Literature Collection

AIM: To explore the perceived impact of a nurse-led domestic and family violence service on access to care. BACKGROUND: Delivered from a metropolitan community based not for profit organisation, this nurse-led service provided a multidisciplinary response to meeting the needs of women, and or women and children experiencing the consequences of domestic and family violence and homelessness. This involved integration of specialist community services to support women's safety planning, housing, and mental health. DESIGN: A mixed methods single-site study was conducted. METHODS: Routine patient attendance data were analysed to identify service use. Semi-structured interviews with service providers and key stakeholders explored perceived service impact on access to care. RESULTS: Data were collected over 2.5 years from n = 233 women experiencing domestic and family violence, of whom 28% (n = 64) identified as First Nations, and 26% (n = 61) had at least one dependent child. The nurse facilitated access through referrals, and care navigation, often driving and accompanying women to their appointments. Person-centered and trauma sensitive approaches were highly effective in gaining trust. Qualitative data themes were, care environment, macro context, care outcomes and person centeredness. CONCLUSION AND IMPLICATIONS: Stakeholders' perspectives highlight the need to improve health professionals' capability to respond effectively when women disclose domestic and family violence. The success of this nurse-led service was its capacity for flexibility, which meant it could address women's unmet health needs in most environments and directly facilitate their access to mainstream healthcare and social supports. IMPACT: Accessing healthcare is extremely challenging for women experiencing domestic violence in Australia. The nurse-led specialist service provided much needed support to women experiencing domestic and family violence and to health professionals within the broader organisation, to improve access to care. Optimising the nurse's scope of practice in terms of authority to refer for investigations and prescribe medications, would further increase access to care. REPORTING METHOD: This study has been reported using the Consensus Reporting Items for Studies in Primary Care (CRISP) checklist. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

BACKGROUND: Evidence demonstrates that medications for treating opioid use disorder (MOUD) -namely buprenorphine, methadone, and extended-release naltrexone-are effective at treating opioid use disorder (OUD) and reducing associated harms. However, MOUDs are heavily underutilized, largely due to the under-supply of providers trained and willing to prescribe the medications. METHODS: To understand comparative beliefs about MOUD and barriers to MOUD, we conducted a mixed-methods study that involved focus group interviews and an online survey disseminated to a random group of licensed U.S. physicians, which oversampled physicians with a preexisting waiver to prescribe buprenorphine. Focus group results were analyzed using thematic analysis. Survey results were analyzed using descriptive and inferential statistical methods. RESULTS: Study findings suggest that physicians have higher perceptions of efficacy for methadone and buprenorphine than for extended-release naltrexone, including for patients with co-occurring mental health disorders. Insurance obstacles, such as prior authorization requirements, were the most commonly cited barrier to prescribing buprenorphine and extended-release naltrexone. Regulatory barriers, such as the training required to obtain a federal waiver to prescribe buprenorphine, were not considered significant barriers by many physicians to prescribing buprenorphine and naltrexone in office-based settings. Nor did physicians perceive diversion to be a prominent barrier to prescribing buprenorphine. In focus groups, physicians identified financial, logistical, and workforce barriers-such as a lack of addiction treatment specialists-as additional barriers to prescribing medications to treat OUD. CONCLUSIONS: Additional education is needed for physicians regarding the comparative efficacy of different OUD medications. Governmental policies should mandate full insurance coverage of and prohibit prior authorization requirements for OUD medications.

INTRODUCTION: Providing health care to rural communities is a challenge, particular for marginalised groups like people who use drugs. The ongoing COVID-19 pandemic further increases these challenges. The use of remote models of care, including telemedicine, help to mitigate the impact of COVID-19 and provide new opportunities to engage existing and new patients in treatment. It is recognised that people who used opioids have increased health needs and struggle to engage in health care compared to the general population. Opioid substitution treatment (OST) is effective at reducing these health inequalities but coverage is often inadequate. To increase access to OST during the pandemic, a national remote model of OST was developed in Ireland. An evaluation is being conducted 18 months after commencement to evaluate its effectiveness at engaging people in OST, its impact on their drug use, general health and quality of life. The evaluation also aims to describe the experiences of both services providers and users and report aspects that can be modified and improved. METHODS: A mixed-methods evaluation is being conducted. It consists of a chart review that collects demographic data (age, sex, family details and education and employment status). It also includes the collection and analysis of data on engagement in treatment, changes in drug use and general health. A series of one-to-one interviews are being conducted (service providers (n=12) and service users (n=10).Thematic analysis of the interview narratives will be conducted using NVivo 11. RESULTS AND DISCUSSION: The results will be ready in 2022.