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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).
12581 Results
3021
Costs of an intervention for primary care patients with medically unexplained symptoms: a randomized controlled trial
Type: Journal Article
Year: 2007
Publication Place: United States
Abstract: OBJECTIVE: This study sought to determine whether an intervention for patients with medically unexplained symptoms in primary care reduced total costs, components of cost, and longer-term costs and whether it led to decreased service use outside the health maintenance organization (HMO). METHODS: A randomized controlled trial involving 206 patients with medically unexplained symptoms was conducted in a staff-model HMO. The protocol emphasized the provider-patient relationship and included cognitive-behavioral therapy and pharmacological management. Cost data for medical treatments were derived from the HMO's electronic database. Patients were interviewed about work days lost and out-of-pocket expenses for medical care outside the HMO. RESULTS: The difference in total costs ($1,071) for the 12-month intervention was not significant. The treatment group had significantly higher costs for antidepressants than the usual-care group ($192 higher) during the intervention, and a larger proportion received antidepressants. The intervention group used less medical care outside the HMO and missed one less work day per month on average (1.23 days), indicating a slight improvement in productivity, but the difference was not significant. The between-group difference in estimated total cost was smaller in the year after the intervention (difference of $341) but were not significant. CONCLUSIONS: The total costs for the intervention group were not significantly different, but the group had greater use of antidepressants. Coupled with findings of improved mental health outcomes for this group in a previous study, the results indicate that the intervention may be cost-effective. The longer-term impact needs to be further studied.
Topic(s):
Financing & Sustainability
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, Medically Unexplained Symptoms
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Reference Links: 
View the DOI record for Costs of an intervention for primary care patients with medically unexplained symptoms: a randomized controlled trial
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View the PubMed citation for Costs of an intervention for primary care patients with medically unexplained symptoms: a randomized controlled trial3022
Costs of care for persons with opioid dependence in commercial integrated health systems
Type: Journal Article
Year: 2014
Publication Place: England
Abstract: BACKGROUND: When used in general medical practices, buprenorphine is an effective treatment for opioid dependence, yet little is known about how use of buprenorphine affects the utilization and cost of health care in commercial health systems. METHODS: The objective of this retrospective cohort study was to examine how buprenorphine affects patterns of medical care, addiction medicine services, and costs from the health system perspective. Individuals with two or more opioid-dependence diagnoses per year, in two large health systems (System A: n = 1836; System B: n = 4204) over the time span 2007-2008 were included. Propensity scores were used to help adjust for group differences. RESULTS: Patients receiving buprenorphine plus addiction counseling had significantly lower total health care costs than patients with little or no addiction treatment (mean health care costs with buprenorphine treatment = $13,578; vs. mean health care costs with no addiction treatment = $31,055; p < .0001), while those receiving buprenorphine plus addiction counseling and those with addiction counseling only did not differ significantly in total health care costs (mean costs with counseling only: $17,017; p = .5897). In comparison to patients receiving buprenorphine plus counseling, those with little or no addiction treatment had significantly greater use of primary care (p < .001), other medical visits (p = .001), and emergency services (p = .020). Patients with counseling only (compared to patients with buprenorphine plus counseling) used less inpatient detoxification (p < .001), and had significantly more PC visits (p = .001), other medical visits (p = .005), and mental health visits (p = .002). CONCLUSIONS: Buprenorphine is a viable alternative to other treatment approaches for opioid dependence in commercial integrated health systems, with total costs of health care similar to abstinence-based counseling. Patients with buprenorphine plus counseling had reduced use of general medical services compared to the alternatives.
Topic(s):
Financing & Sustainability
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View the DOI record for Costs of care for persons with opioid dependence in commercial integrated health systems
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View the PubMed citation for Costs of care for persons with opioid dependence in commercial integrated health systems3023
Costs of screening and brief intervention for illicit drug use in primary care settings
Type: Journal Article
Year: 2015
Publication Place: United States
Abstract: OBJECTIVE: In this article, the authors estimate implementation costs for illicit drug screening and brief intervention (SBI) and identify a key source of variation in cost estimates noted in the alcohol SBI literature. This is the first study of the cost of SBI for drug use only. METHOD: Using primary data collected from a clinical trial of illicit drug SBI (n = 528) and a hybrid costing approach, we estimated a per-service implementation cost for screening and two models of brief intervention. A taxonomy of activities was first compiled, and then resources and prices were attached to estimate the per-activity cost. Two components of the implementation cost, direct service delivery and service support costs, were estimated separately. RESULTS: Per-person cost estimates were $15.61 for screening, $38.94 for a brief negotiated interview, and $252.26 for an adaptation of motivational interviewing. (Amounts are in 2011 U.S. dollars.) Service support costs per patient are 5 to 7.5 times greater than direct service delivery costs per patient. Ongoing clinical supervision costs are the largest component of service support costs. CONCLUSIONS: Implementation cost estimates for illicit drug brief intervention vary greatly depending on the brief intervention method, and service support is the largest component of SBI costs. Screening and brief intervention cost estimates for drug use are similar to those published for alcohol SBI. Direct service delivery cost estimates are similar to costs at the low end of the distribution identified in the alcohol literature. The magnitude of service support costs may explain the larger cost estimates at the high end of the alcohol SBI cost distribution.
Topic(s):
Opioids & Substance Use
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, Financing & Sustainability
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Reference Links: View the PubMed citation for Costs of screening and brief intervention for illicit drug use in primary care settings
3024
Costs of using evidence-based implementation strategies for behavioral health integration in a large primary care system
Type: Journal Article
Year: 2020
Topic(s):
Financing & Sustainability
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, Healthcare Disparities
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Reference Links:
View the DOI record for Costs of using evidence-based implementation strategies for behavioral health integration in a large primary care system
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View the PubMed citation for Costs of using evidence-based implementation strategies for behavioral health integration in a large primary care system3025
Coteaching Recovery to Mental Health Care Professionals
Type: Journal Article
Year: 2018
Abstract: In 2010, the Regional Council of the Capital Region of Denmark endorsed a vision of mental health services based on personal recovery, rehabilitation, and the involvement of caregivers. Programs to achieve this vision include hiring peer support workers, a Recovery College, and service user participation at the organizational level. This column describes a cornerstone of these initiatives—an education program in the recovery model for mental health professionals. In 2013–2014, the Capital Region implemented 148 workshops on recovery-oriented services for all practitioner staff in mental health services in the region. The workshops featured a coteaching model, with both a mental health professional and an individual with lived experience serving as trainers. This model showed promise and should be expanded, including more targeted training for specific services. Such an expansion could be included in a national strategy for user involvement and recovery-oriented practice set to launch in 2018.
Topic(s):
Education & Workforce
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Reference Links: View the PubMed citation for Coteaching Recovery to Mental Health Care Professionals
3027
Counseling and directly observed medication for primary care buprenorphine maintenance: a pilot study
Type: Journal Article
Year: 2012
Publication Place: United States
Abstract: OBJECTIVES: Counseling and medication adherence can affect opioid agonist treatment outcomes. We investigated the impact of 2 counseling intensities and 2 medication-dispensing methods in patients receiving buprenorphine in primary care. METHODS: In a 12-week trial, patients were assigned to physician management (PM) with weekly buprenorphine dispensing (n = 28) versus PM and directly observed, thrice-weekly buprenorphine (DOT) and cognitive-behavioral therapy (CBT) (PM+DOT/CBT; n = 27) based on therapist availability. Fifteen-minute PM visits were provided at entry, after induction, and then monthly. Cognitive-behavioral therapy was weekly 45-minute sessions provided by trained therapists. RESULTS: Treatment groups differed on baseline characteristics of years of opioid use, history of detoxification from opioids, and opioid negative urines during induction. Analyses adjusting for baseline characteristics showed no significant differences between groups on retention or drug use based on self-report or urines. Patient satisfaction was high across conditions, indicating acceptability of CBT counseling with observed medication. The number of CBT sessions attended was significantly associated with improved outcome, and session attendance was associated with a greater abstinence the following week. CONCLUSIONS: Although the current findings were nonsignificant, DOT and individual CBT sessions were feasible and acceptable to patients. Additional research evaluating the independent effect of directly observed medication and CBT counseling is needed.
Topic(s):
General Literature
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Reference Links:
View the DOI record for Counseling and directly observed medication for primary care buprenorphine maintenance: a pilot study
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View the PubMed citation for Counseling and directly observed medication for primary care buprenorphine maintenance: a pilot study3028
Counseling plus buprenorphine-naloxone maintenance therapy for opioid dependence
Type: Journal Article
Year: 2006
Publication Place: United States
Topic(s):
Opioids & Substance Use
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Reference Links:
View the DOI record for Counseling plus buprenorphine-naloxone maintenance therapy for opioid dependence
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View the PubMed citation for Counseling plus buprenorphine-naloxone maintenance therapy for opioid dependence3029
Counseling versus antidepressant therapy for the treatment of mild to moderate depression in primary care: Economic analysis
Type: Journal Article
Year: 2003
Publication Place: England
Abstract: OBJECTIVE: To compare the cost-effectiveness of generic psychological therapy (counseling) with routinely prescribed antidepressant drugs in a naturalistic general practice setting for a follow-up period of 12 months. METHODs: Economic analysis alongside a randomized clinical trial with patient preference arm. Comparison of depression-related health service costs at 12 months. Cost-effectiveness analysis of bootstrapped trial data using net monetary benefits and acceptability curves. RESULTS: No significant difference between the mean observed costs of patients randomized to antidepressants or to counseling (342 pounds sterling vs 302 pounds sterling , p = .56 [t test]). If decision makers are not willing to pay more for additional benefits (value placed on extra patient with good outcome, denoted by K, is zero), then we find little difference between the treatment modalities in terms of cost-effectiveness. If decision makers do place value on additional benefit (K > 0 pounds sterling), then the antidepressant group becomes more likely to be cost-effective. This likelihood is in excess of 90% where decision makers are prepared to pay an additional 2,000 pounds sterling or more per additional patient with a good global outcome. The mean values for incremental net monetary benefits (INMB) from antidepressants are substantial for higher values of K (INMB = 406 pounds sterling when K = 2,500 pounds sterling). CONCLUSION: For a small proportion of patients, the counseling intervention (as specified in this trial) is a dominant cost-effective strategy. For a larger proportion of patients, the antidepressant intervention (as specified in this trial) is the dominant cost-effective strategy. For the remaining group of patients, cost-effectiveness depends on the value of K. Since we cannot observe K, acceptability curves are a useful way to inform decision makers.
Topic(s):
Financing & Sustainability
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3030
Counselling behaviour and content in a pharmaceutical care service in Swedish community pharmacies
Type: Journal Article
Year: 2010
Publication Place: Netherlands
Abstract: OBJECTIVE: To characterise the counselling behaviour of practitioners providing a pharmaceutical care (PC) service in community pharmacy, and to describe the content of the consultations. SETTING: Community pharmacies in Sweden. METHODS: Non-participant observations, including audio recording, of five practitioners in five different pharmacies counselling 16 patients, were analysed qualitatively using an iterative, stepwise, interpretivist approach. MAIN OUTCOME MEASURE: Descriptions of counselling behaviour and content of consultations. RESULTS: The counselling behaviour was characterised by attempts to understand the patients' narratives by listening and asking questions and a willingness to help. The computer often had an important role in consultations, being used for documentation and as a supportive tool for identification of drug-drug interactions. The practitioners often took command in the initial phase of the consultation, and omitted to determine the patients' most urgent drug-related needs. However, counselling behaviour that identified and focused on the patient's needs, giving the computer little attention during the consultation was also observed. Practitioners provided vague descriptions of the purpose and outline of the service. Consultations included a wide variety of issues, which potentially could help patients' achieve optimal outcomes of medical treatment. CONCLUSION: The practitioners provided important advice and different forms of support to patients. Focus on the computer screen limited their abilities to practise patient centred care.
Topic(s):
HIT & Telehealth
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Reference Links:
View the DOI record for Counselling behaviour and content in a pharmaceutical care service in Swedish community pharmacies
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View the PubMed citation for Counselling behaviour and content in a pharmaceutical care service in Swedish community pharmacies3031
Counselling for mental health and psychosocial problems in primary care
Type: Journal Article
Year: 2011
Publication Place: England
Abstract: BACKGROUND: The prevalence of mental health and psychosocial problems in primary care is high. Counselling is a potential treatment for these patients, but there is a lack of consensus over the effectiveness of this treatment in primary care. OBJECTIVES: To assess the effectiveness and cost effectiveness of counselling for patients with mental health and psychosocial problems in primary care. SEARCH STRATEGY: To update the review, the following electronic databases were searched: the Cochrane Collaboration Depression, Anxiety and Neurosis (CCDAN) trials registers (to December 2010), MEDLINE, EMBASE, PsycINFO and the Cochrane Central Register of Controlled Trials (to May 2011). SELECTION CRITERIA: Randomised controlled trials of counselling for mental health and psychosocial problems in primary care. DATA COLLECTION AND ANALYSIS: Data were extracted using a standardised data extraction sheet by two reviewers. Trials were rated for quality by two reviewers using Cochrane risk of bias criteria, to assess the extent to which their design and conduct were likely to have prevented systematic error. Continuous measures of outcome were combined using standardised mean differences. An overall effect size was calculated for each outcome with 95% confidence intervals (CI). Continuous data from different measuring instruments were transformed into a standard effect size by dividing mean values by standard deviations. Sensitivity analyses were undertaken to test the robustness of the results. Economic analyses were summarised in narrative form. There was no assessment of adverse events. MAIN RESULTS: Nine trials were included in the review, involving 1384 randomised participants. Studies varied in risk of bias, although two studies were identified as being at high risk of selection bias because of problems with concealment of allocation. All studies were from primary care in the United Kingdom and thus comparability was high. The analysis found significantly greater clinical effectiveness in the counselling group compared with usual care in terms of mental health outcomes in the short-term (standardised mean difference -0.28, 95% CI -0.43 to -0.13, n = 772, 6 trials) but not in the long-term (standardised mean difference -0.09, 95% CI -0.27 to 0.10, n = 475, 4 trials), nor on measures of social function (standardised mean difference -0.09, 95% CI -0.29 to 0.11, n = 386, 3 trials). Levels of satisfaction with counselling were high. There was some evidence that the overall costs of counselling and usual care were similar. There were limited comparisons between counselling and other psychological therapies, medication, or other psychosocial interventions. AUTHORS' CONCLUSIONS: Counselling is associated with significantly greater clinical effectiveness in short-term mental health outcomes compared to usual care, but provides no additional advantages in the long-term. Participants were satisfied with counselling. Although some types of health care utilisation may be reduced, counselling does not seem to reduce overall healthcare costs. The generalisability of these findings to settings outside the United Kingdom is unclear.
Topic(s):
Financing & Sustainability
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View the PubMed citation for Counselling for mental health and psychosocial problems in primary care
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View the DOI record for Counselling for mental health and psychosocial problems in primary care
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View the PubMed citation for Counselling for mental health and psychosocial problems in primary care3036
County-level estimates of mental health professional shortage in the United States
Type: Journal Article
Year: 2009
Publication Place: United States
Abstract: OBJECTIVE: This study examined shortages of mental health professionals at the county level across the United States. A goal was to motivate discussion of the data improvements and practice standards required to develop an adequate mental health professional workforce. METHODS: Shortage of mental health professionals was conceptualized as the percentage of need for mental health visits that is unmet within a county. County-level need was measured by estimating the prevalence of serious mental illness, then combining separate estimates of provider time needed by individuals with and without serious mental illness derived from National Comorbidity Survey Replication, U.S. Census, and Medical Panel Expenditure Survey data. County-level supply data were compiled from professional associations, state licensure boards, and national certification boards. Shortage was measured for prescribers, nonprescribers, and a combination of both groups in the nation's 3,140 counties. Ordinary least-squares regression identified county characteristics associated with shortage. RESULTS: Nearly one in five counties (18%) in the nation had unmet need for nonprescribers. Nearly every county (96%) had unmet need for prescribers and therefore some level of unmet need overall. Rural counties and those with low per capita income had higher levels of unmet need. CONCLUSIONS: These findings identified widespread prescriber shortage and poor distribution of nonprescribers. A caveat is that these estimates of need were extrapolated from current provider treatment patterns rather than from a normative standard of how much care should be provided and by whom. Better data would improve these estimates, but future work needs to move beyond simply describing shortages to resolving them.
Topic(s):
Education & Workforce
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Reference Links:
View the DOI record for County-level estimates of mental health professional shortage in the United States
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View the PubMed citation for County-level estimates of mental health professional shortage in the United States3037
County-level estimates of mental health professional supply in the United States
Type: Journal Article
Year: 2009
Publication Place: United States
Abstract: OBJECTIVE: This study compiled national county-level data and examined the geographic distribution of providers in six mental health professions and the correlates of county-level provider supply. METHODS: Data for six groups--advanced practice psychiatric nurses, licensed professional counselors, marriage and family therapists, psychiatrists, psychologists, and social workers--were compiled from licensing counts from state boards, certification counts from national credentialing organizations, and membership counts from professional associations. The geographic distribution of professionals was examined with descriptive statistics and a national choropleth map. Correlations were examined among county-level totals and between provider-to-population ratios and county characteristics. RESULTS: There were 353,398 clinically active providers in the six professions. Provider-to-population ratios varied greatly across counties, both within professions and overall. Social workers and licensed professional counselors were the largest groups; psychiatrists and advanced practice psychiatric nurses were the smallest. Professionals tended to be in urban, high-population, high-income counties. Marriage and family therapists were concentrated in California, and other mental health professionals were concentrated in the Northeast. CONCLUSIONS: Rural, low-income counties are likely candidates for interventions such as the training of local clinicians or the provision of incentives and infrastructure to facilitate clinical practice. Workforce planning and policy analysis should consider the unique combination of professions in each area. National workforce planning efforts and state licensing boards would benefit from the central collection of standardized practice information from clinically active providers in all mental health professions.
Topic(s):
Education & Workforce
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Reference Links:
View the DOI record for County-level estimates of mental health professional supply in the United States
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View the PubMed citation for County-level estimates of mental health professional supply in the United States3038
County-level estimates of need for mental health professionals in the United States
Type: Journal Article
Year: 2009
Publication Place: United States
Abstract: OBJECTIVE: The goal of this study was to develop the best current estimates of need for mental health professionals in the United States for workforce planning and to highlight major data gaps. METHODS: Need was estimated indirectly, on the basis of several steps. The 2001 National Comorbidity Survey Replication (NCS-R) (N=9,282) was used to model the probability of having serious mental illness, given demographic predictors. Synthetic estimation was then used to construct national and county-level prevalence estimates for adults in households. Provider time needed by these adults was estimated from NCS-R respondents with serious mental illness who used mental health services (N=356); provider time needed by adults without serious mental illness was estimated from respondents to the 2000 Medical Expenditure Panel Survey (MEPS) (N=16,418). National mental health professional workforce practice patterns were used to convert need estimates to full-time equivalents (FTEs). RESULTS: Adult service users with serious mental illness typically spend 10.5 hours per year with nonprescriber mental health professionals and 4.4 hours per year with prescriber mental health professionals or primary care physicians in mental health visits; adults without serious mental illness spend about 7.8 minutes with nonprescriber mental health professionals and 12.6 minutes with prescriber mental health professionals or primary care physicians in mental health visits per year. With adjustment for mental health services provided by primary care practitioners, the estimated 218,244,402 members of the U.S. adult civilian household population in 2006 required 56,462 FTE prescribing and 68,581 FTE nonprescribing mental health professionals. CONCLUSIONS: Available data indicate that need across the United States varies by demography and geography. These estimates are limited by several issues; in particular, they are based on current provider treatment patterns and do not address how much care ideally should be provided and by whom. Improved estimates will require refined standards of care and more extensive epidemiological data.
Topic(s):
Education & Workforce
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View the DOI record for County-level estimates of need for mental health professionals in the United States
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View the PubMed citation for County-level estimates of need for mental health professionals in the United States