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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).
11198 Results
4224
Gender-specific predictors of methadone treatment outcomes among African Americans at an urban clinic
Type: Journal Article
Year: 2019
Publication Place: United States
Abstract: Background: African American patients with opioid use disorder (OUD) have demonstrated poorer methadone maintenance treatment (MMT) outcomes compared with white patients. This issue is further complicated in urban settings, where African Americans experience high rates of poverty and publicly funded treatment. Despite interrelated factors that disadvantage African Americans, the literature focusing on this population is scant. To address this shortcoming, we conducted the first investigation of gender differences and gender-specific MMT outcome predictors among African Americans (or any racial minority population). This study provides gender-specific findings to improve African American MMT outcomes. Methods: We studied 211 African American patients (male: n = 137, 64.9%) at an urban, university-affiliated MMT clinic. We used existing intake data to assess baseline demographic, substance use, mental health, and interpersonal factors. Primary outcomes were 3-month drug(+) (positive) urine drug screen (UDS) results and treatment retention. Results: Women were more likely (than men) to endorse histories of interpersonal violence, substance abuse in their social network, and mental health problems. Men reported a greater likelihood (than women) for early opioid-use onset and a lack of prior MMT. There were no gender differences in 3-month drug(+) UDS or treatment retention. In multivariable analyses among women, no baseline factors predicted 3-month opioid(+) UDS and physical abuse history predicted a higher proportion of 3-month cocaine(+) UDS. Among men, primary injection opioid use and older age best predicted a higher proportion of 3-month cocaine(+) UDS and parent substance abuse predicted shorter retention. In both gender-stratified analyses, higher proportions of 3-month opioid(+) UDS and cocaine(+) UDS predicted shorter retention. Conclusions: This study offers an analysis of gender differences in risk factors, MMT outcomes, and gender-specific predictors among African American patients. MMT clinics should tailor assessment and treatment protocols to address gender-specific needs.
Topic(s):
Opioids & Substance Use
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, Healthcare Disparities
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Reference Links: 
View the DOI record for Gender-specific predictors of methadone treatment outcomes among African Americans at an urban clinic
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View the PubMed citation for Gender-specific predictors of methadone treatment outcomes among African Americans at an urban clinic4226
General Medical Outcomes From the Primary and Behavioral Health Care Integration Grant Program
Type: Journal Article
Year: 2016
Publication Place: United States
Abstract: OBJECTIVE: Primary and Behavioral Health Care Integration (PBHCI) grants aim to improve the health of people with serious mental illness by integrating primary and preventive general medical services into behavioral health settings. This report describes the general medical outcomes of persons served by early cohorts of programs, funded in 2009 or 2010, that participated in this national demonstration project. METHODS: A quasi-experimental, difference-in-differences design was used to compare changes in general medical health among consumers served at three PBHCI clinics (N=322) and three clinics that were selected as matched control sites (N=469). Propensity-score weighting was used to adjust for baseline differences between PBHCI and control clinic populations. Baseline data were collected between 2010 and 2012; follow-up data were collected approximately one year later. General medical outcomes included blood pressure; body mass index; cholesterol, triglyceride, and blood glucose or HbA1c levels; and self-reported tobacco smoking. RESULTS: Compared with consumers served at control clinics, PBHCI consumers had better outcomes for cholesterol: mean reductions in total cholesterol were greater by 36 mg/dL (p<.01), mean reductions in low-density lipoprotein cholesterol were greater by 35 mg/dL (p<.001), and mean increases in high-density lipoprotein cholesterol were greater by 3 mg/dL (p<.05). No significant PBHCI effects were observed for the other health indicators. CONCLUSIONS: Approximately one year of PBHCI treatment resulted in statistically and potentially clinically significant improvements in cholesterol but not in other general medical outcomes examined. More rigorous implementation of integrated care in community behavioral health settings may be needed to further improve the health of adults with serious mental illness.
Topic(s):
General Literature
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Reference Links:
View the DOI record for General Medical Outcomes From the Primary and Behavioral Health Care Integration Grant Program
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View the PubMed citation for General Medical Outcomes From the Primary and Behavioral Health Care Integration Grant Program4228
General practice patients starting treatment for substance use problems: observations from two data sources across levels of care
Type: Journal Article
Year: 2020
Abstract:
BACKGROUND: In Belgium, the incidence of treatment episodes for substance use problems is monitored by the Network of Sentinel General Practices (SGP), and at higher, specialist care levels by the Treatment Demand Indicator (TDI) surveillance. Using both data sources, we examine 1) how patients starting specialist treatment for substance use problems on referral by their GP compare to those that were referred by non-GP caregivers; 2) how patients starting GP treatment for substance use problems without receiving concurrent specialist treatment compare to those who did. METHODS: Both surveillances are based on the TDI protocol for reporting data to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) on individuals starting treatment as a result of their substance use. Data from 2016 and 2017 were examined using 95% confidence intervals and multivariate logistic regression. RESULTS: According to TDI-data (n = 16,543), determinants of being referred by a GP (versus by a non-GP caregiver) for specialist treatment were age ≥ median (OR 1.25; 95% CI 1.13-1.38), education ≥ secondary level (OR 1.27; 95% CI 1.15-1.41), recent employment (OR 1.71; 1.56-1.88), recent stable accommodation (3.62; 95% CI 3.08-4.26), first treatment episode (OR 1.72; 95% CI 1.57-1.87), recent daily primary substance use (OR 1.46; 95% CI 1.33-1.59) and mono substance use (OR 1.23; 95% CI 1.04-1.48). Type of substance use was a significant determinant with higher odds of using pharmaceuticals (and alcohol) (OR 1.24; 95% CI 1.04-1.48), and lower odds of using cannabis only/primarily (OR 0.73; 95% CI 0.62-0.86), with reference to street drugs minus cannabis only/primarily. According to SGP data (n = 314), determinants of starting GP treatment without concurrent specialist treatment were recent employment (OR 2.58; 95% CI 1.36-4.91), first treatment episode (OR 2.78; 95% CI 1.39-5.55) and living in the Brussels or Walloon region (OR 1.97; 95% CI 1.06-3.66). CONCLUSIONS: This study provides a useful insight into the general practice population treated for substance use problems. It shows that both surveillances consistently found a relatively favourable profile of general practice patients with substance use problems.
Topic(s):
Opioids & Substance Use
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4229
General practice, primary care, and health service psychology: Concepts, competencies, and the Combined-Integrated model
Type: Journal Article
Year: 2004
Publication Place: United States
Abstract: The profession of psychology is being impacted profoundly by broader changes within the national system of health care, as mental and behavioral health services are being recognized as essential components of a comprehensive, preventive, and cost-efficient primary care system. To fully define and embrace this role, the discipline of professional psychology must develop a shared disciplinary identity of health service psychology and a generalized competency-based model for doctoral education and training. This very framework has been adopted by Combined-Integrated (C-I) doctoral programs in professional psychology, which train across the practice areas (clinical, counseling, and school psychology) to provide a general and integrative foundation for their students. Because C-I programs produce general practitioners who are competent to function within a variety of health service settings, this innovative training approach has great potential to educate and train psychologists for a changing health care marketplace.
Topic(s):
Education & Workforce
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Reference Links:
View the DOI record for General practice, primary care, and health service psychology: Concepts, competencies, and the Combined-Integrated model
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View the PubMed citation for General practice, primary care, and health service psychology: Concepts, competencies, and the Combined-Integrated model4232
General practitioners' diagnostic skills and referral practices in managing patients with drug and alcohol-related health problems: Implications for medical training and education programmes
Type: Journal Article
Year: 2003
Publication Place: England
Abstract: The aim of this study was to determine the current practices of established general practitioners in managing patients with drug and alcohol-related problems and identify gaps in training. A random sample of general practitioners completed a survey assessing diagnostic skills and referral practices concerning alcohol and illicit drug use in general practices in February 1999, comprising 110 general practitioners registered with the Central Sydney Division of General Practice. The main outcome measures were competent skills and knowledge, willingness to treat. The majority (96%) of GPs provided clinically appropriate responses for at least one drug category, although none received this rating for all six. Most general practitioners reported that they were unwilling to treat heroin and cocaine problems themselves but expressed willingness to refer patients appropriately. More than a quarter of general practitioners were unaware of the safe drinking levels for men and women or the appropriate treatment for patients consuming above such levels. Age, years in practice, type of practice, willingness to obtain drug use histories and post-graduate training were all significantly associated with general practitioners' willingness to treat and competence in managing drug and alcohol-related problems. In this study, general practioners reported low levels of skills and referrals for treatment of illicit drug use and suboptimal skills in the management of alcohol problems. The results suggest that a more comprehensive approach to education and training is required to bring about a change in practice behaviour. [Fucito LM, Gomes BS, Murnion B, Haber PS. General practitioners' diagnostic skills and referral practices in managing patients with drug and alcohol-related health problems: implications for medical training and education programmes.
Topic(s):
Education & Workforce
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4233
General practitioners' management of mental disorders: a rewarding practice with considerable obstacles
Type: Journal Article
Year: 2012
Publication Place: England
Abstract: BACKGROUND: Primary care improvement is the cornerstone of current reforms. Mental disorders (MDs) are a leading cause of morbidity worldwide and widespread in industrialised countries. MDs are treated mainly in primary care by general practitioners (GPs), even though the latter ability to detect, diagnose, and treat patients with MDs is often considered unsatisfactory. This article examines GPs' management of MDs in an effort to acquire more information regarding means by which GPs deal with MD cases, impact of such cases on their practices, factors that enable or hinder MD management, and patient-management strategies. METHODS: This study employs a mixed-method approach with emphasis on qualitative investigation. Based on a previous survey of 398 GPs in Quebec, Canada, 60 GPs representing a variety of practice settings were selected for further study. A 10-minute-long questionnaire comprising 27 items was administered, and 70-minute-long interviews were conducted. Quantitative (SPSS) and qualitative (NVivo) analyses were performed. RESULTS: At least 20% of GP visits were MD-related. GPs were comfortable managing common MDs, but not serious MDs. GPs' based their treatment of MDs on pharmacotherapy, support therapy, and psycho-education. They used clinical intuition with few clinical tools, and closely followed their patients with MDs. Practice features (salary or hourly fees payment; psycho-social teams on-site; strong informal networks), and GPs' individual characteristics (continuing medical education; exposure and interest in MDs; traits like empathy) favoured MD management. Collaboration with psychologists and psychiatrists was considered key to good MD management. Limited access to specialists, system fragmentation, and underdeveloped group practice and shared-care models were impediments. MD management was seen as burdensome because it required more time, flexibility, and emotional investment. Strategies exist to reduce the burden (one-problem-per-visit rule; longer time slots). GPs found MD practice rewarding as patients were seen as grateful and more complying with medical recommendations compared to other patients, generally leading to positive outcomes. CONCLUSIONS: To improve MD management, this study highlights the importance of extending multidisciplinary GP practice settings with salary or hourly fee payment; access to psychotherapeutic and psychiatric expertise; and case-discussion training involving local networks of GPs and MD specialists that encourage both knowledge transfer and shared care.
Topic(s):
Education & Workforce
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Reference Links:
View the DOI record for General practitioners' management of mental disorders: a rewarding practice with considerable obstacles
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View the PubMed citation for General practitioners' management of mental disorders: a rewarding practice with considerable obstacles4234
General practitioners' management of patients with mental health conditions: The views of general practitioners working in rural north-western New South Wales
Type: Journal Article
Year: 2008
Publication Place: Australia
Abstract: OBJECTIVE: To identify the needs of the region's general practitioners concerning diagnosing, treating and referring patients with mental health disorders and major barriers to the general practitioners' management of these patients. DESIGN: Cross-sectional survey. SUBJECTS: All general practitioners working in rural north-western New South Wales. MEASUREMENTS: Self-assessed levels of confidence (5-point Likert scale) in diagnosing and treating patients with a mental health condition. Practice data relating to presentation of such patients as well as issues affecting treatment and referral. RESULTS: The three most commonly diagnosed and treated mental health conditions are depression, anxiety and dementia. General practitioners assessed themselves as being confident in diagnosing and treating these three mental health conditions and in diagnosing and treating adults and the elderly. The only form of treatment intervention that the general practitioners self-assessed as being confident in relates to medication. Referrals to mental health specialists were due mostly to patients needing mental health counselling, the general practitioners seeking clarification of diagnosis as well as having insufficient skills to provide the best possible care. Barriers to being able to refer relate mainly to specialist services not being available and/or accessible as well as patients being reluctant to accept such a referral. CONCLUSION: Our results indicate that other than for depression, anxiety and dementia, efforts to improve the general practitioners' diagnostic and treatment skills and to diagnose and treat adolescents and children are warranted. Up-skilling the general practitioners' ability to confidently use treatment options other than medication are worth considering.
Topic(s):
Education & Workforce
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4235
General practitioners' opinions on their practice in mental health and their collaboration with mental health professionals
Type: Journal Article
Year: 2005
Publication Place: England
Abstract: BACKGROUND: Common mental health problems are mainly treated in primary care settings and collaboration with mental health services is needed. Prior to re-organisation of the mental health care offer in a geographical area, a study was organized: 1) to evaluate GPs' opinions on their day-to-day practice with Patients with Mental Health Problems (PMHP) and on relationships with Mental Health Professionals (MHPro); 2) to identify factors associated with perceived need for collaboration with MHPro and with actual collaboration. METHODS: All GPs in the South Yvelines area in France (n = 492) were informed of the implementation of a local mental health program. GPs interested in taking part (n = 180) were invited to complete a satisfaction questionnaire on their practice in the field of Mental Health and to include prospectively all PMHP consultants over an 8-day period (n = 1519). For each PMHP, data was collected on demographic and clinical profile, and on needs (met v. unmet) for collaboration with MHPro. RESULTS: A majority of GPs rated PMHP as requiring more care (83.4%), more time (92.3%), more frequent consultations (64.0%) and as being more difficult to refer (87.7%) than other patients. A minority of GPs had a satisfactory relationship with private psychiatrists (49.5%), public psychiatrists (35%) and social workers (27.8%). 53.9% had a less satisfactory relationship with MHPro than with other physicians. Needs for collaboration with a MHPro were more often felt in caring for PMHP who were young, not in employment, with mental health problems lasting for more than one year, with a history of psychiatric hospitalization, and showing reluctance to talk of psychological problems and to consult a MHPro. Needs for collaboration were more often met among PMHP with past psychiatric consultation or hospitalization and when the patient was not reluctant to consult a MHPro. Where needs were not met, GP would opt for the classic procedure of mental health referral for only 31.3% of their PMHP. CONCLUSION: GPs need targeted collaboration with MHPro to support their management of PMHP, whom they are willing to care for without systematic referral to specialists as the major therapeutic option.
Topic(s):
Education & Workforce
See topic collection
4238
General practitioners' views on drug-assisted rehabilitation
Type: Journal Article
Year: 2012
Publication Place: Norway
Abstract: BACKGROUND: The Norwegian model for opioid maintenance treatment (OMT) "Drug-assisted rehabilitation" (DAR) is a cross-disciplinary tripartite model for the treatment of opioid dependence. The model requires collaboration among GPs, the social services and the specialist health services. To some degree it restricts the doctor's professional autonomy. The investigation aims to examine GPs' attitudes to the model and in particular the experiences of those who have actively participated. MATERIAL AND METHOD: An electronic questionnaire (Questback) was sent to Norwegian GPs listed on the members' register of the Norwegian Medical Association. The respondents were questioned about their general opinions of drug-assisted rehabilitation. Those who had had relevant patients were asked about their experiences and evaluations based on 22 statements. RESULTS: 1,165 doctors (34 % of all registered GPs) responded to the survey. 155 (13 %) were negative, 395 (34 %) neutral, and 604 (53 %) were positive towards drug-assisted rehabilitation. 683 (59 %) were doctors with DAR experience. These were treating approximately 50 % of the country's DAR patients. The tripartite model received significant support. Very few want greater autonomy. The majority also support the strong emphasis on monitoring, although some, particularly older doctors with DAR experience, believe that urine tests could be replaced by personal contact. INTERPRETATION: Drug-assisted rehabilitation was mainly viewed positively by Norwegian GPs in this sample. There was little opposition to the doctor's role in the model, even though it restricts the autonomy of the individual doctor to some degree.
Topic(s):
Opioids & Substance Use
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, Education & Workforce
See topic collection
Reference Links:
View the DOI record for General practitioners' views on drug-assisted rehabilitation
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View the PubMed citation for General practitioners' views on drug-assisted rehabilitation