Literature Collection

INTRODUCTION: Patients seeking primary care often present with health concerns related to psychological trauma, highlighting the importance of health care providers' (HCPs) comfort discussing trauma in the primary care setting. This study used mixed methods, including qualitative content analysis, to (1) document HCPs' trauma-related comfort levels and factors contributing to discomfort and (2) examine the associations between provider-level factors and comfort. MATERIALS AND METHODS: Direct patient care providers (74.6% physicians/residents; 68.7% women; 44.8% White; M(age) = 36.7 years, SD(age) = 9.8) were recruited from primary care clinics in an urban public hospital system in the United States to complete a survey assessing trauma-related comfort; responses to open-ended prompts were coded by independent raters. RESULTS: Few HCPs endorsed comfort providing care to patients with known trauma histories (29.8%), most often citing limited knowledge and fear of exacerbating symptoms as contributors to discomfort. HCPs most often endorsed formal education and integrated behavioral health teams as having enhanced their comfort providing trauma-informed care; 59.2% indicated that receiving formal education would further increase comfort. HCPs' comfort was unrelated provider-level factors other than department, F (2,53) =6.56, P = 0.003, and race, F (2,52) =5.69, P = 0.006. DISCUSSION: Findings provide critical context to HCPs' trauma-related discomfort as well as actionable next steps to increase trauma-related comfort during primary care encounters.

BACKGROUND: The United States continues to experience an opioid overdose epidemic with mortality patterns that reflect existing social and environmental inequities. Although research has examined various factors associated with opioid-related mortality, the relationships between social-environmental vulnerability (SEV), health care presence, and geography remain poorly characterized. PURPOSE: To explore whether SEV accelerates opioid overdose rates and to assess how the presence of health care services-specifically opioid treatment programs (OTPs) and primary care providers (PCPs)-modifies these patterns across rural and urban contexts. METHODS: A retrospective ecological analysis using hierarchical linear modeling was conducted from January 2020 to December 2022, analyzing 172,359 observations across 57,453 census tracts within 1219 US counties. The primary exposure was census-tract-level SEV, operationalized using the CDC Environmental Justice Index. Health care indicators included county-level presence of OTPs and PCPs. RESULTS: Areas in the highest quartile of SEV demonstrated elevated acceleration coefficients (β=3.224; SE=0.803; P<.001), with pronounced patterns observed in rural areas, though ecological design limitations preclude individual-level causal inference. Interaction analyses suggested that high-SEV counties containing both OTP and primary care resources demonstrate lower acceleration coefficients (β= -11.478, SE=5.429, P=0.035). Areas without health care presence showed higher baseline rates in overdose acceleration, particularly in urban high-vulnerability settings. CONCLUSIONS: High SEV was associated with accelerated opioid overdose rates during 2020-2022, particularly in rural areas. The presence of OTPs and primary care services within counties was associated with attenuated acceleration in high-vulnerability areas. This may indicate that policies prioritizing comprehensive health care services in high-SEV communities could address opioid overdose disparities.