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Opioids & SU
The Literature Collection contains over 10,000 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).
10858 Results
2341
Comparing Patient-Centered Medical Home Implementation in Urban and Rural VHA Clinics: Results From the Patient Aligned Care Team Initiative
Type: Journal Article
Year: 2018
Publication Place: United States
Abstract: Rural Veterans Health Administration (VHA) primary care clinics are smaller, have fewer staff, and serve more rural patients compared with urban VHA primary care clinics. This may lead to different challenges to implementation of the Patient-Centered Medical Home (PCMH) model, the Patient Aligned Care Team, in the VHAs' large integrated health system. In this cross-sectional observational study of 905 VHA primary clinics in the United States and Puerto Rico, we found overall PCMH implementation was greater in rural compared to urban primary care clinics. Urban-rural differences in PCMH implementation may largely be related to clinic organizational factors.
Topic(s):
Healthcare Disparities
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, Medical Home
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2342
Comparing patients' and other stakeholders' preferences for outcomes of integrated care for multimorbidity: a discrete choice experiment in eight European countries
Type: Journal Article
Year: 2020
Topic(s):
Education & Workforce
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, Financing & Sustainability
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, Healthcare Disparities
See topic collection
2343
Comparing perspectives on medication treatment for opioid use disorder between national samples of primary care trainee physicians and attending physicians
Type: Journal Article
Year: 2020
Topic(s):
Education & Workforce
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, Opioids & Substance Use
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2344
Comparing Preventable Hospitalizations Among Veterans With and Without Mental Illnesses Before and After Implementation of PACT
Type: Journal Article
Year: 2018
Publication Place: United States
Abstract: OBJECTIVES: The authors examined whether the rate of preventable hospitalizations among veterans with mental illness changed after implementation of the Department of Veterans Affairs (VA) primary care medical home-Patient Aligned Care Teams (PACT). METHODS: A 12-year retrospective cohort analysis was conducted of data from 9,206,017 veterans seen in 942 VA primary care clinics between October 2003 and March 2015. Preventable hospitalizations were those related to ambulatory care-sensitive conditions (ACSCs), identified with ICD-9 codes. Changes in rates of ACSC-related hospitalizations were compared between patients with and without mental illness in two age groups (/=65). Patients with mental illness diagnoses were grouped as follows: depression, posttraumatic stress disorder, anxiety, substance use disorder, and serious mental illness. Interrupted time-series analysis was used to model long-term trends and detect deviations after PACT implementation. RESULTS: There was an overall increase in mental illness diagnoses across both age groups. Among older veterans (>/=65) with any mental illness, the rate (per 1,000 patients) of ACSC-related hospitalizations was five fewer in the post-PACT period, compared with the pre-PACT period. Among younger veterans (<65), there was a slight increase in ACSC-related hospitalizations in years 3-5 post-PACT if they had any mental illness (.6 per 1,000 patients), depression (.3), anxiety (1.4), or a substance use disorder (.6). CONCLUSIONS: In this retrospective, observational study examining large systemwide changes in clinical practice, mental illness was more likely to be diagnosed after PACT implementation, compared with before, and results suggested a benefit of PACT implementation among older veterans in terms of a reduction in ACSC-related hospitalizations.
Topic(s):
Medical Home
See topic collection
2345
Comparing Preventable Hospitalizations Among Veterans With and Without Mental Illnesses Before and After Implementation of PACT
Type: Journal Article
Year: 2018
Publication Place: United States
Abstract: OBJECTIVES: The authors examined whether the rate of preventable hospitalizations among veterans with mental illness changed after implementation of the Department of Veterans Affairs (VA) primary care medical home-Patient Aligned Care Teams (PACT). METHODS: A 12-year retrospective cohort analysis was conducted of data from 9,206,017 veterans seen in 942 VA primary care clinics between October 2003 and March 2015. Preventable hospitalizations were those related to ambulatory care-sensitive conditions (ACSCs), identified with ICD-9 codes. Changes in rates of ACSC-related hospitalizations were compared between patients with and without mental illness in two age groups (/=65). Patients with mental illness diagnoses were grouped as follows: depression, posttraumatic stress disorder, anxiety, substance use disorder, and serious mental illness. Interrupted time-series analysis was used to model long-term trends and detect deviations after PACT implementation. RESULTS: There was an overall increase in mental illness diagnoses across both age groups. Among older veterans (>/=65) with any mental illness, the rate (per 1,000 patients) of ACSC-related hospitalizations was five fewer in the post-PACT period, compared with the pre-PACT period. Among younger veterans (<65), there was a slight increase in ACSC-related hospitalizations in years 3-5 post-PACT if they had any mental illness (.6 per 1,000 patients), depression (.3), anxiety (1.4), or a substance use disorder (.6). CONCLUSIONS: In this retrospective, observational study examining large systemwide changes in clinical practice, mental illness was more likely to be diagnosed after PACT implementation, compared with before, and results suggested a benefit of PACT implementation among older veterans in terms of a reduction in ACSC-related hospitalizations.
Topic(s):
Medical Home
See topic collection
2346
Comparing primary care pediatricians' perceptions of clinics with and without integrated behavioral health
Type: Journal Article
Year: 2018
Publication Place: England
Abstract: OBJECTIVE: The purpose of this study was to investigate primary care pediatrician (PCP) perceptions of prevalence of, time spent in, and satisfaction with behavioral health services across clinics with and without on-site behavioral health providers (BHPs). METHODS: A cross-sectional survey design was used to examine satisfaction across sites. Data were collected on PCP perceptions of behavioral health services among 60 pediatricians within two academic medical systems. RESULTS: PCPs perceived behavioral health issues are prevalent and a time-consuming aspect of medical appointments and preferred to have on-site BHPs over off-site referral sources. Compared to sites without an on-site BHP, sites with on-site BHPs were more satisfied with behavioral health service availability and resources, felt they spent more time addressing medical concerns, and spent less time providing anticipatory guidance. DISCUSSION: Study limitations included questions surrounding the validity of survey items to accurately assess PCP perceptions, lack of rigorous experimental design, and reliance on self-report data.
Topic(s):
General Literature
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Reference Links: 
View the DOI record for Comparing primary care pediatricians' perceptions of clinics with and without integrated behavioral health
View DOI Record
View the PubMed citation for Comparing primary care pediatricians' perceptions of clinics with and without integrated behavioral health2348
Comparing telemedicine to in-person buprenorphine treatment in U.S. veterans with opioid use disorder
Type: Journal Article
Year: 2022
Abstract:
BACKGROUND: Telemedicine-delivered buprenorphine (tele-buprenorphine) can potentially increase access to buprenorphine for patients with opioid use disorder (OUD), especially during the COVID-19 pandemic, but we know little about use in clinical care. METHODS: This study was a retrospective national cohort study of veterans diagnosed with opioid use disorder (OUD) receiving buprenorphine treatment from the Veterans Health Administration (VHA) in fiscal years 2012-2019. The study examined trends in use of tele-buprenorphine and compared demographic and clinical characteristics in patients who received tele-buprenorphine versus those who received in-person treatment only. RESULTS: Utilization of tele-buprenorphine increased from 2.29% of buprenorphine patients in FY2012 (n = 187) to 7.96% (n = 1352) in FY2019 in VHA veterans nationally. Compared to patients receiving only in-person care, tele-buprenorphine patients were less likely to be male (AOR = 0.85, 95% CI: 0.73-0.98) or Black (AOR = 0.54, 95% CI: 0.45-0.65). Tele-buprenorphine patients were more likely to be treated in community-based outpatient clinics rather than large medical centers (AOR = 2.91, 95% CI: 2.67-3.17) and to live in rural areas (AOR = 2.12, 95% CI:1.92-2.35). The median days supplied of buprenorphine treatment was 722 (interquartile range: 322-1459) among the tele-buprenorphine patients compared to 295 (interquartile range: 67-854) among patients who received treatment in-person. CONCLUSIONS: Use of telemedicine to deliver buprenorphine treatment in VHA increased 3.5-fold between 2012 and 2019, though overall use remained low prior to COVID-19. Tele-buprenorphine is a promising modality especially when treatment access is limited. However, we must continue to understand how practitioners and patient are using telemedicine and how these patients' outcomes compare to those using in-person care.
Topic(s):
Financing & Sustainability
See topic collection
, Healthcare Disparities
See topic collection
, HIT & Telehealth
See topic collection
, Opioids & Substance Use
See topic collection
Reference Links:
View the DOI record for Comparing telemedicine to in-person buprenorphine treatment in U.S. veterans with opioid use disorder
View DOI Record
View the PubMed citation for Comparing telemedicine to in-person buprenorphine treatment in U.S. veterans with opioid use disorder2349
Comparing the feasibility of four web-based recruitment strategies to evaluate the treatment preferences of rural and urban adults who misuse non-prescribed opioids
Type: Journal Article
Year: 2021
Publication Place: United States
Topic(s):
Education & Workforce
See topic collection
, Healthcare Disparities
See topic collection
, HIT & Telehealth
See topic collection
, Opioids & Substance Use
See topic collection
2351
Comparison between buprenorphine provider availability and opioid deaths among US counties
Type: Journal Article
Year: 2018
Publication Place: United States
Topic(s):
Education & Workforce
See topic collection
, Healthcare Disparities
See topic collection
, Opioids & Substance Use
See topic collection
Reference Links:
View the DOI record for Comparison between buprenorphine provider availability and opioid deaths among US counties
View DOI Record
View the PubMed citation for Comparison between buprenorphine provider availability and opioid deaths among US counties2352
Comparison Between Urinalysis Results and Self-Reported Heroin Use Among Patients Undergoing Methadone Maintenance Treatment in China
Type: Journal Article
Year: 2017
Publication Place: England
Abstract: BACKGROUND: The validity and concordance of two main measures of drug use behavior, self-report and urinalysis, has long been discussed. More understanding is needed about the underlying factors associated with discordance between these two methods. OBJECTIVES: Describe the pattern and associated factors of discordance between self-reported heroin use and the urinalysis results of opiate use among methadone maintenance therapy (MMT) patients in China. METHODS: A total of 2,448 MMT patients from 68 clinics in five provinces of China participated in a survey, which collected information on demographics, drug use and MMT-related factors, depressive symptoms, and drug avoidance self-efficacy. The most recent urine morphine test result was obtained from medical records and compared with self-reported heroin use. Participants who had urinalysis within 14 days of the survey were included in the analysis. RESULTS: Among the 1,092 participants, 70 (6.4%) self-reported heroin use and 195 (17.9%) had positive urinalysis results. The over-reporters group had significantly higher education, and the under-reporters had significantly higher level of drug-avoidance self-efficacy and lower level of depressive symptoms. Among the participants who either self-reported heroin use or had positive urinalysis results, being young, having higher education, and having lower level of depressive symptoms were associated with discordance between self-reports and urinalysis results. CONCLUSION: The combination of both measures in assessing drug use behavior seems necessary. The validity of self-report should be considered differently based on demographic and psychosocial characteristics.
Topic(s):
Opioids & Substance Use
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2355
Comparison of Biological Screening and Diagnostic Indicators to Detect In Utero Opiate and Cocaine Exposure Among Mother-Infant Dyads
Type: Journal Article
Year: 2017
Publication Place: United States
Abstract: BACKGROUND: Opioid and cocaine antenatal substance use can result in significant obstetric and pediatric health implications. Accurate detection of in utero-exposed neonates can improve patient care and health outcomes. Therefore, the effectiveness of mother-infant biological and diagnostic indicators collected at labor and delivery to provide accurate detection of in utero opiate and cocaine exposure was assessed. METHODS: A retrospective medical chart review included 335 mother-infant dyads exposed to antenatal substances who were delivered between January 2009 and March 2014. Mother-infant dyads were a subset of a larger retrospective cohort of 560 substance-using mothers, who had a valid meconium drug screen (MDS) and anesthesia before delivery. Alternative biological and diagnostic indicators of maternal urine drug screens (UDS), maternal substance use International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes, and neonatal exposure diagnostic ICD-9-CM codes were compared against MDS. Data were analyzed using classification accuracy measures. RESULTS: Compared with MDS, maternal UDS had the highest sensitivity [0.52, 95% confidence interval (CI), 0.39-0.65] and specificity (0.88, 95% CI, 0.79-0.97) to detect intrauterine opiate exposure. Maternal substance use diagnosis had the highest sensitivity (0.39, 95% CI, 0.16-0.61) and maternal UDS had the highest specificity (1.00, 95% CI, 0.99-1.00) to detect intrauterine cocaine exposure. Cocaine exposure had significantly higher accuracy scores across detection methods compared with opiate exposure. CONCLUSIONS: Alternative indicators collected at delivery were ineffective at identifying in utero substance exposure, especially neonatal-exposed ICD-9-CM codes. Low sensitivity scores indicate that many exposed neonates could be misdiagnosed or left untreated. Accurate antenatal exposure identification at delivery is an important form of tertiary assessment that warrants the development of improved screening methodology and standardization of hospital biological drug testing.
Topic(s):
Healthcare Disparities
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, Opioids & Substance Use
See topic collection
2357
Comparison of buprenorphine treatment for opioid dependence in 3 settings
Type: Journal Article
Year: 2012
Publication Place: United States
Abstract: Although use of buprenorphine in the treatment of opioid dependence is expected to continue to increase, little is known about the optimal setting for providing the medical and psychosocial care required with buprenorphine pharmacotherapy. OBJECTIVE: This study compared buprenorphine therapy delivered in 3 distinct treatment settings: an opioid treatment program (OTP) offering individual counseling, a group counseling program utilizing the manualized Matrix Model (MMM) of cognitive-behavioral treatment, and a private clinic setting mirroring standard medical management for buprenorphine treatment provided specifically at a psychiatrist's private practice (primary care setting). METHOD: Participants were inducted on buprenorphine and provided with treatment over a 52-week study duration. All participants were scheduled for weekly treatment visits for the first 6 study weeks and 2 sites reduced treatment to monthly visits for dispensing of medication and psychosocial counseling. Outcomes include opioid use, participant retention in treatment, and treatment participation. RESULTS: Participants presenting for treatment at the sites differed only by race/ethnicity and opioid use did not differ by site. Retention differed by treatment site, with the number of participants who stayed in the study until the end of 20 weeks significantly associated with treatment site. The mean number of minutes spent in each individual counseling session also differed by site. Although no difference in opioid use by treatment site was found, results document a significant association between opioid use and buprenorphine dose. DISCUSSION: These results show some differences by treatment site, although the similarity and relative ease in which the sites were able to recruit participants for treatment with buprenorphine, and minor implementation problems reported suggests the feasibility of treatment with buprenorphine across various treatment settings. CONCLUSION: Similar rates of continued opioid use across study sites and few qualitative reports of problems indicates that treatment with buprenorphine and associated psychosocial counseling are safe and relatively easy to implement in a variety of treatment settings.
Topic(s):
Opioids & Substance Use
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Reference Links:
View the DOI record for Comparison of buprenorphine treatment for opioid dependence in 3 settings
View DOI Record
View the PubMed citation for Comparison of buprenorphine treatment for opioid dependence in 3 settings2358
Comparison of characteristics of opioid-using pregnant women in rural and urban settings
Type: Journal Article
Year: 2008
Publication Place: United States
Abstract: Historically, research on opioid use during pregnancy has occurred in urban settings and it is unclear how urban and rural populations compare. We examined socio-demographic and other variables in opioid-using pregnant women seeking treatment and screened for participation in a multi-site randomized controlled trial. Women screened in rural Burlington, Vermont (n = 54), were compared to those screened in urban Baltimore, Maryland (n = 305). Rural opioid-using pregnant women appear to have some characteristics associated with better treatment outcomes (e.g., less severe drug use, greater employment). However, they may face additional barriers in accessing treatment (e.g., greater distance from treatment clinic).
Topic(s):
Opioids & Substance Use
See topic collection
, Healthcare Disparities
See topic collection
Reference Links:
View the DOI record for Comparison of characteristics of opioid-using pregnant women in rural and urban settings
View DOI Record
View the PubMed citation for Comparison of characteristics of opioid-using pregnant women in rural and urban settings2359
Comparison of Collaborative Care and Colocation Treatment for Patients With Clinically Significant Depression Symptoms in Primary Care
Type: Journal Article
Year: 2018
Publication Place: United States
Abstract: OBJECTIVE: The study compared clinical outcomes of depression treatment in primary care with a colocation model versus a collaborative care model (CoCM). METHODS: Patients (N=240) with Patient Health Questionnaire-9 (PHQ-9) scores of >/=10 treated for clinically significant depression symptoms in primary care sites implementing the CoCM or a colocation model were compared. PHQ-9 scores were collected at baseline and 12 weeks. RESULTS: From baseline to follow-up, reductions in PHQ-9 scores were 33% for the CoCM sites and 14% for the colocation sites, with an unadjusted mean difference in scores of 2.81 (p=.001). CONCLUSIONS: More patients treated in sites that used the CoCM experienced a significantly greater reduction in depression symptoms, compared with patients in sites with the colocation model. As greater adoption of integration models in primary care occurs, it will be important to consider potential implications of these results for promoting adoption of CoCM elements. Further replication of these findings is warranted.
Topic(s):
Healthcare Disparities
See topic collection
2360
Comparison of demographic and clinical characteristics between opioid-dependent individuals admitted to a community-based treatment setting and those enrolled in a research-based treatment setting
Type: Journal Article
Year: 2007
Publication Place: United States
Abstract: Despite the significant developments in pharmacotherapy and behavioral treatments for addiction, the dissemination of new treatment methods into the community has been slow. It has been pointed out that treatments developed in research settings may be impractical in community treatment settings, which might help explain the transition lag. Screening and recruitment of participants for research studies might partially explain this, as there is evidence that substance-abusing individuals who participate in clinical research are different on a number of measures from treatment seekers. However, no study has directly compared treatment seekers with research participants drawn from similar populations using prospective methods. This study compared the demographic characteristics, drug use and psychosocial problem severity levels, and personality traits of opioid-dependent individuals seeking help in a community setting (n = 502) with those of opioid-dependent individuals in a primarily research-based drug abuse treatment setting (n = 459); both settings offered a similar set of treatment services (opioid agonist medication and counseling). Although the overall findings revealed numerous similarities between the groups, differences were also observed. Most notably, there were significantly fewer women in the research sample than in the community-based treatment sample. Other differences included a modest but statistically significant increase in psychosocial problem severity levels in the community-based treatment sample and higher drug use problem severity levels in the research sample. Interestingly, many of these differences were strongest in women as compared with men.
Topic(s):
Opioids & Substance Use
See topic collection