet widely used in implementation research. We review qualitative, quantitative, and hybrid approaches to mixed methods dissemination and implementation studies, and describe methods for integrating multiple methods to increase depth of understanding while improving reliability and validity of findings.
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Affiliation(s)
- Carla A Green
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR, 97227, USA,
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Wisdom JP, Wenger D, Robertson D, Van Bramer J, Sederer LI. The New York State Office of Mental Health Positive Alternatives to Restraint and Seclusion (PARS) Project. Psychiatr Serv 2015; 66:851-6. [PMID: 25930039 DOI: 10.1176/appi.ps.201400279] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Positive Alternatives to Restraint and Seclusion (PARS) project of the New York State Office of Mental Health (OMH) was designed to build capacity to use alternatives to restraint and seclusion within state-operated and licensed inpatient and residential treatment programs serving children with severe emotional disturbances. Its long-term goal was to eliminate the use of these restrictive interventions throughout the state's mental health system of care by creating coercion- and violence-free treatment environments governed by a philosophy of recovery, resiliency, and wellness. METHODS The central feature of the PARS project was training in, implementation of, and engagement with the Six Core Strategies to Reduce the Use of Seclusion and Restraint, a comprehensive approach developed by the National Association of State Mental Health Program Directors. This report provides an overview of the project, results from January 2007 through December 2011, and lessons learned by OMH. RESULTS The three participating mental health treatment facilities demonstrated significant decreases in restraint and seclusion episodes per 1,000 client-days. Each identified specific activities that contributed to success, including ways to facilitate open, respectful two-way communication between management and staff and between staff and youths and greater involvement of youths in program decision making. CONCLUSIONS All three facilities continued to implement key components of the PARS initiative after termination of grant-funded activities, and OMH initiated multiple activities to disseminate lessons learned during the project to all inpatient and residential treatment programs throughout the state mental health system.
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Affiliation(s)
- Jennifer P Wisdom
- Dr. Wisdom is with the Department of Health Policy, George Washington University, Washington, D.C. (e-mail: ). All other authors are with the New York State Office of Mental Health in Albany, except for Dr. Sederer, who is at the New York City location
| | - David Wenger
- Dr. Wisdom is with the Department of Health Policy, George Washington University, Washington, D.C. (e-mail: ). All other authors are with the New York State Office of Mental Health in Albany, except for Dr. Sederer, who is at the New York City location
| | - David Robertson
- Dr. Wisdom is with the Department of Health Policy, George Washington University, Washington, D.C. (e-mail: ). All other authors are with the New York State Office of Mental Health in Albany, except for Dr. Sederer, who is at the New York City location
| | - Jayne Van Bramer
- Dr. Wisdom is with the Department of Health Policy, George Washington University, Washington, D.C. (e-mail: ). All other authors are with the New York State Office of Mental Health in Albany, except for Dr. Sederer, who is at the New York City location
| | - Lloyd I Sederer
- Dr. Wisdom is with the Department of Health Policy, George Washington University, Washington, D.C. (e-mail: ). All other authors are with the New York State Office of Mental Health in Albany, except for Dr. Sederer, who is at the New York City location
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Stein BD, Leckman-Westin E, Okeke E, Scharf DM, Sorbero M, Chen Q, Chor KHB, Finnerty M, Wisdom JP. The effects of prior authorization policies on medicaid-enrolled children's use of antipsychotic medications: evidence from two mid-Atlantic states. J Child Adolesc Psychopharmacol 2014; 24:374-81. [PMID: 25144909 PMCID: PMC4162428 DOI: 10.1089/cap.2014.0008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the impact of prior authorization policies on the receipt of antipsychotic medication for Medicaid-enrolled children. METHODS Using de-identified administrative Medicaid data from two large, neighboring, mid-Atlantic states from November 2007 through June 2011, we identified subjects <18 years of age using antipsychotics, from the broader group of children and adolescents receiving behavioral health services or any psychotropic medication. Prior authorization for antipsychotics was required for children in State A <6 years of age from September 2008, and for children <13 years of age from August 2009. No such prior authorizations existed in State B during that period. Filled prescriptions were identified in the data using national drug codes. Using a triple-difference strategy (using differences among the states, time periods, and differences in antidepressant prescribing rates among states over the same time periods), we examined the effect of the prior authorization policy on the rate at which antipsychotic prescriptions were filled for Medicaid-enrolled children and adolescents. RESULTS The impact of prior authorization policies on antipsychotic medication use varied by age: Among 6-12 year old children, the impact of the prior authorization policy on antipsychotic medication prescribing was a modest but statistically significant decrease of 0.47% after adjusting for other factors; there was no effect of the prior authorization among children 0-5 years. CONCLUSIONS Prior authorization policies had a modest but statistically significant effect on antipsychotic use in 6-12 year old children, but had no impact in younger children. Future research is needed to understand the utilization and clinical effects of prior authorization and other policies and interventions designed to influence antipsychotic use in children.
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Wisdom JP, Lewandowski RE, Pollock M, Acri M, Shorter P, Olin SS, Armusewicz K, Horwitz S, Hoagwood KE. What family support specialists do: examining service delivery. Adm Policy Ment Health 2013; 41:21-31. [PMID: 24174330 DOI: 10.1007/s10488-013-0526-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study describes services provided by family support specialists (FSS), peer advocates in programs for children with serious psychiatric conditions, to delineate differences between recommended components of FSS services and services actually provided. An analysis of qualitative interview and observational data and quantitative survey data from 63 staff at 21 mental health programs in New York identified that FSS and other staff have generally similar ideas about FSS services, and that these perceptions of activities are generally congruent with what FSS actually did. Implications of findings are discussed in the context of developing competencies and quality indicators for FSS.
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Affiliation(s)
- Jennifer P Wisdom
- The George Washington University, 2121 Eye St NW Suite 601, Washington, DC, 20052, USA,
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Chrisler JC, Fuentes CDL, Durvasula RS, Esnil EM, McHugh MC, Miles-Cohen SE, Williams JL, Wisdom JP. The American Psychological Association’s Committee on Women in Psychology. Psychology of Women Quarterly 2013. [DOI: 10.1177/0361684313505442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Committee on Women in Psychology (CWP) of the American Psychological Association was founded in 1973 in response to the report of the Task Force on the Status of Women in Psychology. In this article, we set the context for the founding of the task force and committee and briefly describe the history of feminist critique of, and activism within, organized psychology in the United States. From its inception to the present day, CWP has been known as an activist group. We review some of the major contributions CWP has made over four decades in service of the feminist transformation of psychology. We also review the committee’s major contributions to psychology in the public interest, especially to the physical and mental health and well-being of women.
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Affiliation(s)
- Joan C. Chrisler
- Department of Psychology, Connecticut College, New London, CT, USA
| | | | | | | | - Maureen C. McHugh
- Department of Psychology, Indiana University of Pennsylvania, Indiana, PA, USA
| | | | | | - Jennifer P. Wisdom
- Department of Psychology, George Washington University, Washington, DC, USA
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Smith TE, Easter A, Pollock M, Pope LG, Wisdom JP. Disengagement from care: perspectives of individuals with serious mental illness and of service providers. Psychiatr Serv 2013; 64:770-5. [PMID: 23632442 DOI: 10.1176/appi.ps.201200394] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study sought to describe reasons for disengagement from services and practical guidelines to enhance engagement among individuals with serious mental illness and high need for treatment. METHODS Qualitative interviews were conducted with 56 individuals with serious mental illness and 25 providers recruited from a larger project that used administrative data to identify individuals with serious mental illness who had disengaged from care. Individuals with serious mental illness and providers described reasons for disengagement and effective provider engagement strategies. RESULTS Individuals with serious mental illness and providers differed in reported reasons for disengagement. Reasons reported by individuals with serious mental illness included services that were not relevant to their needs, inability to trust providers, and a belief that they were not ill. Providers cited lack of insight, stigma, and language and cultural barriers as common reasons for disengagement. Strategies for increasing engagement were grouped into a framework of acceptable, accessible, and available services. Acceptable services reflect a partnership model that fosters support and instills hope; accessible services minimize barriers related to transportation and intake procedures; and available services address recovery needs in addition to treatment of general medical and psychiatric problems. CONCLUSIONS Individuals with serious mental illness and providers often do not agree on reasons for seeking care. The framework of acceptable, accessible, and available services identifies opportunities for providers to adjust practices and maximize engagement in services among individuals with serious mental illness who are in high need of treatment.
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Affiliation(s)
- Thomas E Smith
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, USA.
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Pope LG, Smith TE, Wisdom JP, Easter A, Pollock M. Transitioning between systems of care: missed opportunities for engaging adults with serious mental illness and criminal justice involvement. Behav Sci Law 2013; 31:444-456. [PMID: 23913815 DOI: 10.1002/bsl.2074] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 05/02/2013] [Accepted: 05/29/2013] [Indexed: 06/02/2023]
Abstract
Individuals with serious mental illness are overrepresented in the criminal justice system and face difficulties accessing mental health services both during incarceration and upon re-entry into the community. This study examines how such individuals describe their experiences receiving care both during and after their time in custody and explores the perspectives of mental health service providers who treat this population upon re-entry. Semi-structured interviews were conducted with 43 individuals identified as having a history of serious mental illness and criminal justice involvement, as well as with 25 providers who have worked with this population. Clients noted the stress of transitioning to criminal justice settings, the uneven availability of services within jail and prison, and the significant challenges faced upon re-entry. Providers reported barriers to working with this population, including minimal coordination with the criminal justice system and challenging behaviors and attitudes on the part of both clients and providers. Findings identify potential target areas for improved care coordination as well as for additional provider education regarding the unique needs of this population.
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Affiliation(s)
- Leah Gogel Pope
- Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA.
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Abstract
Many theoretical frameworks seek to describe the dynamic process of the implementation of innovations. Little is known, however, about factors related to decisions to adopt innovations and how the likelihood of adoption of innovations can be increased. Using a narrative synthesis approach, this paper compared constructs theorized to be related to adoption of innovations proposed in existing theoretical frameworks in order to identify characteristics likely to increase adoption of innovations. The overall goal was to identify elements across adoption frameworks that are potentially modifiable and, thus, might be employed to improve the adoption of evidence-based practices. The review identified 20 theoretical frameworks that could be grouped into two broad categories: theories that mainly address the adoption process (N = 10) and theories that address adoption within the context of implementation, diffusion, dissemination, and/or sustainability (N = 10). Constructs of leadership, operational size and structure, innovation fit with norms and values, and attitudes/motivation toward innovations each are mentioned in at least half of the theories, though there were no consistent definitions of measures for these constructs. A lack of precise definitions and measurement of constructs suggests further work is needed to increase our understanding of adoption of innovations.
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Affiliation(s)
- Jennifer P Wisdom
- George Washington University, 2121 Eye Street Suite 601, Washington, DC, 20052, USA,
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Abstract
OBJECTIVE The purpose of this study was to identify better methods of engaging youths in mental health services by asking experienced mental health consumers for suggestions for clinicians. METHODS 177 members of an integrated health plan, ranging in age from 16-84 years and diagnosed with schizophrenia, schizoaffective disorder, bipolar disorder, or affective psychosis, completed four in-depth semistructured interviews over 24 months as part of a study of recovery from serious mental illness. We transcribed and coded interviews, extracted a set of common themes addressing consumer recommendations to clinicians, and compared these themes across age groups. RESULTS Five primary themes emerged in participants' recommendations: (1) use an age-appropriate approach that reflects youth culture and lifestyles; (2) foster development of autonomy; (3) take a personal, rather than diagnostic, approach; (4) be empathetic and authentic; and (5) create a safe and supportive environment. Consumers age 30 and older described three additional areas in which clinicians could contribute to youths' well being: (1) help find the right diagnosis and the right medication, (2) counsel youths to avoid using alcohol and drugs, and (3) take steps to help prevent social isolation. CONCLUSIONS Study findings suggest that many strategies recommended for working with adults may benefit young people, but that developmentally appropriate modifications to these approaches are needed to foster treatment engagement among youths.
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Affiliation(s)
| | | | - Leah Wolfe
- Center for Health Research, Kaiser Permanente Northwest
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Hoffman KA, Green CA, Ford JH, Wisdom JP, Gustafson DH, McCarty D. Improving quality of care in substance abuse treatment using five key process improvement principles. J Behav Health Serv Res 2012; 39:234-44. [PMID: 22282129 PMCID: PMC3495233 DOI: 10.1007/s11414-011-9270-y] [Citation(s) in RCA: 28] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Process and quality improvement techniques have been successfully applied in health care arenas, but efforts to institute these strategies in alcohol and drug treatment are underdeveloped. The Network for the Improvement of Addiction Treatment (NIATx) teaches participating substance abuse treatment agencies to use process improvement strategies to increase client access to, and retention in, treatment. NIATx recommends five principles to promote organizational change: (1) understand and involve the customer, (2) fix key problems, (3) pick a powerful change leader, (4) get ideas from outside the organization, and (5) use rapid cycle testing. Using case studies, supplemented with cross-agency analyses of interview data, this paper profiles participating NIATx treatment agencies that illustrate successful applications of each principle. Results suggest that organizations can successfully integrate and apply the five principles as they develop and test change strategies, improving access and retention in treatment, and agencies' financial status. Upcoming changes requiring increased provision of behavioral health care will result in greater demand for services. Treatment organizations, already struggling to meet demand and client needs, will need strategies that improve the quality of care they provide without significantly increasing costs. The five NIATx principles have potential for helping agencies achieve these goals.
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Affiliation(s)
- Kim A Hoffman
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., CB 669, Portland, OR 97239, USA.
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Acri MC, Gogel LP, Pollock M, Wisdom JP. What Adolescents Need to Prevent Relapse after Treatment for Substance Abuse: A Comparison of Youth, Parent, and Staff Perspectives. J Child Adolesc Subst Abuse 2012; 21:117-129. [PMID: 24723746 DOI: 10.1080/1067828x.2012.662111] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Little is known about what factors and supports youths identify as important for their sustained recovery after substance abuse treatment, and if their caregivers and treatment staff identify similar needs. The purpose of this study was to explore what youths, caregivers, and staff perceive as important to remain substance free after completing a residential treatment program. METHODS Semi-structured interviews were conducted with 28 adolescents, 30 parents, and 29 staff at 3 treatment agencies. Data were coded thematically and themes were organized by respondent type. RESULTS There was high frequency and concordance across respondents regarding the need for aftercare services, supportive relationships, and activities. Only one item, outpatient treatment, demonstrated significant differences across groups. CONCLUSIONS External supports and activities are important to recovery of adolescents from substances following treatment completion. Implications and potential areas of inquiry are discussed.
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Affiliation(s)
- Mary C Acri
- New York State Psychiatric Institute, New York, NY, USA
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Wisdom JP, Knapik S, Holley MW, Van Bramer J, Sederer LI, Essock SM. Best practices: New York's outpatient mental health clinic licensing reform: using tracer methodology to improve service quality. Psychiatr Serv 2012; 63:418-20. [PMID: 22549525 DOI: 10.1176/appi.ps.20120p418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This column describes how the New York State Office of Mental Health (OMH) redesigned licensing procedures for outpatient clinics by applying a person-centered focus and clinically relevant standards of care. OMH incorporated a tracer methodology to assess services; a licensing instrument that reflected OMH goals; and a systematic piloting, feedback, and implementation process. Clinic staff reported that the new procedures facilitated communication between OMH and clinics, accurately identified clinics' successes, and provided actionable and programmatic feedback. This initiative represents the first step by a state mental health authority to create a system of accountability that is clinically relevant and supported by stakeholders.
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Affiliation(s)
- Jennifer P Wisdom
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, 1051 Riverside Dr, Box 100, New York, NY 10032, USA.
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Wisdom JP, Olin S, Shorter P, Burton G, Hoagwood K. Family Peer Advocates: A Pilot Study of the Content and Process of Service Provision. J Child Fam Stud 2011; 20:833-843. [PMID: 23087591 PMCID: PMC3474363 DOI: 10.1007/s10826-011-9451-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Professional family peer advocates are increasingly employed by public mental health systems to deliver family-to-family support that reduces barriers families face in accessing children's mental health care. These services, however, are neither uniformly available nor standardized. This pilot study describes the process, content and context of family-to-family support services. Simulating a parent seeking services, a trained standardized parent participated as a client in meetings with advocates in four programs and collected data through structured observations, a structured survey, and session audiotapes. The "walk-through" process was determined to be feasible and acceptable to family peer advocates as a way of evaluating services. Four family peer advocates provided an average of 25 services during each 2-session simulation with the standardized parent, including the following: information and educational support, instruction and skills development, emotional and affirmational support, instrumental support, and advocacy. Findings also revealed variability in the range of services provided and identified challenges in aspects of service provision, such as boundaries of advocate roles, availability of confidential service environments, and addressing crises and parent concerns about child safety. This paper provides the first in-depth look at services provided by this emerging workforce.
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Affiliation(s)
- Jennifer P. Wisdom
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive Box 100, New York, NY 10032, USA
| | - Serene Olin
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive Box 100, New York, NY 10032, USA
| | - Priscilla Shorter
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive Box 100, New York, NY 10032, USA
| | - Geraldine Burton
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive Box 100, New York, NY 10032, USA; Families on the Move New York City, Inc., New York, NY, USA; National Alliance for the Mentally Ill, New York City Metro, New York, NY, USA
| | - Kimberly Hoagwood
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive Box 100, New York, NY 10032, USA
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Wisdom JP, Cavaleri MA, Onwuegbuzie AJ, Green CA. Methodological reporting in qualitative, quantitative, and mixed methods health services research articles. Health Serv Res 2011; 47:721-45. [PMID: 22092040 DOI: 10.1111/j.1475-6773.2011.01344.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Methodologically sound mixed methods research can improve our understanding of health services by providing a more comprehensive picture of health services than either method can alone. This study describes the frequency of mixed methods in published health services research and compares the presence of methodological components indicative of rigorous approaches across mixed methods, qualitative, and quantitative articles. DATA SOURCES All empirical articles (n = 1,651) published between 2003 and 2007 from four top-ranked health services journals. STUDY DESIGN All mixed methods articles (n = 47) and random samples of qualitative and quantitative articles were evaluated to identify reporting of key components indicating rigor for each method, based on accepted standards for evaluating the quality of research reports (e.g., use of p-values in quantitative reports, description of context in qualitative reports, and integration in mixed method reports). We used chi-square tests to evaluate differences between article types for each component. PRINCIPAL FINDINGS Mixed methods articles comprised 2.85 percent (n = 47) of empirical articles, quantitative articles 90.98 percent (n = 1,502), and qualitative articles 6.18 percent (n = 102). There was a statistically significant difference (χ(2) (1) = 12.20, p = .0005, Cramer's V = 0.09, odds ratio = 1.49 [95% confidence interval = 1,27, 1.74]) in the proportion of quantitative methodological components present in mixed methods compared to quantitative papers (21.94 versus 47.07 percent, respectively) but no statistically significant difference (χ(2) (1) = 0.02, p = .89, Cramer's V = 0.01) in the proportion of qualitative methodological components in mixed methods compared to qualitative papers (21.34 versus 25.47 percent, respectively). CONCLUSION Few published health services research articles use mixed methods. The frequency of key methodological components is variable. Suggestions are provided to increase the transparency of mixed methods studies and the presence of key methodological components in published reports.
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Affiliation(s)
- Jennifer P Wisdom
- Psychiatry Department, Columbia University, New York State Psychiatric Institute, New York, NY 10032, USA.
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Abstract
OBJECTIVE People experiencing a first episode of psychosis frequently have co-occurring substance use disorders, usually involving alcohol and cannabis, which put them at risk for prolonged psychosis, psychotic relapse, and other adverse outcomes. Yet few studies of first-episode psychosis have addressed the course of substance use disorders and the response to specialized substance abuse treatments. METHODS The authors searched MEDLINE, PsycINFO, and other medical databases for English-language articles published between 1990 and 2009. Included studies addressed two research questions. First, do some clients become abstinent after a first episode of psychosis without specialized substance abuse treatments? Second, for clients who continue to use substances after a first episode of psychosis, does the addition of specialized substance abuse treatment enhance outcomes? RESULTS Nine studies without specialized substance abuse treatment and five with specialized substance abuse treatment assessed the course of substance use (primarily cannabis and alcohol) after a first episode of psychosis. Many clients (approximately half) became abstinent or significantly reduced their alcohol and drug use after a first episode of psychosis. The few available studies of specialized substance abuse treatments did not find better rates of abstinence or reduction. CONCLUSIONS Experience, education, treatment, or other factors led many clients to curtail their substance use disorders after a first episode of psychosis. Specialized interventions for others need to be developed and tested.
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Affiliation(s)
- Jennifer P. Wisdom
- Dr. Wisdom and Dr. Manuel are affiliated with the Division of Mental Health Services and Policy Research, New York State Psychiatric Institute, 1051 Riverside Drive, Box 100, New York, NY 10032 (). Dr. Drake is with the Departments of Psychiatry and Community and Family Medicine, Dartmouth University, Lebanon, New Hampshire
| | - Jennifer I. Manuel
- Dr. Wisdom and Dr. Manuel are affiliated with the Division of Mental Health Services and Policy Research, New York State Psychiatric Institute, 1051 Riverside Drive, Box 100, New York, NY 10032 (). Dr. Drake is with the Departments of Psychiatry and Community and Family Medicine, Dartmouth University, Lebanon, New Hampshire
| | - Robert E. Drake
- Dr. Wisdom and Dr. Manuel are affiliated with the Division of Mental Health Services and Policy Research, New York State Psychiatric Institute, 1051 Riverside Drive, Box 100, New York, NY 10032 (). Dr. Drake is with the Departments of Psychiatry and Community and Family Medicine, Dartmouth University, Lebanon, New Hampshire
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Wisdom JP, Ford JH, Wise M, Mackey D, Green CA. Substance abuse treatment programs' data management capacity: an exploratory study. J Behav Health Serv Res 2011; 38:249-64. [PMID: 20574647 DOI: 10.1007/s11414-010-9221-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Despite treatment improvement and performance management imperatives, little research describes the data management capacity of substance abuse treatment programs, and useful metrics are not available to gauge capacity. This exploratory study evaluates clinical and administrative data management at eight substance abuse treatment programs in four US states to identify factors for developing an appropriate metric. Findings indicate that programs tend to manage data inefficiently and have few protocols guiding information management. Barriers to better data management included lack of integrated information technology (IT) systems; limited funding, time, and staff for developing and implementing IT-related changes; and divergent staff skills in and attitudes toward IT. This snapshot of substance abuse treatment programs' data management capabilities suggests a need for a metric to examine data management capability in these settings. Infusion of expertise, training, and funding are needed to improve substance abuse treatment programs' IT-related systems and data management processes.
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Affiliation(s)
- Jennifer P Wisdom
- Clinical Psychology in Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, USA.
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Abstract
OBJECTIVE People experiencing a first episode of psychosis often have co-occurring substance use, which increases risk of prolonged psychosis and impairs recovery. This article examines the prevalence of substance use in people with first-episode psychosis. METHODS The authors searched MEDLINE and other databases for articles published between 1990 and 2009 that described current or lifetime prevalence of substance use, misuse, abuse, or dependence in individuals with first-episode psychosis. RESULTS Forty-four unique studies provided information. More than 25% of individuals with first-episode psychosis in reviewed studies indicated current or lifetime alcohol use, lifetime alcohol abuse/dependence, current or lifetime cannabis use, or lifetime cannabis abuse or dependence. For all substances, lifetime prevalence of abuse/dependence was higher than current abuse/dependence. CONCLUSIONS Despite variation in assessment methods, findings were generally consistent. Individuals with first-episode psychosis have lower current substance prevalence than lifetime prevalence, suggesting cessation of some substance use prior to seeking treatment for psychosis.
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Affiliation(s)
- Jennifer P Wisdom
- a Columbia University and New York State Psychiatric Institute , New York , New York , USA
| | - Jennifer I Manuel
- a Columbia University and New York State Psychiatric Institute , New York , New York , USA
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Abstract
OBJECTIVES The study evaluated responses from adolescents in substance abuse treatment, their parents, and treatment staff to the question of what constitutes treatment success. METHODS Semistructured interviews were conducted with 28 adolescents, 30 parents, and 29 staff at three residential substance abuse treatment programs in two states. Data were coded and organized into themes by respondent type. RESULTS Respondents reported knowing when treatment was no longer needed based on changes in adolescents' substance use, treatment-related and other behaviors, and attitudes and character. A fourth category of responses indicated respondents' ambiguity regarding successful completion of substance abuse treatment. Little concurrence was found among adolescents, parents, and treatment center staff to indicate criteria suggesting that discharge is appropriate. CONCLUSIONS Substance abuse treatment programs and their clients may benefit from ensuring that staff, parents, and adolescents are aware of treatment goals to promote more effective treatment and improve collaboration toward the adolescent's recovery.
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Affiliation(s)
- Jennifer P Wisdom
- Division of Mental Health Services and Policy Research, New York State Psychiatric Institute, New York, NY 10032, USA.
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Wisdom JP, Ford JH, McCarty D. The Use of Health Information Technology in Publicly-Funded U. S. Substance Abuse Treatment Agencies. ACTA ACUST UNITED AC 2010. [DOI: 10.1177/009145091003700207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Drug and alcohol treatment agencies are challenged to improve their infrastructure to meet growing technological and organizational demands. Health care reform and increased emphasis on performance monitoring in the United States are leading to improvements in health information technology. We assess literature to: (1) survey opportunities for health information technology for publicly-funded substance abuse treatment; (2) describe the use of electronic medical records in U.S. substance use treatment programs; (3) identify barriers and facilitators to implementing technology in substance abuse treatment programs; and (4) discuss applications of these concepts to private and international substance abuse treatment. Although these technologies hold promise to improve outcomes in the areas of cost-effectiveness, provider time savings, and quality improvement, substantial barriers exist to implementing health information technology in substance abuse treatment programs. Increased incentives, evidence, and implementation guidance can facilitate health information technology infrastructure improvement in substance abuse treatment to increase competitiveness in the U.S. health care market and improve the quality of care.
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