Literature Collection

BACKGROUND: Patient participation in health systems is increasing globally. English general practices have been required to establish patient participation groups (PPGs) since 2015. However, little is known about current PPG coverage and distribution. AIM: To explore the relationship between PPG coverage and quality with general practice deprivation deciles, geographical location, and Care Quality Commission (CQC) ratings. DESIGN AND SETTING: Mixed-methods documentary analysis of quantitative and qualitative data was carried out from general practice CQC reports in Yorkshire and Humber, England. METHOD: Data were extracted from CQC reports for practices in the most and least deprived areas across three integrated care systems (ICSs). Quantitative data examined PPG coverage by practice deprivation decile, location, and CQC rating. Qualitative thematic analysis assessed PPG quality. RESULTS: Of 122 practices, 99 (81.1%) had a PPG, 16 (13.1%) lacked one, and seven (5.7%) had a partial PPG. Practices in the most deprived areas were significantly less likely to have a PPG than those in the least deprived areas (P = 0.006). While there were minor differences in PPG coverage between ICS locations, no significant variation was observed based on CQC ratings. PPG activities included workforce adjustments and training, infrastructure, communications, accessibility and appointments, health promotion and education, and fundraising. CONCLUSION: Practices in the most deprived areas were significantly less likely to have a PPG (P = 0.006), and their PPGs engaged in different activities compared with those in the least deprived areas. This may exacerbate inequalities as PPGs are one mechanism to support patient participation and improve general practice quality and experience.

BACKGROUND: With the onset of the COVID-19 crisis, many federal agencies relaxed policies regulating opioid use disorder treatment. The impact of these changes has been minimally documented. The abrupt nature of these shifts provides a naturalistic opportunity to examine adaptations for opioid use disorder treatment in primary care. OBJECTIVE: To examine change in medical and behavioral health appointment frequency, visit type, and management of patients with opioid use disorder in response to COVID-19. DESIGN: A 14-item survey queried primary care practices that were enrolled in a medications for opioid use disorder statewide expansion project. Survey content focused on changes in service delivery because of COVID-19. The survey was open for 18 days. PARTICIPANTS: We surveyed 338 clinicians from 57 primary care clinics located in California, including federally qualified health centers and look-alikes. A representative from all 57 clinics (100%) and 118 staff (34.8% of all staff clinicians) participated in the survey. MAIN MEASURES: The survey consisted of seven dimensions of practice: medical visits, behavioral health visits, medication management, urine drug screenings, workflow, perceived patient demand, and staff experience. KEY RESULTS: A total of 52 of 57 (91.2%) primary care clinics reported practice adaptations in response to COVID-19 regulatory changes. Many clinics indicated that both medical (40.4%) and behavioral health visits (53.8%) were now exclusively virtual. Two-thirds (65.4%) of clinics reported increased duration of buprenorphine prescriptions and reduced urine drug screenings (67.3%). The majority (56.1%) of clinics experienced an increase in patient demand for behavioral health services. Over half (56.2%) of clinics described having an easier or unchanged experience retaining patients in care. CONCLUSIONS: Many adaptations in the primary care approach to patients with opioid use disorder may be temporary reactions to COVID-19. Further evaluation of the impact of these adaptations on patient outcomes is needed to determine whether changes should be maintained post-COVID-19.

This information is meant to support providers of office based opioid treatment programs (OBOT) relating to the coronavirus (COVID-19) situation in Ohio.