Literature Collection

The fast developmental pace and widespread use of mobile technology and the internet mean that smartphone-based m-health (mobile health) applications (apps) have huge potential to further expand the reach of and access to drug-related health services towards a common goal of ensuring a healthier Europe. However, m-health for drug users and for health professionals in the field of drugs is still in its infancy and poorly documented at European Union (EU) level. The aim of this scoping study was therefore to carry out a first exploration of available smartphone applications in the drugs field within a European and global context. It explored the range of m-health applications available to users and professionals seeking information, support and advice in a wide range of EU languages. The systematic search of drug-related smartphone applications identified a total of 67 applications across the three main app stores. The identified m-health applications apply various technologies ranging from simple text-based content display to more advanced interactive functions such as video transmission, geo-tagging functions and automated personalised feedback. Based on the main objectives, content and target end-users of the 67 identified apps, three main groups of drug-related m-health applications emerged: apps that aim to disseminate drug-related information and advice, apps that provide interventions and support for drug users and apps for capacity building among health professionals. Most m-health apps address risk behaviour associated with drugs in general or drug use in specific settings (e.g. nightlife settings). Some drug-specific apps are available for more commonly used drugs such as cannabis and cocaine. A number of challenges for users, app developers and policymakers were identified in this scoping study. The lack of scientific evaluations of drug-related m-health interventions is concerning considering the increasing interest in and availability of such apps. Additionally, the lack of quality control of the content of these apps available to EU citizens, with no age limits, remains to be addressed. Global differences in therapeutic approaches used in the identified apps were apparent, especially between the United States and Europe, and this raises questions about the cross-cultural relevance of m-health applications. At the same time, the impact of the new EU General Data Protection Regulation may be of particular relevance in a context of fast global development of drug-related m-health apps available to EU citizens.

BACKGROUND: Incorporation of cognitive screening into the busy primary care will require the development of highly efficient screening tools. We report the convergence validity of a very brief, self-administered, computerized assessment protocol against one of the most extensively used, clinician-administered instruments-the Montreal Cognitive Assessment (MoCA). METHOD: Two hundred six participants (mean age = 67.44, standard deviation [SD] = 11.63) completed the MoCA and the computerized test. Three machine learning algorithms (ie, Support Vector Machine, Random Forest, and Gradient Boosting Trees) were trained to classify participants according to the clinical cutoff score of the MoCA (ie, /=26, n = 165), suggesting greater sensitivity to age-related changes in cognitive functioning. CONCLUSION: Future studies should examine ways to improve the sensitivity of the computerized test by expanding the cognitive domains it measures without compromising its efficiency.

AIM: This developmental study tested the feasibility of training pharmacy staff on the psychologically informed environments (PIE) approach to improve the delivery of care. BACKGROUND: Community pharmacies provide key services to people who use drugs (PWUD) through needle exchange services, medication-assisted treatment and naloxone distribution. PWUD often have trauma backgrounds, and an approach that has been demonstrated to work well in the homeless sector is PIEs. METHODS: Bespoke training was provided by clinical psychologists and assessed by questionnaire. Staff interviews explored changes made following PIE training to adapt the delivery of care. Changes in attitude of staff following training were assessed by questionnaire. Peer researchers interviewed patient/client on observed changes and experiences in participating pharmacies. Staff interviews were conducted six months after training to determine what changes, if any, staff had implemented. Normalisation process theory (NPT) provided a framework for assessing change. FINDINGS: Three pharmacies (16 staff) participated. Training evaluation was positive; all participants rated training structure and delivery as 'very good' or 'excellent'. There was no statistically significant change in attitudes. COVID-19 lockdowns restricted follow-up data collection. Staff interviews revealed training had encouraged staff to reflect on their practice and communication and consider potentially discriminatory practice. PIE informed communication skills were applied to manage COVID-19 changes. Staff across pharmacies noted mental health challenges for patients. Five patients were interviewed but COVID-19 delays in data collection meant changes in delivery of care were difficult to recall. However, they did reflect on interactions with pharmacy staff generally. Across staff and patient interviews, there was possible conflation of practice changes due to COVID-19 and the training. However, the study found that training pharmacy teams in PIE was feasible, well received, and further development is recommended. There was evidence of the four NPT domains to support change (coherence, cognitive participation, collective action and reflexive monitoring).

BACKGROUND: Fentanyl test strips (FTS) are a harm reduction method for people to test their drugs for fentanyl. Ideal points for FTS distribution have not been identified. Many people who use drugs have frequent contact with the Emergency Department (ED). We piloted FTS distribution in two urban hospital EDs. METHODS: Between June-December 2021 in Philadelphia, PA, patients with past 30-day drug use completed a survey about drug use, fentanyl attitudes, and FTS; then offered FTS and a brief training. Survey data were analyzed using SPSS for bivariate statistics. RESULTS: Patients (n = 135) were primarily White (68.1%) and male (72.6%). Participants regularly interacted with substance use (57.8%) and benefits coordination (49.6%) services. The most common drugs used were heroin/fentanyl (68.9%), crack cocaine (45.2%) and cannabis (40.0%). Most (98.5%) had heard of fentanyl though few (18.5%) had ever used FTS. Across most drug types, participants were concerned about fentanyl. All accepted FTS training and distribution. Few (9.6%) were somewhat or very concerned about having FTS if stopped by police and this number varied by race (7.6% of White people were somewhat or very concerned, compared to 12.8% of Black people). Most participants were already engaged in risk reduction practices. DISCUSSION: FTS are a widely desired harm reduction tool to facilitate informed decision-making, and non-harm reduction locations are potentially feasible and acceptable distribution sites. Given regular contact with EDs and social services across the sample, FTS should be offered at non-harm reduction locations that come into frequent contact with people who use drugs.