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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
2065
CKD quality improvement intervention with PCMH integration: health plan results
Type: Journal Article
Year: 2019
Publication Place: United States
Abstract: OBJECTIVES: To execute a chronic kidney disease (CKD) intervention to assess feasibility and preliminary outcomes for a health plan. STUDY DESIGN: This CKD quality improvement study was incorporated into an existing CareFirst primary care patient-centered medical home cohort with a pre- and postintervention assessment from July 1, 2015, to June 30, 2017. METHODS: The study targeted the population at risk for CKD with diabetes and/or hypertension by implementing a care plan according to the stratification by estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (uACR) or CKD heat map class. RESULTS: The population included 7420 individuals (51.8% female) with a mean age of 55.9 years; 19.1% had diabetes only, 42.2% had hypertension only, and 38.2% had both conditions. Overall, there was no change in eGFR testing among risk groups (84.8%), but a small significant increase in uACR testing occurred (from 31.3% to 33.0%; P = .0020). Reductions in admissions per 1000 patients were from 362.5 to 249.0 for class 3, 311.7 to 219.2 for class 4, and 590.9 to 323.5 for class 5. Lastly, there were reductions in 30-day readmissions per 1000 patients, from 51.9 to 13.7 for class 4 and 45.5 to 0 for class 5. Although there were increases in many of the per-member per-month costs assessed pre- versus post intervention, net savings in medical costs were $276.80 and $480.79 for CKD classes 3 and 5, respectively. CONCLUSIONS: This scalable CKD intervention demonstrated feasibility. For advanced CKD, decreased hospitalization and a reduction in several important costs were observed. These preliminary results support the stratification of laboratory data for CKD population health innovation in commercial health plans.
Topic(s):
Financing & Sustainability
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, Medical Home
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Reference Links: View the PubMed citation for CKD quality improvement intervention with PCMH integration: health plan results
2066
CKD quality improvement intervention with PCMH integration: health plan results
Type: Journal Article
Year: 2019
Publication Place: United States
Abstract: OBJECTIVES: To execute a chronic kidney disease (CKD) intervention to assess feasibility and preliminary outcomes for a health plan. STUDY DESIGN: This CKD quality improvement study was incorporated into an existing CareFirst primary care patient-centered medical home cohort with a pre- and postintervention assessment from July 1, 2015, to June 30, 2017. METHODS: The study targeted the population at risk for CKD with diabetes and/or hypertension by implementing a care plan according to the stratification by estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (uACR) or CKD heat map class. RESULTS: The population included 7420 individuals (51.8% female) with a mean age of 55.9 years; 19.1% had diabetes only, 42.2% had hypertension only, and 38.2% had both conditions. Overall, there was no change in eGFR testing among risk groups (84.8%), but a small significant increase in uACR testing occurred (from 31.3% to 33.0%; P = .0020). Reductions in admissions per 1000 patients were from 362.5 to 249.0 for class 3, 311.7 to 219.2 for class 4, and 590.9 to 323.5 for class 5. Lastly, there were reductions in 30-day readmissions per 1000 patients, from 51.9 to 13.7 for class 4 and 45.5 to 0 for class 5. Although there were increases in many of the per-member per-month costs assessed pre- versus post intervention, net savings in medical costs were $276.80 and $480.79 for CKD classes 3 and 5, respectively. CONCLUSIONS: This scalable CKD intervention demonstrated feasibility. For advanced CKD, decreased hospitalization and a reduction in several important costs were observed. These preliminary results support the stratification of laboratory data for CKD population health innovation in commercial health plans.
Topic(s):
Financing & Sustainability
See topic collection
, Medical Home
See topic collection
Reference Links: View the PubMed citation for CKD quality improvement intervention with PCMH integration: health plan results
2067
Classes of depression symptom trajectories in patients with major depression receiving a collaborative care intervention
Type: Journal Article
Year: 2018
Publication Place: United States
Abstract: PURPOSE: Collaborative care is effective in improving symptoms of patients with depression. The aims of this study were to characterize symptom trajectories in patients with major depression during one year of collaborative care and to explore associations between baseline characteristics and symptom trajectories. METHODS: We conducted a cluster-randomized controlled trial in primary care. The collaborative care intervention comprised case management and behavioral activation. We used the Patient Health Questionnaire-9 (PHQ-9) to assess symptom severity as the primary outcome. Statistical analyses comprised latent growth mixture modeling and a hierarchical binary logistic regression model. RESULTS: We included 74 practices and 626 patients (310 intervention and 316 control recipients) at baseline. Based on a minimum of 12 measurement points for each intervention recipient, we identified two latent trajectories, which we labeled 'fast improvers' (60.5%) and 'slow improvers' (39.5%). At all measurements after baseline, 'fast improvers' presented higher PHQ mean values than 'slow improvers'. At baseline, 'fast improvers' presented fewer physical conditions, higher health-related quality of life, and had made fewer suicide attempts in their history. CONCLUSIONS: A notable proportion of 39.5% of patients improved only 'slowly' and probably needed more intense treatment. The third follow-up in month two could well be a sensible time to adjust treatment to support 'slow improvers'.
Topic(s):
General Literature
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Reference Links:
View the DOI record for Classes of depression symptom trajectories in patients with major depression receiving a collaborative care intervention
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View the PubMed citation for Classes of depression symptom trajectories in patients with major depression receiving a collaborative care intervention2068
Classes of depression symptom trajectories in patients with major depression receiving a collaborative care intervention
Type: Journal Article
Year: 2018
Publication Place: United States
Abstract: PURPOSE: Collaborative care is effective in improving symptoms of patients with depression. The aims of this study were to characterize symptom trajectories in patients with major depression during one year of collaborative care and to explore associations between baseline characteristics and symptom trajectories. METHODS: We conducted a cluster-randomized controlled trial in primary care. The collaborative care intervention comprised case management and behavioral activation. We used the Patient Health Questionnaire-9 (PHQ-9) to assess symptom severity as the primary outcome. Statistical analyses comprised latent growth mixture modeling and a hierarchical binary logistic regression model. RESULTS: We included 74 practices and 626 patients (310 intervention and 316 control recipients) at baseline. Based on a minimum of 12 measurement points for each intervention recipient, we identified two latent trajectories, which we labeled 'fast improvers' (60.5%) and 'slow improvers' (39.5%). At all measurements after baseline, 'fast improvers' presented higher PHQ mean values than 'slow improvers'. At baseline, 'fast improvers' presented fewer physical conditions, higher health-related quality of life, and had made fewer suicide attempts in their history. CONCLUSIONS: A notable proportion of 39.5% of patients improved only 'slowly' and probably needed more intense treatment. The third follow-up in month two could well be a sensible time to adjust treatment to support 'slow improvers'.
Topic(s):
General Literature
See topic collection
Reference Links:
View the DOI record for Classes of depression symptom trajectories in patients with major depression receiving a collaborative care intervention
View DOI Record
View the PubMed citation for Classes of depression symptom trajectories in patients with major depression receiving a collaborative care intervention2069
Classification and diagnosis of patients with medically unexplained symptoms
Type: Journal Article
Year: 2007
Publication Place: United States
Abstract: Patients with medically unexplained symptoms (MUS) have little or no demonstrable disease explanation for the symptoms, and comorbid psychiatric disorders are frequent. Although common, costly, distressed, and often receiving ill-advised testing and treatments, most MUS patients go unrecognized, which precludes effective treatment. To enhance recognition, we present an emerging perspective that envisions a unitary classification for the entire spectrum of MUS where this diagnosis comprises severity, duration, and comorbidity. We then present a specific approach for making the diagnosis at each level of severity. Although our disease-based diagnosis system dictates excluding organic disease to diagnose MUS, much exclusion can occur clinically without recourse to laboratory or consultative evaluation because the majority of patients are mild. Only the less common, "difficult" patients with moderate and severe MUS require investigation to exclude organic diseases. By explicitly diagnosing and labeling all severity levels of MUS, we propose that this diagnostic approach cannot only facilitate effective treatment but also reduce the cost and morbidity from unnecessary interventions.
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Classification and diagnosis of patients with medically unexplained symptoms
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View the PubMed citation for Classification and diagnosis of patients with medically unexplained symptoms2071
Classification of somatization and functional somatic symptoms in primary care
Type: Journal Article
Year: 2005
Publication Place: Australia
Abstract: OBJECTIVE: A substantial proportion of patients found in primary care complain of physical symptoms not attributable to any known conventionally defined disorder, that is, medically unexplained or functional somatic symptoms. The objective of this paper is to outline the problems with the current classification and propose a classification more suitable for primary health care. METHOD: We refer to and discuss relevant literature including papers on our own research on the topic in the light of our experiences from major projects on somatizing patients in primary health care. RESULTS: Functional somatic symptoms may impose severe suffering on the patient and are costly for society because of high health-care utilization, lost working years and social expenses. At present, studies on functional somatic symptoms and disorders and their treatment are hampered by lack of a valid and reliable diagnostic classification. The diagnostic categories of somatoform disorders are overlapping. Thus, the present situation is that patients with identical symptoms and clinical pictures may receive different diagnostic labels depending on the focus of interests of the assessing physician. A particular problem in primary care is that the somatoform diagnostic categories only include persistent cases and do not offer the opportunity for classification of the patients with short-symptom duration found in this setting. We present a framework for a new descriptive classification of functional somatic symptoms and unfounded illness worrying, and outline a new classification that covers the whole spectrum of severity seen in clinical practice. CONCLUSION: A precondition for an appropriate management of patients with functional somatic symptoms is a valid taxonomy common for all medical specialties facilitating cooperative care. Classification systems as outlined in this paper may be a candidate for such a system, but it should be subject to further evaluation in research.
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Classification of somatization and functional somatic symptoms in primary care
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View the PubMed citation for Classification of somatization and functional somatic symptoms in primary care2076
Clinic-based treatment of opioid-dependent HIV-infected patients versus referral to an opioid treatment program: A randomized trial
Type: Journal Article
Year: 2010
Publication Place: United States
Abstract: BACKGROUND: Opioid dependence is common in HIV clinics. Buprenorphine-naloxone (BUP) is an effective treatment of opioid dependence that may be used in routine medical settings. OBJECTIVE: To compare clinic-based treatment with BUP (clinic-based BUP) with case management and referral to an opioid treatment program (referred treatment). DESIGN: Single-center, 12-month randomized trial. Participants and investigators were aware of treatment assignments. (ClinicalTrials.gov registration number: NCT00130819) SETTING: HIV clinic in Baltimore, Maryland. PATIENTS: 93 HIV-infected, opioid-dependent participants who were not receiving opioid agonist therapy and were not dependent on alcohol or benzodiazepines. INTERVENTION: Clinic-based BUP included BUP induction and dose titration, urine drug testing, and individual counseling. Referred treatment included case management and referral to an opioid-treatment program. MEASUREMENTS: Initiation and long-term receipt of opioid agonist therapy, urine drug test results, visit attendance with primary HIV care providers, use of antiretroviral therapy, and changes in HIV RNA levels and CD4 cell counts. RESULTS: The average estimated participation in opioid agonist therapy was 74% (95% CI, 61% to 84%) for clinic-based BUP and 41% (CI, 29% to 53%) for referred treatment (P < 0.001). Positive test results for opioids and cocaine were significantly less frequent in clinic-based BUP than in referred treatment, and study participants receiving clinic-based BUP attended significantly more HIV primary care visits than those receiving referred treatment. Use of antiretroviral therapy and changes in HIV RNA levels and CD4 cell counts did not differ between the 2 groups. LIMITATION: This was a small single-center study, follow-up was only moderate, and the study groups were unbalanced in terms of recent drug injections at baseline. CONCLUSION: Management of HIV-infected, opioid-dependent patients with a clinic-based BUP strategy facilitates access to opioid agonist therapy and improves outcomes of substance abuse treatment. PRIMARY FUNDING SOURCE: Health Resources and Services Administration Special Projects of National Significance program.
Topic(s):
Opioids & Substance Use
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2077
Clinical and community prevention and treatment service for depression: a whole greater than the sum of its parts
Type: Journal Article
Year: 2012
Publication Place: Netherlands
Topic(s):
General Literature
See topic collection
Reference Links:
View the DOI record for Clinical and community prevention and treatment service for depression: a whole greater than the sum of its parts
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View the PubMed citation for Clinical and community prevention and treatment service for depression: a whole greater than the sum of its parts2078
Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentre randomised controlled trial
Type: Journal Article
Year: 2012
Publication Place: England
Abstract: OBJECTIVE: To determine whether mobile phone based monitoring improves asthma control compared with standard paper based monitoring strategies. DESIGN: Multicentre randomised controlled trial with cost effectiveness analysis. SETTING: UK primary care. PARTICIPANTS: 288 adolescents and adults with poorly controlled asthma (asthma control questionnaire (ACQ) score >/= 1.5) from 32 practices. INTERVENTION: Participants were centrally randomised to twice daily recording and mobile phone based transmission of symptoms, drug use, and peak flow with immediate feedback prompting action according to an agreed plan or paper based monitoring. MAIN OUTCOME MEASURES: Changes in scores on asthma control questionnaire and self efficacy (knowledge, attitude, and self efficacy asthma questionnaire (KASE-AQ)) at six months after randomisation. Assessment of outcomes was blinded. Analysis was on an intention to treat basis. RESULTS: There was no significant difference in the change in asthma control or self efficacy between the two groups (ACQ: mean change 0.75 in mobile group v 0.73 in paper group, mean difference in change -0.02 (95% confidence interval -0.23 to 0.19); KASE-AQ score: mean change -4.4 v -2.4, mean difference 2.0 (-0.3 to 4.2)). The numbers of patients who had acute exacerbations, steroid courses, and unscheduled consultations were similar in both groups, with similar healthcare costs. Overall, the mobile phone service was more expensive because of the expenses of telemonitoring. CONCLUSIONS: Mobile technology does not improve asthma control or increase self efficacy compared with paper based monitoring when both groups received clinical care to guidelines standards. The mobile technology was not cost effective. TRIAL REGISTRATION: Clinical Trials NCT00512837.
Topic(s):
HIT & Telehealth
See topic collection