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Opioids & SU
The Literature Collection contains over 11,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More
Use the Search feature below to find references for your terms across the entire Literature Collection, or limit your searches by Authors, Keywords, or Titles and by Year, Type, or Topic. View your search results as displayed, or use the options to: Show more references per page; Sort references by Title or Date; and Refine your search criteria. Expand an individual reference to View Details. Full-text access to the literature may be available through a link to PubMed, a DOI, or a URL. References may also be exported for use in bibliographic software (e.g., EndNote, RefWorks, Zotero).
853 Results
362
Improving medication safety in primary care using electronic health records
Type: Journal Article
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.
Topic(s):
HIT & Telehealth
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, Healthcare Policy
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Reference Links: View the PubMed citation for Improving medication safety in primary care using electronic health records
365
Improving primary health care services for young people experiencing psychological distress and mental health problems: a personal reflection on lessons learnt from Australia and England
Type: Journal Article
Year: 2012
Publication Place: England
Abstract: BACKGROUND: Australia and England show high rates of psychological distress and mental health problems in young people. Both are high-income countries and have stated their intention to improve the delivery of health care to young people in primary care settings. Australia has an international reputation for improving care through innovative services and educational initiatives. England has taken a different direction and has concentrated more on developing policy and making recommendations to improve access for young people. AIM: To describe a Churchill Fellowship visit to Australia to observe initiatives in primary care based youth-friendly mental health care and to reflect upon the observations, comparing and contrasting with the English model. METHODS: The observations and reflections presented draw on field notes from site visits and meeting with key players, accessing web resources and referring to the literature, both grey and published. FINDINGS: Australia offers plurality in health care delivery and innovative responses to addressing youth mental health. There are two key approaches. The first is the development of services specializing in youth mental health. The second approach is to build capacity of existing primary care services to recognize the particular bio-psychosocial needs of adolescents (and their families). In contrast, England has tended to focus primarily on policy development and improving youth access. CONCLUSIONS: The paper draws attention to a number of political, clinical and educational developments in both Australia and England. Both countries demonstrate different strategies in response to the high levels of psychological distress in young people. Learning from colleagues in other settings can inform our own practice. Ultimately responding to young people's mental health needs is best served by youth-friendly policy which prepares clinicians for effective practice, informed by applied research and supported by adequate resources. Investment in young people's health must be a priority for us all.
Topic(s):
Healthcare Disparities
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, Healthcare Policy
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368
In Rural Areas, Buprenorphine Waiver Adoption Since 2017 Driven By Nurse Practitioners And Physician Assistants
Type: Journal Article
Year: 2019
Abstract:
Few patients with opioid use disorder receive medication for addiction treatment. In 2017 the Comprehensive Addiction and Recovery Act enabled nurse practitioners (NPs) and physician assistants (PAs) to obtain federal waivers allowing them to prescribe buprenorphine, a key medication for opioid use disorder. The waiver expansion was intended to increase patients' access to opioid use treatment, which was particularly important for rural areas with few physicians. However, little is known about the adoption of these waivers by NPs or PAs in rural areas. Using federal data, we examined waiver adoption in rural areas and its association with scope-of-practice regulations, which set the extent to which NPs or PAs can prescribe medication. From 2016 to 2019 the number of waivered clinicians per 100,000 population in rural areas increased by 111 percent. NPs and PAs accounted for more than half of this increase and were the first waivered clinicians in 285 rural counties with 5.7 million residents. In rural areas, broad scope-of-practice regulations were associated with twice as many waivered NPs per 100,000 population as restricted scopes of practice were. The rapid growth in the numbers of NPs and PAs with buprenorphine waivers is a promising development in improving access to addiction treatment in rural areas.
Topic(s):
Education & Workforce
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, Healthcare Disparities
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, Healthcare Policy
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, Opioids & Substance Use
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Reference Links:
View the DOI record for In Rural Areas, Buprenorphine Waiver Adoption Since 2017 Driven By Nurse Practitioners And Physician Assistants
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View the PubMed citation for In Rural Areas, Buprenorphine Waiver Adoption Since 2017 Driven By Nurse Practitioners And Physician Assistants369
Including safety-net providers in integrated delivery systems: issues and options for policymakers
Type: Journal Article
Year: 2012
Publication Place: United States
Abstract: Health care reform legislation has spurred efforts to develop integrated health care delivery systems that seek to coordinate the continuum of health services. These systems may be of particular benefit to patients who face barriers to accessing care or have multiple health conditions. But it remains to be seen how safety-net providers, including community health centers and public hospitals--which have long experience in caring for these vulnerable populations--will be included in integrated delivery systems. This issue brief explores key considerations for incorporating safety-net providers into integrated delivery systems and discusses the roles of state and federal agencies in sup-porting and testing models of integrated care delivery. The authors conclude that the most important principles in creating integrated delivery systems for vulnerable populations are: (1) an emphasis on primary care; (2) coordination of all care, including behavioral, social, and public health services; and (3) accountability for population health outcomes.
Topic(s):
Financing & Sustainability
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, Healthcare Policy
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Reference Links: View the PubMed citation for Including safety-net providers in integrated delivery systems: issues and options for policymakers
370
Increased access to evidence-based primary mental health care: Will the implementation match the rhetoric?
Type: Journal Article
Year: 2007
Publication Place: Australia
Abstract: There is clear evidence that coordinated systems of medical and psychological care ("collaborative care") are superior to single-provider-based treatment regimens. Although other general practice-based mental health schemes promoted collaborative care, the new Medicare Benefits Schedule payments revert largely to individual-provider service systems and fee-for-service rebates. Such systems have previously resulted in high out-of-pocket expenses, poor geographical and socioeconomic distribution of specialist services, and proliferation of individual-provider-based treatments rather than collaborative care. The new arrangements for broad access to psychological therapies should provide the financial basis for major structural reform. Unless this reform is closely monitored for equity of access, degree of out-of-pocket expenses, extent of development of evidence-based collaborative care structures, and impact on young people in the early phases of mental illness, we may waste this opportunity. The responsibility for achieving the best outcome does not lie only with governments. To date, the professions have not placed enough emphasis on systematically adopting evidence-based forms of collaborative care.
Topic(s):
Financing & Sustainability
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, Healthcare Policy
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Reference Links: View the PubMed citation for Increased access to evidence-based primary mental health care: Will the implementation match the rhetoric?
374
Inducing sustainable improvement in depression care in primary care practices
Type: Journal Article
Year: 2008
Publication Place: United States
Abstract: BACKGROUND: Improving primary care depression care is costly and challenging to sustain. The feasibility and potential success ofa modified improvement collaborative model to create sustained improvements in depression care was assessed. METHODS: Sixteen practices from the American Academy of Family Physicians National Research Network and the American College of Physicians Practice-based Research Network completed a nine-month program. Two practice champions (PCs) from each practice attended three two-day learning sessions, where practice change strategies and key depression care elements were discussed. The nine-item Patient Health Questionnaire (PHQ-9) was used for screening, diagnosis, surveillance, tracking and care management, and self-management support. Pre- and postintervention depression care survey data were gathered from all practice clinicians, and qualitative data were collected via interviews with PCs and field notes from learning sessions. RESULTS: On the basis of PC reports at nine months, 16 practices had implemented the PHQ-9 for depression case-finding and 13 for monitoring severity; 5 practices had implemented tracking and care management and 1, self-management support. At the 15-month follow-up, nearly all changes had been sustained, and additional practices had implemented tracking/care management and self-management support. Significant pre-post improvements were reported on several subscales of the clinician survey, demonstrating substantial diffusion from the PC to other clinicians in the practice. DISCUSSION: The program led to measurable improvements in implementation of office procedures and systems known to improve depression care. The improvements were both sustained beyond the end of the program and substantially diffused to the other clinicians in the practice.
Topic(s):
Financing & Sustainability
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, HIT & Telehealth
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, Healthcare Policy
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Reference Links: View the PubMed citation for Inducing sustainable improvement in depression care in primary care practices
375
Initial lessons from the first national demonstration project on practice transformation to a patient-centered medical home
Type: Journal Article
Year: 2009
Publication Place: United States
Abstract: The patient-centered medical home (PCMH) is emerging as a potential catalyst for multiple health care reform efforts. Demonstration projects are beginning in nearly every state, with a broad base of support from employers, insurers, state and federal agencies, and professional organizations. A sense of urgency to show the feasibility of the PCMH, along with a 3-tiered recognition process of the National Committee on Quality Assurance, are influencing the design and implementation of many demonstrations. In June 2006, the American Academy of Family Physicians launched the first National Demonstration Project (NDP) to test a model of the PCMH in a diverse national sample of 36 family practices. The authors make up an independent evaluation team for the NDP that used a multimethod evaluation strategy, including direct observation, in-depth interviews, chart audit, and patient and practice surveys. Early lessons from the real-time qualitative analysis of the NDP raise some serious concerns about the current direction of many of the proposed PCMH demonstration projects and point to some positive opportunities. We describe 6 early lessons from the NDP that address these concerns and then offer 4 recommendations for those assisting the transformation of primary care practices and 4 recommendations for individual practices attempting transformation.
Topic(s):
Medical Home
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, Healthcare Policy
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