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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
2801
Definitive urine drug testing in office-based opioid treatment: a literature review
Type: Journal Article
Year: 2018
Publication Place: England
Abstract: Individuals who receive buprenorphine treatment for opioid use disorder in office-based settings may be at risk for, or have a history of, polysubstance use. Urine drug testing is an important clinical tool for monitoring medication adherence and patient stability; and screening for illicit drug use and dangerous drug-drug interactions. This article is intended to educate practitioners in office-based opioid treatment settings on selecting appropriate substances for a definitive drug testing panel that are known to be used concurrently, sequentially, or in combination with buprenorphine for opioid use disorder. It is also intended to educate such practitioners on selecting appropriate testing technology to reduce risks to the health and safety of patients prescribed buprenorphine for opioid use disorder. In developing this article, the author conducted a search from May 2018 through December 2017 of peer-reviewed and government-supported articles in electronic databases. The literature showed that several common substances are often abused in conjunction with certain other substances, increasing the risk of serious adverse events, including death. Whether used on their own, concurrently, sequentially, or in combination, substances of abuse carry significant health risks. Definitive urine drug testing, given its high specificity and sensitivity, can accurately identify the use of specific prescription medications and illicit substances that, especially when taken with buprenorphine or other substances, may cause harm to a patient. When testing for buprenorphine and other opioids; sedatives, hypnotics, and anxiolytics; cocaine; amphetamines; and PCP and other club drugs, providers in office-based opioid treatment settings are strongly advised to use definitive urine drug tests as the primary testing methodology. In addition, practitioners must be able to identify all other substances that a patient may be consuming, taking into consideration the patient's historical and current drugs of choice, given that concurrent use with buprenorphine or other substances may cause serious adverse events. This article highlights the pressing market demand for comprehensive, definitive urine drug testing at a more reasonable cost.
Topic(s):
Opioids & Substance Use
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Reference Links: 
View the DOI record for Definitive urine drug testing in office-based opioid treatment: a literature review
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View the PubMed citation for Definitive urine drug testing in office-based opioid treatment: a literature review2803
Delayed villous maturation in term placentas exposed to opioid maintenance therapy: a retrospective cohort study
Type: Journal Article
Year: 2017
Publication Place: United States
Topic(s):
Opioids & Substance Use
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, Healthcare Disparities
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Reference Links:
View the DOI record for Delayed villous maturation in term placentas exposed to opioid maintenance therapy: a retrospective cohort study
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View the PubMed citation for Delayed villous maturation in term placentas exposed to opioid maintenance therapy: a retrospective cohort study2804
Delineating responsibility: Primary care provider perspective
Type: Journal Article
Year: 2015
Publication Place: United States
Topic(s):
Education & Workforce
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Reference Links:
View the DOI record for Delineating responsibility: Primary care provider perspective
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View the PubMed citation for Delineating responsibility: Primary care provider perspective2805
Delivering On Accountable Care: Lessons From A Behavioral Health Program To Improve Access And Outcomes
Type: Journal Article
Year: 2016
Publication Place: United States
Abstract: Patients with behavioral health disorders often have worse health outcomes and have higher health care utilization than patients with medical diseases alone. As such, people with behavioral health conditions are important populations for accountable care organizations (ACOs) seeking to improve the efficiency of their delivery systems. However, ACOs have historically faced numerous barriers in implementing behavioral health population-based programs, including acquiring reimbursement, recruiting providers, and integrating new services. We developed an evidence-based, all-payer collaborative care program called Behavioral Health Associates (BHA), operated as part of UCLA Health, an integrated academic medical center. Building BHA required several innovations, which included using our enterprise electronic medical record for behavioral health referrals and documentation; registering BHA providers with insurance plans' mental health carve-out products; and embedding BHA providers in primary care practices throughout the UCLA Health system. Since 2012 BHA has more than tripled the number of patients receiving behavioral health services through UCLA Health. After receiving BHA treatment, patients had a 13 percent reduction in emergency department use. Our efforts can serve as a model for other ACOs seeking to integrate behavioral health care into routine practice.
Topic(s):
Education & Workforce
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, Financing & Sustainability
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, HIT & Telehealth
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, Healthcare Disparities
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Reference Links:
View the DOI record for Delivering On Accountable Care: Lessons From A Behavioral Health Program To Improve Access And Outcomes
View DOI Record
View the PubMed citation for Delivering On Accountable Care: Lessons From A Behavioral Health Program To Improve Access And Outcomes2806
Delivering opioid maintenance treatment in rural and remote settings
Type: Journal Article
Year: 2015
Publication Place: Australia
Topic(s):
Opioids & Substance Use
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, Healthcare Disparities
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, Education & Workforce
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, Financing & Sustainability
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Reference Links:
View the DOI record for Delivering opioid maintenance treatment in rural and remote settings
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View the PubMed citation for Delivering opioid maintenance treatment in rural and remote settings2807
Delivering perinatal depression care in a rural obstetric setting: a mixed methods study of feasibility, acceptability and effectiveness
Type: Journal Article
Year: 2018
Publication Place: England
Abstract:
OBJECTIVES: Universal screening for depression during pregnancy and postpartum is recommended, yet mental health treatment and follow-up rates among screen-positive women in rural settings are low. We studied the feasibility, acceptability and effectiveness of perinatal depression treatment integrated into a rural obstetric setting. METHODS: We conducted an open treatment study of a screening and intervention program modified from the Depression Attention for Women Now (DAWN) Collaborative Care model in a rural obstetric clinic. Depression screen-positive pregnant and postpartum women received problem-solving therapy (PST) with or without antidepressants. A care manager coordinated communication between patient, obstetrician and psychiatric consultant. We measured change in the Patient Health Questionnaire 9 (PHQ-9) score. We used surveys and focus groups to measure patient and provider satisfaction and analyzed focus groups using qualitative analysis. RESULTS: The intervention was well accepted by providers and patients, based on survey and focus group data. Feasibility was also evidenced by recruitment (87.1%) and retention (92.6%) rates and depression outcomes (64% with >50% improvement in PHQ 9) which were comparable to clinical trials in similar urban populations. Conclusions for practice: DAWN Collaborative Care modified for treatment of perinatal depression in a rural obstetric setting is feasible and acceptable. Behavioral health services integrated into rural obstetric settings could improve care for perinatal depression.
Topic(s):
Education & Workforce
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, Healthcare Disparities
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, Measures
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2808
Delivering person-centered care with an electronic health record
Type: Journal Article
Year: 2019
Publication Place: England
Abstract: BACKGROUND: Electronic health records are now widely adopted in medical and behavioral health settings. While they have the potential to improve the quality of care, the research findings on their impact on clinical practice and outcomes have been mixed. This study explores how the electronic health record and its stage of development influenced the implementation of person-centered care planning in community mental health clinics. METHODS: The study was set in five community mental health clinics which utilized an EHR and had been trained in person-centered care planning. Using an objective quantitative measure of fidelity, the study examined fidelity to PCCP across time and by stage of EHR development. Data from focus groups, interviews with clinic leaders and consultant reports was analyzed to explore the process of implementation and the role of the electronic health record. RESULTS: All clinics demonstrated an overall increase in PCCP fidelity at the conclusion of the study period but there were significant differences in PCCP fidelity among clinics with EHRs in different stages of development. Electronic health records emerged as a significant implementation factor in the qualitative data with clinics being unable to individualize service plans and encountering technical difficulties. Barriers to person-centered care included drop-down boxes and pre-determined outcomes. Clinic responses included customizing their record or developing workarounds. CONCLUSIONS: The study demonstrated the need to align the electronic health record with a person-centered approach which includes individualizing information and orienting service plans to personal life goals. The ability of clinics to be able to customize their records and balance the need for unique and aggregate information in the record is critical to improve both the provider experience and the quality of care. TRIAL REGISTRATION: Clinicaltrials.gov , NCT02299492 , registered on November 24, 2014.
Topic(s):
HIT & Telehealth
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Reference Links:
View the DOI record for Delivering person-centered care with an electronic health record
View DOI Record
View the PubMed citation for Delivering person-centered care with an electronic health record2809
Delivering person-centered care with an electronic health record
Type: Journal Article
Year: 2019
Publication Place: England
Abstract: BACKGROUND: Electronic health records are now widely adopted in medical and behavioral health settings. While they have the potential to improve the quality of care, the research findings on their impact on clinical practice and outcomes have been mixed. This study explores how the electronic health record and its stage of development influenced the implementation of person-centered care planning in community mental health clinics. METHODS: The study was set in five community mental health clinics which utilized an EHR and had been trained in person-centered care planning. Using an objective quantitative measure of fidelity, the study examined fidelity to PCCP across time and by stage of EHR development. Data from focus groups, interviews with clinic leaders and consultant reports was analyzed to explore the process of implementation and the role of the electronic health record. RESULTS: All clinics demonstrated an overall increase in PCCP fidelity at the conclusion of the study period but there were significant differences in PCCP fidelity among clinics with EHRs in different stages of development. Electronic health records emerged as a significant implementation factor in the qualitative data with clinics being unable to individualize service plans and encountering technical difficulties. Barriers to person-centered care included drop-down boxes and pre-determined outcomes. Clinic responses included customizing their record or developing workarounds. CONCLUSIONS: The study demonstrated the need to align the electronic health record with a person-centered approach which includes individualizing information and orienting service plans to personal life goals. The ability of clinics to be able to customize their records and balance the need for unique and aggregate information in the record is critical to improve both the provider experience and the quality of care. TRIAL REGISTRATION: Clinicaltrials.gov , NCT02299492 , registered on November 24, 2014.
Topic(s):
HIT & Telehealth
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Reference Links:
View the DOI record for Delivering person-centered care with an electronic health record
View DOI Record
View the PubMed citation for Delivering person-centered care with an electronic health record2810
Delivering psychiatric services in primary-care setting
Type: Journal Article
Year: 2012
Publication Place: United States
Topic(s):
General Literature
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Reference Links: View the PubMed citation for Delivering psychiatric services in primary-care setting
2813
Delivery of self training and education for stressful situations (DESTRESS-PC): A randomized trial of nurse assisted online self-management for PTSD in primary care
Type: Journal Article
Year: 2015
Publication Place: United States
Topic(s):
HIT & Telehealth
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, Healthcare Disparities
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, Measures
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, Education & Workforce
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2814
Demand and characteristics of a psychiatric 24-hour emergency service performed by mandatory rotation of licensed psychiatrists in Swiss primary care
Type: Journal Article
Year: 2014
Publication Place: New Zealand
Abstract: BACKGROUND: To investigate characteristics of and satisfaction with psychiatric 24-hour emergency primary care performed by mandatory rotation of licensed psychiatrists as a viable baseline for possible reorganizational measures. METHODS: This was a questionnaire-based cross-sectional study (November 2010-April 2011). The number of patient-psychiatrist encounters, modes of contact, and patient and psychiatrist characteristics were assessed. Diagnoses were coded with ICD-10 (International Classification of Diseases, version 10). RESULTS: From 167 duty episodes, 74 (44%) were recorded. Of the psychiatrists (n=44), 52% were female, and mean age (standard deviation) was 49.9 (5.2) years. The median number of encounters per episode was 4 (interquartile range 0-8), mainly in the evenings. Demand for "face-to-face" (direct) patient visits was significantly more common (64.0%) than practice (1.3%) or telephone consultations (34.7%). In 83.8%, psychiatrists judged the encounter as adequate at the patient's location. A total of 43 different diagnoses were recorded: mainly schizophrenic disorders (23.9%), suicidal behavior (15.2%), and acute stress reactions (10.3%). Psychiatrists felt burdened by services (62.5%): in 39.2%, they felt threatened; and in 6.8%, violence occurred. In 32.4%, bills were not paid for. If services were optional, 45.2% would participate. CONCLUSION: Our findings indicate justified demand for direct mobile patient visits, suggesting that emergency care should be multifaceted, and sole provision of psychiatric care at stationed emergency facilities may not always be appropriate. Reorganization of 24-hour emergency services should carefully evaluate patient and provider's needs before changing established structures.
Topic(s):
General Literature
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2816
Dementia care initiative in primary practice: study protocol of a cluster randomized trial on dementia management in a general practice setting
Type: Journal Article
Year: 2009
Publication Place: England
Abstract: BACKGROUND: Current guidelines for dementia care recommend the combination of drug therapy with non-pharmaceutical measures like counselling and social support. However, the scientific evidence concerning non-pharmaceutical interventions for dementia patients and their informal caregivers remains inconclusive. Targets of modern comprehensive dementia care are to enable patients to live at home as long and as independent as possible and to reduce the burden of caregivers. The objective of the study is to compare a complex intervention including caregiver support groups and counselling against usual care in terms of time to nursing home placement. In this paper the study protocol is described. METHODS/DESIGN: The IDA (Initiative Demenzversorgung in der Allgemeinmedizin) project is designed as a three armed cluster-randomized trial where dementia patients and their informal caregivers are recruited by general practitioners. Patients in the study region of Middle Franconia, Germany, are included if they have mild or moderate dementia, are at least 65 years old, and are members of the German AOK (Allgemeine Ortskrankenkasse) sickness fund. In the control group patients receive regular treatment, whereas in the two intervention groups general practitioners participate in a training course in evidence based dementia treatment, recommend support groups and offer counseling to the family caregivers either beginning at baseline or after the 1-year follow-up. The study recruitment and follow-up took place from July 2005 to January 2009. 303 general practitioners were randomized of which 129 recruited a total of 390 patients. Time to nursing home admission within the two year intervention and follow-up period is the primary endpoint. Secondary endpoints are cognitive status, activities of daily living, burden of care giving as well as healthcare costs. For an economic analysis from the societal perspective, data are collected from caregivers as well as by the use of routine data from statutory health insurance and long-term care insurance. DISCUSSION: From a public health perspective, the IDA trial is expected to lead to evidence based results on the community effectiveness of non-pharmaceutical support measures for dementia patients and their caregivers in the primary care sector. For health policy makers it is necessary to make their decisions about financing new services based on strong knowledge about the acceptance of measures in the population and their cost-effectiveness. TRIAL REGISTRATION: ISRCTN68329593.
Topic(s):
Medically Unexplained Symptoms
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2817
Dementia risk reduction in primary care: what Australian initiatives can teach us
Type: Journal Article
Year: 2009
Publication Place: Australia
Abstract: Only limited research has been undertaken to identify factors that impede or facilitate the implementation of evidence-based health promotion, prevention and early intervention (PPEI) activities within primary practice. We examined recent Australian initiatives that encouraged primary care practitioners to implement PPEI activities to reduce the risk of chronic disease, particularly those that have focused on lifestyle risk factors. The aim was to identify barriers and facilitators to the uptake of these activities to inform the Australian National Dementia Prevention Strategy. Barriers that were consistently reported across evaluations and that appear to be of most concern to Australian general practitioners include the issues of financial remuneration and time constraints secondary to heavy work commitments. Factors that were effective in overcoming barriers included the integration of interventions within existing activities, the specification of a clear, funded role for practice nurses and the support of the Australian General Practice Network. It was concluded that these factors should be considered if PPEI activities for dementia are to be successfully incorporated within primary care.
Topic(s):
HIT & Telehealth
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Reference Links: View the PubMed citation for Dementia risk reduction in primary care: what Australian initiatives can teach us
2818
Demographic and economic predictors of mental health problems and contact with treatment resources among adults in a low-income primary care setting
Type: Journal Article
Year: 2013
Abstract: The purpose of this study was to examine the prevalence of mental health-related problems in a low-income primary care setting, as well as the demographic and economic variables associated with these problems and contact with treatment resources. A total of 346 patient records were randomly selected among patients at an urban Iowa primary care clinic serving lower-income and uninsured individuals. Logistic models examined relationships among demographic factors, poverty level, and insurance status and three outcomes: Lifetime mental health problems, receipt of pharmacological intervention, and contact with psychosocial services. Female gender was associated with reporting mental health problems, and age and ethnicity interacted to predict reported mental health problems. Among those reporting mental health problems, female gender was predictive of contact with psychosocial services, while female gender with Caucasian ethnicity was predictive of receiving pharmacological intervention. Results support the need for primary care providers working with lower-income individuals to be active in discussing mental health issues with patients.
Topic(s):
Healthcare Disparities
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