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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).
11202 Results
2462
Complexity in practice: understanding primary care as a complex adaptive system
Type: Journal Article
Year: 2010
Publication Place: England
Abstract: BACKGROUND: This series summarises new empirical research on quality improvement through case studies of the implementation of clinical governance arrangements in two primary care organisations (PCOs). OBJECTIVE: To describe a new socio-technical model for effective quality improvement and clinical governance. METHOD: The research strategy included a literature review, survey, in-depth interviews, participant observation and purposively sampled case studies, conducted within a social constructionist ontological perspective. This approach contextualises the origins of clinical governance and the trend towards collaborative partnerships and federated models of practice, enabled by developments in primary care informatics. RESULTS: People operating within multidisciplinary networks communicate with each other to determine actions that govern their most relevant concerns. Quality improvement in two PCOs is enabled through social interactions between individuals and groups with complex relationships; and information technology (IT) systems which make some aspects of the quality of care explicit. CONCLUSIONS: The results are real-world exemplars of the emergent properties of complex adaptive systems. Improving clinical governance in primary care requires both complex social interactions and underpinning informatics. The socio-technical lessons learned from this research should inform future management approaches.
Topic(s):
HIT & Telehealth
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Reference Links: View the PubMed citation for Complexity in practice: understanding primary care as a complex adaptive system
2464
Compliance with opioid treatment guidelines for chronic non-cancer pain (CNCP) in primary care at a Veterans Affairs Medical Center (VAMC)
Type: Journal Article
Year: 2013
Publication Place: England
Abstract: OBJECTIVE: The primary objective of this study was to measure prescribing compliance with the Veterans Affairs/Department of Defense treatment guidelines for chronic non-cancer pain (CNCP) in the primary care setting. We also determined the proportion of subjects who demonstrated aberrant drug-related behaviors (ADRBs) and the patient characteristics associated with them. DESIGN: This is a retrospective chart review. SETTING: Primary care setting in Veterans Affairs Medical Center. SUBJECTS: All patients with CNCP between the ages of 18 and 87 years who received opioid prescriptions for 3 or more consecutive months during a 1-year period (July 2009 to August 2010) were eligible for inclusion. A random sample of 800 patients was selected using pharmacy prescription database. Chi-square test was utilized to analyze associations between ADRB and patient characteristics. RESULTS: About half the patients in our sample had a signed opioid pain care agreement (OPCA), and at least one urine drug test (UDT) was obtained. UDT was positive for an illicit drug/unreported opioid in 19.5% of the patients, and negative for the prescribed drug in 25.2% of the sample. About 10% of the sample population had morphine equivalent dose equal to or greater than 200 mg/day. ADRBs were identified in 22.9% of the patients. Younger age, psychiatric comorbidities, history of substance abuse, and high opioid dose were associated with high risk of ADRB, but the presence of OPCA lowered the risk of ADRB. CONCLUSION: This article studied the prescribing practices of opioids in a primary care setting and can be used to enhance provider education regarding chronic pain guidelines.
Topic(s):
Opioids & Substance Use
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2465
Comprehending care in a medical home: A usual source of care and patient perceptions about healthcare communication
Type: Journal Article
Year: 2008
Publication Place: United States
Abstract: OBJECTIVE: To examine whether having a usual source of care (USC) is associated with positive patient perceptions of health care communication and to identify demographic factors among patients with a USC that are independently associated with differing reports of how patients perceive their involvement in health care decision making. METHODS: Cross-sectional analyses of nationally representative data from the 2002 Medical Expenditure Panel Survey. Among adults with a health care visit in the past year (n = approximately 16,700), we measured independent associations between having a USC and patient perceptions of health care communication. Second, among respondents with a USC (n = approximately 18,000), we assessed the independent association between various demographic factors and indicators of patients' perceptions of their autonomy in making health care decisions. RESULTS: Approximately 78% of adults in the United States reported having a USC. Those with a USC were more likely to report that providers always listened to them, always explained things clearly, always showed respect, and always spent enough time with them. Patients who perceived higher levels of decision-making autonomy were non-Hispanic, had health insurance coverage, lived in rural areas, and had higher incomes. CONCLUSIONS: Patients with a USC were more likely to perceive positive health care interactions. Certain demographic factors among the subgroups of Medical Expenditure Panel Survey respondents with a USC were associated with patient perceptions of greater decision-making autonomy. Efforts to ensure universal access to a USC must be partnered with broader awareness and training of USC providers to engage patients from various demographic backgrounds equally when making health care decisions at the point of care.
Topic(s):
Medical Home
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Reference Links:
View the DOI record for Comprehending care in a medical home: A usual source of care and patient perceptions about healthcare communication
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View the PubMed citation for Comprehending care in a medical home: A usual source of care and patient perceptions about healthcare communication2466
Comprehensibility and readability of patient self-administered opioid assessment screening tools
Type: Journal Article
Year: 2007
Publication Place: United States
Abstract: OBJECTIVE: The aims of this study were to evaluate the cognitive complexity and reading demands of patient self-administered Opioid Assessment Screening Tools (OASTs) for use in adults with nonmalignant pain. METHODS: Using comprehensive search strategies, we identified english-language OASTs with established validity and reliability for inclusion in our study. Cognitive complexity of individual OAST statements or questions were assessed using three techniques (number of items, number of words, and linguistic problems), whereas readability was measured using the Flesch-Kinkaid formula. RESULTS: Four (n=4) were identified and included in our review: Current Opioid Misuse Measure (COMM), Pain Medication Questionnaire (PMQ), Screener and Opioid Assessment for Patient with Pain, and Screening Tool for Addiction Risk (STAR). Number of total OAST statements or questions ranged from a low of 14 (STAR) to a high of 26 (PMQ), whereas number of words (length) per statement or question averaged from a low of 10.2 +/- 1.1 (STAR) to a high of 15.9 +/- 3.8 (PMQ). The STAR (1.3 +/- 1.1) had the fewest number of linguistic problems per statement or question, whereas the PMQ (3.0 +/- 1.4) had the most linguistic problems per statement or question. Although, readability of OASTs ranged from approximately sixth (STAR) to eighth (COMM, PMQ) grade, there was notable variation in readability across individual statements or questions. CONCLUSIONS: Our study demonstrates that formatting characteristics, including linguistic problems, and high readability of several OAST statements or questions may hinder many patients' ability to accurately complete and comprehend OASTs independently.
Topic(s):
Opioids & Substance Use
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, Measures
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Reference Links: View the PubMed citation for Comprehensibility and readability of patient self-administered opioid assessment screening tools
2467
Comprehensive and compassionate responses for opioid use disorder among pregnant and parenting women
Type: Journal Article
Year: 2021
Publication Place: England
Abstract:
Pregnant and parenting women with opioid use disorder face multiple challenges to recovery. Trauma histories, poverty, stigma and discrimination, and lack of access to treatment intersect to marginalise this population. It is important that pregnant and parenting women with opioid use disorder receive comprehensive care to improve their health, the health of their child(ren), and prevent the intergenerational transmission of opioid and other substance use disorders. For nearly 50 years the Maternal Addiction Treatment, Education, and Research program has provided an evolving and expanding range of comprehensive services for treating opioid and other substance use disorders in this population. In this review the rationale for, and processes by which, key components of a comprehensive approach are discussed. These components include patient navigation for access to care, low-barrier medications for opioid use disorder, effective trauma-responsive therapy, prenatal and well-child healthcare, and other support services that make it possible for pregnant and parenting women to engage in treatment and improve the health of the entire family. Additionally, a method for supporting staff to build resilience and reduce fatigue and burnout is discussed. These components comprise an effective model of care for pregnant and parenting women with opioid and other substance use disorders.
Topic(s):
Education & Workforce
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, Healthcare Disparities
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, Opioids & Substance Use
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Reference Links:
View the DOI record for Comprehensive and compassionate responses for opioid use disorder among pregnant and parenting women
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View the PubMed citation for Comprehensive and compassionate responses for opioid use disorder among pregnant and parenting women2473
Comprehensiveness and continuity of care and the inseparability of mental and behavioral health from the patient-centered medical home
Type: Journal Article
Year: 2010
Publication Place: United States
Topic(s):
Medical Home
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2475
Computer-aided CBT self-help for anxiety and depressive disorders: experience of a London clinic and future directions
Type: Journal Article
Year: 2004
Publication Place: United States
Topic(s):
HIT & Telehealth
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Reference Links:
View the DOI record for Computer-aided CBT self-help for anxiety and depressive disorders: experience of a London clinic and future directions
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View the PubMed citation for Computer-aided CBT self-help for anxiety and depressive disorders: experience of a London clinic and future directions2476
Computer-aided psychological treatments: evolving issues
Type: Journal Article
Year: 2009
Publication Place: United States
Abstract: Evidence is growing that several computer-aided psychotherapy (CP) systems can effectively improve a range of common mental health problems. Most clients find CP acceptable because of its convenience, confidentiality, and reduction of stigma. CP can be accessed in a clinic, but recently clients have used CP especially on the Internet at home, with brief support on a telephone helpline and/or by email. Brief and efficient screening and support greatly reduce attrition. CP's efficacy, and encouragement of its dissemination and implementation by some national funding bodies and governmental agencies, has led to its spread as a regular care option and is increasing access to psychological therapies in some countries. Transfer of this new approach from use in tight research studies to use as an integrated part of everyday care under widely varying conditions generates teething problems that are being managed in diverse ways across different centers. Anonymized Internet audit of CP outcomes facilitates effective care and clinical governance. This review examines the current state of the art as well as the science and broad applications of CP.
Topic(s):
HIT & Telehealth
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Reference Links: View the PubMed citation for Computer-aided psychological treatments: evolving issues
2477
Computer-assisted cognitive-behavioral therapy for adolescent depression in primary care clinics in Santiago, Chile (YPSA-M): study protocol for a randomized controlled trial
Type: Journal Article
Year: 2014
Publication Place: England
Abstract: BACKGROUND: Depression is a common and disabling condition. In Chile, assistance is guaranteed by law through a national program for depression in primary care services, and there is evidence of effective treatment for depressed women. However, there is a shortage of evidence-based treatments for depression in adolescents. The incorporation of technology to expand therapeutic options is becoming more common. This proposal aims to compare the efficacy of therapy that enhances traditional face-to-face cognitive-behavioral therapy (CBT) with a computer-based program versus usual care to treat depression in adolescents in primary care clinics in Santiago, Chile. METHODS AND DESIGN: This is a two-arm, single-blind, randomized controlled trial with a target enrollment of 216 depressed adolescents between 15 and 19 years of age, attending four primary care clinics in Santiago, Chile. In the active arm, depressed adolescents will receive eight sessions of computer-assisted CBT, led by trained psychologists on a weekly basis. In the control arm, depressed adolescents will receive treatment as usual from the primary care centers. Mean depression scores and indicators of dysfunctional thoughts, problem-solving strategies, and health-related quality of life will be measured at baseline and four and six months after randomization. DISCUSSION: As far as we know, this is the first randomized controlled trial of a computer-assisted CBT intervention for depressed adolescents in a Latin American country. TRIAL REGISTRATION: Clinical Trials: NCT01862913.
Topic(s):
HIT & Telehealth
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, Healthcare Disparities
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2478
Computer-assisted delivery of cognitive behavioral therapy for anxiety disorders in primary-care settings
Type: Journal Article
Year: 2009
Publication Place: United States
Topic(s):
HIT & Telehealth
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Reference Links:
View the DOI record for Computer-assisted delivery of cognitive behavioral therapy for anxiety disorders in primary-care settings
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View the PubMed citation for Computer-assisted delivery of cognitive behavioral therapy for anxiety disorders in primary-care settings2480
Computer-facilitated substance use screening and brief advice for teens in primary care: an international trial
Type: Journal Article
Year: 2012
Publication Place: United States
Abstract: OBJECTIVE: Primary care providers need effective strategies for substance use screening and brief counseling of adolescents. We examined the effects of a new computer-facilitated screening and provider brief advice (cSBA) system. METHODS: We used a quasi-experimental, asynchronous study design in which each site served as its own control. From 2005 to 2008, 12- to 18-year-olds arriving for routine care at 9 medical offices in New England (n = 2096, 58% females) and 10 in Prague, Czech Republic (n = 589, 47% females) were recruited. Patients completed measurements only during the initial treatment-as-usual study phase. We then conducted 1-hour provider training, and initiated the cSBA phase. Before seeing the provider, all cSBA participants completed a computerized screen, and then viewed screening results, scientific information, and true-life stories illustrating substance use harms. Providers received screening results and "talking points" designed to prompt 2 to 3 minutes of brief advice. We examined alcohol and cannabis use, initiation, and cessation rates over the past 90 days at 3-month follow-up, and over the past 12 months at 12-month follow-up. RESULTS: Compared with treatment as usual, cSBA patients reported less alcohol use at follow-up in New England (3-month rates 15.5% vs 22.9%, adjusted relative risk ratio [aRRR] = 0.54, 95% confidence interval 0.38-0.77; 12-month rates 29.3% vs 37.5%, aRRR = 0.73, 0.57-0.92), and less cannabis use in Prague (3-month rates 5.5% vs 9.8%, aRRR = 0.37, 0.17-0.77; 12-month rates 17.0% vs 28.7%, aRRR = 0.47, 0.32-0.71). CONCLUSIONS: Computer-facilitated screening and provider brief advice appears promising for reducing substance use among adolescent primary care patients.
Topic(s):
HIT & Telehealth
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Reference Links:
View the DOI record for Computer-facilitated substance use screening and brief advice for teens in primary care: an international trial
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View the PubMed citation for Computer-facilitated substance use screening and brief advice for teens in primary care: an international trial