Literature Collection

Psychoactive substance use among children in Afghanistan is an issue of concern. Somewhere around 300,000 children in the country have been exposed to opioids that either parents directly provided to them or by passive exposure. Evidence-based and culturally appropriate drug prevention and treatment programs are needed for children and families. The goals of this study were to: (1) examine lifetime psychoactive substance use in girls and boys at treatment entry; and (2) examine differential changes in substance use during and following treatment between girls and boys. Children ages 10-17 years old entering residential treatment were administered the Alcohol, Smoking and Substance Involvement Screening Test for Youth (ASSIST-Y) at pre- and post-treatment, and at three-month follow-up. Residential treatment was 45 days for children and 180 days for adolescents and consisted of a comprehensive psychosocial intervention that included education, life skills, individual and group counseling and, for older adolescents, vocational skills such as embroidery and tailoring. Girls and boys were significantly different regarding lifetime use of five substances at treatment entry, with girls less likely than boys to have used tobacco, cannabis, stimulants, and alcohol, and girls more likely than boys to have used sedatives. Differences between boys and girls were found for past-three-month use of four substances at treatment entry, with girls entering treatment with higher past-three-month use of opioids and sedatives, and boys with higher past-three-month use of tobacco, cannabis, and alcohol. Change over the course of treatment showed a general decline for both girls and boys in the use of these substances. Girls and boys in Afghanistan come to treatment with different substance use histories and differences in past-three-month use. Treatment of children for substance use problems must be sensitive to possible differences between girls and boys in substance use history.

INTRODUCTION: Previous studies show that some primary care clinicians do not feel equipped to treat patients with opioid use disorder (OUD). This study addressed the gaps in confidence and knowledge of primary care physicians and other participants (i.e., participants who were not physicians) in diagnosing, treating, prescribing, and educating patients with OUD through interactive learning sessions. METHODS: The American Academy of Family Physicians National Research Network held monthly OUD learning sessions from September 2021 to March 2022 with physicians and other participants (n = 31) from 7 practices. Participants took baseline (n = 31), post-session (n = 11-20), and post-intervention (n = 21) surveys. Questions focused on confidence, knowledge, among others. We used non-parametric tests to compare individual responses pre-versus-post participation as well as to compare responses between groups. RESULTS: All participants experienced significant changes in confidence and knowledge for most topics covered in the series. When comparing physicians to other participants, physicians had greater increases in confidence in dosing and monitoring for diversion (P = .047), but other participants had greater increases in confidence in the majority of topic areas. Physicians also had greater increases in knowledge than other participants in dosing and monitoring for safety (P = .033) and dosing and monitoring for diversion (P = .024), whereas other participants had greater increases in knowledge in most remaining topics. Participants agreed that sessions provided practical knowledge, except for relevancy of the case study portion of the session to current practice (P = .023) and the session improved participant ability to care for patients (P = .044). CONCLUSION: Through participating in interactive OUD learning sessions, knowledge and confidence increased among physicians and other participants. These changes may impact participants' decisions to diagnose, treat, prescribe, and educate patients with OUD.

OBJECTIVE: To assess the feasibility and impact of incorporating a multidisciplinary pharmacogenomics (PGx) service within an underserved behavioral health clinic, with an emphasis on clinician perceptions. METHODOLOGY: This study was conducted in two phases at the Texas A&M Family Care Clinic. Phase one involved an online cross-sectional survey of the multidisciplinary clinic team to assess their knowledge, attitudes, and readiness for PGx integration. Phase two detailed the development and implementation of a PGx service within the Integrated Behavioral Health (IBH) clinic, outlining the workflow and collaborative approach used to offer genetic testing to eligible patients. KEY FINDINGS: Of the 23 survey participants, 91% believed the PGx service would positively impact patient care, and 87% expressed interest in receiving PGx-related training. Confidence in pharmacists' ability to lead the service was reported by 65% of respondents. The primary concerns identified included cost of care, clinical utility, and potential workflow disruptions. A collaborative implementation model was developed, including preemptive and reactive testing pathways. CONCLUSION: The implementation of a pharmacist-driven PGx service in an underserved behavioral health clinic was well-received by the clinical team and deemed feasible. While concerns regarding resources and workflow were noted, strong interest in training and multidisciplinary collaboration highlights the potential for scalable PGx service models in similar settings.

BACKGROUND: Social determinants of health (SDOH) are non-medical factors that impact health outcomes. Pharmacists within integrated health system specialty pharmacies (HSSPs) are positioned to identify and address SDOH barriers. OBJECTIVE: The objective was to implement and evaluate a pharmacist-led SDOH program for HSSP patients. PRACTICE DESCRIPTION: The practice innovation was implemented within four health systems in Michigan and Massachusetts with associated HSSPs and a standard specialty pharmacy clinical management model incorporating initial patient counseling and periodic reassessments. PRACTICE INNOVATION: A SDOH screening and intervention program was developed and piloted at four health systems with associated HSSPs. Patients with HIV, rheumatoid arthritis (RA), and hyperlipidemia meeting pre-defined inclusion criteria were enrolled in the program from September 2023 through September 2024. After screening patients for SDOH barriers, pharmacists offered targeted interventions and structured follow-ups to ensure resolution of challenges. EVALUATION METHODS: Patients enrolled in the program were analyzed using data extracted from the electronic medical record and patient management platform. The primary outcome was intervention acceptance rate; secondary outcomes included intervention categories, patient-perceived value of interventions, ongoing support needs, pharmacist time spent, and clinical outcomes. RESULTS: Of the 50 patients (HIV: n=6; RA: n=27; hyperlipidemia: n=17) enrolled, 56% completed screening and 79% of those accepted interventions. Of the 19 patients who received follow-up, 63% found the interventions beneficial, and 4 required ongoing support. The most frequent interventions included food security/nutrition (46%) and physical activity (25%). The average time per intervention was 60 minutes (range: 15-180 minutes). Patients with interventions demonstrated clinical outcomes improvements, including a mean RAPID3 score reduction of 3 points (range: 1.3-27.3) and mean LDL reduction of 29.75 mg/dL (range: 44-137) for RA and hyperlipidemia, respectively. CONCLUSIONS: These pilot results suggest that a pharmacist-led SDOH program may be effective in addressing patient barriers, demonstrated by high acceptance rate and perceived benefit of interventions and improved clinical outcomes.