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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).
11272 Results
5021
Improving the identification and treatment of depression in low-income primary care clinics: a qualitative study of providers in the VitalSign6 program
Type: Journal Article
Year: 2019
Publication Place: England
Topic(s):
Education & Workforce
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, Healthcare Disparities
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, HIT & Telehealth
See topic collection
5023
Improving the management of late-life depression in primary care: barriers and facilitators
Type: Journal Article
Year: 2011
Publication Place: United States
Abstract: The objectives of this study were to elicit Canadian health professionals' views on the barriers to identifying and treating late-life depression in primary care settings and on the solutions felt to be most important and feasible to implement. A consensus development process was used to generate, rank, and discuss solutions. Twenty-three health professionals participated in the consensus process. Results were analysed using quantitative and qualitative methods. Participants generated 12 solutions. One solution, developing mechanisms to increase family physicians' awareness of resources, was highly ranked for importance and feasibility by most participants. Another solution, providing family physicians with direct mental health support, was highly ranked as important but not as feasible by most participants. Deliberations emphasized the importance of case specific, as needed support based on the principles of shared care. The results suggest that practitioners highly value collaborative care but question the feasibility of implementing these principles in current Canadian primary care contexts.
Topic(s):
General Literature
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Reference Links: 
View the DOI record for Improving the management of late-life depression in primary care: barriers and facilitators
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View the PubMed citation for Improving the management of late-life depression in primary care: barriers and facilitators5024
Improving the physical health of the mentally ill: recent advances
Type: Journal Article
Year: 2020
Publication Place: United States
Abstract:
PURPOSE OF REVIEW: This review of the literature examines the most recent advances in the battle to improve the physical health of people with severe mental illness. Covering the 2018/2019 time period, the article offers a glance of future healthcare models and research directions. RECENT FINDINGS: A systematic search of the PubMed and Cochrane databases, along with additional journal articles available online but not yet allocated to a journal edition, produced a total of 24 journal articles suitable for review. The review period was from January 2018 to December 2019. The four main themes of investigation, intervention, integration and training emerged. SUMMARY: The uptake and integration of primary care into mental health services for people with SMI is still facing many barriers. Healthy lifestyle and physical activity interventions need to run alongside medical treatment for both mental and physical health in order to provide holistic care. To do this, clarification of professional roles and responsibility need to be defined and adhered to, along with additional training for staff and coordination of services.
Topic(s):
Education & Workforce
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, Healthcare Disparities
See topic collection
Reference Links:
View the DOI record for Improving the physical health of the mentally ill: recent advances
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View the PubMed citation for Improving the physical health of the mentally ill: recent advances5027
Improving the skills of rural and remote generalists to manage mental health emergencies
Type: Journal Article
Year: 2010
Publication Place: Australia
Abstract: CONTEXT: People living in rural and remote areas have been found to suffer higher rates of mental illness and psychological distress than their urban counterparts. However, rural and remote Australians also suffer from a lack of specialist mental health services. Mental health consumers are concerned about the lack of access to specialist mental health care and report poor service quality and stigmatizing staff attitudes when presenting with mental health emergencies at acute care facilities. Standards for the Mental Health Workforce released in 2002 promote respect for the individual, their family and carers; best practice in the assessment, early detection and management of acute illness; promotion of mental health and safety; and the prevention of relapse. These standards are for generalists providing care to mentally ill patients; their family and carers in the acute care setting; as well as specialist mental health professionals. Up-skilling generalists in rural and remote areas to respectfully and effectively manage mental health emergency care is a priority. ISSUES: A short course, 'Managing Mental Health Emergencies' was developed by the Australian Rural Nurses and Midwives in 2002. Almost 750 participants had completed the course at the time of the evaluation. The objectives of the course were to: develop an increased knowledge of mental health presentations and gain confidence in managing and assessing mental health clients; gain an understanding of the referral processes in the local environment; gain an insight into the impact of mental health emergencies on individuals, their family and carers; and identify strategies to minimise the impact of managing mental health emergencies on the healthcare team. The model of training matched what is known to be best practice in rural and remote health practitioner development in emergency care, being local, interdisciplinary, and engaging local expert service providers while being overseen by a national steering committee. The evaluation consisted of a pre- (n=456) and post-course (n=163) survey, and follow-up interviews with participants between 3 and 6 months post-course (n=44). LESSONS LEARNED: The pre- and post-survey identified that, as a result of the course, participants had improved confidence in seeking information about suicide ideation, were significantly more able to differentiate between substance intoxication and psychosis (chi(2)[df=1, n=619] =140.9, p<.000); and between dementia and delirium (chi(2)[df=3, n=619] =126.5, p<.000). The follow-up interview notes were analysed using thematic analysis. Three themes were used: changing attitudes; changing clinical practice; and communication. Participants had reflected on their attitudes following the course and recognized how these had been stigmatizing. Many participants reported putting their new skills into practice and reported better recognition of non-verbal cues and better information seeking from family members, past history and police. The Managing Mental Health Emergencies course is a valuable addition to the emergency courses available to rural and remote healthcare providers.
Topic(s):
Education & Workforce
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Reference Links: View the PubMed citation for Improving the skills of rural and remote generalists to manage mental health emergencies
5029
Improving transfer of mental health care for rural and remote consumers in South Australia
Type: Journal Article
Year: 2009
Publication Place: England
Abstract: In Australia, it is commonplace for tertiary mental health care to be provided in large regional centres or metropolitan cities. Rural and remote consumers must be transferred long distances, and this inevitably results in difficulties with the integration of their care between primary and tertiary settings. Because of the need to address these issues, and improve the transfer process, a research project was commissioned by a national government department to be conducted in South Australia. The aim of the project was to document the experiences of mental health consumers travelling from the country to the city for acute care and to make policy recommendations to improve transitions of care. Six purposively sampled case studies were conducted collecting data through semistructured interviews with consumers, country professional and occupational groups and tertiary providers. Data were analysed to produce themes for consumers, and country and tertiary mental healthcare providers. The study found that consumers saw transfer to the city for mental health care as beneficial in spite of the challenges of being transferred over long distances, while being very unwell, and of being separated from family and friends. Country care providers noted that the disjointed nature of the mental health system caused problems with key aspects of transfer of care including transport and information flow, and achieving integration between the primary and tertiary settings. Improving transfer of care involves overcoming the systemic barriers to integration and moving to a primary care-led model of care. The distance consultation and liaison model provided by the Rural and Remote Mental Health Services, the major tertiary provider of services for country consumers, uses a primary care-led approach and was highly regarded by research participants. Extending the use of this model to other primary mental healthcare providers and tertiary facilities will improve transfer of care.
Topic(s):
HIT & Telehealth
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Reference Links:
View the DOI record for Improving transfer of mental health care for rural and remote consumers in South Australia
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View the PubMed citation for Improving transfer of mental health care for rural and remote consumers in South Australia5030
Improving treatment engagement of underserved U.S. racial-ethnic groups: a review of recent interventions
Type: Journal Article
Year: 2013
Publication Place: United States
Abstract: OBJECTIVE: Unequal mental health among U.S. underserved racial-ethnic populations has become a prominent national concern. Contributing to this inequity is our limited ability to engage individuals from underserved populations into treatment. To help address this, a systematic literature review was conducted to examine the evidence base for interventions that can improve mental health treatment engagement among underserved racial-ethnic minority populations. METHODS: A MEDLINE search and bibliographic review yielded 1,611 studies that were reviewed according to several inclusion criteria: publication during or after 2001, U.S. adult sample, a randomized design, sufficient (>/=50%) representation of underserved racial-ethnic groups, adequate sample size (>/=27 participants per condition), explicit focus on mental health treatment engagement, and evaluation of an engagement outcome (for example, adherence or retention). RESULTS: Ten studies met inclusion criteria. Evidence supported the efficacy of collaborative care for depression as an engagement enhancement intervention among underserved racial-ethnic populations. Several other interventions demonstrated possible efficacy. The effect of the interventions on clinical outcomes, such as symptom improvement and rehospitalization, was mixed. CONCLUSIONS: Collaborative care for depression can be recommended for improving engagement in depression care in primary care among underserved racial-ethnic populations. Future research should continue to examine approaches with initial evidence of efficacy in order to expand the number of engagement enhancement interventions for underserved racial-ethnic adult populations. Additional issues for future engagement research include relative intervention efficacy across racial-ethnic groups, inclusion of other understudied groups (for example, Asian Americans and Native Americans), and greater clarification of the impact of improved engagement on clinical outcomes.
Topic(s):
Healthcare Disparities
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Reference Links:
View the DOI record for Improving treatment engagement of underserved U.S. racial-ethnic groups: a review of recent interventions
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View the PubMed citation for Improving treatment engagement of underserved U.S. racial-ethnic groups: a review of recent interventions5031
Improving treatment of depression in primary health care: a case study of obstacles to perform a clinical trial designed to implement practice guidelines
Type: Journal Article
Year: 2014
Abstract: Aim The aim of this study is to investigate factors contributing to the failure of a randomized clinical trial designed to implement and test clinical practice guidelines for the treatment of depression in primary health care (PHC). BACKGROUND: Although the occurrence of depression is increasing globally, many patients with depression do not receive optimal treatment. Clinical practice guidelines for the treatment of depression, which aim to establish evidence-based clinical practice in health care, are often underused and in need of operationalization in and adaptation to clinical praxis. This study explores a failed clinical trial designed to implement and test treatment of depression in PHC in Sweden. METHOD: Qualitative case study methodology was used. Semi-structured interviews were conducted with eight participants from the clinical trial researcher group and 11 health care professionals at five PHC units. Additionally, archival data (ie, documents, email correspondence, reports on the clinical trial) from the years 2007-2010 were analysed. Findings The study identified barriers to the implementation of the clinical trial in the project characteristics, the medical professionals, the patients, and the social network, as well as in the organizational, economic and political context. The project increased staff workload and created tension as the PHC culture and the research activities clashed (eg, because of the systematic use of questionnaires and changes in scheduling and planning of patient visits). Furthermore, there was a perception that the PHC units' management did not sufficiently support the project and that the project lacked basic incentives for reaching a sustainable resolution. Despite efforts by the project managers to enhance and support implementation of the innovation, they were unable to overcome these barriers. The study illustrates the complexity and barriers of performing clinical trials in the PHC.
Topic(s):
General Literature
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5033
Improving use of narcotics for nonmalignant chronic pain: a lesson from Community Care of North Carolina
Type: Journal Article
Year: 2012
Publication Place: United States
Abstract: OBJECTIVE: To describe the development, implementation, and effects of collaborative effort to reduce diversion of prescription drugs in Caldwell County, NC. DESIGN: Development and implementation of practice guideline, statewide opioid registry, and survey of all primary care providers. SETTING: Rural Caldwell County, NC, has a population of 83,029, of which 89 percent are non-Hispanic White; 2009 median household income of $35,489. PATIENTS, PARTICIPANTS: All primary care clinicians in the county (N = 35). INTERVENTIONS: A task force developed and implemented a practice guideline that encouraged the following: 1) signing of pain contracts; 2) requiring patients to undergo random urine drug testing; and 3) requiring random pill counts. North Carolina implemented a statewide registry in 2007 that contained information on virtually all opioid prescriptions filled by pharmacies. MAIN OUTCOME MEASURE(S): Opioid pill confiscations by the Caldwell County Narcotics Division 24 months prior to implementation of the guidelines, the first 12 months during guideline implementation, and 12 months after the guideline was fully implemented. RESULTS: From 2005 to 2007, opioid pill confiscations decreased by 300 percent. Of the 35 physicians who were sent surveys, 27 responded (77 percent response rate). Ninety percent of respondents who prescribe opioids use the chronic pain guidelines. Sixty percent report an improvement in the overall management of patients with chronic pain; 65 percent reported having more confidence in treating patients with chronic pain; and 60 percent reported using the opioid registry. CONCLUSIONS: This county wide medical initiative appears to have resulted in a significant improvement in the abuse and diversion of medically derived opioids.
Topic(s):
Opioids & Substance Use
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, Healthcare Disparities
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Reference Links:
View the DOI record for Improving use of narcotics for nonmalignant chronic pain: a lesson from Community Care of North Carolina
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View the PubMed citation for Improving use of narcotics for nonmalignant chronic pain: a lesson from Community Care of North Carolina5034
In Fighting An Opioid Epidemic, Medication-Assisted Treatment Is Effective But Underused
Type: Journal Article
Year: 2016
Publication Place: United States
Topic(s):
Opioids & Substance Use
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Reference Links:
View the DOI record for In Fighting An Opioid Epidemic, Medication-Assisted Treatment Is Effective But Underused
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View the PubMed citation for In Fighting An Opioid Epidemic, Medication-Assisted Treatment Is Effective But Underused5040
In Rural Areas, Buprenorphine Waiver Adoption Since 2017 Driven By Nurse Practitioners And Physician Assistants
Type: Journal Article
Year: 2019
Abstract:
Few patients with opioid use disorder receive medication for addiction treatment. In 2017 the Comprehensive Addiction and Recovery Act enabled nurse practitioners (NPs) and physician assistants (PAs) to obtain federal waivers allowing them to prescribe buprenorphine, a key medication for opioid use disorder. The waiver expansion was intended to increase patients' access to opioid use treatment, which was particularly important for rural areas with few physicians. However, little is known about the adoption of these waivers by NPs or PAs in rural areas. Using federal data, we examined waiver adoption in rural areas and its association with scope-of-practice regulations, which set the extent to which NPs or PAs can prescribe medication. From 2016 to 2019 the number of waivered clinicians per 100,000 population in rural areas increased by 111 percent. NPs and PAs accounted for more than half of this increase and were the first waivered clinicians in 285 rural counties with 5.7 million residents. In rural areas, broad scope-of-practice regulations were associated with twice as many waivered NPs per 100,000 population as restricted scopes of practice were. The rapid growth in the numbers of NPs and PAs with buprenorphine waivers is a promising development in improving access to addiction treatment in rural areas.
Topic(s):
Education & Workforce
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, Healthcare Disparities
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, Healthcare Policy
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, Opioids & Substance Use
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Reference Links:
View the DOI record for In Rural Areas, Buprenorphine Waiver Adoption Since 2017 Driven By Nurse Practitioners And Physician Assistants
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View the PubMed citation for In Rural Areas, Buprenorphine Waiver Adoption Since 2017 Driven By Nurse Practitioners And Physician Assistants