Literature Collection

BACKGROUND: The COVID-19 pandemic drove significant disruptions in access to substance use disorder (SUD) treatment and harm reduction services. Healthcare delivery via telemedicine has increasingly become the norm, rendering access to a phone essential for engagement in care. METHODS: Adult patients with SUD who lacked phones (n = 181) received a free, pre-paid phone during encounters with inpatient and outpatient SUD programs. We evaluated changes in healthcare engagement including completed in-person and telemedicine outpatient visits and telephone encounters 30 days before and after phone receipt. We used descriptive statistics, where appropriate, and paired t-tests to assess the change in healthcare engagement measures. RESULTS: Patients were predominantly male (64%) and white (62%) with high rates of homelessness (81%) and opioid use disorder (89%). When comparing 30 days before to 30 days after phone receipt, there was a significant increased change in number of telemedicine visits by 0.3 (95% CL [0.1,0.4], p < 0.001) and telephone encounters by 0.2 (95% CL [0.1,0.3], p = 0.004). There was no statistically significant change in in-person outpatient visits observed. CONCLUSIONS: Pre-paid phone distribution to patients with SUD was associated with an increased healthcare engagement including telemedicine visits and encounters.

OBJECTIVE: To examine the degree to which a broadband behavioral health screener administered in preadolescence in primary care (PC) could serve as an early risk indicator for depression and suicide risk in adolescence. METHODS: Participants included 9329 patients who attended well visits at 9 and 12 years old in a large pediatric PC network. The sample was 49% female, 64% White, 18% Black, 4% Asian, 14% other races, and 6% Hispanic/Latinx. Caregivers completed the Pediatric Symptom Checklist (PSC-17) about their child at age 9; youth completed the Patient Health Questionnaire-9 Modified for Teens (PHQ-9-M) at age 12. RESULTS: After adjusting for demographic covariates, patients scoring above the risk cutoffs on the PSC-17 total scale and subscales (internalizing, externalizing, and attention) at age 9 had significantly greater odds of elevated depression and/or suicide risk on the PHQ-9-M at age 12 (odds ratios: 2.41-4.23, P < .001). Approximately one third of patients with depression (sensitivity: 37.1%) or suicide (sensitivity: 33.3%) risk at age 12 were identified as at risk on the PSC-17 at age 9. CONCLUSIONS: Results suggest that the PSC-17, a well-researched screener widely used in pediatrics, has moderate predictive value with respect to depression and suicide risk during adolescence. More research is needed on the feasibility and potential benefits of broadband behavioral health screening in preadolescence to promote early identification and prevention efforts.

BACKGROUND: The Integrated Care for Older People (ICOPE) approach was developed by the World Health Organization (WHO) aiming to shift the traditional focus of care based on diseases to a function- and person-centered approach, focused on maintaining and monitoring intrinsic capacity (IC). This study aimed to investigate the ability of the ICOPE screening tool to identify older people with clinically meaningful impairments in IC domains. METHODS: This cross-sectional analysis included 603 older adults, participants (mean age 74.7 [SD = 8.8] years, women 59.0%) of the INSPIRE Translational (INSPIRE-T) cohort. Responses at screening were compared to results of the subsequent in-depth assessment (ie, Mini-Mental State Examination, Mini Nutritional Assessment, Short Physical Performance Battery, Patient Health Questionnaire-9, and clinical investigation of vision problems) to determine its predictive capacity for impairments at the IC domains (ie, cognition, psychological, sensory (vision), vitality, and locomotion). RESULTS: The ICOPE screening items provided very high sensitivity for identifying abnormality in vision (97.2%) and varied from 42.0% to 69.6% for the other domains. High specificity (>70%) was observed for all the IC domains, except for vision (2.7%). CONCLUSIONS: The ICOPE screening tool can be a useful instrument enabling the identification of older people with impairments in IC domains, but studies with different populations are needed. It should be considered as a low-cost and simple screening tool in clinical care.

OBJECTIVE:  Our objective was to examine the biomedical and sociodemographic factors associated with the prescription of naloxone among pregnant people with opioid-use disorder (OUD) who were admitted for initiation of medications for OUD (i.e., buprenorphine-containing medications or methadone) following the implementation of a statewide initiative focused on reducing adverse perinatal health outcomes. STUDY DESIGN:  This is a single-site, retrospective cohort study of pregnant people admitted for the management of OUD at an urban, tertiary care center between 2013 and 2020. The primary outcome is evidence of a prescription of naloxone, ascertained from the electronic medical record. Bivariate and multivariable logistic regression modeling was performed to evaluate biomedical and sociodemographic variables associated with a prescription for naloxone. Covariates for inclusion in the multivariate logistic regression model were selected based on a p < 0.05 on bivariate analysis. Statistical significance was set at p < 0.05. RESULTS:  One hundred and thirty-nine participants met the inclusion criteria. On bivariate analysis, people who received naloxone were more likely to be admitted after the initiation of a statewide initiative focused on reducing adverse perinatal outcomes associated with perinatal OUD. Those individuals reporting intravenous drug use (IVDU) were less likely to receive naloxone. On multivariate logistic regression, after controlling for IVDU and epoch of admission, both IVDU (adjusted odds ratio [aOR]: 0.27, 95% confidence interval [CI]: 0.11-0.70) and epoch of admission (aOR: 3.48, 95% CI: 1.28-9.50) were independently associated with receipt of prescription of take-home naloxone. CONCLUSION:  Naloxone prescription was independently associated with the epoch of admission and route of drug administration. These data can be useful in the evaluation and development of clinical practices to increase rates of naloxone prescription in pregnant people with OUD admitted for inpatient management. KEY POINTS: · Thirty four percent of individuals with perinatal OUD were prescribed take-home naloxone (THN).. · Epoch of admission and route of drug administration were independently associated with THN.. · These data can be used to guide public health and clinical programming for pregnant people..