Literature Collection

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Opioids & SU

The Literature Collection contains over 9,000 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).

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3
'Trying to put a square peg into a round hole': a qualitative study of healthcare professionals' views of integrating complementary medicine into primary care for musculoskeletal and mental health comorbidity
Type: Journal Article
Authors: Deborah Sharp, Ava Lorenc, Gene Feder, Paul Little, Sandra Hollinghurst, Stewart Mercer, Hugh MacPherson
Year: 2018
Publication Place: England
Abstract:

BACKGROUND: Comorbidity of musculoskeletal (MSK) and mental health (MH) problems is common but challenging to treat using conventional approaches. Integration of conventional with complementary approaches (CAM) might help address this challenge. Integration can aim to transform biomedicine into a new health paradigm or to selectively incorporate CAM in addition to conventional care. This study explored professionals' experiences and views of CAM for comorbid patients and the potential for integration into UK primary care. METHODS: We ran focus groups with GPs and CAM practitioners at three sites across England and focus groups and interviews with healthcare commissioners. Topics included experience of co-morbid MSK-MH and CAM/integration, evidence, knowledge and barriers to integration. Sampling was purposive. A framework analysis used frequency, specificity, intensity of data, and disconfirming evidence. RESULTS: We recruited 36 CAM practitioners (4 focus groups), 20 GPs (3 focus groups) and 8 commissioners (1 focus group, 5 interviews). GPs described challenges treating MSK-MH comorbidity and agreed CAM might have a role. Exercise- or self-care-based CAMs were most acceptable to GPs. CAM practitioners were generally pro-integration. A prominent theme was different understandings of health between CAM and general practitioners, which was likely to impede integration. Another concern was that integration might fundamentally change the care provided by both professional groups. For CAM practitioners, NHS structural barriers were a major issue. For GPs, their lack of CAM knowledge and the pressures on general practice were barriers to integration, and some felt integrating CAM was beyond their capabilities. Facilitators of integration were evidence of effectiveness and cost effectiveness (particularly for CAM practitioners). Governance was the least important barrier for all groups. There was little consensus on the ideal integration model, particularly in terms of financing. Commissioners suggested CAM could be part of social prescribing. CONCLUSIONS: CAM has the potential to help the NHS in treating the burden of MSK-MH comorbidity. Given the challenges of integration, selective incorporation using traditional referral from primary care to CAM may be the most feasible model. However, cost implications would need to be addressed, possibly through models such as social prescribing or an extension of integrated personal commissioning.

Topic(s):
Education & Workforce See topic collection
,
Healthcare Disparities See topic collection
4
‘They don't actually join the dots’: An exploration of organizational change in Irish opiate community treatment services
Type: Journal Article
Authors: Kelly Peter, J. Hegarty, Kyle R. Dyer, A. O Donovan
Year: 2022
Topic(s):
Education & Workforce See topic collection
,
Opioids & Substance Use See topic collection
6
"And Then COVID Hits": A Qualitative Study of How Jails Adapted Services to Treat Opioid Use Disorder During COVID-19
Type: Journal Article
Authors: C. Harrington, A. Bailey, E. Delorme, S. Hano, E. A. Evans
Year: 2023
Abstract:

Background: Jails in Massachusetts are among the first nationwide to provide correctional populations with medications to treat opioid use disorder (MOUD). The COVID-19 pandemic caused jails to pivot and adapt MOUD programming. We aimed to identify adaptations and barriers to MOUD access that COVID-19 exacerbated or created, and document new elements that staff wish to sustain as COVID-19 recedes. Methods: We conducted semi-structured in-depth interviews and focus groups in 2020-2021 with 29 jail staff who implement MOUD programming in two Massachusetts jails. We conducted qualitative data analysis in Atlas.ti 8 using an inductive approach. Results: Participants shared that access to MOUD among correctional populations is understood by jail staff to be an essential health service. Thus, to facilitate continued access to MOUD, both during incarceration and also at community reentry, jail staff quickly implemented changes in MOUD regulations and dosing protocols and established telehealth capacity. Despite these program adaptations, participants identified how COVID-19 increased health and social needs among correctional populations, reduced availability of community-based healthcare and recovery-supportive services, and introduced new factors that could undermine recovery. Innovations that participants wished to sustain as COVID-19 receded included telehealth capacity, smaller-sized therapeutic groups, and application of a public health approach to treat opioid use disorder among correctional populations. Conclusions: During disruptive events, jails can adapt MOUD programming to ensure access for people living in jail and upon release. Findings identify factors for understanding the outcomes of jail-based MOUD programming during COVID-19 and highlight opportunities to improve service delivery after COVID-19.

Topic(s):
Opioids & Substance Use See topic collection
,
Education & Workforce See topic collection
,
Healthcare Disparities See topic collection
7
"Cocaine Bugs": Implications for Primary Care Providers
Type: Journal Article
Authors: J. Torales, J. Almirón-Santacruz, I. Barrios, M. O'Higgins, O. Melgarejo, R. Navarro, I. González, M. Jafferany, J. M. Castaldelli-Maia, A. Ventriglio
Year: 2022
Publication Place: United States
Topic(s):
Education & Workforce See topic collection
,
Opioids & Substance Use See topic collection
10
"Dying is Not a Fear": Teen and Parent Perspectives on Messaging to Prevent Crystal Meth Use Among Teens in Rural North Idaho
Type: Journal Article
Authors: M. R. Skeer, D. M. Landy, J. M. Abrahams, J. Towers
Year: 2021
Publication Place: United States
Abstract:

Crystal methamphetamine ("meth") use is on the rise in the USA, having devastating effects on individuals and communities. Innovative prevention strategies are therefore critical. Through an exploratory qualitative study, we examined the perspectives and experiences of teenagers and parents around meth prevention messaging formats and strategies. Teens and adults were recruited through middle and high schools, libraries, local sporting events, and word of mouth in three communities in North Idaho, May-September 2016. Guided by the theoretical framework of the Extended Parallel Process Model, we conducted focus groups and small group interviews (three teen; two adults). Using a deductive content analytic approach, we developed teen- and adult-specific codebooks, analyzed the transcripts with NVivo 12-Plus, and identified themes. Teens and adults were all acutely aware of meth use in their communities, personally knowing people who were addicted to meth, and all understood the oral ("meth mouth") and physical ("crank bugs") consequences of meth use. Three primary themes were identified, which focused on the effects of, addiction to, and messaging around crystal meth use. For teens and adults, images illustrating the effects of meth were least effective if they appeared unrealistic or comical. Teens resonated most with messages focusing on pain and vanity (bad teeth and breath), and there was consensus that showing teens images simulating changes in their appearance over time as a result of meth use in a clinical setting would be an effective prevention strategy. Teens and adults who had exposure to meth addiction in North Idaho felt that prevention messages focused on meth are imperative, given its high prevalence and deleterious effects. Future work will entail developing and testing a communication-based meth prevention strategy along with tailored messaging that can be used with teens in dental settings.

Topic(s):
Education & Workforce See topic collection
,
Healthcare Disparities See topic collection
,
Opioids & Substance Use See topic collection
11
"I didn't feel like a number": The impact of nurse care managers on the provision of buprenorphine treatment in primary care settings
Type: Journal Article
Authors: N. Beharie, M. Kaplan-Dobbs, A. Urmanche, D. Paone, A. Harocopos
Year: 2022
Publication Place: United States
Abstract:

BACKGROUND AND OBJECTIVE: To promote increased access to and retention in buprenorphine treatment for opioid use disorder, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) implemented the Buprenorphine Nurse Care Manager Initiative (BNCMI) in 2016, in which nurse care managers (NCMs) coordinate buprenorphine treatment in safety-net primary care clinics. To explore how patients experienced the care they received from NCMs, DOHMH staff conducted in-person, in-depth interviews with patients who had, or were currently receiving, buprenorphine treatment at BNCMI clinics. Participants were patients who were receiving, or had received, buprenorphine treatment through BNCMI at one of the participating safety-net primary care practices. METHODS: The study team used a thematic analytic and framework analysis approach to capture concepts related to patient experiences of care received from NCMs, and to explore differences between those who were in treatment for at least six consecutive months and those who left treatment within the first six months. RESULTS: Themes common to both groups were that NCMs showed care and concern for patients' overall well-being in a nonjudgmental manner. In addition, NCMs provided critical clinical and logistical support. Among out-of-treatment participants, interactions with the NCM were rarely the catalyst for disengaging with treatment. Moreover, in-treatment participants perceived the NCM as part of a larger clinical team that collectively offered support, and the care provided by NCMs was often a motivating factor for them to remain engaged in treatment. CONCLUSION: Findings suggest that by providing emotional, clinical, and logistical support, as well as intensive engagement (e.g., frequent phone calls), the care that NCMs provide could encourage retention of patients in buprenorphine treatment.

Topic(s):
Education & Workforce See topic collection
,
Opioids & Substance Use See topic collection
12
"I didn't want to be on Suboxone at first…" - Ambivalence in Perinatal Substance Use Treatment
Type: Journal Article
Authors: B. Ostrach, C. Leiner
Year: 2019
Publication Place: United States
Abstract:

OBJECTIVES: The objectives of this article are to present findings from recent qualitative research with patients in a combined perinatal substance use treatment program in Central Appalachia, and to describe and analyze participants' ambivalence about medication-assisted treatment for opioid use disorder (OUD), in the context of widespread societal stigma and judgement. METHODS: We conducted research in a comprehensive outpatient perinatal substance use treatment program housed in a larger obstetric practice serving a large rural, Central Appalachian region. The program serves patients across the spectrum of substance use disorders but specifically offers medication-assisted treatment to perinatal patients with OUD. We purposively and opportunistically sampled patients receiving prescriptions for buprenorphine or buprenorphine-naloxone dual product, along with prenatal care and other services. Through participant-observation and semi-structured interviews, we gathered qualitative data from 27 participants, in a total of 31 interviews. We analyzed transcripts of interviews and fieldnotes using modified Grounded Theory. RESULTS: Participants in a combined perinatal substance use treatment program value supportive, non-judgmental care but report ambivalence about medication, within structural and institutional contexts of criminalized, stigmatized substance use and close scrutiny of their pregnancies. Women are keenly aware of the social and public consequences for themselves and their parenting, if they begin or continue medication treatment for OUD. CONCLUSIONS: Substance use treatment providers should consider the social consequences of medication treatment, as well as the clinical benefits, when presenting treatment options and recommendations to patients. Patient-centered care must include an understanding of larger social and structural contexts.

Topic(s):
Education & Workforce See topic collection
,
Healthcare Disparities See topic collection
,
Opioids & Substance Use See topic collection
14
"I'm not going to lay back and watch somebody die": A qualitative study of how people who use drugs' naloxone experiences are shaped by rural risk environment and naloxone distribution/overdose education intervention
Type: Journal Article
Authors: Z. Kesich, U. Ibragimov, K. Komro, K. Lane, M. Livingston, A. Young, H. Cooper
Year: 2023
Abstract:

Background Overdoses have surged in rural areas in the U.S. and globally for years, but harm reduction interventions have lagged. Overdose education and naloxone distribution (OEND) programs are highly effective to prevent overdose mortality, but little is known about people who use drugs' (PWUD) experience with these interventions in rural areas. Here, we analyze qualitative data with rural PWUD to learn about their experiences with an OEND intervention, and about how their perceptions of their rural risk environments influenced the interventions' effects. Methods Twenty-nine one-on-one, semi-structured qualitative interviews were conducted with rural PWUD engaged in the CARE2HOPE OEND intervention in Appalachian Kentucky. Interviews were conducted via Zoom, audio-recorded, and transcribed verbatim. Thematic analysis was conducted, guided by the Rural Risk Environment Framework. Results The OEND intervention transformed participants' roles locally, so they became an essential component of the local rural healthcare environment. The intervention provided access to naloxone and information, thereby increasing PWUD's confidence in naloxone administration. Through the intervention, over half of participants gained knowledge on naloxone (access points, administration technique) and on the criminal-legal environment as it pertained to naloxone. Most participants opted to accept and carry naloxone, citing factors related to the social environment (sense of responsibility to their community) and physical/healthcare environments (high overdose prevalence, suboptimal emergency response systems). Over half of participants described recent experiences administering intervention-provided naloxone. These experiences were shaped by features of the local rural social environment (anticipated negative reaction from recipients, prior naloxone conversations). Conclusions By providing naloxone paired with non-stigmatizing health and policy information, the OEND intervention offered the material and informational support that allowed participants to become a part of the healthcare environment. Findings highlight need for more outreach to rural PWUD on local policy that impacts them; tailored strategies to help rural PWUD engage in productive dialogue with peers about naloxone and navigate interpersonal conflict associated with overdose reversal; and opportunities for rural PWUD to formally participate in emergency response systems as peer overdose responders. Trial Registration The ClinicalTrials.gov ID for the CARE2HOPE intervention is NCT04134767. The registration date was October 19 (th) , 2019.

Topic(s):
Healthcare Disparities See topic collection
,
Opioids & Substance Use See topic collection
,
Education & Workforce See topic collection
19
"It's a place that gives me hope": A qualitative evaluation of a buprenorphine-naloxone group visit program in an urban federally qualified health center
Type: Journal Article
Authors: S. Lai, E. Li, A. Silverio, R. Debates, E. L. Kelly, L. C. Weinstein
Year: 2021
Publication Place: United States
Abstract:

Medication for opioid use disorder (MOUD) with buprenorphine is effective in treating opioid use disorder yet remains underutilized. Scant research has examined the experience of patients, clinic staff, and providers in a "low-threshold" group-based MOUD program. This study evaluates a "low-threshold" MOUD program at a federally qualified health center (FQHC) in Philadelphia, Pennsylvania through the perspectives of its key stakeholders. Methods: This qualitative study involved focus groups of patients, providers, and clinic staff. Focus groups were conducted between October 2017 and June 2018. Grounded theory was used for analysis. Results: There were a total of 10 focus groups, including 20 patient participants and 26 staff members. Program participants noted that a strength of the program is its person-centered harm reduction approach, which is reflected in the program's policies and design. Program participants discussed the programmatic design choices that facilitated their participation and engagement in the program: ease of access, integration into primary care, and group-based visit model. Challenges in program implementation included varying acceptance and understanding of harm reduction among staff, the unpredictability of clinic volume and workflow, and the need to balance access to primary care and MOUD. Conclusion: This group-based MOUD program's philosophy of person-centered harm reduction, low-barrier approach, the structure of group-based visits, and integrated care contributes to increased patient access and retention. Understanding the strengths and challenges of the program may be useful for other safety-net clinics considering a MOUD program.

Topic(s):
Education & Workforce See topic collection
,
Opioids & Substance Use See topic collection
20
"It's more than Just a Job to Them": A Qualitative Examination of Patient and Provider Perspectives on Medication-Assisted Treatment for Opioid Use Disorder
Type: Journal Article
Authors: M. R. Filteau, F. L. Kim, B. Green
Year: 2021
Publication Place: United States
Abstract:

The expansion of access to medication-assisted treatment by states and the federal government serves as one important tool for tackling the opioid crisis. Achieving this goal requires increasing the number of medical professionals who hold DATA Waiver 2000 waived status, which allows providers to prescribe the medication utilized by treatment programs. Waived providers are scarce throughout rural America, placing a potentially large burden on those who do hold a waiver. This paper uses data gathered through qualitative interviews with healthcare workers and patients at MAT clinics in Montana to understand how the relationship between rural healthcare workers and MAT patients contributes to burnout and potential staff turnover in a rural setting. Patients defined quality care via the patient-staff relationship, including expectations of personal support and viewing staff availability as a requirement for their recovery. Healthcare workers, in contrast, refer to their availability to patients as overwhelming and necessary both during and after business hours. These findings illuminate the need to continue expanding MAT access in rural communities, especially in non-specialty care settings including primary care offices and Federally Qualified Health Centers.

Topic(s):
Education & Workforce See topic collection
,
Healthcare Policy See topic collection
,
Opioids & Substance Use See topic collection