Literature Collection

Family medicine departments see elevating equity, diversity, and inclusion (EDI)* as socially necessary and as powerful in achieving core missions. The importance and timeliness of this longstanding issue in medicine are magnified by the COVID-19 pandemic with its disproportionate effect on communities of color and by civil unrest focused on racial justice. EDI plays out in three pillars: (1) care delivery and health, (2) workforce recruitment and retention, and (3) learner recruitment and training. People are at very different places with EDI work with regard to knowledge, experience, comfort and confidence. This is a wide-ranging developmental challenge, not a narrow, technical, or quick fix. The Immediate Goal: To make a strong start in taking all faculty and staff on a participatory journey that brings changes in everything they do, using inclusive means to this inclusive end. Initial Achievements: An inclusive process that resulted in (1) a shared intellectual framework-definitions with "north star" goals across the three pillars of EDI action, (2) shared acceptance of need for change, (3) top growth areas with actions to take, and (4) harnessing the energy for action-many volunteers, a visible leader, and charge. Ongoing Action: Application of an equity lens to department relationships, specific incidents, tools and education, policy review, and measures development. Invitation to Further Conversation Among Departments: EDI work can quickly create a shared intellectual framework and broadly engage people in taking a department down its developmental path. Operating principles for undertaking such work are offered for conversation among departments.

Numerous barriers exist for patients attempting to access treatment for opioid-use disorder and/or naloxone, with geographical, racial, and age-related differences exacerbating these hardships.

Opioid use disorders (OUDs) are receiving significant attention in the U.S. as a public health crisis. Access to treatment for OUDs is essential and was expected to improve following implementation of the federal parity law and the Affordable Care Act. This study examines changes in coverage and management of treatments for OUDs (opioid treatment programs (OTPs) as a covered service benefit, buprenorphine as a pharmacy benefit) before, during, and after parity and ACA implementation. Data are from three rounds of a nationally representative survey conducted with commercial health plans regarding behavioral health services in benefit years 2003, 2010, and 2014. Data were weighted to be representative of health plans' commercial products in the continental United States (2003 weighted N = 7,469, 83% response rate; 2010 N = 8,431, 89% response rate; and 2014 N = 6,974, 80% response rate). Results showed treatment for OUDs was covered by nearly all health plan products in each year of the survey, but the types and patterns varied by year. Prior authorization requirements for OTPs have decreased over time. Despite the promise of expanded access to OUD treatment suggested by parity and the ACA, improved health plan coverage for treatment of OUDs, while essential, is not sufficient to address the opioid crisis.