Literature Collection

OBJECTIVES: Provision of smoking-cessation treatment is limited in office-based buprenorphine maintenance treatment (BMT) settings. This study describes smoking and smoking-cessation behaviors among patients receiving office-based BMT. METHODS: Cross-sectional study of patients receiving office-based BMT at a community health center in the Bronx, NY. We interviewed patients assessing sociodemographic, and substance use and tobacco use characteristics, including methods used for smoking cessation. We reported simple frequencies and explored associations of BMT characteristics with smoking behaviors. RESULTS: Of 68 patients, 87.7% were current cigarette smokers, 7.9% were former smokers, and 4.4% had never smoked. Of lifetime smokers, 83.1% reported at least 1 prior quit attempt, and 78.5% had used medication (75.4% used nicotine replacement therapy, 29.2% varenicline, and 9.2% bupropion). Ten patients (15.4%) reported using electronic cigarettes to try to quit smoking. Stopping "cold turkey" (40.0%) and gradually decreasing the number of cigarettes smoked (32.3%) were nonpharmacological methods of quitting tried most often. Use of behavioral support, including stop-smoking programs and counseling, was low. Higher dose and longer duration of BMT was associated with greater smoking frequency. CONCLUSIONS: Patients receiving BMT have a high prevalence of cigarette smoking, though most have tried to quit, and have prior experience with pharmacotherapy for smoking cessation. Efforts to optimize smoking-cessation treatments among BMT patients are needed.

BACKGROUND: Information communication technology (ICT) is a critical enabler of integrated models of community-based primary health care; however, little is known about how existing technologies have been used to support new models of integrated care. To address this gap, we draw on data from an international study of integrated models, exploring how ICT is used to support activities of integrated care and the organizational and environmental barriers and enablers to its adoption. METHODS: We take an embedded comparative multiple-case study approach using data from a study of implementation of nine models of integrated community-based primary health care, the Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH) study. Six cases from Canada, three each in Ontario and Quebec, and three in New Zealand, were studied. As part of the case studies, interviews were conducted with managers and front-line health care providers from February 2015 to March 2017. A qualitative descriptive approach was used to code data from 137 interviews and generate word tables to guide analysis. RESULTS: Despite different models and contexts, we found strikingly similar accounts of the types of activities supported through ICT systems in each of the cases. ICT systems were used most frequently to support activities like care coordination by inter-professional teams through information sharing. However, providers were limited in their ability to efficiently share patient data due to data access issues across organizational and professional boundaries and due to system functionality limitations, such as a lack of interoperability. CONCLUSIONS: Even in innovative models of care, managers and providers in our cases mainly use technology to enable traditional ways of working. Technology limitations prevent more innovative uses of technology that could support disruption necessary to improve care delivery. We argue the barriers to more innovative use of technology are linked to three factors: (1) information access barriers, (2) limited functionality of available technology, and (3) organizational and provider inertia.

OBJECTIVES: Longer retention in treatment is associated with positive outcomes. For women, who suffer worse drug-related problems than men, social technologies, which are more readily adopted by women, may offer promise. This naturalistic study examined whether a smartphone-based relapse-prevention system, A-CHESS (Addiction-Comprehensive Health Enhancement Support System), could improve retention for women with substance use disorders in an impoverished rural setting. METHODS: A total of 98 women, age 18 to 40, in southeastern Kentucky and mandated to treatment, received A-CHESS with intensive outpatient treatment for 6 months. For comparison, data were obtained for a similar but non-equivalent group of 100 same-age women also mandated to treatment in the same clinics during the period. Electronic medical record data on length-of-stay and treatment service use for both groups were analyzed, with A-CHESS use data, to determine whether those using A-CHESS showed better retention than those without. RESULTS: Women with A-CHESS averaged 780 service units compared with 343 for the comparison group. For those with discharge dates prior to the study's end, A-CHESS patients stayed in treatment a mean of 410 vs 262 days for the comparison group. CONCLUSIONS: Given associations between retention and positive outcomes, mobile health technology such as A-CHESS may help improve outcomes among women, especially in settings where access to in-person services is difficult. The findings, based on a non-equivalent comparison, suggest the need for further exploration with rigorous experimental designs to determine whether and to what degree access to a smartphone with A-CHESS may extend and support recovery for women.