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Opioids & SU

The Literature Collection contains over 7,000 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).

7594 Results

61

A budget impact analysis of telemedicine-based collaborative care for depression

Type: Journal Article

Authors: J. C. Fortney, M. L. Maciejewski, S. P. Tripathi, T. L. Deen, J. M. Pyne

Year: 2011

Source:

Fortney JC, Maciejewski ML, Tripathi SP, Deen TL, Pyne JM. A budget impact analysis of telemedicine-based collaborative care for depression. Medical Care 2011;49:872-880, . https://doi.org/10.1097/MLR.0b013e31821d2b35.

Publication Place: United States

Abstract: BACKGROUND: Patients with depression use more health services than patients without depression. However, when depression symptoms respond to treatment, use of health services declines. Most depression quality improvement studies increase total cost in the short run, which if unevenly distributed across stakeholders, could compromise buy-in and sustainability. The objective of this budget impact analysis was to examine patterns of utilization and cost associated with telemedicine-based collaborative care, an intervention that targets patients treated in small rural primary care clinics. METHODS: Patients with depression were recruited from VA Community-based Outpatient Clinics, and 395 patients were enrolled and randomized to telemedicine-based collaborative care or usual care. Dependent variables representing utilization and cost were collected from administrative data. Independent variables representing clinical casemix were collected from self-report at baseline. RESULTS: There were no significant group differences in the total number or cost of primary care encounters. However, as intended, patients in the intervention group had significantly greater depression-related primary care encounters (marginal effect=0.34, P=0.004) and cost (marginal effect=$61.4, P=0.013) to adjust antidepressant therapy for nonresponders. There were no significant group differences in total mental health encounters or cost. However, as intended, the intervention group had significantly higher depression-related mental health costs (marginal effect=$107.55, P=0.03) due to referrals of treatment-resistant patients. Unexpectedly, patients in the intervention group had significantly greater specialty physical health encounters (marginal effect =0.42, P=0.001) and cost (marginal effect =$490.6, P=0.003), but not depression-related encounters or cost. Overall, intervention patients had a significantly greater total outpatient cost compared with usual care (marginal effect=$599.28, P=0.012). CONCLUSIONS: Results suggest that telemedicine-based collaborative care does not increase total workload for primary care or mental health providers. Thus, there is no disincentive for mental health providers to offer telemedicine-based collaborative care or for primary care providers to refer patients to telemedicine-based collaborative care.

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62

A Budget Impact Analysis of the Collaborative Care Model for Treating Opioid Use Disorder in Primary Care

Type: Journal Article

Authors: C. M. Lee, C. Scheuter, D. Rochlin, T. Platchek, R. M. Kaplan

Year: 2019

Source:

Lee CM, Scheuter C, Rochlin D, Platchek T, Kaplan RM. A Budget Impact Analysis of the Collaborative Care Model for Treating Opioid Use Disorder in Primary Care. Journal Of General Internal Medicine 2019;34:1693-1694, . https://doi.org/10.1007/s11606-019-04998-5.

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63

A buprenorphine education and training program for primary care residents: Implementation and evaluation

Type: Journal Article

Authors: H. V. Kunins, N. L. Sohler, A. Giovanniello, D. Thompson, C. O. Cunningham

Year: 2013

Source:

Kunins HV, Sohler NL, Giovanniello A, Thompson D, Cunningham CO. A buprenorphine education and training program for primary care residents: Implementation and evaluation. Substance Abuse 2013;34:242-247, . https://doi.org/10.1080/08897077.2012.752777.

Publication Place: United States

Abstract: BACKGROUND: Although substance use disorders are highly prevalent, resident preparation to care for patients with these disorders is frequently insufficient. With increasing rates of opioid abuse and dependence, and the availability of medication-assisted treatment, one strategy to improve resident skills is to incorporate buprenorphine treatment into training settings. METHODS: In this study, esidency faculty delivered the BupEd education and training program to 71 primary care residents. BupEd included (1) a didactic session on buprenorphine, (2) an interactive motivational interviewing session, (3) monthly case conferences, and (4) supervised clinical experience providing buprenorphine treatment. To evaluate BupEd, the authors assessed (1) residents' provision of buprenorphine treatment during residency, (2) residents' provision of buprenorphine treatment after residency, and (3) treatment retention among patients treated by resident versus attending physicians. RESULTS: Of 71 residents, most served as a covering or primary provider to at least 1 buprenorphine-treated patient (84.5 and 66.2%, respectively). Of 40 graduates, 27.5% obtained a buprenorphine waiver and 17.5% prescribed buprenorphine. Treatment retention was similar between patients cared for by resident PCPs versus attending PCPs (90-day retention: 63.6% [n = 35] vs. 67.9% [n = 152]; P = .55). CONCLUSION: These results show that BupEd is feasible, provides residents with supervised clinical experience in treating opioid-dependent patients, and can serve as a model to prepare primary care physicians to care for patients with opioid dependence.

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64

A call to maximize impact of the SUPPORT for Patients and Communities Act through standard inclusion of opioid use disorder treatment curricula in medical schools

Type: Journal Article

Authors: A. Shapiro, L. R. Villarroel, P. George

Year: 2019

Source:

Shapiro A, Villarroel LR, George P. A call to maximize impact of the SUPPORT for Patients and Communities Act through standard inclusion of opioid use disorder treatment curricula in medical schools. Advances In Medical Education And Practice 2019;10:581-583, . https://doi.org/10.2147/AMEP.S205946.

Abstract:

Physicians who want to prescribe buprenorphine to treat opioid use disorder require a waiver established by the Drug Addiction Treatment Act (DATA) of 2000, often through completion of an eight-hour training course. This is an issue for a number of reasons, including that opioid overdose deaths continue to rise nationally. However, on October 24, 2018, the SUPPORT (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment) for Patients and Communities Act was signed into law. This bill allows any physician who graduates in good standing from an allopathic or osteopathic medical school in the United States that incorporates necessary material around opioid misuse in their standard curriculum, without need for any additional training, to prescribe buprenorphine. This perspective piece describes why this is an important first step and what more needs to be done within medical education to combat the opioid epidemic.

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65

A care management model for enhancing physician practice for Alzheimer Disease in primary care

Type: Journal Article

Authors: Mary Guerriero Austrom, Cora Hartwell, Patricia S. Moore, Malaz Boustani, Hugh C. Hendrie, Christopher M. Callahan

Year: 2005

Source:

Austrom MG, Hartwell C, Moore PS, Boustani M, Hendrie HC, Callahan CM. A care management model for enhancing physician practice for Alzheimer Disease in primary care. Clinical Gerontologist: The Journal Of Aging And Mental Health 2005;29:35-43, . https://doi.org/10.1300/J018v29n02_05.

Publication Place: US: Haworth Press

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66

A case of pseudosomatization disorder

Type: Web Resource

Authors: S. Epstein, R. M. McCarron

Year: 2006

Source:

Epstein S, McCarron RM. A case of pseudosomatization disorder. Psychiatric Times 2006;23.

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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67

A case report: Implementing a nurse telecare program for treating depression in primary care

Type: Journal Article

Authors: J. F. Meresman, E. M. Hunkeler, W. A. Hargreaves, A. J. Kirsch, P. Robinson, A. Green, E. Z. Mann, M. Getzell, P. Feigenbaum

Year: 2003

Source:

Meresman JF, Hunkeler EM, Hargreaves WA, Kirsch AJ, Robinson P, Green A, et al. A case report: Implementing a nurse telecare program for treating depression in primary care. The Psychiatric Quarterly 2003;74:61-73, .

Publication Place: United States

Abstract: The treatment of depression in primary care needs improvement. Previously, we reported that a nurse telecare intervention for treating depression in primary care clinics significantly improved treatment outcomes. The usefulness of nurse telecare, however, depends upon the feasibility of dissemination. In this report we describe nurse telecare and the steps required for implementation, and describe its dissemination in various settings. In addition to medication, which is managed by a primary care physician, the key elements of nurse telecare are focused behavioral activation, emotional support, patient education, promotion of treatment adherence, and monitoring of progress, delivered in ten brief telephone appointments over four months by primary care nurses. Support from key administrators and clinical champions is crucial to success. Nurses need "dedicated" scheduled time for telecare activities. Nurse telecare has been piloted and disseminated in diverse settings. The model required only small modifications for dissemination, and was implemented with minimal investment of resources and no negative impact on clinic operations.

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68

A case series of buprenorphine/naloxone treatment in a primary care practice

Type: Journal Article

Authors: B. Doolittle, W. Becker

Year: 2011

Source:

Doolittle B, Becker W. A case series of buprenorphine/naloxone treatment in a primary care practice. Substance Abuse 2011;32:262-265, . https://doi.org/10.1080/08897077.2011.599256.

Publication Place: United States

Abstract: Physicians' adoption of buprenorphine/naloxone treatment is hindered by concerns over feasibility, cost, and lack of comfort treating patients with addiction. We examined the use of buprenorphine/naloxone in a community practice by two generalist physicians without addiction training, employing a retrospective chart review. From 2006-2010, 228 patients with opiate abuse/dependence were treated with buprenorphine/naloxone using a home-induction protocol. Multiple co-morbidities including diabetes (23% of patients), hypertension (36%), Hepatitis C (43%), and depression (74%) were concurrently managed. In this diverse sample, 1/228 experienced precipitated withdrawal during induction. Of the convenience subsample analyzed (n = 28), 82% (+/-10%) had negative urine drug tests for opioids; 92% (+/-11%) were negative for cocaine; 88% (+/-12%) were positive for buprenorphine. This case series demonstrated feasibility and safety of a low-cost buprenorphine/naloxone home induction protocol employed by generalists. Concurrent treatment of multiple comorbidities conforms with the patient-centered medical home ideal. Randomized trials of this promising approach are needed.

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69

A case study evaluation of a community multidisciplinary team in South East England using a mixed-method approach

Type: Journal Article

Authors: J. W. Muscat

Year: 2020

Source:

Muscat JW. A case study evaluation of a community multidisciplinary team in South East England using a mixed-method approach. The British Journal Of General Practice : The Journal Of The Royal College Of General Practitioners 2020;70. https://doi.org/10.3399/bjgp20X711569.

Publication Place: England

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70

A case study of early experience with implementation of collaborative care in the Veterans Health Administration

Type: Journal Article

Authors: M. Tai-Seale, M. E. Kunik, A. Shepherd, J. Kirchner, A. Gottumukkala

Year: 2010

Source:

Tai-Seale M, Kunik ME, Shepherd A, Kirchner J, Gottumukkala A. A case study of early experience with implementation of collaborative care in the Veterans Health Administration. Population Health Management 2010;13:331-337, . https://doi.org/10.1089/pop.2009.0082.

Publication Place: United States

Abstract: Primary care remains critically important for those who suffer from mental disorders. Although collaborative care, which integrates mental health services into primary care, has been shown to be more effective than usual care, its implementation has been slow and the experience of providers and patients with collaborative care is less well known. The objective of this case study was to examine the effects of collaborative care on patient and primary care provider (PCP) experiences and communication during clinical encounters. Participating physicians completed a self-administered visit reconstruction questionnaire in which they logged details of patient visits and described their perceptions of the visits and the influence of collaborative care. Audio recordings of visits were analyzed to assess the extent of discussion about colocated mental health services and visit time devoted to mental health topics. The main outcome measures were the extent of discussion and recommendation for collaborative care during clinical visits and providers' experiences based on their responses to the visit reconstruction questionnaire. Providers surveyed expressed enthusiasm about collaborative care and cited the time constraint of office visits and lack of specialty support as the main reasons for limiting their discussion of mental health topics with patients. Despite the availability of mental health providers at the same clinic, PCPs missed many opportunities to address mental health issues with their patients. Ongoing education for PCPs regarding how to conduct a "warm handoff" to colocated providers will need to be an integral part of the implementation of collaborative care.

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71

A Case Study of Implementing Grant-Funded Integrated Care in a Community Mental Health Center

Type: Journal Article

Authors: M. Aby

Year: 2020

Source:

Aby M. A Case Study of Implementing Grant-Funded Integrated Care in a Community Mental Health Center. The Journal Of Behavioral Health Services & Research 2020;47:293-308, . https://doi.org/10.1007/s11414-019-09671-7.

Abstract:

The US government funds integrated care demonstration projects to decrease health disparities for individuals with serious mental illness. Drawing on the Exploration Preparation Implementation Sustainability (EPIS) implementation framework, this case study of a community mental health clinic describes implementation barriers and sustainability challenges with grant-funded integrated care. Findings demonstrate that integrated care practices evolve during implementation and the following factors influenced sustainability: workforce rigidity, intervention clarity, policy and funding congruence between the agency and state/federal regulations, on-going support and training in practice application, and professional institutions. Implementation strategies for primary care integration within CMHCs include creating a flexible workforce, shared definition of integrated care, policy and funding congruence, and on-going support and training.

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72

A Case Study of Implementing Grant-Funded Integrated Care in a Community Mental Health Center

Type: Journal Article

Authors: Aby Martha

Year: 2020

Source:

Martha A. A Case Study of Implementing Grant-Funded Integrated Care in a Community Mental Health Center. The Journal Of Behavioral Health Services & Research 2020;47:293-308, . https://doi.org/10.1007/s11414-019-09671-7.

Publication Place: New York

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73

A chance to do it better: Methadone maintenance treatment in the age of Covid-19

Type: Journal Article

Authors: D. Frank

Year: 2021

Source:

Frank D. A chance to do it better: Methadone maintenance treatment in the age of Covid-19. Journal Of Substance Abuse Treatment 2021;123:108246+. https://doi.org/10.1016/j.jsat.2020.108246.

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74

A Change in Perspective: From Dual Diagnosis to Multimorbidity

Type: Journal Article

Authors: Ish P. Bhalla, Robert A. Rosenheck

Year: 2017

Source:

Bhalla IP, Rosenheck RA. A Change in Perspective: From Dual Diagnosis to Multimorbidity. Psychiatric Services 2017. https://doi.org/10.1176/appi.ps.201700194.

Abstract: Objective: There has been increasing interest within psychiatry in the concept of multimorbidity because psychiatric patients typically present with multiple concurrent disorders, these disorders mutually exacerbate one another, and their interaction shapes treatment options. Metrics have not been developed to document multimorbidity in psychiatric clinical practice. Methods: Four classes of indicators relevant to multimorbidity were defined and evaluated among veterans treated in mental health specialty clinics nationally in the Veterans Health Administration (VHA) in fiscal year 2012. Results: Of the 843,583 veterans with at least three visits to a specialty mental health clinic, 94.6% had more than one general medical or mental disorder and 77.6% had more than one mental disorder, compared with 30.6% with co-occurring psychiatric and substance use disorders. Conclusions: Real-world psychiatric care is more accurately approached from the multimorbidity perspective than from the perspective of principal, dual, or comorbid diagnoses.

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75

A chronic opioid therapy dose reduction policy in primary care

Type: Journal Article

Authors: M. B. Weimer, D. M. Hartung, S. Ahmed, C. Nicolaidis

Year: 2016

Source:

Weimer MB, Hartung DM, Ahmed S, Nicolaidis C. A chronic opioid therapy dose reduction policy in primary care. Substance Abuse 2016;37:141-147, . https://doi.org/10.1080/08897077.2015.1129526.

Publication Place: United States

Abstract: BACKGROUND: High-dose opioids prescribed for the treatment of chronic pain have been associated with increased risk of opioid overdose. Health systems and states have responded by developing opioid dose limitation policies. Little is known about how these policies affect prescribing practices or characteristics of patients who respond best to opioid tapers from high-dose opioids. METHODS: We conducted a retrospective cohort study to evaluate change in total opioid dose after the implementation of a provider education intervention and a 120 mg morphine equivalents per day (MED) opioid dose limitation policy in one academic primary care clinic. We compared opioid prescriptions 1 year before and 1 year after the intervention. We used univariate and multivariate logistic regression to assess which patient characteristics predicted opioid dose reduction from high opioid dose. RESULTS: Out of a total of 516 patients prescribed chronic opioid therapy, 116 patients (22%) were prescribed high-dose opioid therapy (>120 mg MED). After policy adoption, the average daily dose of opioids declined by 64 mg MED (95% confidence interval [CI]: 32-96; P < .001) and 41 patients (37%) on high-dose opioids tapered their doses below 120 mg MED (Tapered to Safer Dose group). In multivariate analyses, female sex was the only significant association with dose taper; female patients were less likely to taper to a safer dose (adjusted odds ratio [aOR] = 0.28, 95% CI: 0.11-0.70). CONCLUSIONS: A combined intervention of education and a practice policy that limits opioid doses for patients prescribed chronic opioid therapy may be an important component of system-level strategies to reduce opioid misuse and overdose; it may also help identify patients suitable for medication-assisted treatment for opioid use disorder. Specific strategies may be needed to assist women with opioid dose tapers.

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76

A Clinical Care Algorithmic Toolkit for Promoting Screening and Next-Level Assessment of Pediatric Depression and Anxiety in Primary Care

Type: Journal Article

Authors: L. Honigfeld, S. J. Macary, D. J. Grasso

Year: 2017

Source:

Honigfeld L, Macary SJ, Grasso DJ. A Clinical Care Algorithmic Toolkit for Promoting Screening and Next-Level Assessment of Pediatric Depression and Anxiety in Primary Care. Journal Of Pediatric Health Care : Official Publication Of National Association Of Pediatric Nurse Associates & Practitioners 2017;31:e15-e23, .

Publication Place: United States

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77

A Clinical Care Monitoring and Data Collection Tool (H3 Tracker) to Assess Uptake and Engagement in Mental Health Care Services in a Community-Based Pediatric Integrated Care Model: Longitudinal Cohort Study

Type: Journal Article

Authors: M. McCreary, A. C. Arevian, M. Brady, A. E. Mosqueda Chichits, L. Zhang, L. Tang, B. Zima

Year: 2019

Source:

McCreary M, Arevian AC, Brady M, Chichits AEM, Zhang L, Tang L, et al. A Clinical Care Monitoring and Data Collection Tool (H3 Tracker) to Assess Uptake and Engagement in Mental Health Care Services in a Community-Based Pediatric Integrated Care Model: Longitudinal Cohort Study. Jmir Mental Health 2019;6. https://doi.org/10.2196/12358.

Publication Place: Canada

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78

A Clinical Nurse Specialist--Led Emergency Department Naloxone Distribution Program

Type: Journal Article

Authors: Stephanie C. Mullennix, Jackeline Iseler, Gregory M. Kwiatkowski, Lisa McCann-Spry, Jeffrey Skinner, Nicholas Kuhl, Eric Keith VanDePol, Cara Anne Poland

Year: 2020

Source:

Mullennix SC, Iseler J, Kwiatkowski GM, McCann-Spry L, Skinner J, Kuhl N, et al. A Clinical Nurse Specialist--Led Emergency Department Naloxone Distribution Program. Clinical Nurse Specialist: The Journal For Advanced Nursing Practice 2020;34:116-123, . https://doi.org/10.1097/NUR.0000000000000515.

Publication Place: Baltimore, Maryland

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79

A clinical prediction rule for detecting major depressive disorder in primary care: the PREDICT-NL study

Type: Journal Article

Authors: N. P. Zuithoff, Y. Vergouwe, M. King, I. Nazareth, E. Hak, K. G. Moons, M. I. Geerlings

Year: 2009

Source:

Zuithoff NP, Vergouwe Y, King M, Nazareth I, Hak E, Moons KG, et al. A clinical prediction rule for detecting major depressive disorder in primary care: the PREDICT-NL study. Family Practice 2009;26:241-250, . https://doi.org/10.1093/fampra/cmp036.

Publication Place: England

Abstract: BACKGROUND: Major depressive disorder often remains unrecognized in primary care. OBJECTIVE: Development of a clinical prediction rule using easily obtainable predictors for major depressive disorder in primary care patients. METHODS: A total of 1046 subjects, aged 18-65 years, were included from seven large general practices in the center of The Netherlands. All subjects were recruited in the general practice waiting room, irrespective of their presenting complaint. Major depressive disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Text Revision edition criteria was assessed with the Composite International Diagnostic Interview. Candidate predictors were gender, age, educational level, being single, number of presented complaints, presence of non-somatic complaints, whether a diagnosis was assigned, consultation rate in past 12 months, presentation of depressive complaints or prescription of antidepressants in past 12 months, number of life events in past 6 months and any history of depression. RESULTS: The first multivariable logistic regression model including only predictors that require no confronting depression-related questions had a reasonable degree of discrimination (area under the receiver operating characteristic curve or concordance-statistic (c-statistic) = 0.71; 95% Confidence Interval (CI): 0.67-0.76). Addition of three simple though more depression-related predictors, number of life events and history of depression, significantly increased the c-statistic to 0.80 (95% CI: 0.76-0.83). After transforming this second model to an easily to use risk score, the lowest risk category (sum score or = 30). CONCLUSION: A clinical prediction rule allows GPs to identify patients-irrespective of their complaints-in whom diagnostic workup for major depressive disorder is indicated.

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80

A clinical psychologist in GP-Land: an evaluation of brief psychological interventions in primary care

Type: Journal Article

Authors: S. Dath, C . Y. Dong, M. W. Stewart, E. Sables

Year: 2014

Source:

Dath S, . Y. Dong C, Stewart MW, Sables E. A clinical psychologist in GP-Land: an evaluation of brief psychological interventions in primary care. The New Zealand Medical Journal 2014;127:62-73, .

Publication Place: New Zealand

Abstract: AIM: To evaluate the clinical outcomes and other impacts of brief therapy provided in a primary care setting by a clinical psychologist who was mainly employed in secondary mental health. METHOD: The outcomes of 23 primary care patients referred to a clinical psychologist were evaluated using the General Health Questionnaire (GHQ), the World Health Organisation Quality of Life (WHOQoL) scale, and the Beck Depression Inventory (BDI). A mixture of quantitative and qualitative data from patients and staff were analysed to identify other impacts of the intervention. RESULTS: Large improvements in BDI, GHQ, and WHOQOL scores were found, with strong changes consistent with the targets of the intervention. Patients reported primary-based clinical psychology input was more convenient and many engaged who had resisted referral to secondary mental health services. Other benefits to the service, including improved primary-secondary service integration, improved primary management of mental health difficulties, and improved liaison with mental health specialists, were reported by primary health staff. CONCLUSION: Brief psychological interventions by a visiting clinical psychologist in a general practice setting had substantial benefits for the patients and for the practice. This project indicates the value of integrated psychological input consistent with recent moves to better primary-secondary integration in mental health care.

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