Literature Collection

261

Impact of COVID-19 telehealth policy changes on buprenorphine treatment for opioid use disorder

Type: Journal Article

Authors: Lewei Lin, Lan Zhang, Hyungjin Myra Kim, Madeline C. Frost

Year: 2022

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262

Impact of COVID-19-related methadone regulatory flexibilities: views of state opioid treatment authorities and program staff

Type: Journal Article

Authors: S. G. Mitchell, J. Jester, J. Gryczynski, M. Whitter, D. Fuller, C. Halsted, R. P. Schwartz

Year: 2023

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263

Impact of Medicaid Expansion on Access to Opioid Analgesic Medications and Medication Assisted Treatment

Type: Journal Article

Authors: A. Sharp, A. Jones, J. Sherwood, O. Kutsa, B. Honermann, G. Millett

Year: 2018

Abstract: OBJECTIVES: To assess the impact of the expansion of Medicaid eligibility in the United States on the opioid epidemic, as measured through increased access to opioid analgesic medications and medication-assisted treatment. METHODS: Using Medicaid enrollment and reimbursement data from 2011 to 2016 in all states, we evaluated prescribing patterns of opioids and the 3 Food and Drug Administration-approved medications used in treating opioid use disorders by using 2 statistical models. We used difference-in-differences and interrupted time series models to measure prescribing rates before and after state expansions. RESULTS: Although opioid prescribing per Medicaid enrollee increased overall, we observed no statistical difference between expansion and nonexpansion states. By contrast, per-enrollee rates of buprenorphine and naltrexone prescribing increased more than 200% after states expanded eligibility, while increasing by less than 50% in states that did not expand. Methadone prescribing decreased in all states in this period, with larger decreases in expansion states. CONCLUSIONS:The Medicaid expansion enrolled a population no more likely to be prescribed opioids than the base Medicaid population while significantly increasing uptake of 2 drugs used in medication-assisted treatment.

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264

Impact of Medicare Annual Wellness Visits on Uptake of Depression Screening

Type: Journal Article

Authors: E. Pfoh, R. Mojtabai, J. Bailey, J. P. Weiner, S. M. Dy

Year: 2015

Abstract: OBJECTIVE: Depression screening is a required part of an initial annual wellness visit (AWV), a benefit for Medicare Part B beneficiaries. It is uncertain whether AWVs will increase depression screening. This study assessed whether patients with an AWV were more likely to be screened for depression than those with a primary care visit. METHODS: A cross-sectional analysis of electronic health record data was conducted for 4,245 Medicare patients who had at least one primary care visit at one of 34 practices within a large multisite provider network between September 2010 and August 2012. Quota sampling was used so that half of the participants had an AWV and half had a randomly selected primary care visit during the study period (the index visit). Multilevel logistic regressions were used to determine whether patients with an AWV had increased odds of depression screening compared with patients with a primary care visit, after adjustment for physician and clinic clustering. RESULTS: Fifteen percent of patients with non-AWVs and 10% of patients with AWVs received depression screening. After accounting for clustering, there was no statistically significant difference in depression screening by visit type. There was a strong site effect, with one site conducting screening during 78% of AWVs and 82% of non-AWVs. Six sites screened none of their patients. CONCLUSIONS: Overall, depression screening during the index AWV was uncommon. By itself, the AWV benefit does not appear to be a strong enough incentive to increase depression screening.

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265

Impact of Policy Change on Access to Medication for Opioid Use Disorder in Primary Care

Type: Journal Article

Authors: J. Krupp, F. Hung, T. LaChapelle, M. E. Yarrington, K. Link, Y. Choi, H. Chen, A. D. Marais, N. Sachdeva, H. Chakraborty, M. S. McKellar

Year: 2023

Abstract:

OBJECTIVES: The opioid overdose epidemic is escalating. Increasing access to medications for opioid use disorder in primary care is crucial. The impact of the US Department of Health and Human Services' policy change removing the buprenorphine waiver training requirement on primary care buprenorphine prescribing remains unclear. We aimed to investigate the impact of the policy change on primary care providers' likelihood of applying for a waiver and the current attitudes, practices, and barriers to buprenorphine prescribing in primary care. METHODS: We used a cross-sectional survey with embedded educational resources disseminated to primary care providers in a southern US academic health system. We used descriptive statistics to aggregate survey data, logistic regression models to evaluate whether buprenorphine interest and familiarity correlate with clinical characteristics, and a χ(2) test to evaluate the effect of the educational intervention on screening. RESULTS: Of the 54 respondents, 70.4% reported seeing patients with opioid use disorder, but only 11.1% had a waiver to prescribe buprenorphine. Few nonwaivered providers were interested in prescribing, but perceiving buprenorphine to be beneficial to the patient population was associated with interest (adjusted odds ratio 34.7, P < 0.001). Two-thirds of nonwaivered respondents reported the policy change having no impact on their decision to obtain a waiver; however, among interested providers, it increased their likelihood of obtaining a waiver. Barriers to buprenorphine prescribing included lack of clinical experience, clinical capacity, and referral resources. Screening for opioid use disorder did not increase significantly after the survey. CONCLUSIONS: Although most primary care providers reported seeing patients with opioid use disorder, interest in prescribing buprenorphine was low and structural barriers remained the dominant obstacles. Providers with a preexisting interest in buprenorphine prescribing reported that removing the training requirement was helpful.

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266

Impacts of an Integrated Medicaid Managed Care Program for Adults with Behavioral Health Conditions: The Experience of Illinois

Type: Journal Article

Authors: X. Xiang, R. Owen, F. L. F. G. Langi, K. Yamaki, D. Mitchell, T. Heller, A. Karmarkar, D. French, N. Jordan

Year: 2019

Publication Place: United States

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267

Implementation of integrated health homes and health outcomes for persons with serious mental illness in Los Angeles County

Type: Journal Article

Authors: Todd P. Gilmer, Benjamin F. Henwood, Marissa Goode, Andrew J. Sarkin, Debbie Innes-Gomberg

Year: 2016

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268

Implementation of the Provision of the Comprehensive Addiction and Recovery Act of 2016 Relating to the Dispensing of Narcotic Drugs for Opioid Use Disorder. Final rule

Type: Journal Article

Authors: Department of Justice Drug Enforcement Administration

Year: 2018

Publication Place: United States

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269

Implementing a fax referral program for quitline smoking cessation services in urban health centers: a qualitative study

Type: Journal Article

Authors: J. Cantrell, D. Shelley

Year: 2009

Publication Place: England

Abstract: BACKGROUND: Fax referral services that connect smokers to state quitlines have been implemented in 49 U.S. states and territories and promoted as a simple solution to improving smoker assistance in medical practice. This study is an in-depth examination of the systems-level changes needed to implement and sustain a fax referral program in primary care. METHODS: The study involved implementation of a fax referral system paired with a chart stamp prompting providers to identify smoking patients, provide advice to quit and refer interested smokers to a state-based fax quitline. Three focus groups (n = 26) and eight key informant interviews were conducted with staff and physicians at two clinics after the intervention. We used the Chronic Care Model as a framework to analyze the data, examining how well the systems changes were implemented and the impact of these changes on care processes, and to develop recommendations for improvement. RESULTS: Physicians and staff described numerous benefits of the fax referral program for providers and patients but pointed out significant barriers to full implementation, including the time-consuming process of referring patients to the Quitline, substantial patient resistance, and limitations in information and care delivery systems for referring and tracking smokers. Respondents identified several strategies for improving integration, including simplification of the referral form, enhanced teamwork, formal assignment of responsibility for referrals, ongoing staff training and patient education. Improvements in Quitline feedback were needed to compensate for clinics' limited internal information systems for tracking smokers. CONCLUSIONS: Establishing sustainable linkages to quitline services in clinical sites requires knowledge of existing patterns of care and tailored organizational changes to ensure new systems are prioritized, easily integrated into current office routines, formally assigned to specific staff members, and supported by internal systems that ensure adequate tracking and follow up of smokers. Ongoing staff training and patient self-management techniques are also needed to ease the introduction of new programs and increase their acceptability to smokers.

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270

Implementing buprenorphine in addiction treatment: Payer and provider perspectives in Ohio.

Type: Journal Article

Authors: Todd Molfenter, Carol Sherbeck, Mark Zehner, Andy Quanbeck, Dennis McCarty, Jee-Seon Kim, Sandy Starr

Year: 2015

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271

Implementing Community-Level Policies to Prevent Alcohol Misuse

Type: Government Report

Authors: Substance Abuse and Mental Health Services Administration

Year: 2022

Publication Place: Rockville, MD

Topic(s):

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Disclaimer:

Grey literature is comprised of materials that are not made available through traditional publishing avenues. Examples of grey literature in the Repository of the Academy for the Integration of Mental Health and Primary Care include: reports, dissertations, presentations, newsletters, and websites. This grey literature reference is included in the Repository in keeping with our mission to gather all sources of information on integration. Often the information from unpublished resources is limited and the risk of bias cannot be determined.

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272

Implementing Medication-Assisted Treatment for Opioid Use Disorder in Rural Primary Care: Environmental Scan, Volume 1

Type: Government Report

Authors: Garrett E. Moran, Caroline M. Snyder, Rebecca F. Noftsinger, Joshua K. Noda

Year: 2017

Publication Place: Rockville, MD

Topic(s):

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Disclaimer:

This grey literature reference is included in the Academy’s Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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273

Implications of Increased Access to Buprenorphine for Medical Providers in Rural Areas: A Review of the Literature and Future Directions

Type: Journal Article

Authors: H. M. Gregory, V. M. Hill, R. W. Parker

Year: 2021

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274

Implications of the Patient Protection and Affordable Care Act: Preparing the professional psychology workforce for primary care.

Type: Journal Article

Authors: Ronald H. Rozensky

Year: 2014

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275

Improved outcomes associated with medical home implementation in pediatric primary care

Type: Journal Article

Authors: W. C. Cooley, J. W. McAllister, K. Sherrieb, K. Kuhlthau

Year: 2009

Publication Place: United States

Abstract: OBJECTIVE: The medical home model with its emphasis on planned care, care coordination, family-centered approaches, and quality provides an attractive concept construct for primary care redesign. Studies of medical home components have shown increased quality and reduced costs, but the medical home model as a whole has not been studied systematically. This study tested the hypothesis that increased medical homeness in primary care practice is associated with decreased utilization of health services and increased patient satisfaction. METHODS: Forty-three primary care practices were identified through 7 health plans in 5 states. Using the Medical Home Index (MHI), each practice's implementation of medical home concepts "medical homeness" was measured. Health plans provided the previous year's utilization data for children with 6 chronic conditions. The plans identified 42 children in each practice with these chronic conditions and surveyed their families regarding satisfaction with care and burden of illness. RESULTS: Higher MHI scores and higher subdomain scores for organizational capacity, care coordination, and chronic-condition management were associated with significantly fewer hospitalizations. Higher chronic-condition management scores were associated with lower emergency department use. Family survey data yielded no recognizable trends with respect to the medical home measurement. CONCLUSIONS: Developing an evidence base for the value of the primary care medical home has importance for providers, payers, policy makers, and consumers. Reducing hospitalizations through enhanced primary care provides a potential case for new reimbursement strategies supporting medical home services such as care coordination. Larger-scale studies are needed to further develop/examine these relationships.

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276

Improving access to care through Advanced Practice Registered Nurses: Focus on perinatal patients with Opioid Use Disorder

Type: Journal Article

Authors: M. Ramage, C. Tak, D. Goodman, E. Johnson, C. Barber, H. E. Jones

Year: 2021

Publication Place: England

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277

Improving health outcomes in young people - a holistic, team based approach

Type: Journal Article

Authors: S. Radford, M. L. Van Driel, K. Swanton

Year: 2011

Publication Place: Australia

Abstract: BACKGROUND: Young people aged 12-25 years are poorly serviced by current models of healthcare; they are under represented in Medicare data and are poor seekers of healthcare. However, the majority of mental health problems commence during this age span, significant sexual health issues arise, and there is poor compliance with treatment for chronic disease. OBJECTIVE: This article describes a holistic, multisector primary healthcare delivery model which may provide a way forward to improve both access and outcomes for young people. DISCUSSION: The 'headspace Gold Coast' model incorporates the relationship the young person has with both the organisation and the individuals within it; a focus on social and vocational rehabilitation; and a team based approach. The model provided at headspace serves an unmet need for young people in urban settings. However, more and ongoing support is crucial, including options for integration into existing primary care.

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278

Improving medication management of depression in health plans

Type: Journal Article

Authors: Constace M. Horgan, Elizabeth L. Merrick, Maureen T. Stewart, Sarah H. Scholle, Sarah Shih

Year: 2008

Publication Place: US: American Psychiatric Assn

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279

Improving medication safety in primary care using electronic health records

Type: Journal Article

Authors: L. S. Nemeth, A. M. Wessell

Year: 2010

Publication Place: United States

Abstract: OBJECTIVES: Electronic health record (EHR) systems offer promising tools to assist clinicians and staff with improving medication safety, yet many of the decision support components within these information systems are not well used. The aim of this study was to identify the strategies planned by primary care practices participating in a 2-year medication safety quality improvement intervention within the Practice Partner Research Network. METHODS: A theoretical model for primary care practice improvement was used to foster team-based approaches to prioritizing performance, system redesign, better use of EHR tools, and patient activation. The intervention included network meetings, site visits and performance reports. Improvement plans were qualitatively evaluated from field notes and organized to present a comprehensive approach to improving medication safety in primary care using EHRs. RESULTS: A total of 32 distinct plans and 11 common strategies were developed by practices to improve adherence with prescribing and monitoring indicators. Common plans included enhancing medication reconciliation to improve the accuracy of medication lists, using Practice Partner Research Network reports to identify patients meeting criteria for preventable medication errors, and customizing and applying EHR decision support tools for medication dosing, drug-disease interactions, and monitoring. CONCLUSIONS: Medication safety might be improved by implementing specific strategies within the primary care setting. Further evaluation is needed to provide an evidence base for improvement.

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280

Improving primary care mental health: Survey evaluation of an innovative workforce development in England

Type: Journal Article

Authors: E. F. Harkness, P. Bower, L. Gask, B. Sibbald

Year: 2005

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