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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).
11231 Results
202
A chronic opioid therapy dose reduction policy in primary care
Type: Journal Article
Year: 2016
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.
Topic(s):
Opioids & Substance Use
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, Healthcare Disparities
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, Education & Workforce
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Reference Links: 
View the DOI record for A chronic opioid therapy dose reduction policy in primary care
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View the PubMed citation for A chronic opioid therapy dose reduction policy in primary care204
A Clinical Care Algorithmic Toolkit for Promoting Screening and Next-Level Assessment of Pediatric Depression and Anxiety in Primary Care
Type: Journal Article
Year: 2017
Publication Place: United States
Topic(s):
Education & Workforce
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, Healthcare Disparities
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205
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
Year: 2019
Publication Place: Canada
Topic(s):
Healthcare Disparities
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, HIT & Telehealth
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208
A clinical prediction rule for detecting major depressive disorder in primary care: the PREDICT-NL study
Type: Journal Article
Year: 2009
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.
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the DOI record for A clinical prediction rule for detecting major depressive disorder in primary care: the PREDICT-NL study
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View the PubMed citation for A clinical prediction rule for detecting major depressive disorder in primary care: the PREDICT-NL study209
A clinical psychologist in GP-Land: an evaluation of brief psychological interventions in primary care
Type: Journal Article
Year: 2014
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.
Topic(s):
General Literature
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Reference Links: View the PubMed citation for A clinical psychologist in GP-Land: an evaluation of brief psychological interventions in primary care
210
A clinical trial of peer-based culturally responsive person-centered care for psychosis for African Americans and Latinos
Type: Journal Article
Year: 2010
Publication Place: England
Abstract: BACKGROUND: Providing culturally competent and person-centered care is at the forefront of changing practices in behavioral health. Significant health disparities remain between people of color and whites in terms of care received in the mental health system. Peer services, or support provided by others who have experience in the behavioral health system, is a promising new avenue for helping those with behavioral health concerns move forward in their lives. PURPOSE: We describe a model of peer-based culturally competent person-centered care and treatment planning, informed by longstanding research on recovery from serious mental illness used in a randomized clinical trial conducted at two community mental health centers. METHODS: Participants all were Latino or African American with a current or past diagnosis within the psychotic disorders spectrum as this population is often underserved with limited access to culturally responsive, person-centered services. Study interventions were carried out in both an English-speaking and a Spanish-speaking outpatient program at each study center. Interventions included connecting individuals to their communities of choice and providing assistance in preparing for treatment planning meetings, all delivered by peer-service providers. Three points of evaluation, at baseline, 6 and 18 months, explored the impact of the interventions on areas such as community engagement, satisfaction with treatment, symptom distress, ethnic identity, personal empowerment, and quality of life. CONCLUSIONS: Lessons learned from implementation include making cultural modifications, the need for a longer engagement period with participants, and the tension between maintaining strict interventions while addressing the individual needs of participants in line with person-centered principles. The study is one of the first to rigorously test peer-supported interventions in implementing person-centered care within the context of public mental health systems.
Topic(s):
Healthcare Disparities
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211
A clinically integrated curriculum in evidence-based medicine for just-in-time learning through on-the-job training: The EU-EBM project
Type: Journal Article
Year: 2007
Publication Place: England
Abstract: BACKGROUND: Over the last years key stake holders in the healthcare sector have increasingly recognised evidence based medicine (EBM) as a means to improving the quality of healthcare. However, there is considerable uncertainty about the best way to disseminate basic knowledge of EBM. As a result, huge variation in EBM educational provision, setting, duration, intensity, content, and teaching methodology exists across Europe and worldwide. Most courses for health care professionals are delivered outside the work context ('stand alone') and lack adaptation to the specific needs for EBM at the learners' workplace. Courses with modern 'adaptive' EBM teaching that employ principles of effective continuing education might fill that gap. We aimed to develop a course for post-graduate education which is clinically integrated and allows maximum flexibility for teachers and learners. METHODS: A group of experienced EBM teachers, clinical epidemiologists, clinicians and educationalists from institutions from eight European countries participated. We used an established methodology of curriculum development to design a clinically integrated EBM course with substantial components of e-learning. An independent European steering committee provided input into the process. RESULTS: We defined explicit learning objectives about knowledge, skills, attitudes and behaviour for the five steps of EBM. A handbook guides facilitator and learner through five modules with clinical and e-learning components. Focussed activities and targeted assignments round off the learning process, after which each module is formally assessed. CONCLUSION: The course is learner-centred, problem-based, integrated with activities in the workplace and flexible. When successfully implemented, the course is designed to provide just-in-time learning through on-the-job-training, with the potential for teaching and learning to directly impact on practice.
Topic(s):
Education & Workforce
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214
A clustered controlled trial of the implementation and effectiveness of a medical home to improve health care of people with serious mental illness: study protocol
Type: Journal Article
Year: 2018
Publication Place: England
Topic(s):
Healthcare Disparities
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, Medical Home
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218
A collaborative approach for the care management of geropsychiatric services
Type: Journal Article
Year: 2011
Publication Place: United States
Abstract: PURPOSE/OBJECTIVES: To share a successful collaborative approach between the medical and behavioral health departments of a managed care organization that improved both utilization rates and management for health plan members with dementia. PRIMARY PRACTICE SETTING: Acute care hospitals FINDINGS/CONCLUSIONS: There was a significant reduction in subsequent hospital admits, beddays, and emergency department visits for this population resulting in a substantial financial savings. Patient outcomes, as well as patient and caregiver satisfaction, was improved. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Prior to the implementation of this pilot, there was a gap in services for health plan members experiencing dangerous behavioral issues associated with their dementia diagnosis. Case management of this population was difficult because of the limited options available in our market area. This innovative program afforded a nontraditional approach to inpatient care that maximized case management possibilities for this population.
Topic(s):
Financing & Sustainability
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Reference Links:
View the DOI record for A collaborative approach for the care management of geropsychiatric services
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View the PubMed citation for A collaborative approach for the care management of geropsychiatric services219
A collaborative approach to embedding graduate primary care mental health workers in the UK National Health Service
Type: Journal Article
Year: 2008
Publication Place: England
Abstract: The UK National Health Service (NHS) workforce has recently seen the arrival of the Graduate Mental Health Worker (GMHW) in primary care. We established a Quality Improvement Collaborative to assist in embedding this new workforce in one Strategic Health Authority Area of England. The intervention utilised 'collaborative' technology which involves bringing together groups of practitioners from different organizations to work in a structured way to improve the quality of their service. The process was evaluated by an action research project in which all stakeholders participated. Data collection was primarily qualitative. During the project, there was an increase in throughput of new patients seen by the GMHWs and increased workforce satisfaction with a sense that the collaborative aided the change process within the organizations. Involvement of managers and commissioners from the Primary Care Trusts where the GMHWs were employed appeared to be important in achieving change. This was not, however, sufficient to combat significant attrition of the first cohort of workers. The project identified several barriers to the successful implementation of a new workforce for mental health problems in primary care, including widespread variation in the level and quality of supervision and in payment and terms of service of workers. A collaborative approach can be used to support the development of new roles in health care; however, full engagement from management is particularly necessary for success in implementation. The problems faced by GMHWs reflect those faced by other new workers in healthcare settings, yet in some ways are even more disturbing given the lack of governance arrangements put in place to oversee these developments and the apparent use of relatively unsupported and inexperienced novices as agents of change in the NHS.
Topic(s):
Education & Workforce
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Reference Links:
View the DOI record for A collaborative approach to embedding graduate primary care mental health workers in the UK National Health Service
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View the PubMed citation for A collaborative approach to embedding graduate primary care mental health workers in the UK National Health Service