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Opioids & SU
The Literature Collection contains over 10,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More
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OBJECTIVES: During the early months of the COVID-19 pandemic, virtual and telephone visits rapidly replaced most in-person care within the Veterans Health Administration (VA) to reduce the virus spread. To address the emerging mental health needs of older Veterans (e.g., social isolation) in the context of chronic underlying mental health needs (e.g., trauma), we developed an 8-week virtual group treatment manual. This article describes the results from a survey of geriatric mental health clinicians who used the COVID group manual to determine its acceptability and feasibility in these settings. METHODS: Clinicians across three VA integrated care settings (home-based primary care, community living centers, and geriatric primary care) were surveyed about their experiences implementing this treatment (n = 21). RESULTS: Clinicians found this intervention to be effective with their patients and useful and adaptable beyond the early pandemic period. CONCLUSIONS: This group teletherapy intervention was feasible and acceptable when treating Veterans in integrated geriatric healthcare settings. Despite technical challenges experienced by older Veterans, clinicians found this manual to be effective in addressing COVID-related worry and social isolation. CLINICAL IMPLICATIONS: This rapid response manual has remained clinically useful in geriatric mental health care settings beyond the initial weeks of the pandemic.
BACKGROUND: Medication-assisted treatment with buprenorphine or methadone is recommended for pregnant patients with opioid use disorders (OUDs) to minimize adverse maternal and neonatal outcomes. Collaborative care approaches have been successfully utilized with office-based opioid treatment with buprenorphine in primary care settings, but research is significantly limited in the obstetric setting. Our aim with this study is to demonstrate the feasibility of a collaborative care model for pregnant patients with opioid use disorder. METHODS: This is a case series of 16 pregnancies in 14 women initiated on office-based opioid treatment with buprenorphine in a perinatal mental health service embedded in 2 obstetric clinics. Patients are treated by a psychiatrist alongside their prenatal care provider and followed for up to 6 months postpartum and referred to ongoing substance abuse treatment to a community prescriber. RESULTS: The average age of the patients was 30.3 years, and an average gestational age of 23.6 weeks at the time of referral. Treatment continued until delivery in 15 (93.8%) pregnancies, with an average duration of treatment of 14.5 weeks. The majority (60%) had a cesarean delivery. Twelve (80%) infants were admitted to the Neonatal Intensive Care Unit (NICU) for monitoring or treatment of neonatal abstinence syndrome, 14 (87.5%) patients continued or resumed treatment with buprenorphine postpartum at the time of discharge from our program, and 13 (81.3%) were referred to a community prescriber. CONCLUSIONS: A collaborative care approach to buprenorphine treatment is feasible during pregnancy. Further research is needed to improve the treatment of OUD during pregnancy.